It shouldn't be this hard to find therapy when you're Black, pregnant, depressed, and living through a pandemic

• Finding a therapist while pregnant required the writer to navigate the maze of U.S. healthcare.
• Quality mental health care can feel out of reach, especially for Black women.
• The Covid-19 lockdowns shredded the community support that many pregnant women were counting on.

A few months ago and early in my pregnancy, I found myself alone in a hospital room-partners weren't allowed, due to Covid restrictions-hooked up to an IV and suddenly overwhelmed with fear.

They couldn't find room for me on the maternity unit, so I'd been taken to one of the general floors. Would I get Covid here in the hospital? My mind rushed ahead. Black women like me were eight times more likely than white women to die while giving birth. Would I lose my baby? I was scared and desperate and asked if I could speak to a therapist. There was none available.

This past year has been hard on everyone. For women like me who were pregnant at any point during the pandemic, the virus shredded the community support that was previously in place. The pandemic has also helped expose a longstanding truth: good mental health care can feel out of reach, especially for Black women.

Like many people with manageable life problems, I relied on friends and family to provide an emotional buffer. But while that kind of support was important, it could easily crumble for various reasons-including, it turns out, a global pandemic.

As an immigrant living in New York City, I had always dreamed that my mother, a retired nurse and midwife, would be by my side during and after my pregnancy. But the American Embassy in Kenya closed due to the pandemic, issuing only emergency visas as needed. I respected this decision, but it was deeply painful because my high risk pregnancy felt like an emergency to me.

The accompanying emotional toll wore me down so much that I overcame my African upbringing that frowned on therapy. "You live in the first world. What's there to be unhappy about?" relatives would say. I needed professional help--guaranteed hot showers, though a great gift, couldn't cure the erosion of one's mental health.

It turned out, that was the easy part. Because the next step required me to navigate the maze of U.S. healthcare and insurance.

BALANCING IT ALL

After two years of fertility treatment, I was ecstatic to be pregnant, thinking I'd be one of those fit expecting moms running in Brooklyn's Prospect Park every morning. I was in good health, had a job, a supportive partner, and health insurance. My pregnancy complications took me by surprise.

My wonderful doctors practiced at top institutions such as NorthWell/Lenox Hill, yet not once did they inquire how I was coping emotionally. I already knew that Black women, who experience misogynoir, the challenge of being both a woman and Black, had a tougher time finding the right therapist since there were many cultural issues to consider. The pandemic taught me that mental health care barriers came in numerous forms.

I quickly learned that very few therapists and psychiatrists accepted my insurance. As I called the numbers of in-network therapists listed on my insurance company's website, I learned the information was outdated or the therapist no longer worked there. On Psychology Today and other websites, I found out-of-network therapists who offered sliding-scale fees, though most that I spoke with had long waiting lists. And even if I could get an appointment, I worried about the financial burden. Sure, my husband and I were considered middle-class, but out-of-network costs and sliding scale plans ranged from $120-$170 per session. Our gross income, from which the sliding scale was calculated, didn't tell the full story of our financial situation.

It turned out that the cheapest option was to see a general practitioner who could recommend anti-anxiety or depression drugs, but that felt like a risky path since I was unsure what the long-term impact on my unborn child would be. What I wanted, what I needed, was talk therapy with a trained professional.

Weak from surviving only on fluids and battling depression, I could barely call my parents, let alone jump through the hoops of consulting multiple therapists to find the right one for this delicate period of my life. I was too ashamed to ask my husband to help--he was already taking care of all our household needs and chores, in addition to his demanding job and our puppy. I also wanted to hold on to that image of the overachieving, resilient Black woman who can balance it all.

"Ideally, mental health care should be integrated into general health care, not just care surrounding pregnancy and postpartum," Dr. Shelly Cohen, a reproductive psychiatrist, told me. "The challenge we have in the US medical system is that everything is siloed. Doctors often limit their thinking to their specialty and patients have to figure out how to get help for their other health problems."

"Having a therapist is key because it provides a steady witness to your life and progress, week by 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 US, and the impact on pregnant Black women is of special concern for the intrauterine and post-natal development of our offspring. Black women also face the chronic stress of racism, known as weathering, which can impact our health outcomes. Research has found that maternal depression affects children from the womb all the way to young adulthood. But, as I've discovered, mental health care is seldom integrated into prenatal care.

President Joe Biden's Covid-19 Stimulus Package included support for children and for mental health broadly. But there has not been major federal action to specifically target the perinatal mental health of Black women.

Closer to home, New York mayoral candidate Eric Adams proposed a doula for every pregnant woman. The idea could have a meaningful impact- having a doula has been linked to lower rates of cesarean delivery, premature birth, low birth weight, and postpartum depression, as well as increased rates of breastfeeding and higher patient satisfaction with motherhood.

But none of this directly improves Black women's access to talk therapy and non-psychiatric mental healthcare. Nothing, not even doulas, can replace critical professional mental healthcare, which is so hard for many to access.

Even as a Black woman, I have plenty of resource privilege-unlimited wifi, a day job at a public health agency, some research savviness, 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 get the right therapist. How much harder is it for women who may be suffering more than me and with fewer resources?

One new option, which I only just learned about from a therapist friend, Maggie Gitu, is that immigrants can teleconference with therapists from our home countries. This can allow us to be "seen and heard without the burden of translating themselves into whiteness," Gitu explained. That's the option that I ended up choosing: a therapist from my home country who I could see via Zoom. I'm due soon and will likely not be pregnant again. But for other women, and especially Black women, who are pregnant now and in the future, I hope we can offer better.