Asian Americans are the fastest-growing racial or ethnic group in the United States, but remain severely underrepresented in the area of maternal mental health (MMH).  Until recently, there had been no Asian-American and Pacific Islander (AAPI)-specific MMH resources and very limited research on MMH and the AAPI population. That’s why mental health app Expectful has created a new set of resources specifically for Asian-American moms dealing with maternal mental health disorders with Cindy Herrick, Strategic Partnerships & National Campaigns Lead for 2020 Mom, MMH patient expert and advocate, and Certified Peer Support Specialist in Maternal Mental Health.   

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Along with Dr. Deepika Goyal, PhD, FNP, professor at The Valley Foundation School of Nursing, nurse practitioner at Santa Clara Valley Medical Center, and a leading researcher on MMH, Cindy has joined Expectful in working to raise awareness about the AAPI community and MMH disorders.  Together, Cindy and Deepika share their maternal mental health experiences and how they became advocates: Cindy in the area of policy and awareness building and Deepika with her research efforts. 

Cindy’s story: 

A decade ago, I gave birth to my son, a monumental moment that has given me what would become one of the most cherished and challenging roles in life: being my son’s mom. What I didn’t know then was that that moment also gave birth to another milestone role in my life: the role of an advocate.  

The defining moment that fueled my path came right after I delivered my son. After months of suffering from maternal OCD, depression and anxiety, I went into unexpected labor a month early.  With the haunting uncertainty of pregnancy and labor behind me, my tired mind hoped that my mental health would finally take a turn for the better after delivery.

That turned out to be wishful thinking.  

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I remember feeling “off” right after delivering my son: I didn’t feel connected to the baby, I was terrified of touching him and I felt empty and depersonalized. I chalked it up to not having slept for 24 hours and thought some sleep would “fix me.” The trouble continued when I couldn’t sleep. I started compulsively and constantly checking on my son. Even when my very supportive husband took over watching my son full-time at night, I couldn’t sleep.  

After 48 hours of not getting any sleep, I finally begged the hospital staff for help. I begged them to take my son to the nursery so I could get some sleep; I was too anxious to sleep with him in the same room, but they insisted the baby remain in my room. I learned that the hospital was “rooming-in only”, meaning that they kept the baby in the room for “better bonding” during the entire hospital stay. The irony was, by keeping the baby in the room, I became even more sleep deprived and disconnected from my son. I told the OB on call that I was already under the care of a psychiatrist for depression and anxiety during my pregnancy, and that I felt like something was not right.  The doctor told me that I “just had the baby blues”, gave me a Xanax, and then proceeded to put a big “DO NOT DISTURB” sign on my door so I could sleep.

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I waited for sleep to come, but the Xanax did nothing for my sleep. Was I broken? Why didn’t the Xanax fix me? My fear escalated.  

That night, I wandered the hospital hallways in desperation, sobbing and delirious from lack of sleep.  Every room I passed in the maternity ward had seemingly happy moms bonding with their baby—and here I was, trying to run away from mine. The nurses saw me, but they clearly didn’t know how to help me. One offered me a Percocet to see if it could help with sleep, while another lectured my very supportive husband for not “doing enough” to help. 

I felt unheard, unhinged, lonely, trapped and hopeless. I was less than three days into motherhood and I had already failed. The big DO NOT DISTURB sign on my door said as much—it felt like a public mockery of my failure as a mom. How on earth could I survive this? I couldn’t breathe. Then came the defining moment: I looked at my husband, and then to my son, and back to my husband and said quietly, “Maybe I made a mistake… maybe he’s better without me… ”

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My heart still breaks for the person I was in that moment, but the memory of that painful and hopeless experience became the powerful catalyst for me to become a passionate advocate for maternal mental health. 

Today, I can’t imagine life without my son. It took me three long, painful years and a harrowing ride on the psychiatric med roller coaster to fight my way out of the MMH fog of postpartum depression, anxiety, severe insomnia, and undiagnosed OCD.  10 years ago, there weren’t a lot of maternal mental health specific clinicians available, so it took a lot of trial and error, self-advocacy and research to figure out how to get well.  When I finally started feeling a little more like myself again, I vowed to work to help change the system. I joined 2020 Mom to help close gaps in the maternal mental health care system through policy and systems change. The system had failed me, but I could work to make sure that other moms never experienced the hopelessness and desperation I felt that harrowing night.

