Black Maternal Health Week 2022: Dr. Nicole Christian-Brathwaite
“Ensure that your treatment team understands the risks that come with being a pregnant Black woman in America. Don’t be afraid to ask for help – it is impossible to be a new mother by yourself. [And] the baby blues are one thing, but if it goes beyond a few weeks and you're feeling like you can't control your emotions, or you're feeling completely downtrodden and hopeless, or you're questioning your worth, there's no shame in asking for help. Actually, it will save your life.”
Dr. Nicole Christian-Brathwaite (she/her/hers) is the Senior Vice President and Chief Medical Officer for Scheduled Care and AtHome Care at Array Behavioral Care, and the founder and CEO of Well Minds Psychiatry and Consulting Company, PLLC. She is a double Board-certified Adult and Child and Adolescent psychiatrist, and is nationally recognized for her work in perinatal and post-partum mental health, trauma-informed care, telepsychiatry, mental health in communities of color, school psychiatry, implicit bias, and racism in mental health. Dr. Christian-Brathwaite has been featured in the Boston Globe, NPR, The Roland Martin Show, The Washington Post, and numerous podcasts.
This blog is made possible by a sponsorship from Sage Therapeutics. All content on this page has been curated by the Mass. PPD Fund without input from Sage Therapeutics, Inc.
Interviewed and edited by Jessie Colbert, Executive Director, Mass. PPD Fund
Did you have expectations about bringing home a new baby? What did you think it would be like? What were your hopes and fears?
I think I was most worried about being a good mother. Do I have what it takes to be the mother that my child needed? I remember when I found out that we were having a boy, I thought, I don't know how to raise a boy! What do boys need? And do I have enough time? I was still in training when I had my first son, and trying to figure out this work-life balance thing that people talk about. Because as a trainee or [medical] resident, there's no such thing as life – there’s just work. So, just trying to determine exactly what that would look like.
I wasn't anticipating the things that became a challenge, because a lot of people don't talk about the more difficult things of childbirth, of parenting. No one really told me how hard breastfeeding would be. Certainly no one prepared you for postpartum depression. That never came up. So, it was never even something I thought to worry about.
Oftentimes when a baby is born, parents have plenty of support for the baby, but not a lot of support for themselves. Did you feel like you had people looking out for you?
There were, but I very quickly realized that I had to be explicit in asking for what I needed. When you’re pregnant – I’m sure many women experience this – you are the most important thing. But then once you deliver, you’re almost an afterthought. People are coming to see the baby and hold the baby. But you need help with washing clothes, cooking, and cleaning. When I really became depressed and struggled with doing those basic things, even when people would offer, my first instinct would be to decline. I felt like I should be able to do it. Does this say something about my ability to be a mother or my parenting skills if I have to accept help?
But eventually I realized that I needed to ask for help. So, my mom came and stayed with us for a few months. And family and friends started occasionally bringing food or coming over and helping. I was very clear with my husband that he needed to take more night duty —I was so sleep-deprived that I felt like I was becoming delirious. People were helpful, but if I wasn't specific about the help that I needed, it wasn't as useful. They were very willing, but they didn't know what I needed unless I asked.
Tell me about your journey with mental health challenges around your new baby. When did you realize something was “not right”?
I had never thought about postpartum depression, even as a psychiatrist. In psychiatric training, we didn't focus very much on women's mental health. We didn't focus on understanding or screening for postpartum depression. We talked about it, maybe skimmed it over. But this is a topic that many physicians are afraid to address. No one wants to treat mental illness in a pregnant woman. Many [doctors] are anxious about it because of the potential risk of making an error and the consequences are so great. But, also not realizing that not addressing it is even worse, that those consequences are more significant.
I had a pretty difficult birth with my son – he was nine pounds 14 ounces. In my mind, I thought the more challenging thing would be a C-section. I didn't realize that having a vaginal birth and dealing with lacerations also had a pretty prolonged and significant recovery. It was very difficult because it was so painful. I think maybe if I had been more prepared, I wouldn't have been so caught off guard. And being a big baby, he ate a lot! Also, he didn't sleep because he was always hungry!
Probably by month one, I realized I was struggling. I dreaded nights. Sometimes I dreaded days. I was questioning my value as a mother, as a wife. I began to question if my family needed me, or if I was becoming more of a burden than a support. Those thoughts persisted for at least another one to two months, as my overall mental health just continued to decline. I was too ashamed to tell anyone. People assumed I was suffering from the baby blues, or they just assumed, well, you’re having trouble, he’s not sleeping and this is what’s normal. Not realizing that it had gone so far beyond what we consider normal because it was impacting my quality of life and my basic level of functioning. It was impacting my ability to even see the future.
After 8 weeks of maternity leave, Nicole returned to work as a Child and Adolescent Psychiatry Fellow.
