Baby A’saan’s meal time is right around 5 p.m. Cassidy Romaine, his mom, settles on their couch to breastfeed surrounded by plants — greenery that Romaine, an aspiring gardener and herbalist, says helps keep her sane.

At five months postpartum, Romaine’s been doing well managing a new baby and her own mental health. Her last two pregnancies were much harder, including one where she went into premature labor and lost her baby girl a few days after birth. 

A year after that trauma, she was pregnant again. While things went well with her now 13-year-old son Antonio, Romaine recalled holding her breath the whole pregnancy as she grieved the death of her daughter. It felt like being in survival mode. It wasn’t until 10 years later that she realized she’d experienced prenatal and postpartum depression.

“It can be almost like suffocating,” said Romaine, 35, “It’s like, now this human being is depending on you. That’s a lot of weight, and it can be heavy, and it can be hard and it can be lonely no matter who’s around, or what help you have.”

Depression, anxiety and other mental health issues are the most common complications during and after pregnancy, affecting an estimated 1 in 5 women. Yet, 75 percent of postpartum problems go untreated. The consequences can be devastating. Suicide and overdoses are leading causes of maternal death in the United States. 

While medical science is focusing more on treating symptoms — the Food and Drug Administration recently approved the first-ever pill specifically aimed at postpartum depression — tough-it-out societal attitudes remain hard to shake. 

For families and kids, finding ways to help new mothers navigate depression is critical but it’s still hard to get people to understand this isn’t just about feeling down for a day or two.

“My first pregnancy with the ending so soon and losing a baby,” said Romaine, “I think I was young and I just didn’t recognize or understand or know what postpartum depression or really depression at all really looked like, or felt like or anything like that. Nobody talked about it.“

‘They feel like they are failing their children’

Perinatal mood disorders, like postpartum depression or anxiety, are common and treatable. It’s not just sadness. It can look like excessive worry, irritability or fatigue. 

A 2015 Minnesota Department of Health report found depression and anxiety grip at least 15 percent of new mothers in Minnesota — nearly 30 percent within low-income communities. Even after being diagnosed with postpartum depression or anxiety, about half of moms using public health programs don’t get followup care.

“I call it the perinatal perfect storm of hormonal change,” said Dr. Helen Kim, a reproductive psychiatrist and director of the Hennepin Healthcare Mother-Baby Program.

“There’s a developmental change. There’s also the psychological change of identity shifts and the grief and loss … like the grief that people feel in becoming parents,” said Kim, who also works with the Redleaf Center for Family Health, an extension of the Hennepin Healthcare Mother-Baby Program launched in 2019 focused on intensive mental health help for pregnant and postpartum mothers.

Data from the state’s pregnancy risk assessment monitoring system found about 11 percent of those responding between 2016 and 2020 reported experiencing postpartum depression but that there were significant disparities around income, race and ethnicity.

Twenty-three percent of Native American and 18 percent of African American respondents reported experiencing postpartum depression compared to 9 percent of white respondents. The state report also found the percentage of low-income respondents who self-reported postpartum depression “almost doubled that of high-income respondents.”

In her practice, Kim said it can be even harder on patients when they are hospitalized due to a maternal mental health condition. It’s imperative, she added, that new families have support from their communities but also from policies, including equitable parental leave, health insurance and child care.

“If we only focus on the hormones and the identity, we put the responsibility of why postpartum prenatal depression happens squarely on the shoulders of women and they already feel it,” Kim said. “They feel like they are failing their children, when actually, we as a country and as a community are failing.”

Minnesota law calls on the state Health Department to work with health care providers, mental health advocates and others to make sure women know about postpartum depression, including treatments. Still, it can be hard to process the fact that there’s a problem.

According to the National Institutes of Health, about one in five people who give birth experience postpartum depression and it’s even higher in communities impacted by historical or systemic oppression like teen parents or people of color. That affects the entire family structure and an infant’s development.

“If your seed is planted in soil that’s been contaminated with the toxic stress of slavery and systemic racism and or immigration status, or colonialism, or all these other kind of historical traumas, and of course, the soil is not healthy, all the seeds that are planted in that will be affected by that toxicity,” Kim said.

‘It doesn’t make you weak’

Last year, the Food and Drug Administration approved the first oral treatment for postpartum depression. Until now, treatment for postpartum depression was only available through IV and was often cost prohibitive, said Kim. 

Kim said while the pill is an exciting new development in treatment she says she’d likely recommend other treatments first.

She and her team use what’s called the Five S’s of treatment for perinatal mood disorders: safety, sleep, support, structure and stabilizing medication.

But there’s one more “S” that can be a barrier in treatments for perinatal mood disorders: stigma.

“People [were] being looked down on for using a crisis nursery when they need to — to keep themselves and their children safe. We really have a stigma about people asking for help and admitting that there’s a problem,” said Rebecca Polston, a midwife and the founder of Roots Community Birth Center in north Minneapolis.

Polston said she’s heard of mothers who ask for help only to have child protective services called on them. 

Clients at Polston’s clinic are offered mental health checks throughout their pregnancy and after, and one thing Polston’s learned is that depression is rarely treated in isolation. One of the best treatments is being connected to other people.

“What we have working for us is our culture,” Polston said “What we have working for us is our community. So that’s where our solutions lie.”

When she was pregnant with her 2-year-old son, Rachel Lowe, 33, experienced postpartum depression and anxiety that she said left her feeling lost and misunderstood.

“Especially when a doctor would see it on paper, it made them judge how I was being as a mother or like, ‘She must not be taking care of her kid because she has these mental things going on right now.’ So it was definitely just tough.”

When she got pregnant with her 4-month-old daughter, she vowed not to go through that again.

“It’s like a 180 between my two children as far as how I felt,” Lowe said. “They’re still great. They’re amazing. They’re taken care of. But I can tell a huge difference in my mental health once I poured into me.”

She created a self-care routine and a community of parents, friends and family and most importantly, she let them help.

“Don’t be afraid to ask for help,” Lowe said.  “It doesn’t make you weak. It doesn’t make you less of a mother. It literally takes a village.”

Reporting in collaboration with “Call to Mind,” an MPR News mental health initiative.

Resources for people who may need help with postpartum depression: