- Finding a therapist during pregnancy required the writer to navigate the health maze in the United States.
- Quality mental health care may seem out of reach, especially for black women.
- The Covid-19 roadblocks destroyed the support of the community that many pregnant women counted on.
- See more stories on the Insider business page.
A few months ago and at the beginning of my pregnancy, I found myself alone in a hospital room – partners were not allowed, due to Covid’s restrictions – connected to an IV and suddenly overcome with fear.
They were unable to find space for me at the maternity hospital, so I was taken to one of the general floors. Would I pick up Covid here at the hospital? My mind raced. Black women like me were eight times more likely than white women to die in childbirth. Would I lose my baby? I was scared and desperate and asked if I could speak to a therapist. There were none available.
The past year has been difficult for everyone. For women like me, who were pregnant at some point during the pandemic, the virus destroyed the support of the community that previously existed. The pandemic has also helped to expose an old truth: good mental health care can seem out of reach, especially for black women.
Like many people with manageable life problems, I depended on friends and family to provide an emotional buffer. But while this type of support is important, it could easily collapse for a variety of reasons – including, it seems, a global pandemic.
As an immigrant living in New York City, I always dreamed that my mother, nurse and retired midwife, would be by my side during and after my pregnancy. But the American embassy in Kenya closed due to the pandemic, issuing emergency visas only as needed. I respected that decision, but it was deeply painful because my high-risk pregnancy felt like an emergency to me.
The emotional impact that accompanied it drained me so much that I overcame my African upbringing that disapproved of therapy. “You live in the first world. What is there to be unhappy about?” relatives would say. I needed professional help – guaranteed hot showers, although a great gift, could not cure someone’s erosion of mental health.
It turns out that that was the easy part. Because the next step required me to navigate the US health and insurance maze.
BALANCING EVERYTHING
After two years of fertility treatment, I was ecstatic to be pregnant, thinking that I would be one of those fit pregnant mothers who ran in Brooklyn’s Prospect Park every morning. I was in good health, I had a job, a partner who supported me and a health plan. My pregnancy complications took me by surprise.
People practicing social detachment in Prospect Park, Brooklyn, during the coronavirus pandemic, May 4, 2020.
Roy Rochlin / Getty Images
My wonderful doctors worked in leading institutions, such as NorthWell / Lenox Hill, but never once asked how I was dealing with it emotionally. I already knew that black women, who experience misogynoir, the challenge of being a woman and a black woman, found it more difficult to find the right therapist, as there were many cultural issues to be considered. The pandemic taught me that barriers to mental health care came in many forms.
I quickly learned that very few therapists and psychiatrists accepted my insurance. When I called the network therapist numbers listed on my insurer’s website, I found that the information was out of date or that the therapist was no longer working there. On Psychology Today and on other sites, I found off-line therapists who offered varying rates, although most with whom I spoke had long waiting lists. And even if I got an appointment, I worried about the financial burden. Sure, my husband and I were considered to be middle class, but off-network costs and sliding scale plans ranged from $ 120 to $ 170 per session. Our gross revenue, from which the sliding scale was calculated, did not tell the whole story of our financial situation.
I found that the cheapest option was to see a general practitioner who could recommend anti-anxiety or depression medications, but that seemed like a risky path, as I wasn’t sure what the long-term impact would be on my unborn child. What I wanted, what I needed, was psychotherapy with a trained professional.
Weak from surviving on fluids and battling depression, I was barely able to call my parents, let alone skip the difficulties of consulting with various therapists to find the right for this delicate period of my life. I was ashamed to ask my husband for help – he was already taking care of all our needs and household chores, in addition to his demanding work and our puppy. I also wanted to maintain the image of the gifted and resilient black woman who can balance everything.
“Ideally, mental health care should be integrated with general health care, not just pregnancy and postpartum care,” Dr. Shelly Cohen, a reproductive psychiatrist, told me. “The challenge we have in the medical system in the United States is that everything is isolated. Doctors often limit their thinking to their specialty and patients have to figure out how to get help with their other health problems.”
“Having a therapist is critical because it provides a constant testimony of your life and progress, week after week,” she said.
A VULNERABLE POPULATION AND NOT ENOUGH HELP
A recent study shows that the COVID-19 pandemic has disproportionately impacted the well-being of vulnerable populations in the United States, and the impact on pregnant black women is of particular concern for our children’s intrauterine and postnatal development . Black women also face the chronic stress of racism, known as weathering, which can affect our health outcomes. The research found that maternal depression affects children from the womb to adulthood. But, as I found out, mental health care is rarely integrated with antenatal care.
President Joe Biden’s Covid-19 stimulus package included support for children and mental health in general. But there has been no major federal action to specifically target black women’s perinatal mental health.
A pregnant woman wearing an anti-risk suit and other people line up in front of a pharmacy in Queens, New York, on April 27, 2020.
JOHANNES EISELE / AFP via Getty Images
Closer to home, New York City’s mayoral candidate Eric Adams proposed a doula for every pregnant woman. The idea can have a significant impact – having a doula has been associated with lower rates of cesarean delivery, premature birth, low birth weight and postpartum depression, as well as higher rates of breastfeeding and greater patient satisfaction with motherhood.
But none of this directly improves black women’s access to psychotherapy and non-psychiatric mental health. Nothing, not even doulas, can replace critical professional mental health care, which is so difficult for many to access.
Even as a black woman, I have a lot of resource privileges – unlimited wi-fi, a day job at a public health agency, some research skills, access to many qualified people who can point me in the right direction. With all this, I still felt lost at sea while trying to find the right therapist. Is it much more difficult for women who may be suffering more than me and with fewer resources?
A new option, which I just learned from a friendly therapist, Maggie Gitu, is that immigrants can teleconferences with therapists from our countries. This can allow us to be “seen and heard without the burden of translating ourselves into whiteness,” explained Gitu. This is the option that I ended up choosing: a therapist from my country that I was able to see via Zoom. I have to be born soon and I probably won’t be pregnant again. But for other women, especially black women, who are pregnant now and in the future, I hope that we can offer something better.