Supporting Black Pregnant and Parenting People’s Mental Health during COVID-19: An interview with Dr. Alexis Lighten Wesley

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By: Sherine Andreine Powerful, MPH, Doctor of Public Health candidate at the Harvard T.H. Chan School of Public Health and Research Assistant at the Maternal Health Task Force

The absence of research reflecting Black birthing people’s efforts to secure their own healing and survival during COVID-19 is disheartening. While various articles exist on how the pandemic may exacerbate pregnancy-related mortality among Black people in places like Brazil and the U.S., fewer papers on adverse pregnancy outcomes center Black pregnant and parenting people’s humanity or coping during COVID-19. The pandemic has heightened people’s experiences of anxiety, depression, and other mental health conditions that are the body’s valid responses to traumas like oppression. Indeed, for centuries Black people have lived the reality that structural racism creates violent and deadly outcomes for Black pregnant people. The proliferation of studies validating this does little to assuage the very real fears of people who are pregnant at this time.

Perinatal and reproductive psychiatrist Dr. Alexis Lighten Wesley.
Perinatal and reproductive psychiatrist Dr. Alexis Lighten Wesley.

Dr. Alexis Lighten Wesley is a physician working to alleviate her clients’ pandemic-related fears. A perinatal and reproductive psychiatrist, she studied public health at Yale University and medicine at the University of Connecticut. She trained in psychiatry at the George Washington University Hospital and is now finishing a child and adolescent psychiatry fellowship at Children’s National Hospital. Dr. Wesley graciously shared her perspective as a Black psychiatrist on supporting Black pregnant and parenting people and resilience as a community characteristic.

Supporting Black Pregnant and Parenting People during COVID-19

Given the trauma and isolation that COVID-19 and police violence compound, Black pregnant and parenting people are less likely to receive or ask for help, being physically disconnected from loved ones and intimately acquainted with a racist medical system. Dr. Wesley notes that many birthing people feel pressure to have pregnancy and parenthood be joyful times, which causes silent suffering, because “you’re not supposed to be sad, you’re not supposed to be depressed, you’re not supposed to be anxious.” As the pandemic continues, parents face added pressures of family caretaking, working, or job-seeking. Also, for many Black birthing people, happiness about pregnancy already does not come easily because of limited social and emotional support and knowing they’re “raising Black children in a world that doesn’t value Black lives equally.”

To address this, Dr. Wesley discusses with clients what pregnancy can look like and what bringing a Black child into the world might be like during COVID-19. Her efforts are aided by the data on Black childbirth mortality, which equips some clients with information to take preventative measures. Dr. Wesley sees this buttressed self-efficacy in birthing people’s efforts to advocate more for themselves, establish clear boundaries, or seek culturally-affirming providers. As many of her clients’ first Black psychiatrist, Dr. Wesley validates their experiences: “Black patients often feel a sense of safety in the care of Black doctors given the longstanding history of racism and lack of inclusion in medicine.” Indeed, studies show that Black pregnant people feel better cared for and Black babies are less likely to die when they have Black providers.

Dr. Wesley is also adamant about Black pregnant and parenting people acknowledging the full spectrum of their feelings to process, grieve, and practice self-compassion. She expressed that as anti-Black police violence continues during the pandemic, some clients feel guilty about their participation in social change efforts when they have to manage home responsibilities. So part of her work is helping clients set realistic expectations and extend additional grace to themselves, because “we all have different roles to play and it’s okay… your role [isn’t] less relevant than someone else’s.” It’s clear that many Black pregnant and parenting people are dealing with the demands to fight oppression, but focusing on their own survival and healing is resistance, too.

Resilience as a Community Characteristic

Dr. Wesley has heard her clients admit to feeling they have to be tenacious and endure the loneliness of COVID-19. While the idea of individual resilience provides strength for some, it can also negatively feed into harmful stereotypes of Black people as impervious to pain, strong, or superhuman. Instead, Dr. Wesley focuses on resilience as a community characteristic that requires utilizing one’s support systems and asking for help, especially since pregnancy can be a high-risk time for mental health conditions. She defines Black resilience as collectively “being able to cultivate Black strength and Black joy, despite the adversity and racial injustice that Black people have faced for centuries.” For Black parents this means “bringing a child into this world, teaching our children how to face adversity, how to love themselves, and how to thrive.”

Being able to cope during the pandemic requires drawing more on one’s virtual village, now that there are limitations on in-person connections. Dr. Wesley asserts that it’s important for birthing people to “still feel that love and support from their social networks because that’s a huge part of pregnancy and raising children. We always say it takes a village, but COVID-19 has definitely put up a barrier to access that village.” Although many people have been able to deal with isolation by transitioning to remote interactions for social support, not everyone can do so due to inequities in technology access. Until greater systems-level approaches to increase digital tools access is taken up more as a health equity issue, people will have to utilize the support resources available to them, whether socially-distanced, virtual, or otherwise.

Of course, Black people are pulling from their own assets to create support for and among themselves during the pandemic. Some of Dr. Wesley’s clients have joined virtual postpartum groups, scheduled weekly video calls, and utilized group chats to share their pregnancy process with loved ones. She has also seen clients employ risk reduction techniques where they weigh the pros and cons of different social connections, such as in-person interactions restricted to their faith communities, outdoor physical activity meetups, or children’s playtime bubbles. Although there are limitations to the coping techniques people are able to employ, Dr. Wesley takes seriously her role as “a sounding board to help people navigate the best decisions for themselves and their family” while still being able to have a social network and keep their loved ones safe.

The Work Has Only Just Begun

Overall, Dr. Wesley believes that to better support Black pregnant and parenting people’s mental health during COVID-19, medical and public health researchers and practitioners need to:

  1. be more attentive and thoughtful when highlighting the statistics of pregnancy morbidity and mortality for Black people;
  2. consider the unintentional harms of promoting resilience as an individual trait, particularly in light of the harmful strong Black person trope; and
  3. create opportunities for clients to a) receive accurate and culturally-affirming information and b) co-create treatment plans that center their values and reflect the social justice climate.

While this advice is universally helpful, it’s important to provide additional support to Black birthing people due to entrenched racism that can manifest fatally. Unfortunately, 400+ years of oppression of Black people isn’t likely to be eradicated soon, and even with vaccination efforts underway and reports of declining COVID-19 cases, the pandemic is far from over. As such, the mental health effects of experiencing the pandemic and police violence will continue to intensify.

Those working in medicine and public health should try to mitigate this by incorporating the recommendations above, engaging and highlighting nuanced accounts of how Black pregnant people are coping and healing, and leveraging insights gained to guide practice and research. With attention to Black pregnancy morbidity and mortality seemingly at an apex, the work towards reducing adverse pregnancy and birth outcomes still has far to go. Sustained support and community strengths at the center of such efforts will make all the difference.