E10: Understanding Postpartum Depression through a Senegalese-American Lens

Ever wondered what postpartum depression looks like from a Senegalese-American perspective, or been curious about the stark cultural differences in women's health between Senegal and America? This episode of The Jeune Maman Podcast takes you on a cultural journey as we explore these issues with Dr. Holda Gueye-Weinstein, a renowned OBGYN. We delve into the surprising contrasts between American and Senegalese patients in terms of self-advocacy and compliance, and discuss the imperative need for Senegalese women to take more control over their health, ask questions and make decisions that resonate with their specific lifestyles.

We also discover how Senegal's traditional practices around postpartum care, from unique soups to massages, aid in the recovery of new mothers, and we contrast this with what is common in the American culture. Important topics such as labor, birth control, and exercise during pregnancy are not left out as we compare these across both cultures. We close the curtain with a comprehensive discussion on postpartum depression, as we identify warning signs and emphasis the need for a culturally sensitive medical team to aid women during this challenging phase. This episode is a must-listen for everyone, particularly women navigating postpartum depression from a Senegalese-American viewpoint.

Check out Dr. Gueye-Weinstein Visionary Women's Health site:
Gynecology Clinic| Spa | Visionary Women's Health | United States (visionarywomenshealth.com)

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Transcript

Aissatou: 0:03

Hello listeners, welcome back to The Jeune Maman Podcast, where we talk about all things postpartum, motherhood, pregnancy, tips and tricks and more, from a Senegalese-American perspective. I'm your host, Aissatou Guisse, and today we have an anticipated topic, a much- anticipated topic within our community that so many of you all have asked me about, and I'm honored and humbled to have a guest speaker who is an expert in this field and many other fields, and we'll get into that a little bit later on. Before we do that, I want to give a quick intro into who my guest speaker is today and then allow her the opportunity as well to introduce herself. So today we are going to be talking with Dr Holda Gueye- Weinstein, and she is a John- Hopkins trained board certified OBGYN, as well as a fellow of the American Board of Obstetrics and Gynecology. She is a top OBGYN doctor both in the United States and internationally, and her rigorous training has made her an expert in her field.

Aissatou: 1:05

She is described by her patients as a keen listener with an interest in your entire health picture, so she's not interested in just one part of who you are, she's interested in the whole part of who you are from a health standpoint, so she can help achieve the optimal outcomes for her patients. She's known to deliver the type of medical care that has become so hard to find, and I know, as black women, as new moms especially Senegalese new moms who may not have the wealth of resources around us where we can talk about all of these topics, which was the reason why I started this podcast in the first place, that's such an important thing. So, I'm very, very excited to have as our guest speaker today, and I want to give her the opportunity to say hello to my listeners.

Dr.Gueye-Weinstein: 1:49

Thank you, I'm very happy to be here. Thank you for that wonderful introduction. I don't really have too much to add. I think you did a great job. I would just say that I am the Medical Director at Visionary Women's Health, which is, I'm going to say, the first center for the type of health care that I would like all women to have access to in the United States. That's currently in Maryland. My dream and my vision is to spread this center across the country, because I think we have many issues around women's health in general. I'm also the founder of a nonprofit organization called HALFA, which basically helps bring access to life-saving medical care for women, specifically in West Africa, and so we've done many, many projects in Senegal, worked with the government there to bring things like cervical cancer screening and decreased maternal mortality. So, women's health is at the core, at the heart of everything that I love to do.

Aissatou: 2:59

Thank you. Thank you for that introduction. I think our listeners are going to be very excited to hear more about overall women's health. But when we get into the topic of postpartum depression, it's a component of women's health, but it's one that's often overlooked in our community.

Aissatou: 3:16

So, I'm personally very excited to hear about that one, but before we do that, I want to ask you, Dr, what has been your experience with pregnancy and motherhood in the Senegalese culture, and with that specifically, I mean, are there any clashes or challenges that you face with patients due to cultural barriers?

