By Lenzy Krehbiel-Burton

The scars have mostly faded, but a few are still visible on Grace’s arms.

“This one was from struggling with breastfeeding,” she said, pointing at a faint white line on her left forearm.

“Can’t remember what this one from,” she said, pointing at a smaller, thinner line next to it. “Some of the memories from that year are a little hazy though.”

Grace is among the estimated one in seven women nationally — and one in six in Oklahoma — who have dealt with postpartum depression.

A Citizen Potawatomi Nation member who lives in the Tulsa, Oklahoma, area, she agreed to speak about her postpartum depression if no identifying information was used, including her real first name.

Often resulting from a combination of emotional and physical factors, postpartum depression is a mood disorder that impacts a new mother’s ability to care for herself or her baby.

After childbirth, a woman’s progesterone and estrogen levels quickly drop, leading to brain chemistry changes that can often trigger mood swings. When coupled with sleep deprivation, it can lead to full-blown depression.

A shorter, milder version, referred to as “baby blues,” affects up to 80 percent of new mothers but often dissipates within two or three weeks of delivery.

The National Institute of Mental Health reports that symptoms include feeling moody, irritable or restless; a loss of interest in previously enjoyed activities; crying more often than usual or for no discernable reason; experiencing inexplicable bouts of anger or rage; withdrawing from friends and family; feeling sad, empty or overwhelmed; difficulty bonding with the baby; persistently doubting the ability to care for the baby and in some cases, contemplating self-harm or hurting the baby.

Factors contributing to a high risk for postpartum depression include a personal or family history of depression or bipolar disorder, medical complications during childbirth and mixed feelings about the pregnancy. Experiencing a significant life stressor during pregnancy or soon after giving birth — such as a loved one’s death, job loss or domestic violence — also increases a new mother’s risk, according to the National Institute of Mental Health.

According to a Centers for Disease Control and Prevention study, almost 20 percent of indigenous new mothers reported experiencing postpartum depression symptoms within the first nine months after childbirth. By comparison, 8.6 percent of white mothers and 10.8 percent of black mothers reported those same symptoms.

“These findings underscore the need for universal screening and appropriate treatment for pregnant and postpartum women as recommended by the American College of Obstetricians and Gynecologists,” said Jean Ko, the study’s author.

A lack of access to care exacerbates the problem for many indigenous mothers.

According to the National Rural Health Association, among counties nationwide with a population of 20,000 or fewer, 75 percent do not have at least one practicing psychiatrist. Among the estimated 605,000 Natives eligible to utilize one of Indian Health Services’ 41 urban health centers nationwide, only one in five reported access those programs in 2000.

Going into her pregnancy, Grace knew she had several risk factors for postpartum depression. Along with her own depression and anxiety, her mother dealt with postpartum depression after she was born. Although neither of her grandmothers explicitly said they had postpartum depression, family members’ descriptions of their actions and attitudes after childbirth were consistent with the symptoms.

Additionally, the unplanned pregnancy was considered high-risk due to her husband’s family history, and Grace attempted to keep some distance in case something went awry.

“I was doing everything I could to minimize the risk, but you can’t just waive away genetics,” she said. “So I wanted to at least try to have a buffer there just in case. I figured if the baby came out alive and OK, we would bond after she was out … but I just didn’t think I could handle it emotionally if we bonded while she was still in my uterus, and she didn’t survive.”

Grace said she knew within a few days of her daughter’s birth that something was wrong, but she did not want to admit it publicly. Instead, she threw herself into trying to be an overachiever in public while cutting herself to cope in private.

“I didn’t want anyone to know that I was terrified,” she said. “I was scared to be alone with the baby because I was afraid I’d snap from sleep deprivation.

“I was afraid to hand the baby over to anyone — even my in-laws — for very long because I knew that everyone else would figure out how quickly my daughter would be better off with anyone but me and would take her away permanently.”

An estimated 60 percent of postpartum depression cases go undiagnosed. The U.S. Preventive Services Task Force announced in 2016 that pregnant women and new mothers need more attention when it comes to depression screening.

In an email, Glenna Stumblingbear-Riddle and Jessica Brody, two psychologists with Citizen Potawatomi Nation’s Department of Behavioral Health, confirmed their department is in the process of adding a women’s support group later this year.

“The biggest reason is due to the lack of resources concerning this area,” Stumblingbear-Riddle said. “We will be starting new groups this year. We hope to rotate them out every eight weeks focusing on different topics.”

With support from her husband and immediate family members, Grace eventually opened up about her depression and sought counseling. She stopped self-harming, and after several months of individual therapy sessions, medication and exercise, she eventually overcame her postpartum depression.

However, the yearlong bout left behind more scars than the faded white marks on her arms.

“Even afterward, it took me a very long time to be able to properly bond with my daughter,” Grace said. “You know how sometimes you associate a song or a place with a specific memory? I know it wasn’t her fault, but I’d look at my daughter, and it would remind me of cutting and being suicidal.”