Dear Moms, Moms-to-Be, and All Who Support Moms (for you are critically important too!),

The celebration of Mother's Day can bring a host of emotions. It may invite feelings of joy, contentment, apprehension, or bittersweet sentiments, depending on where you are on your motherhood journey or passage through a perinatal mood or anxiety disorder. Wait. You didn't realize you were on an adventure? Have you been paying attention to the signs? You are not alone. I didn't. I had a license. In nursing, that is. Years of experience catching babies in the delivery room, a Master's degree as a women's health nurse practitioner, which including counseling women on the warning signs of postpartum depression. But, when you are in the driver's seat, focused on the destination of being a happy, confident mother while still holding onto some sense of your original self, it is sometimes difficult to take in all of the details on the path that surrounds you.

"Expect Delays – Day and Night" I saw this posted on an electronic sign during my drive to New Jersey to visit my beautiful 6-month-old niece last week. And, with the anticipation of getting some long awaited baby time, I thought about how the message on that sign translated into a general theme of parenting in those early months.

Sleep is sporadic. Household tasks that you could once bang out in a couple of hours now take DAYS to complete. Two bills out of four get paid. Half the dishwasher gets emptied. And the partially folded pile of clean clothes now needs to be rewashed since the baby projectile vomited over your shoulder and onto it. Plus, has anyone noticed the conspiracy against moms at meal time? Babies have radar, and get their own hunger cues going just as soon as mom sits down to put something in her mouth.

These are the obvious "delays" on the parenting adventure. But, when your trip includes additional challenges like depression or anxiety, it can feel like you are being sent on a long, alternate route. In the midst of anxiety and panic attacks with my second son I encountered more delays that interrupted my ability to be well in a timely manner. I was my own worst enemy. "If I could just get a good night's sleep, I'd feel better." The denial came inmany forms. I put on my happy face to friends, neighbors and family. I went through the motions day-to-day, overwhelmed by the unrealistically high expectations I placed on myself, and all the while was filled with self-doubt about my ability to be a "good mother".

It wasn't until I was 6 months postpartum that I finally contacted my OB nurse practitioner for help. If I have any regrets, THAT would be it — unnecessarily "waiting it out", when I could have been feeling better and enjoying my wonderful boys. Counseling, medication, fish oils, exercise, improving sleeping habits and getting time alone from the hectic pace of our lives were all components of what helped me to cope with the anxiety. Gradually, I felt that I was not dreading the day from the minute I woke up. I was able to start letting go of the "little things" that would consume my thoughts like cleaning up every crumb on the kitchen floor. I found myself laughing more and being able tosimply play and be in the moment with my baby and two-year-old son. I finally started to feel more like myself again!

I am still your typical "type-A" personality, but when work, the children and life become overwhelming at times now (and it certainly can!), I have better coping skills to counteract the stress and prevent it from being all-consuming. My personal expedition began with a love of obstetric nursing, followed by my own two very empowering childbirths, and my encounter with postpartum anxiety and recovery. This path has ultimately led to the birth of our hospital's Postpartum Emotional Support Program that provides a weekly support group, inpatient risk assessment screening for postpartum mood and anxiety disorders along with education, follow-up and referral processes. Oh, and one MUCH happier mama!

If you have encountered a similar detour on your motherhood journey, please trust that there ARE treatments and support available to help you get back on track. As your travel advisor, I must emphasize that this is NOT your fault. The etiology of perinatal mood and anxiety disorders are biopsychosocial in nature. You do not have control over the biochemistry in your brain, much like any other physiological system in your body. There are a number of psychological factors that go along with becoming a mother, and it takes time to adjust to this new role and bond with the baby. And, even if you are having your second, third or fifth child, guess what? You are still a new mom in the context that you are juggling a new conglomeration of children at different ages, PLUS a newborn, sleep deprivation, etc.

Be sure to STOP. Ask for directions. Find a healthcare provider or therapist who will listen and is knowledgeable about women's reproductive mental health. Understand that there are generally a variety of routes that can help you reach your destination. There isn't one particular therapist, drug or treatment modality that will fit ALL individuals. You are unique. Therefore the length of your postpartum trek may differ from the next woman.

Find support along your travels. I facilitate a PPD support group at our hospital. Over the course of weeks and months I have seen trust develop, relationships form, and confidence build among these women. They foster an amazing amount of strength and courage in each other, and one by one they give each other hope. What you may be experiencing is not a weakness. But, through this experience and with help, you WILL develop a greater self-awareness and deeper insight to yourself as an individual and mother. You WILL find your way back to a new sense of normalcy and joy with your baby and family.

Happy Mother's Day!

Alison Palmer, RN, MS, WHNP-BC is a maternal-newborn clinical nurse specialist and perinatal mental health nurse coordinator at Elliot Hospital in Manchester, NH. She is also the New Hampshire state coordinator for Postpartum Support International, and best of all, loves being a mother to her two young and active boys. For more info, contact her at (603) 663-8927 or