Dr.Gueye-Weinstein: 3:32

Yeah, so I would say that the very first observation this is before Senegalese women even walk through my door to get care is that there's this big difference between the Senegalese pregnant mom and the American mom, in that most American moms will actually come in and say I've done so much research on you and you're the only doctor that I want to see and I'm so excited to be here, and et cetera, whereas I find most Senegalese patients go places by default. So often, many times I can't even count how many times they'll walk in and they'll say, oh, my goodness, you're a Senegalese doctor, and that doesn't happen very often with American moms. They walk in knowing who they're going to see, they've done their research, they know what hospital they want to deliver in, they know the teams and the kinds of delivery they want, et cetera, and I think that's cultural. It's not that Senegalese women don't care, it's just that they're not used to being given that choice, and so most often the decision comes from simply I live here, this is the hospital that's here, so I'm going to go to this clinic and that's where it ends. So I think there's already that difference in self-advocacy knowing that there is a choice, knowing that there are many different ways that you can approach your own health.

Dr.Gueye-Weinstein: 5:03

That, I see, is a difference between Senegalese patients and American patients, and I think that behavior also leaks into their care. I would say Senegalese patients are very compliant. They will always do what they are told, but they don't always ask questions. They don't always feel comfortable challenging authority or challenging the plan or asking why are we doing that C-section and not allowing me to just to labor? And I think from my practice overseas, I definitely see that behavior mirrored in Senegal, where you're not even allowed to ask questions and it's not on very well to do so, and I definitely would encourage Senegalese women to get out of that mindset, especially in the United States, and to take their health, to be more responsible for it, and ask questions, because it is actually very, very welcomed here and it's gonna give you, the patient, the opportunity to make the best decisions that work for your own lifestyle and your situation.

Aissatou: 6:10

I love that answer because I saw myself in a lot of what you were saying in the very beginning, before I even was pregnant, I was deathly afraid of giving birth. The labor and delivery experience was something that I was terrified of, and it was because I didn't know anything. It's such a mysterious experience that we're not really told what happens.

Aissatou: 6:34

I think, to an earlier point that you made, the complacency excuse me. Maybe not complacency, but the compliant aspect of our culture tells us that this is something we go through naturally. Women are designed to be pregnant and give birth, so there really isn't much to research on or know. You're just supposed to know how to do it.

Dr.Gueye-Weinstein: 6:54

And so.

Aissatou: 6:54

I think that leads us to this place where we feel like we don't have to know much because our bodies won't naturally do it, and then it seeps into how we receive care from practitioners. I remember in the very beginning I wasn't asking a lot of questions. It wasn't until I was empowered and luckily, through my employer, we have a program where, if you're going through life changes such as pregnancy, there's a medical team that's made available to you for any questions that you have.

Aissatou: 7:24

So they encouraged me to come up with a birth plan, to ask my doctor what's the plan to get to this stage and that stage. So it really made me much more comfortable with the whole birthing experience and I think even beyond advocacy part of it your personal health, your mental health when it comes to dealing with pregnancy, you're much alleviated if you are more informed.

Dr.Gueye-Weinstein: 7:44

of course, Absolutely, and I actually want to piggyback on that, on your experience, because it's so pervasive in the Senegalese community. And what's happening is that when a young girl grows up in Senegal, you don't get conversations about sex and marriage or having a baby. You just sort of observe it and you it's almost you're assuming that you're just going to know what to do, but what actually is happening is, once you get married and you're pregnant, you have a community of women that now will actually start to coach you when that coaching is needed whether this is from your mother, your aunts, cousins, other women that have already gone through it are now going to actually start talking to you about how to take care of yourself, what to expect during delivery, and that's not something that will happen prior to that stage. Now you're in the United States or in France or wherever country that's outside of Senegal, and you get to that point in your life and that community isn't there.