Having been in the maternal mental health space for seven years now, I have seen many wonderful shifts and growth in the landscape of MMH. While previously we had been fighting just to get MMH on the map, we now have the luxury to dig a little deeper into nuanced aspects of it. 

Recently, when Expectful reached out to talk to me about their new resource for Asian American Moms, I had another catalyst moment: why has it taken this many years and a recent spike in crimes against Asian Americans for people to finally start talking about the Asian maternal mental health experience? Why haven’t we been talking about this issue before?

As I researched the MMH landscape—a landscape I knew better than the average new mom looking for help—I was disheartened to realize that there were few to no resources specific to Asian moms.  Furthermore, it quickly became apparent that there was also a huge gap in the research literature specific to MMH and Asian moms. How many Asian moms have been falling through the cracks? 

We must do more to support Asian moms.  

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What little research we have on Asian moms and MMH indicate that Asian moms are not immune to MMH disorders. In fact, Asian moms are 9 times more likely than their white counterparts to experience suicidal ideations during the postpartum period. Mainstream mental health research shows that due to cultural stigma and generational values, many Asian Americans are less likely to reach out for help for mental illness. 

Maternal mental health already carries a heavy stigma. When you add on another layer of cultural shame and stigma to the existing barriers to care, it’s no wonder that Asian moms have been suffering in silence. As a 1.5 generation Taiwanese immigrant (born in Taiwan, immigrated at 5) with strong ties to my Taiwanese roots, I felt that pull of advocacy again in my heart—but this time I was in a position to do something about it.  

I spoke to my executive director at 2020 Mom about this gap, and published a piece highlighting what I’ve learned about the gap for AAPI moms. Then I reached out to Dr. Deepika Goyal, the leading researcher in this space and also an Asian mom with lived experience. Her research has shaped much of what we currently know about MMH and the Asian population. I was delighted when she decided to also share her advocacy story as well as her research expertise on this topic. It is my hope that our shared stories and experiences will spark a much needed conversation about how to better support Asian moms suffering from maternal mental health disorders.  

Deepika’s story: 

My MMH journey began in the 1980s with the birth of my first child. At that time, I was living on a military base in Japan and far away from family and friends. In many Asian cultures, it is customary for a female relative to come and stay for a few months to help the new mom and baby. No one was able to come and help me, which left me feeling abandoned and alone. I was sad and weepy all of the time, I didn’t feel like myself, and I knew something was wrong. I suffered alone and in silence and somehow, I got through it. 

Fast forward 10 years: I was in graduate school and read an article by Dr. Cheryl Beck about postpartum depression. I had never heard of this before— it was my “aha,” moment and I realized that I likely had undiagnosed PPD 10 years earlier. I often think back to that time and wonder why no healthcare provider ever asked how I was feeling emotionally. I decided to find out more about MMH and found a lot of research that included Caucasian women, but study samples included very few Asian-American women. The results of the few Asian-American women that did take part in studies were reported together, losing all of the nuances within each distinct group. This is where my research path began: I am an advocate for MMH and Asian-American moms through my research. 

Related: You’re not alone: Postpartum depression is common and can last longer than a year, says study

My research found that there remains a deep-rooted stigma regarding mental health in Asian families. Stigma and shame associated with MMH issues create a barrier for women who need help. Asian-American women do experience MMH issues, and are less likely to be diagnosed with PPD than Caucasian women. Although Asian-American women will confide in their spouses about any MMH symptoms before telling anyone else, they prefer complementary and alternative therapies versus antidepressants and/or counseling, and most importantly, they will only seek professional mental health help if their symptoms are severe. 

Years ago, maternal mental health was often a siloed and taboo topic. Advocates were simply fighting to have MMH mainstreamed and to be heard as a collective. However, as the topic of MMH has been normalized and thankfully made its way into mainstream discussions, the time has come to talk about Asian moms and MMH. The growing AAPI population and the recent influx of stressors for the AAPI population creates an urgent need for a call to action to fund more resources, research and development of culturally-sensitive interventions. With adequate resources, support and funding, we can all work to promote the health and welfare for Asian mothers and help them and their families thrive.