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SALT LAKE CITY — Michelle Stoll was driving down the dark, rainy freeway with her 8-month-old baby fussing in the back, when nothing happened.
She was stunned.
Since giving birth to her son, she had been caught in a whirlpool of anger — against her husband for the slightest mistakes, her baby for not sleeping, and, herself for being angry with the newborn she had desperately wanted.
Stoll had never understood when doctors would talk about setting an upset baby down and walking away, to not risk shaking them, but after hours of her colicky baby screaming and no sleep, she began to understand.
If her son didn't sleep, she was so exhausted she couldn't think straight. If he did sleep, she couldn't sleep because she was absolutely certain he would stop breathing at any moment.
At one point, she found herself yelling at the baby to just go to sleep.
"That was what pushed it over the edge for me. I thought, 'Why am I yelling at an infant?'" she said.
Stoll loved her baby more than anything, and yet, she was struggling so much. She had never heard of a woman getting upset with her baby like this, so she assumed she must just be a bad mother and a bad person.
She turned to her husband, sobbing, and said, "I cannot keep doing this. Something's got to give."
A week before her evening drive, she went to her doctor who told her that anxiety, irritability, agitation, insomnia, anger and constant worry were actually more common in postpartum depression and anxiety than feelings of sadness and depression. She was not alone.
Stoll started on an antidepressant and was told to expect to wait three to six weeks before the medication helped, but just a week later, she was already feeling the effects.
And now, the rain, the fussing, driving at night on the freeway by herself — any one of these things would have recently sent her into a panic attack. But instead, she felt only a faint trace of stress. For the first time in a very long time, life felt manageable.
Having been able to access (mental health resources) consistently and affordably has literally changed the trajectory of my life.
–Michelle Stoll, Utah County mother of two
Stoll is one of the 10% of women worldwide who experience postpartum anxiety. She felt privileged to have health insurance and the resources to get the help she needed through medication and therapy.
"Having been able to access (mental health resources) consistently and affordably has literally changed the trajectory of my life," she said. "I can't imagine being in a position where you're struggling financially, or with health insurance, or both, on top of mood disorders and just being a mom, in general. I can't begin to imagine how much that must compound the issues."
The Utah chapter of Postpartum Support International is starting a scholarship program to combat the overlap of financial struggles and mental health issues by providing postpartum or perinatal mental health support to locals who would otherwise not be able to afford it.
Although postpartum depression has become more widely recognized and screened in recent years, people can experience a number of mood disorders during the entire perinatal period (from pregnancy to the first twelve months of the child's life).
In 2020, 24.1% of Utah women self-reported depression during pregnancy and 15.1% self-reported experiencing postpartum depression, according to data from the Centers for Disease Control and Prevention. And Postpartum Support International's site states that approximately 6% of pregnant women worldwide and 10% of postpartum women worldwide develop anxiety.
The organization has worked with community partners to raise awareness around perinatal mental health, connecting families to specific providers trained in mental health treatment. Members of the organization's board began to notice that many people who desperately needed help ran into a financial barrier.
Sometimes they only had specific health insurance that didn't cover mental health services. Sometimes, they had no insurance. Sometimes, they had to meet a high deductible and couldn't afford to get help. And sometimes, they couldn't find providers in their insurance network and had to pay out of pocket.
The idea to offer scholarships to eligible families came up during a brainstorming session at a PSI Utah retreat. Soon, the board decided that the program would help meet the highest community needs regarding perinatal mental health.
"And we have just begun," said Camille Hawkins, scholarship program coordinator. "We want to bridge some of the gaps for families that are uninsured or underinsured."
According to its official mission statement, PSI Utah's vision is "that every person and parent, statewide, will have access to information and resources, social support and informed professional care related to the childbearing and child-raising years."
In late June, the organization held its annual Climb Out of the Darkness fundraiser to promote awareness of postpartum depression and other perinatal mental health issues, with all donations and raffle ticket revenue going toward scholarships. People can still donate to these scholarships here.
The local chapter is also trying to connect providers in the community to perinatal mental health training created and offered by the national Postpartum Support International organization, so that there are more trained providers available in local communities.
No paid leave
Hawkins said the biggest issues she's seen as a mental health provider in Utah are lack of access to affordable child care and lack of paid parental leave.
In 2017, Louisa Nuffer Greear gave birth to her first child at what she calls "the baby factory" — Utah Valley Hospital in Provo.
After the birth, Greear's husband was able to take three unpaid days off, and then, with no option for unpaid leave, he had to go back to work. He was the breadwinner, and the short three days was all they could afford.
Greear had already been feeling depressed during her pregnancy because of the toll it took on her body. Her husband traveled a lot for work, and her doctor insisted that she take as little medication as possible to not risk affecting the baby.
She wasn't working, so she was often home alone, laying on the bed or the couch, all day, trying to keep down juice so she could actually gain weight.
"That's a recipe for depression — to just be stuck like that, in a basement apartment in Spanish Fork," Greear said. "I could see the front door, and I could just stare at it and think, 'Wouldn't it be nice to get dressed and go outside and not feel like I was going to faint?'"
Greear hadn't previously been very aware that perinatal mood disorders can begin during pregnancy. In fact, according to PSI Utah's website, the majority (at least 60%) of mothers with postpartum depression had symptoms that began during pregnancy.