Dr.Gueye-Weinstein: 8:48

So I think your assumption is one that is probably common to the Senegalese community, where you're just like am I just supposed to know what to do? Yeah, but had you been in Senegal, you would probably already get that support just to guide you on what to do exactly. So. I think it's important to realize that we are isolated and we are now in a new setting where that education and that support isn't there. So we have to start to get that support in a different way. It's gonna look very different than if you were in Senegal.

Aissatou: 9:22

Absolutely, absolutely. I'm gonna piggyback off of your piggyback. I get so many people that write me messages saying I'm going through this experience right now and I don't have anyone to talk to about it.

Aissatou: 9:34

And I think, like you said, if we're in a communal place where everyone can kind of see what you're going through, it's much easier for them to give you that coaching and that advice. But I remember when I was pregnant my mom would call me and she's like you, don't ask me questions. It's because that's not a muscle memory that I have to just come and be like hey, this is what I'm feeling today. Can you tell me about it?

Aissatou: 9:53

And then for her too it was kind of uncomfortable, because a lot of it is like just say no. That's like a wall of phrase that she'll say whenever she's referring to something in her childhood with her marriage, and so I think there's just this big black box around pregnancy, sex and marriage. That, yeah, I agree with you, when you're not living in Senegal in that environment, that you can be disadvantaged Very yeah.

Aissatou: 10:19

Thank you, that was wonderful. So my next question is, as a Senegalese doctor, what are some things that you have heard said in our community that you either one fully support or two reject wholeheartedly, based on your training? So an example that I want to give here is are there any tips or tricks that are recommended in our culture that are actually detrimental medically, or, vice versa, any medical benefits that are culturally discouraged?

Dr.Gueye-Weinstein: 10:48

So, yeah, that's a great question. I am going to give a full disclaimer that I so I've been living in the United States since I was two and then I went back to Senegal around the age of 13, and I lived there for about two years, so the total sort of sum of my conscious life in Senegal was really just two years. Now, of course, I go there for medical missions, but they're in a very specific context in terms of my interaction. So my answer is going to pull from what patients have been willing to share with me my interaction with patients and not so much maybe cultural things that I'm aware of there just because I didn't grow up there. And if you have specific practices that you want to bring up that are very common, I'm happy to kind of give you my opinion on it. Okay, so to answer your question just from my perspective, I would say there are certain things that I think that I have seen Senegalese women do so well that I wish we did here. One example is the postpartum care. I've had many Senegalese women tell me about how they're getting their bodies massaged and they have specific foods made for them, whether it's calorie dense food for breast feeding and specific soups, the perineal care. When I was actually working in Senegal, I saw how women were isolated from their husbands and just kind of surrounded with other women to take care of them, which is amazing because it really gives you your body that chance to just rest, which is what we recommend here. We actually just tell patients to perform pelvic rest for a specific period and that's done really, really well in Senegal. And for those women who bring that back here, I think that my Senegalese patients have always been stubborn to coming to the hospital early enough. So often I will tell them please come in so I can check you. But they don't. They'll just try to stay at home as long as possible, which in many ways is actually a good thing, as long as there's nothing concerning that's going on. Of course, if there is a sign excessive bleeding or your baby's not moving or anything that's dangerous then that's not a good thing. But for just the routine labor, a lot of American patients are reluctant to labor at home because they want to get that epidural on board as soon as possible. So I actually appreciate that very much with Senegalese patients, because you're just more likely to do well if you get to the hospital at a further point in your labor.

Dr.Gueye-Weinstein: 13:41

I do think some of the challenges that I have run into have to do with, for example, we often want to get women on some form of birth control right after delivery, just to avoid that chance of getting pregnant again right after having a baby, which can be pretty complicated from a medical standpoint, and sometimes birth control doesn't necessarily mean you're taking a medication. It could be that we are going to use condoms or we're going to talk about the calendar method with your periods if you're not breastfeeding and you're getting those cycles. I find that conversation is one that's very difficult. The condom issue is one that's not very welcomed. The partners often they'll tell me no, I can't tell my partner, we just aren't going to have sex. That's not an option.

