Alison Palmer thought she had motherhood figured out after her first pregnancy.

Her son Matt was a dream baby. He followed a predictable feeding schedule and slept on schedule like clockwork. But with her second son Ryan, it was completely different. Ryan was anything but predictable – he didn’t sleep well, was hard to console and difficult with breastfeeding.

Even with 27 years of experience in the field of women’s health – she has been a labor and delivery nurse and has counseled women on signs of postpartum depression – Palmer found herself in uncharted territory, trying to navigate the wild and unpredictable world of caring for a newborn while struggling with her own mental health.

“When I had my kids and I had worked in the field, I felt like I knew all about postpartum depression and anxiety,” said Palmer. “But it doesn’t always translate well into real life. It’s a whole learning curve.”

After her pregnancy a decade ago, Palmer knew she was struggling but refused to acknowledge it. However, things escalated during the postpartum phase, and she found it difficult to cope.

Night after night, as soon as the kids were tucked in, she would head down to the basement and hop on the treadmill and have emotional meltdowns. She would then return upstairs and try to shake it. Her husband knew little about her mental health challenges until six months into her postpartum journey, when she had a major mental health crisis during the day while he was working at home. Concerned for her well-being, he urged her to reach out for help.

“I think there was just such a catharsis, a relief in just admitting that I was struggling and being able to say it out loud to a professional,” Palmer said about the time she finally reached out to get counseling.

The World Health Organization reports that nearly 20% of women will develop a mental health condition during pregnancy or within the first year after giving birth. These conditions may manifest as depression, anxiety, obsessive-compulsive disorders and various other forms of mental illness that affect maternal health.

As a medical assistant and maternal mental health advocate in pediatrics at Dartmouth Hitchcock Clinics, Heather Martin has witnessed the devastating impact of maternal mental illness firsthand. Her sister struggled with postpartum psychosis, and despite being prescribed medication, Martin lost her sister to suicide within three weeks of her niece being born.

Martin’s personal tragedy inspired her to become an advocate for maternal mental health. She drafted a proclamation to recognize May 3 as Mental Health Awareness Day in New Hampshire, which was officially signed by Gov. Chris Sununu this month.

“The biggest part of that is not just to have a piece of paper but to actually spread the word to get attention for this issue,” said Martin. “This not only spreads awareness but helps break the stigma and makes it OK for our moms to speak up and ask for help.”

Part of the challenge faced by mothers when seeking support and resources is the expectation that mothers are supposed to be strong, caring and loving at all times.

“I think moms and women are often held to a high standard without the support,” said Palmer, who had a preconceived notion of motherhood and the ideal image of a perfect mother. “There’s so much pressure to be it all and do it all.”

As a certified psychiatric nurse practitioner specializing in reproductive psychiatry and behavioral health integration, Palmer is now an advocate for maternal mental health. She offers consultation services to healthcare organizations seeking support resources for perinatal mental health.

Maternal mental health

While access to mental health services in New Hampshire is concerning, the lack of access to maternal mental healthcare for mothers is even more acute.

New Hampshire has received an F grade compared to other states in its efforts to address maternal mental health, according to a recent report by the Policy Center for Maternal Mental Health. The state’s rating was primarily affected by a shortage of healthcare providers in relation to patients and a lack of adequate mental health screening. Connecticut, another New England state, also received an F grade in this report.

In New Hampshire, according to Martin, there aren’t enough facilities where mothers can receive inpatient or intensive outpatient treatment, and there are no options available for mothers to stay with their babies while receiving treatment.

Palmer and Martin emphasize the importance of preventing mental health problems during pregnancy by conducting screenings for mood disorders and mental health history. They also stress the need for families to be educated about the warning signs and to have open discussions on the subject.

“It’s OK to not be OK,” Martin assures women who don’t feel good during pregnancy or motherhood. “With help and support, you will be well.”

If you need help

National Maternal Mental Health Hotline: Call or text 833-943-5746 for confidential support before, during, and after pregnancy. It is a free 24-hour helpline with counselors who speak English and Spanish.

National Suicide Prevention Lifeline: Call 1-800-273-TALK (8255) for free and confidential support for people in distress, prevention and crisis resources for you or your loved ones and best practices for professionals.

Veterans: Veterans and their loved ones can call 1-800-273-8255 and press 1, chat online or send a text message to 838255 to receive confidential support 24 hours a day, 365 days a year. Support for deaf and hard-of-hearing individuals is available.

Crisis Text Line: Free, 24/7 support for those in crisis. Text 741741 from anywhere in the U.S. to text with a trained Crisis Counselor.

Trans Lifeline: Call 1-877-565-8860 for a hotline staffed by transgender people for transgender people. Trans Lifeline volunteers are ready to respond to whatever support needs community members might have.

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