Perinatal Mental Healthcare for Military-Connected Mothers: The Power of Stories (Part I)
By Shakima Tozay LICSW, PMH-C, CCM, CDP®
This article is the first in a two-part series that explores the lived experiences of military-connected mothers and how perinatal mental health professionals can effectively support them. Read part II .
The reality hit me hard. Military spouses who have recently given birth are 2.3 times more likely to experience a perinatal mood and anxiety disorder (PMAD) compared to civilians in the general population. Also surprising is that 19.5% of active-duty mothers screen positive for PMADs, which is a higher rate compared to their civilian counterparts, according to research (Wayne UNC Healthcare, 2019).
The Maternal Mental Health Leadership Alliance reveals that 1 in 5 mothers experience a maternal mental health condition. As a perinatal mental health provider, this made me wonder what more can be done to support military-connected mothers during the challenging transition into motherhood. It became clear to me that this was not just a statistic but an often-hidden battle that countless military families face.
Military-connected mothers face unique obstacles in their transition to motherhood, including limited support and access to mental health care. According to a research study in the Journal of Military, Veteran and Family Health, stigma and career-related issues are significant barriers for military spouses seeking help for postpartum mental health issues (My Hanh Nguyen et al., 2023).
To address this, as perinatal mental health providers, we must first listen to the stories of these mothers and advocate for improved support and resources for PMADs.
I spoke with two mothers who have connections to the military and are passionate about advocating for better access to support and resources in this field. Their experiences hold the potential to spark positive transformation.
Meet Eleisha: Finding Resources to Cope With Pregnancy and Infant Loss
Eleisha is a 42-year-old mother of five children (four living) and works as a respiratory therapist at a local hospital where she provides care to military families. She was born into a military family, with both of her parents serving in the U.S. Army. She married a Coast Guard officer and is proud to have her son currently serving in the Navy.
As part of her work, she also serves as a perinatal bereavement advocate, drawing from her own experience of losing her daughter Sofia during childbirth while stationed at Naval Medical Center Portsmouth in 2007. At the time, there was limited support for families going through such a loss, and Eleisha remembers the pediatrician becoming emotional while performing her daughter’s code.
“It was his first neonatal death,” she said. “So that’s hard on a provider.” Although the staff at the hospital were kind, they lacked experience in dealing with neonatal deaths. However, Eleisha was fortunate to have the support of a nurse who had been through her own loss, leading to an immediate connection between them.
To gain a deeper understanding of the support Eleisha received after her daughter’s passing, we delved into how she managed to handle such a heartbreaking loss. She discussed relying on a variety of resources, including support groups, assistance from community members, seeking medical testing, and leaning on her family during her perinatal mental health journey.
“There had been some ladies from the community that were volunteering their services, and they were donating care packages basically for the families. Care boxes and outfits. So, my daughter was dressed in a very beautiful outfit that these ladies had taken the time to make themselves. I contacted the group and started volunteering with them. I mean I can’t sew to save my life. But I started helping them with things, just getting the care packages made. And so … we also looked for answers through genetic testing and we lean[ed] in on each other to make it through as best as we knew how at the time.”
Additionally, Eleisha sought solace and healing through somatic practices such as “breath work, yoga, meditation, and Reiki.” The road to recovery from trauma and grief, she explained, was a challenging one, with ups and downs over several years.
Eleisha also spoke about how military-connected mothers face unique challenges after experiencing a pregnancy loss. For instance, being away from home and family support, having to make difficult decisions about burial arrangements, and navigating the demands of military life can all take an immense toll on their mental health.
“As you can imagine, the initial shock, grief, trauma, and life-altering experience [of] losing one’s baby in a birth process can be [hard] on the human psyche. But for the military family, most are always away from home and family support. Many have other children and no one to assist with their care while dealing with these unexpected events. Burying your child in a place you don’t call home. You know, or [you’re] having to face that decision. What do you do? [Considering one’s] religious belief[s] and background and all that with [also] having to decide [what to do]. You know, deciding. Do I cremate my child, or do I bury her in a place where I don’t call home? And I may never be back, you know. And many military spouses are deployed or do so shortly after leaving the family in a space where there is no time to grieve. Many families shy away from mental health support and fear how this could affect their military careers. The list truly could just go on and on.”
Eleisha is a passionate advocate for perinatal bereavement. Through her personal experience, she seeks to empower others who have also lost a child at birth. On her Instagram page, Eleisha shares her journey of healing and provides words of comfort and links to helpful resources. Through beautiful imagery, she puts a face to the struggle and offers support to those in need.
Eleisha reflected on the lasting impact of grief, sharing that “grief will never leave us, you know, grief is a part of life.” As an advocate for military-connected mothers during the perinatal period, she recognizes the challenges they face after enduring loss. To raise awareness and provide support, she has organized events in her workplace, such as a wave of light remembrance ceremony on October 15 to honor little ones who are no longer with us. Eleisha also encourages incorporating somatic practices into healing. Coping with grief while finding moments of joy and peace in life is possible, even though grief is present.