Dr.Gueye-Weinstein: 14:36

Birth control there's a concern whether it's going to cause infertility or issues.

Dr.Gueye-Weinstein: 14:41

It becomes a little bit challenging to offer the necessary information to get them to do what's best for them, and it all it means is it just requires extra time and effort on my end, which is not a problem, but I do see that that's a recurring sort of roadblock with the synaglize patients.

Dr.Gueye-Weinstein: 15:03

I also think that for patients who have lived in Senegal and are coming here and then are pregnant. Life in Senegal is not as sedentary as it is here, and so one challenge that often comes up is we want patients to move during pregnancy because of that increased risk of clots. But this new paradigm of living here doesn't always allow patients send these patients to do that, and so the American that goes to the gym and does all these things is not necessarily what the Senegalese patient would think to do. They're still trying to use doing work at home and maybe trying to go outside and take a walk or go to the market, but here you're using a car for most of that, so their lives just tend to be a little bit more sedentary. And trying to navigate more movement and trying to get that exercise in this new way of living has also been a bit challenging with some of the patients.

Aissatou: 16:05

Okay, no, I think, in terms of examples, a lot of what you spoke on were things that I experienced in my own pregnancy and I think what I was alluding to when I asked a question. I remember, when I was pregnant, working out my mom would be like no, no, don't work out. Like to your point of going to the gym. That was highly discouraged, even though medically it can be good for the body to be active when you're pregnant. Another example that you touched on was the birth control issue. So I think even before pregnancy, my mom would give me stories about how, if you were a married woman and you've never had a child before, birth control can make you infertile. She mentioned that doctors like midwives in Senegal would not prescribe you a birth control if you've never had a child before. So I think, to your point, a lot of it is just around education, taking that additional time to help folks understand what it is that the medical treatment they're receiving is for, and removing some of that cultural taboo or misinformation around it yeah, absolutely, absolutely.

Aissatou: 17:16

Great. So now we're going to shift gears into the hot topic of this episode, which is postpartum depression. Do you believe it exists in our culture and if so, how should we approach talking about it?

Dr.Gueye-Weinstein: 17:29

So it absolutely exists in our culture. Postpartum depression is a universal experience. It's just of course that in the United States it is a formalized diagnosis. We talk about it, we screen for it, whereas I don't think that that's done in Senegal. I actually, unfortunately, have seen postpartum depression very frequently, not only in my Senegalese patients, but a lot of my immigrant patients in general, just because of the stress of being an immigrant in the United States. So Senegalese women are at greater risk of experiencing whether it's postpartum blues or postpartum depression, and it's important to recognize it and to know how to address it.

Aissatou: 18:19

Thank you for that. I think that a lot of people will be relieved to hear that. We know in our heads that the postpartum blues especially like sometimes you know how you feel, right. But here it comes from a medical professional. For me at least, it helps, because in our culture it tends to get minimized as I don't know, being moody and just not coping well with motherhood, which I mean. Part of postpartum depression and blues is that there's a coping mechanism, there's a new experience that you're going through, and so I think, when we can validate that that is an experience that we have and to hear that we might actually be at greater risk for it, especially with some of the cultural practices we have around having a baby, such as giving gifts to your in-laws, can you imagine after nine months of being pregnant, you have to think about this new challenge of making everybody around you happy, when maybe the tables should be turned to focusing on how to make you, as a new mom, happy.

