If you are a struggling new mother or know someone who is, Heather Martin, CHW, wants you to be aware that help is available through Dartmouth Health Children’s and other resources throughout the state.
Martin is a community health worker at Dartmouth Health Children’s and the founder of their new Maternal Mental Health Navigator that provides postpartum support and advocacy for maternal mental health.
Since losing her sister to suicide brought on by postpartum psychosis, Martin has been on a mission to get new mothers the support they need.
Mental health conditions rising among new mothers
The numbers are startling.
From the start of pregnancy until her baby’s first birthday, more than one in five mothers nationally will experience a mental health condition such as anxiety or depression.
Vermont and New Hampshire have equally alarming numbers.
A report from the New Hampshire Department of Health & Human Services (DHHS) shows that maternal mental health conditions were the primary factor in more than half of pregnancy-associated deaths.
The Vermont Agency of Human Health Services Department of Health recently reported that mothers who had a diagnosis of a mental health disorder accounted for more than 90% of deaths during the perinatal stage–the period of time from pregnancy up until a year after giving birth.
Most of those deaths occurred among people with multiple diagnoses.
The length and type of maternal mental health struggles
Throughout the 4th trimester (which refers to the three months after childbirth) and up to the baby’s first birthday, mothers remain vulnerable to hormonal shifts, sleep deprivation, and the transition to parenthood.
Among the most common resulting mental health conditions are postpartum depression, anxiety, and PMAD (Perinatal Mood and Anxiety Disorders). Also present can be feelings of isolation, a desire to self-harm, and intrusive, distressing and uncontrolled thoughts, like imagining oneself falling down a flight of stairs.
“We’re all worried about what’s going on during pregnancy and with the new baby, but we often don’t think about what is happening to mom during this 4th trimester and beyond,” Martin says.
Improvements in awareness and proposed maternal mental support statewide
The good news, says Martin, is that nationally and in states like New Hampshire and Vermont, awareness of postpartum mental health is growing.
Last year, Martin and then-New Hampshire Governor Chris Sununu were among those signing a proclamation establishing May 5-11 each year as Maternal Mental Health Week with a goal to raise awareness and destigmatize maternal mental health struggles. This year again, Governor Kelly Ayotte, Martin and others have signed it.
Martin has also gotten involved with the New Hampshire Perinatal Quality Collaborative (NHPQC), a network developed with Dartmouth Health and the New Hampshire Division of Public Health Services (DPHS) that works toward improving maternal and infant healthcare and outcomes.
She has advocated for the passage of 2.0 SB 246, legislation that supports the mental and physical health of pregnant and postpartum women, families, and maternal health providers in New Hampshire. Among the new bill’s provisions are requiring Medicaid to cover maternal depression screenings for new mothers at their well-child visits. It also requires health insurance policies to cover mothers’ prenatal and postnatal depression screenings at the child’s one-month, two-month, four-month, and six-month well-child visits and home visits. Among the proposed measures, too, is a perinatal psychiatric provider consult line.
“This is all good for moms,” Martin says.
Screening for signs and symptoms of maternal mental health
At Dartmouth Health Children’s, new moms are screened with the Edinburgh Postnatal Depression Scale(EDPS). Based on a multiple-choice response format, the EDPS evaluates how frequently new mothers have experienced certain thoughts and feelings over the prior seven days.
Each answer is scored between zero and three based on frequency. A total score of more than ten suggests minor or major depression may be present, but scores under ten can still suggest a mother would benefit from support. Talk to a provider right away if you are concerned about your mental health.
In the past 7 days:
- I have been able to laugh and see the funny side of things.
- I have looked forward with enjoyment to things.
- I have blamed myself unnecessarily when things went wrong.
- I have been anxious or worried for no good reason.
- I have felt scared or panicky for no very good reason.
- Things have been getting on top of me.
- I have been so unhappy that I have had difficulty sleeping.
- I have felt sad or miserable.
- I have been so unhappy that I have been crying.
- The thought of harming myself has occurred to me.
Meanwhile, Martin continues to do all she can for moms at Dartmouth Health Children’s.
In her role running the Navigator program, Martin ensures that mothers receive mental health screenings and that pediatricians are educated about warning signs.
The Edinburgh screening that pediatricians now give includes questions around a mother's emotional well-being, anxiety levels, sleep deprivation, and whether a mother is experiencing self-blame or considering self-harm.
If the screening indicates reason for concern, Martin works with providers to make sure the mother gets access to needed help.
Support might include a doula, home visits, lactation consultants, therapists and other forms of mental health treatment, as well as perinatal support networks and encouraging mothers to reach out to other mothers in their own networks.
“Having that person that has lived experience, who can listen, is sometimes just what a mom needs. Knowing that you are not alone, the floodgates can just open up because you can suddenly feel supported in a powerful way,” says Martin, who has also launched an initiative called The New Hampshire Mom Hub, which moms can visit for additional resources.
The outlook for maternal mental health
Given all the work now being done, Martin is hopeful that the importance of maternal mental health is beginning to get the attention it deserves and that what happened to her sister will become less common.
“I think people are realizing at last that mom’s mental health has such an impact not only on the baby and the mom, but on the whole family as a unit,” she says. “We can all do our part to support mothers. It’s very important.”