Dr Sandeep Vohra / X/@DrSandeepVohra

Up to one in five birthing moms will experience some form of perinatal mental health disorder. One to two women per 1,000 births develop postpartum psychosis. “This increases the risk of infanticide and/or suicide. Onset is sudden, usually within one to two weeks following childbirth,” said panelists at an Ethnic Media Services briefing on June.4. 

Symptoms include delusions, hallucinations, paranoia, rapid mood swings, cognitive impairment, focus on death, and reckless behavior. “The mother should be under the care of a doula who can advocate for her. The mother must see a medical provider or be taken to the emergency room for assessment and care,” said Khefri Riley who has over 18 years of experience as a postpartum doula.

A doula provides emotional and physical support before, during, and after pregnancy and childbirth. They are not medical professionals but are certified to help a birthing mother before, during, and after pregnancy.

“It is very hard for the mothers who don’t have an experienced support structure,” said Riley adding, “That is where a doula can be of help.”

There’s a lot of stigma around talking about mental health. As it is a taboo subject it is difficult to ascertain family history of it. Moms don't know whether someone in their extended family has suffered from it. When faced by it they don’t recognize the symptoms. 

“We are able to amplify the voices of families. We are able to recognize when something is happening that's not okay, recognize it earlier on rather than it being a state of crisis,” said Riley.

Onset of postpartum depression not recognized by family 

“There is a parent with a shiny new baby and really needing lots of support. While the term postpartum is defined as the first 42 days after birth, those of us who have children know that that is only the beginning. What happens if the breastfeeding challenges are on day 43 or what happens if mom starts to slide into a depression that no one would recognize because she is very good at covering?” asked Kairis Chiaji, Medi-Cal doula at the EMS briefing. 

Feeding can be difficult, sometimes taking hours and hours on end. The pressure to breastfeed, compounded with the baby not latching on unbeknownst to the mother, can push her over the edge. 

Weaning can be traumatic for a woman’s mental health as well as physical. 

Dr Sandeep Vohra, a top psychiatrist in Delhi, warned that if postpartum psychosis is not caught in time it can lead to permanent mental damage. Seventy five percent of persons remain untreated, increasing the risk of long-term negative impacts on mothers, babies, and families.

A cry for help

Sleep deprivation and physical exhaustion can amplify the feelings of pressure a mother feels. 

“We hear you,” said the Department of Health Care Services (DHCS) leader and two doula community healthcare providers at the briefing, to the young mothers who are completely out of their depth with the new situations they find themselves in. 

Doulas are hand holding new mothers from inception to the first birthday of the baby. Doula services include personal support to birthing individuals and their families throughout pregnancy and one-year postpartum under Medi-Cal. This includes emotional and physical support, as well as support for and after miscarriage or abortion.

California extended coverage for Medi-Cal eligibility from 60 days postpartum to 12 months postpartum and eliminated premiums for families. This new healthcare approach supports Medi-Cal members from conception through 12 months postpartum, regardless of birth outcome. With the new changes in healthcare policy their services include support for mental health. 

Psychosis is a medical emergency; mothers can feel they are not fit to be a parent. The separation between reality and what's not real can disappear. 

Mothers in an inpatient psychiatric facility are separated from their babies however this is essential for the mother and the baby's health, says Dr Vohra. 

Medi-Cal, California’s Medicaid program, covers one in three Californians — or 15 million, including 1.3 million children. 

Women of color disproportionately impacted

Women of color are three to four times more likely to experience complications during pregnancy and childbirth and die from these complications than white women. This is not well known. 
 
“Doulas actually act as advocates specifically for more marginalized folks, specifically those voices who need to be heard. Oftentimes voices are silenced,” said the panelist.

“To increase access to services and reduce barriers, the Department of Health Care Services (DHCS) has issued a standing recommendation for doula services. This means that Medi-Cal members don't have to get a separate written referral to receive Medi-Cal covered doula services. Instead, members can go directly to a doula who accepts Medi-Cal to begin receiving care. The department has created a doula directory by county,” said Erica Holmes, Chief of the Benefits Division at DHCS.
 
“You will find other information including doula specialties, language spoken, ethnicity, and their contact information. The department will be updating this directory on a regular basis. “As of the end of May of 2024, the department is pleased to announce that we have approved 455 group and individual doula applications.” 

“With the right treatment, the right medication recovery can be complete, medication-free, but timely action is critical,” said Dr Vohra.

“While they might not be able to prevent psychosis, they can certainly treat it.”