Dr.Gueye-Weinstein: 19:16

So yeah, yeah, and you know, I think again when I compare the mom that had a baby in Senegal to the mom here. The mom that had the baby in Senegal that needs to give gifts to their in-laws is probably getting support from other people to coordinate that, whether it's your own mother, for example, their or other family members that are more than eager to coordinate that, because we all know that they love doing those things. Whereas the mom here is probably, you know, in-laws are probably in Senegal or not with them, or it's just them and their husband and maybe even other little children that they still have to take care of. And so now you have all of these demands on the mother who is expected to be the child, the one who raises all the children, the one who takes care of the household, and now the one who manages the in-laws without any support is a recipe for postpartum depression. So it's almost unfair, in my opinion, to have the same expectations on a mother that's here and comparing that same mother to someone that's in Senegal that maybe has a little bit more support.

Dr.Gueye-Weinstein: 20:34

And that isn't to say that postpartum depression doesn't happen in Senegal, because I have seen it happen there quite a few times, but we have to be mindful of what those risks are, and one of the biggest risks that I see is just that lack of support, that lack of a tribe that is gonna support you, whether it's education. What do you do when you're struggling with breastfeeding? What do you do? How do you know that your bleeding is normal? How do you take care of yourself? How, if you're feeling overwhelmed and exhausted, who do you turn to? There are a myriad of elements that go into support that are lacking often in a lot of the immigrants that are here and have children here, and that is a big risk factor for postpartum depression.

Aissatou: 21:26

Absolutely, absolutely. So in dealing with postpartum depression. Let's say, for those Senegalese moms that are outside of Senegal, going back to an earlier point you made on finding that right doctor, that you go to right. That is specific to the needs that you have.

Aissatou: 21:42

How can we, as moms living outside of Senegal, get the proper care for postpartum depression with the cultural consideration behind it? Like, for example, when I'm looking for a therapist, I try to find a black therapist, a black female therapist, maybe a black Senegalese female therapist, if I can get that, because they're gonna understand certain things without me having to dive deep into it and explain it to the nth degree?

Dr.Gueye-Weinstein: 22:08

Absolutely, and that's why I think that choosing your obstetrician from the get go is so important. I mean, this is such a huge life experience that you're about to go through and it has risks Having a baby, even though it's a really happy time, there's morbidity and mortality involved in it that we don't like to talk about but is real, especially for black women. So it's really important to find the right team, the team that's gonna hear you and listen to you and not dismiss you, and recognize the issues when they arise. Because your first move when you think maybe you have postpartum depression is to reach out to your obstetrician, because it's your OB that's gonna be able to say, okay, this looks like just the blues, but here's what we can do. Or this is depression and let's get you a referral with psychiatry, or let's start this medication, or let's have this therapist see you. Your obstetrician should be your first point of reference.

Dr.Gueye-Weinstein: 23:13

There are I've had some patients say I went to a psychiatrist because I was feeling this way, but the psychiatrist wasn't well-versed with depression related to pregnancy or being able to differentiate postpartum depression and the blues, and so they took them down sort of a rabbit hole of treating depression, anxiety and other issues that were going to be short-lived. So after they had seen me, we changed the plan a little bit and they were fine within six to eight weeks of a modified treatment. So your obstetrician is your number one go-to if you think you're suffering from postpartum depression. But you need to make sure that you're with the right obstetrician. Like you said, if it's someone that does not understand your cultural context, maybe just can't really hear what's going on with you. If you're talking about some of the dynamics in marriage, for example, that exists in Senegal, a lot of Americans don't get that. They can become very judgmental very quickly when it's not necessarily that your husband's bad. We just have different cultural realities.

Aissatou: 24:26

Yeah. So that's a good point. That context really helps in understanding where that patient is speaking from. So how can we? What are some of the signs of postpartum depression or blues that our listeners can pay attention to?

