When Black Parents Live in Mental Health Care Deserts, How Can They Process Birth Trauma?

Recently my husband and I shared the story of our second unassisted home birth on season two of NATAL, a podcast docuseries about having a baby while Black. After almost a year of anticipation, we were excited when we learned edits were complete and our story would finally air! As a trained Full Circle Doula, this would be great publicity for my business.I tuned in on the day the podcast was released. But my excitement quickly turned into grief.

I initially enjoyed remembering and telling my story gave me the space to curate my thoughts. But after hearing it told back to me, it became clear the hardships I'd encountered mirrored many Black families' experiences birthing in the United States during the COVID-19 pandemic. And all of it— unstable housing, loss of income and health insurance, a move across the country—had been more traumatic than I initially understood. I asked myself how I had missed the many stressors that eventually amounted to birth trauma. And I wondered what the implications might have been had I never realized it and been able to process it.

"Birth trauma refers to the emotional and/or physiological impact of a particularly grueling, frightening, or distressing experience related to childbirth," says Dr. Angel Montfort, PsyD, PMH-C, a licensed psychologist whose clinical practice is the Center for Maternal Mental Health. She says forceful use of invasive methods and emergency interventions, health scares and near-death experiences for mother or baby, and neglect or malpractice by medical staff are some of the many experiences that can cause this trauma. These traumas can happen at any stage of pregnancy, delivery, or postpartum. "Afterward, the birthing person is typically in a state of emotional shock or denial," she says.

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It's hard to calculate statistics for birth trauma because trauma depends on what a mother feels about what happens during birth. But Black women face an increased risk of experiencing birth trauma because they are more likely to be exposed to risk factors like experiencing high levels of stress during and after labor. Dr. Montfort says this is rooted in implicit bias and systematic racism and that "Black women are less likely to be believed when they sense that 'something's not right.'"

Studies show that physicians are more verbally dominant, less patient-centered with Black patients, [and] Black people are believed to be able to withstand higher levels of pain." She also says there's a shortage of Black physicians, doulas, midwives, etc., and the pressure to be a 'strong black woman' makes it difficult for Black women to feel comfortable asking for help.

Unfortunately, though, in Black communities—especially in rural areas like where I've given birth— maternal mental health resources are limited or altogether nonexistent. An ABC News analysis of data from the Centers for Medicare and Medicaid Services says these mental health care deserts span 570 counties in the United States. Further, they say 75% of rural counties across the country have no mental health providers or fewer than 50 per 100,000 people.

Additionally, stigmas around mental health, racial bias leading to dismissal or misdiagnoses of conditions, and less than adequate health insurance are some of the barriers to mental health care that exist for Black families. Dr. Montfort says Black mothers may fear their baby will be taken from them if they disclose mental health concerns, which is valid given the disparities in child removal rates from Black parents. "This can delay access to mental health services. Without proper support, new mothers are at a significantly higher risk for developing perinatal mood and anxiety disorders."

A bulletin published by the National Partnership for Women and Families in 2021 also says, "when left undiagnosed and untreated, Mental Maternal Health (MMH) conditions can lead to long-term adverse health consequences for the birthing person, their infant, and family." With such a drastic gap between maternal mental health needs and access to maternal mental health care, it is worth exploring alternative options for Black families traumatized during their births.

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Dr. Montfort says those who don't have access to mental health treatment can find narrative methods such as storytelling can be helpful in processing trauma and that narrative methods are a component of many trauma therapy methods. Dr. Montfort also says telling our stories can help us piece it together, assist with remembering what happened clearly, and help identify strategies to advocate for ourselves in the future. We can use storytelling to create a space to validate our feelings about what happened. It can also permit others to join us in sharing.

"Storytelling has always been foundational to our family histories and the sustainability of our community legacies," says Dr. Andrea Mason, Ed.D, a doula and birth mentor. Speaking about our experiences with other Black families can help us realize that what we have experienced is common to our collective existence. This can be empowering and transform a traumatic experience into an opportunity for post-traumatic growth. This can happen after a traumatic event and enhance appreciation of life, relation to others, personal strength, new possibilities, and spiritual change.

This was exactly the case when I heard my story. I grieved the peaceful birth experience I didn't have. Still, I celebrated all that I had gone through and felt more deeply rooted as a Black American woman in the United States. I realized that I had survived trauma largely because the opportunity to tell my story presented itself to me. I felt fortunate in an unfortunate situation because I had the support and the space to reflect.

It is comforting to know that though we can't always access clinical mental health services, we can always access storytelling traditions we've always known. Of course, everyone won't be able to share their story in such a big way as I did when I shared my story on NATAL, but it doesn't mean they can't share their stories. They can use social media or blogs to tell them.

They can also listen to and collect the stories of others like them so they understand they are not alone. This is something else I've done.

Giving birth brings many changes. Unfortunately for Black people, those changes could result in trauma due to racism. But if we allow it, storytelling is a great way to start to process and heal.

Though this story addresses motherhood for a cisgender woman, Kindred by Parents acknowledges that not all people who give birth and/or mother identify as women.