In the past decade, the rate of postpartum mood disorders has doubled nationwide. In Colorado, a village of nonprofits, hospitals, and researchers are working to change that.
People tell you all kinds of things when you’re pregnant. One comment I heard most often during my pregnancy last year? You’ll never feel love quite like holding your baby for the first time. So when I finally gave birth, I prepared myself for an overwhelming rush of emotions, only to feel something I never expected—indifference.
Over the next few weeks, I forced myself to admire my baby. I studied her little fingers and toes, knowing that one day they wouldn’t be so small. But she remained a stranger to me, one who didn’t do much other than eat, sleep, and cry. One day, I finally spoke aloud to my husband the guilt-laden words that had been simmering in my mind: “I don’t feel like I love her like I’m supposed to.”
It was early July 2024. Outside my window, squirrels scampered up bright green trees, birds landed on my balcony, and my apartment’s AC struggled to beat back the blazing heat. Summer in Colorado was warm and colorful, but the inside of my home had never felt so gloomy. I spent my days pacing the living room, rocking my baby who couldn’t be soothed. Recovering from the physical pain of delivery took longer than I expected, and rolling out of bed in the morning was excruciating.
As my husband and I took shifts caring for our newborn at night, each getting maybe four hours of shut-eye, sleep deprivation crept in. In the early hours of the night, I hallucinated shadows in the hallway. When I did sleep, I’d jolt awake in a panic thinking I had dropped my baby on the floor, only to find her sleeping peacefully in her bassinet. Friends stopped checking in after too many declined coffee dates. When my mom would come over to help, she’d often find me sitting in the same spot on my faded orange couch, my face tear-streaked. One day, I thought to myself, Having a baby was the worst mistake of my life.
In June 2023, a Boulder woman drove her two-month-old baby to a hospital parking lot where she killed him before attempting to take her own life. In an affidavit, she told police she had been experiencing various postpartum mental health conditions on top of extreme sleep deprivation, and she did not want her baby to suffer like she had. Although she had made appointments to see a therapist, she missed them. This past August, she accepted a plea deal and was sentenced to 40 years in prison for the crime.
Such horrific, headline-making stories may be rare, but in Colorado, the leading cause of pregnancy- and postpartum-related deaths is suicide—and the mental illnesses that can lead to that devastating outcome are far from uncommon. A November 2024 study published in JAMA Network Open found that nationwide, the rate of postpartum depression (PPD) doubled from 2010 to 2021. According to research from the U.S. Centers for Disease Control and Prevention, one in eight new mothers experience PPD, and one in five experience postpartum anxiety (PPA) or substance use disorder. Other research suggests that up to 50 percent of all PPD and PPA cases remain undiagnosed, largely due to stigmas that compel patients to stay silent.
Those statistics are why Hyeyoung Oh Nelson, a professor of health and behavioral sciences at the University of Colorado Denver, has recently shifted the focus of her career to studying mental health in the perinatal stage (which consists of pregnancy and the postpartum period). In a 2024 study she published in Social Science & Medicine, Oh Nelson found that isolation during the postpartum period—which in her research is defined as up to five years after birth—can increase one’s risk for mental health disorders. “We go from these highly medicalized systems where you have regular points of contact with your provider, especially toward the end of your pregnancy, and then you have a baby and you’re just sent away and demedicalized completely,” Oh Nelson says. “And that isolation is combined with physical recovery and learning to care for this newborn.”
But the fact that rates of postpartum mood disorders have been rising is actually a positive sign, according to Dr. Sarah Nagle-Yang, deputy executive director of Colorado Women’s Behavioral Health and Wellness at the University of Colorado School of Medicine—because it means more people are being diagnosed. In 2015, the American College of Obstetricians and Gynecologists recommended at least one routine depression screening for all postpartum patients, which is now offered at new parents’ six-week checkup. Since then, many pediatricians have also started offering questionnaires at well-child visits, which happen frequently during babies’ first six months of life. However, nearly 40 percent of birthing parents skip the six-week postpartum visit with their OB-GYN, and historical health care inequities may keep them from being honest when they are handed screening forms.
Through her research, Oh Nelson learned that women of color were especially hesitant to report their true feelings on postpartum screening questionnaires out of fear of child protective services getting involved. “I remember even for me,” says Oh Nelson, who has two children, “it was just one more piece of paper you have to fill out quickly before you see your pediatrician.” Instead, Oh Nelson is advocating for completely rethinking the perinatal mental health system. She’d like to see new parents receive in-person check-ins with doctors trained in identifying mental health disorders. “This ‘village’ that we hear so much about doesn’t really exist,” she says. “If you can afford a postpartum doula and a lactation consultant and mental health assistance, then that’s great. But many people can’t.”
Ashleigh Leader thinks her postpartum mood disorder started a few weeks after she gave birth to her daughter in late 2023. Following a difficult journey trying to conceive, the 41-year-old Douglas County resident had PPROM (preterm premature rupture of membranes), the medical term for when a patient’s water breaks early. After pushing for six hours, Leader underwent an emergency C-section at just 33 weeks pregnant. Her five-pound, 10-ounce baby stayed in the neonatal intensive care unit for over three weeks. “I struggled to establish my milk supply. I wasn’t able to hold my baby a lot of the time,” Leader says. “And anytime I could hold her, I had to navigate 50 different cords and make sure that I wasn’t strangling her or ripping her oxygen off.”