Dr.Gueye-Weinstein: 24:43

Sure, so after we have a baby as a woman, there is a normal process where so labor delivery, is a very emotionally charged experience. We are one part of us is afraid. Another part of us is eager to have this baby, and that mixture, with all the medical interventions, is very overwhelming. So I hope that men are also listening to your podcast because it's important for them, especially Senegalese men, to understand this experience from the woman's perspective, because they're not involved. In Senegal, they're literally told not to go to the labor room. They're just completely excluded intentionally. But they're not here. They're expected to be in the labor room with their wife, and so it's important to understand that just that experience alone is almost like being in a car crash for the body, for the woman. So from that experience it's normal, if everything went well, to sort of have this sense of relief and excitement initially when you have your baby, because you just went from this roller coaster to parking. But then what happens immediately after that is now your hormones are going through drastic fluctuations and for a lot of women that's gonna mean that you're going to be experiencing some level of whether it's a little bit of worry or anxiety, ups and downs, and for most women this is manageable, especially if they have a good support system, good habits, they're able to rest, et cetera. For some women, however, those fluctuations will go into what we call postpartum blues, and it means that You'll find yourself being sad when you know you should be happy, you just had a baby, or you'll have some resentment over certain issues. So you're you're almost having this maladaptive Reaction to your life, but you can't really say why. Because you should be happy and you just had this baby. But it doesn't get into the realm of depression where you can't take care of yourself, you can't take care of your baby. You're sleeping all the time, so you're just not feeling your best.

Dr.Gueye-Weinstein: 27:05

Post-partum depression is when you have all of those negative emotions or uncomfortable emotions, but now you also are finding that you don't want to take a shower, you don't feel like eating, you don't want to take care of your baby, you feel guilty that you don't want to take care of your baby.

Dr.Gueye-Weinstein: 27:22

Some women will go as far as wanting to hurt their baby, and now they're fighting those feelings of wanting to hurt hurt their baby, or they want to hurt their spouse, or they want to hurt themselves. It when it becomes problematic with a day to day function and you're having those thoughts that feel very intrusive, then you know that you should probably seek some help and that this may be post-partum depression. The difference with post-partum depression and just routine depression is when supported properly, it's often short lived, and so those first 12 weeks after having a baby is a risky time for post-partum depression. So your baby could be two months old and now you're starting to have the symptoms of post-partum depression, and often people don't recognize that. They think well, I had my baby a while ago, so maybe this is something else. No, your body is still going through all of the changes of pregnancy and you should still reach out to your obstetrician as the first step.

Aissatou: 28:27

Wow, that was very insightful, thank you, and I think it's good to hear too that it's not something that's always immediate after you have a baby. It can creep up on you afterwards, so thank you for that.

Aissatou: 28:39

I know there's so much on post-partum depression and we're not able to cover everything in one episode. I want to say thank you. Thank you so much, doctor. This has been super, super helpful and I think our listeners will find that they are able to learn from this episode and hopefully we can have more discussions around post-partum depression. I think it's not, like I said, it's not something we can cover in one episode topic, not in one conversation, definitely, and so I want to encourage my listeners to reach out to me If there's more you would like to hear on this topic. Let me know your experiences as well with post-partum depression. I can't say that I've gone through it, but I definitely have post-partum blues, I think, where I'm not as excited about something or I feel that guilt around motherhood. So let's talk about it everyone. I'm very, very excited to get this episode out there, hear your feedback, and I want to say thank you to Dr Gay. Do you have any parting thoughts for us?

Dr.Gueye-Weinstein: 29:36

The only thing I would say is I would encourage Senegalese woman out there to intentionally choose your medical team. It should be a collaborative effort, not a person telling you what to do. Gather your social support, make sure you have access to reliable education and information, and get your partner on board with supporting you and understanding what's going on with you.

Aissatou: 30:00

I like that last bit. I always say in my episodes that we have to get our partners involved. Yes, absolutely, absolutely Well, thank you so much, dr. This has been a wonderful discussion.

Dr.Gueye-Weinstein: 30:10

I really appreciate it. It was all my pleasure.

Aissatou: 30:14

All right, thank you, listeners. I'll see you in the next episode.