It felt very premature returning to work because I was still healing physically. And certainly, we were not on a good sleep schedule by two months. Having to return to work while still being in pain, still questioning my worth, felt insurmountable. I had to manage my own mental health struggles because I was taking care of children who were dealing with significant trauma. When you're in such a vulnerable and emotional state, it's so much harder to not internalize other people's pain and take that home. There's a phenomenon in mental health called vicarious trauma, when you're working with highly traumatized populations, and you start to take on some of those symptoms. I felt like I was starting to experience that.
I remember driving to work one day after a particularly grueling night with the baby. I had blocked ducts, so breastfeeding was very painful. When I realized I had to supplement with formula, I felt like a failure. In that moment, I was so convinced that my son would be better off if I weren't here, my husband be better off because I was the problem. In that moment, for the first time in my life, I experienced suicidal thoughts. Postpartum depression had fully taken over. I no longer felt like I was in control. Postpartum depression was controlling how I perceived myself and the world.
Fortunately, at that exact moment, my phone rang, and I honestly cannot remember who called. I just remember getting off at the exit, and turning around, coming home, and having a conversation with my husband. I made it very clear to him that I was not okay. His response was, Okay, well, let's pray about it. I said, Of course, yes, we will, but then we need to come up with a plan. I need help. I was terrified. I never imagined it would ever get to this point. I never understood how truly debilitating postpartum depression could be.
Can you share the plan you made to help you get better? What worked for your healing?
A couple of things. One, I realized I could not keep it a secret. I started to share my experience with close friends and family, and that's when I realized that many women in my inner circle had gone through the same thing. I should have recognized earlier that not only did I have risk factors for PPD, but I was not alone. Prior to my first son, we had a first-trimester loss. I remember when I finally was able to talk about it, there were so many people who said, Oh my gosh, me too! That was horrible.
There are plenty of people who have experienced postpartum depression and did not feel safe talking about it. Even my mother, when I talked to her, she's like, Oh my gosh, I was so depressed when I had you. And I’m like, wait, when we talked about preparing for the baby, you never told me that you struggled with postpartum depression! Even talking to my best friends, a few endorsed experiencing suicidal thoughts! What?! How did I not know about this? I came to the realization that there were so many people who had experienced a similar struggle, yet never felt like they could ask for support or assistance. So that was the first thing: talking to people in my inner circle and letting them know that I needed that support, but also commiserating, realizing that I was not alone and that many people had gone through it.
I also reached out to my training director and asked him to help me find mental health support. To help find someone that has experience working with postpartum depression, but could also understand the unique position that I was in being a mental health provider. He connected me to a psychiatrist who was able to do both therapy and medication. It was certainly helpful when family and friends began supporting us by bringing food, cleaning, doing laundry, and my husband started doing more nighttime duty. I was actually able to string together six hours of sleep! Lastly, being very aware of my symptoms – realizing that when I'm feeling more emotional, crying more, making more self-deprecating statements, sleeping poorly, isolating myself, lacking motivation, and having increased negative thoughts — recognizing those warning signs. I never let it get that bad again. But it definitely took time, it was a couple of months before I really felt like I was back to myself.
In recognition of Black Maternal Health Week, what are some key things you’d like to say to other Black moms who are building their families?
There are so many. For one, the saying “it takes a village” really rings true in this situation, particularly with the rates of morbidity and mortality for Black women around childbirth. The village doesn't just start when the baby is born, the village starts as soon as you find out you're pregnant. Going to doctor's appointments with someone who can support you, whether it's a doula, your partner, your mother, or a family member, but having someone else there to help you advocate for yourself. It is crucial that you understand and articulate what is important to you during your pregnancy, labor, and delivery, and during the postpartum period. I realize certain things are unrealistic – I had a two-page, double-spaced birth plan! Certainly, there were a number of “nice to haves,” but other things were incredibly important to me.
If there are any concerns, if something doesn’t feel right, don’t be afraid to speak up. Not being heard or being dismissed is not acceptable because your life could potentially be on the line. Have this conversation upfront with your [provider]. Ensure that your treatment team understands the risks that come with being a pregnant Black woman in America. I need to make sure you see me and you hear me.
The second thing I would say is, don’t be afraid to ask for help. There's this strong Black woman trope that people believe in, and even we as Black women internalize, and assume that we shouldn't or couldn't ask for help. That type of thinking has to go. It is impossible to be a new mother by yourself. If we go back generations, new mothers never did it alone, ever. It's only now that culturally it's become acceptable. It’s not realistic! You literally just gave birth to a human being. Your body is healing, your hormones are all over the place. Be very specific about what you need. I always tell people to ask for food, ask for cleaning, ask for help with the laundry. The things that are burdensome on a normal day, but when you're operating on two hours of sleep and trying to feed this baby every two hours, those are things you just can't do.
The last thing is, the baby blues are one thing, but if it goes beyond a few weeks and you're feeling like you can't control your emotions, or you're feeling completely downtrodden and hopeless, or you're questioning your worth, there's no shame in asking for help. Actually, it will save your life.
Dr. Nicole Christian-Brathwaite has compiled many valuable resources on mental wellness, anti-racism, and other key topics on her website, including postpartum resources (see COVID-19 resources pg. 4). Please also find a resource listing on our site.