After the baby was born, her depression worsened quickly. Her doctor suspected it was just the "baby blues" and prescribed an antidepressant that he expected her to wean off of pretty quickly.
Greear stared at him, nervous to contradict him and say that something was definitely wrong. Even though she was a fighter, as a woman, she was used to being dismissed.
So, there she was: a new mother of her first baby, all alone, and 800 miles from her mother.
She called this "an extremely low point" that seemed to go on forever.
Then, at last, she saw a light at the end of the tunnel. She drove to her sister-in-law's wedding in Canada with a newborn — something that seemed wild to do.
After the wedding, Greear went to her parents' house in Washington. When she pulled into the driveway, she told her husband, "I am not leaving. I am parking here." He would have been traveling for two weeks anyway, leaving her home alone. She resolved to stay where she could get help.
"You are not OK," her mother told her and helped her book an appointment with a new OB-GYN.
"The new doctor took one look at me and could tell that something in me was breaking. I was still bleeding. I was horribly engorged. I had so much milk I could have breastfed a whole street of babies and still felt full and sore," Greear said.
She finally got the help and support that she needed, and the antidepressants started kicking in. Life seemed livable again. And when it came time to have her second child three years later, she felt more prepared.
She gave birth on March 28, 2020, right when the world was shutting down amid the start of the COVID-19 pandemic, and even though she wasn't allowed to leave labor and delivery or see her daughter for almost a week, her postpartum experience was so much easier this time around, having the support and medication she needed.
People who are experiencing postpartum mood disorders often experience constant fight-or-flight responses, which, naturally, drain them physically, mentally and emotionally, Hawkins said.
But people who are able to get help can learn and develop strategies like breathing and sensory techniques, affirmations, flexible thinking and mind-body exercise, and they are then able to regulate their own nervous systems.
"They can be present in their lives. They can connect, enjoy relationships, work and be productive at work. They can be creative and experience joy and help others," she said. "People typically start to feel better in their bodies and symptoms of depression and anxiety are reduced."
Perinatal mood disorders in men
Perinatal mood disorders can also occur in the non-birthing parent, as well as in cases of infertility, pregnancy loss, surrogacy and adoption.
Although perinatal mood disorders are much more common in birthing parents than in non-birthing parents, at least 10% of fathers will develop postpartum depression, according to data from PSI Utah. That percentage goes up if their partner also suffers from perinatal mood disorders.
In the Stoll and Greear families, both moms and dads experienced postpartum mental illness.
"My husband got (postpartum depression) probably as bad or worse than I did," Greear said. "I was blindsided by that. It took a year to a year-and-a-half to find out that was what was happening."
She hadn't been aware how common it is, but when she thought about it, it made sense. They had been married for almost four years when they had their first baby, and all of that one-on-one time was just gone.
"How could that not affect someone?" she asked herself, especially given the stigma that men have to be tough. But, even understanding that, she knew that she was not a mental health professional. Her husband needed outside help.
"I can be proactive on my own behalf, but what can you do to fix another person? You can't. You don't get to fix people. That was heart-wrenching. And it's still heart-wrenching. Once you deal with that it doesn't go away. It's hard and sad, even when there's so many happy things," Greear said.
Now, the couple attends mental health counseling together, and Greear's husband also attends alone. It has helped immensely.
Benefits for the whole community
Because Stoll has had access to mental health support during her perinatal mood disorders, she is now able to be a more capable, understanding mother.
"It's really affected raising my kids quite profoundly. I am in a better headspace, so better equipped to handle meltdowns and crying and late nights and power struggles. I'm able to look at my kids and say, 'OK, you're communicating something to me through your behavior,' and then I meet that need in a healthier way," she said.
"Now, I'm raising kids who are emotionally intelligent about themselves and their relationships, and that absolutely has an effect on the neighborhood and community. Those kids are going to approach life differently. They're going to be empathetic and think about the needs of other people and advocate for themselves and say 'This is not OK,'" she continued.
When you reach out for support to a family member or friend or support group or provider, you are saying I care about me and my family and my kids, and I want to do what it takes to feel like myself again.
–Camille Hawkins, program coordinator at Postpartum Support International Utah
The community benefit is a large part of why PSI Utah is doing what it's doing. The organization has seen firsthand how parents who receive treatment are able to process their stories and set down big boulders of trauma, depression and anxiety.
"These parents have more mental and emotional space to give back to society and engage with children. In general, this leads to happier and healthier societies," Hawkins said.
Not only is helping struggling individuals within a society the responsible and ethical thing to do, she explained, it also allows the next generation to be raised by stable, available parents — one of the biggest investments a society can make in its future.
"Studies have shown that when parents are struggling with health concerns, they are not as available or interactive with their children. Babies and children may have some residual effects from that lack of interaction," Hawkins said. "This is common and if you're experiencing some of these things, it doesn't mean you're a bad mom."
She encouraged people to apply for assistance if they are uninsured or underinsured and could benefit from this kind of help. Those who want to help PSI Utah be able to provide support for local families can donate online, at psiutah.org/donate.
Hawkins wants to let any parents struggling with mental health issues, surrounding parenthood in any capacity, that they are not alone — asking for help is brave and necessary.
"When you reach out for support to a family member or friend or support group or provider, you are saying I care about me and my family and my kids, and I want to do what it takes to feel like myself again," she said.
