No one could understand what was happening in Kay Matthews’ head, and she struggled to tell them. All she knew was that, in 2013, the stillborn birth of her daughter was an emotionally crippling blow.
But the treatment Matthews and her partner, who later became her husband, received at the hospital in the aftermath of the tragedy made matters worse.
From caregivers constantly asking if she was giving birth alone — “As if the Black man sitting in the chair next to me was not my partner,” Matthews says — to being released with only the clothes she wore the day she thought she was giving birth, Matthews got the message that she was on her own.
“I was not receiving the care that I feel like you should receive,” she says. “It should be more than just, ‘You lost a baby — move on.’ I got no pamphlets, no follow up information, nothing.”
Traumatized and grieving from the stillbirth, and feeling abandoned by the medical system, Matthews slipped into the emotional abyss of postpartum depression. Experts say the condition is common among new mothers, but is commonly overlooked if the mom is a Black woman, like Matthews.
“I knew I was different, but I didn’t know why,” she says. “I knew I wasn’t this person that I was in the postpartum period, before I lost my daughter.”
Though she clearly was grieving, no one diagnosed her with postpartum depression “simply because they looked at my birth outcome,” Matthews says. “So I figured out ways to save myself.”
A Family Affair
Research shows the number of U.S. women with postpartum depression has reached an alarming level, jumping from 9.4% in 2010 to roughly 19% in 2021. For Black women, the increase nearly tripled, from just over 9% to almost 25%.
Experts say several factors — from high pre-pregnancy body mass index among women to mothers-to-be living in underserved neighborhoods, and even long-term exposure to air pollution — are believed to contribute to the increased rate of PPD.
Despite increased risk, studies show Black mothers are 46% less likely to be screened for PPD. Fewer than 37% of Black women received treatment for maternal mental health disorders like PPD compared to 67% of white women, according to a Columbia University survey.
Postpartum depression has been linked to emotional detachment between the birthing mother and her partner, poor maternal attachment between a newborn and its mother, difficulty starting or continuing breast-feeding and stunted infant growth.
The primary culprit, experts say, is stress.
Experts say PPD can also disrupt a newborn’s sleep — affecting an entire household — as well as delaying the child’s cognitive and language development.
A few years later, after recovering from her trauma, Matthews founded the Shades of Blue Project a nonprofit dedicated to helping others experiencing PPD.
“I will always share that the work chose me. I did not choose it,” Matthews says. The experience, she says, “made me realize how prevalent racism is within the healthcare system.”
Mental Health and Maternal Death
Dr. Joy Baker, an obstetrician practicing in rural Georgia, also was inspired to work with postpartum women because of a patient’s unforeseen, PPD-related tragedy.
“I had a patient who had a lot of health issues during pregnancy and I was very involved in maternal morbidity and mortality work,” says Baker. “I was so focused on this patient’s medical conditions, I completely missed the fact that she actually had a mental health disorder.”
Although Baker helped safely deliver the baby, her patient’s mental health nosedived. “She died by suicide, and it just wasn’t on my radar,” Baker said.
A member of Georgia’s maternal mortality review committee, Baker found that mental health is a key driver of maternal deaths during or after childbirth. Conditions like depression and anxiety account for 23% of maternal deaths, according to the Centers for Disease Control and Prevention.
Moreover, those conditions have been linked to preterm birth and low infant birth weight, as well as increased chance of potentially dangerous hypertension and diabetes during pregnancy.
The primary culprit, experts say, is stress, which releases the hormone cortisol.
Constant stress during pregnancy creates “a hostile, traumatic environment within the womb,” Baker says. “That can lead to an increased [chance] of preterm birth” and danger for the mother.
“We cannot forget mental health when it comes to changing the statistics in our state with regards to severe morbidity and mortality for moms.”
Georgia has the second-highest rate of maternal mortality in the nation. The state is working with national health organizations to create a set of directives hospitals can use to handle patients specifically at risk for postpartum depression.
One of those risks include depending on Medicaid, health insurance for low-income people. Socioeconomic status “is the big stressor that can lead to depression and anxiety,” Baker says.
Medicaid also helps cover prescription costs for patients who are prescribed Zurzuvae, a drug that specifically treats PPD. Without insurance, however, the standard two-week course of treatment can cost roughly $8,700.
The Shades of Blue Project is based in Houston but serves women nationwide by offering support services and essential baby supplies. The nonprofit also has events planned in conjunction with Black Maternal Mental Health Week, July 19-25.
A Rough Road Ahead
Both Baker and Matthews are bracing for how the Trump administration’s sweeping tax and spending bill will affect nonprofits and rural hospitals.
Since roughly 40% of the nation’s births are covered by Medicaid insurance the future looks grim.
“In Georgia, [it’s] a little higher — probably closer to 50%. I don’t know what we’re going to do,” says Baker. “I’m hoping that we can dodge that bullet, but if we can’t, I really am so concerned for the progress that we made. We will go backwards.”
“There’s going to be a lot of shut-down when it comes to social support services in serving communities across the board,” Matthews says. “The impact for what’s to come is going to be having an astronomical impact on this work, and all we can do is stay in position. Not ‘Get in position,’ but ‘Stay in position,’ because this was one of those things [bound] to come — and now it’s here.”