Regarding specific resources available for military-connected mothers, she noted that in her 24 years associated with the military, she has only been made aware of the Pregnancy Loss Awareness Network (PLAN) initiative, a new program through the U.S. Navy Fleet and Family Support Centers.
“As someone who works closely with military families, I believe we can do better to serve these families who have dedicated their lives to serve our country. I am unsure of what that looks like, but these families need to know that they’re not alone, and there needs to be protocols in place for these families and lots of resources to guide them and assist them in navigating life after loss, and enough time to grieve and process. In my experience, many families have no idea of the resources available to them, their children and spouses learning how to process and heal from this grief, the trauma, all while feeling the pressure to continue to perform and at their previous status … Having the right support system ready in place and the right resources and information to help guide these families is just key.”
Meet Gaby: Navigating Work, Life and Postpartum Anxiety
Gaby, a 32-year-old Navy veteran and military spouse, has three children with her husband. Along with being a mother, Gaby also serves as the Executive Director of the Military Birth Resource Network & Postpartum Coalition (MBRNPC). When her oldest child was born 7 years ago, Gaby was still on active duty and received all her care at a military treatment facility.
She described having a traumatic birth experience and shared that she struggled with breastfeeding due to a lack of access to lactation consultants. Despite this, she found support in her local community, which helped her recover. “So, luckily, out in the community I received support, and I credit that for saving me from postpartum depression after feeling that my body had failed me, that I was broken, and that it was my fault,” Gaby said.
Gaby shared what it was like balancing working and being a leader while also dealing with postpartum anxiety at home.
“You know, we’re very type A. Things like this don’t happen to me. If I can’t handle myself in my home, how am I supposed to be leading my sailors? Like, how can I complete the mission if I am anxious or depressed or having mental health issues? So, I think I spent a lot of time really suppressing what was happening, but it was starting to come out in different ways, whether it was rage or anger at home or very anxious to where I didn’t want anybody else holding my son. You know, not dad, not anyone. I didn’t want him anywhere. I was worried about being late for work … I would show up to work 2.5 hours before anything would happen. And I have to leave the house 2 hours before I have to be there. But I wasn’t reasoning right.”
While discussing the resources and support available to Gaby during her recovery from a traumatic birth and coping with postpartum mental health struggles, she recalled the support she received from her manager.
“I had a boss at the time who was also a breastfeeding mom and also had experience with PMADs, [who] sat me down one day, and I remember her being like, ‘Are you OK? How are you doing?’ And I just broke down. She was like, ‘You know, it’s OK to not be OK. That is not a failure on your part.’ And from that moment forward, I’m so grateful that I had that. I had a leader in my life who 1) had lived experience, but 2) really took the time to look at me and be like, ‘Are you OK?’… And for her to tell me it was OK really opened my eyes to this.”
After acknowledging that she was not mentally healthy, Gaby felt a responsibility to seek assistance for herself and her loved ones. Even after explaining her history with anxiety stemming from a traumatic experience, someone who didn’t fully comprehend her struggles still suggested that Gaby try antidepressants. However, she refused to take any medication for depression because she didn’t feel like it was a problem for her.
While discussing the challenges military-connected mothers face when seeking mental health support, Gaby revealed that stigma remains the biggest obstacle, especially within the military and male-dominated cultures. She explained that it can be difficult to find healthcare providers who understand and are willing to help with these issues. The resources are there, but it’s not always easy to find someone who knows how to handle the situation. Gaby stressed the need for more open communication and understanding for proper care to be given.
“We need providers that are equipped to handle PMADs and understand that,” she said. Gaby strongly believes that agencies serving military families, both within the military and outside of it, should have the necessary resources and support available to treat perinatal mental health disorders. This includes having experience and training in this specific area. Gaby acknowledges Postpartum Support International (PSI) for playing a key role in her own recovery and helping her gain a deeper understanding of the impact of PMADs.
Drawing from the challenges and triumphs of these military-connected mothers and their experiences with perinatal mental health, we can continue to bring attention to the urgent matters at hand.
In part II of this series, I offer practical recommendations for perinatal mental health professionals to effectively assist expecting and new military-connected mothers.
About the Author
Shakima “Kima” Tozay, LICSW, PMH-C, CCM, CDP®
Shakima “Kima” Tozay, LICSW, PMH-C, CCM, CDP® is a mother to her son Jaxson, who was born stillborn due to complications related to Preeclampsia. She is a writer, speaker, military Veteran, and military spouse. She has over 17 years of experience serving the military and veteran community in various roles. Kima is a Clinical Social Worker with certifications in Perinatal Mental Health, Case Management, Diversity, Equity, and Inclusion. She is driven by the belief that everyone deserves access to health care that is respectful and equitable. In addition to volunteering with Postpartum Support International, she shares her story to raise awareness of the importance of integrating the patient voice in health research and quality improvement as a member of the Preeclampsia Foundation Patient Advisory Council and MoMMa’s Voices. When not volunteering, Kima enjoys hiking, writing, and taking road trips with her husband and furry side kicks where she finds peace walking along rocky beaches.