Over the next couple of months, Leader experienced sleep deprivation beyond what you would normally expect when caring for a newborn. Her premature baby had come home on an oxygen machine, which made Leader anxious. Every night, she’d lie awake listening to the machine and her daughter’s grunts, anxiously Googling her concerns into the early hours of the morning. As her mental state declined, her obstetrician tried to prescribe medication to help her anxiety, but Leader found she was unable to take the usual pills due to her medical history. She found a psychiatrist, but the next available appointment was at least six weeks away. “My brain finally started to tell me, ‘You should just kill yourself,’ ” Leader says.
Desperate for help, Leader visited her local emergency room, thinking that she would be able to chat with an on-call psychiatrist, find a medication that would work for her, and go home. Instead, the doctor placed her on a 72-hour psychiatric hold, during which a patient is involuntarily sent to a mental health facility, given a hospital gown and a simple bed, and continuously monitored for three days. “There’s no way to get out of a 72-hour hold, even though I was being separated from my baby and trying to establish a milk supply,” Leader says. “It made everything a billion times worse.”
Leader finally found relief and community in a postpartum support group for new mothers called YANA (You Are Not Alone). The Centennial-based nonprofit offers one-on-one mentorship, group sessions, and a weekly podcast to Colorado moms, all free. Nikki Brooker founded the eight-year-old organization in the wake of another tragedy: In 2016, a Douglas County woman drove her two children to a Sports Authority parking lot, where she killed them before dying by suicide. At the time, Brooker was a teacher at the elementary school one of the children had attended. “A sixth-grade boy came in sobbing,” Brooker says. “As I walked him to the counseling center, he looked at me and said, ‘How do I know my mom’s not going to kill me tonight?’ That changed me.” When Brooker spoke with the woman’s husband months later, he told her he felt that his late wife never recovered from her postpartum mood disorders, even though years had passed since she gave birth.
That conversation led Brooker to research postpartum care worldwide. She began noticing a simple correlation between countries with lower rates of maternal mood disorders and more supportive postpartum health care practices. The Netherlands, for instance, assigns every new mother a midwife to offer her up to 80 hours of postnatal support spread over eight days after birth, all covered by the country’s basic health insurance plans. There, rates of postpartum depression are nearly half what they are in the United States. “After I had my first two babies, I realized that having no friends or family with kids of their own is freaking hard,” Brooker says. “I started joining and creating mom groups and realized, Oh, this is what mothering should be like. Mothering used to be a team sport, and now it’s individual. We need to change that.”
In March 2024, the University of Colorado Anschutz Medical Campus launched the Healthy Expectations Perinatal Intensive Outpatient program, the first program of its kind focused on maternal mood disorders in the state. There, groups of women learn skills to cope with depression and anxiety, gain confidence in parenting, and engage in wellness classes (like yoga and art therapy). The eight-week program is held on the CU Anschutz Medical Campus for three hours, three days a week. Crucially, it allows mothers to bring their babies: An early childhood educator and other staff take care of infants from newborns up to a year old in a playroom adjacent to the moms’ group therapy room.
“Group therapy and growing in confidence as a new parent are important components of treatment,” says the CU School of Medicine’s Nagle-Yang, who oversees the program. “When a patient is receiving hospital-based inpatient services, they’re separated from their baby. Here, patients receive an intensive level of care without sacrificing that connection.”
Thanks to a state Medicaid expansion in 2022 that increased postpartum mental health care coverage for birthing parents from six weeks to a year after delivery, more Coloradans may now be able to pay for programs like Healthy Expectations. Brown University researchers found that similar expansions led to a 20 percent increase in patients accessing mental health care. And as of January, state Medicaid covers postpartum care for all people, regardless of their immigration status.
Still, freshly postpartum Coloradans are unlikely to seek out resources on their own, especially as they’re learning how to care for a newborn. The Colorado Perinatal Mental Health Project (CO PMHP), a nonprofit and the state’s chapter of Postpartum Support International, is working to bridge that gap. Last year, Caring for Denver Foundation gave CO PMHP a grant to launch the Birth Squad, which consists of in-person and remote support groups that are open to anyone in need but include affinity groups for Black and Latina moms. While the Birth Squad currently cares only for Denver-area parents, CO PMHP hopes to expand its coverage throughout the state this year.
CO PMHP’s mission is personal for its co-founders and co-executive directors, Kristin Aaker and Patrece Hairston Peetz. Before starting the nonprofit, Hairston Peetz experienced postpartum mood disorders herself and had a difficult time getting care, despite being a child psychologist. “I was a provider and had access to resources and lots of support but still really struggled to find spaces where I could find help,” she says. “It was through whispers in the drop-off line and at the park where you would have those conversations.”
I shared some of my own postpartum struggles with Ashleigh Leader, who recommended I read Mother Brain: How Neuroscience is Rewriting the Story of Parenthood. Penned by health journalist Chelsea Conaboy, the 2022 book examines how parents’ brains physically change after having a child. I paused when I got to chapter three, where Conaboy wrote that 40 percent of first-time mothers reported feeling indifference after birth, just like I had. “The feeling of affection came for those mothers, as it does for most birthing parents, with just a bit of time,” she wrote.
Getting involved with YANA dramatically helped Leader, and ultimately, her mental state improved hour by hour, day by day, week by week. But all the support groups, therapy services, and medications in the world might not be enough, says CU Denver’s Oh Nelson, if we keep expecting new parents to find help for themselves while at the same time juggling a newborn, financial stressors, and other family and social obligations. “I don’t think pharmaceuticals are necessarily the answer here if we can’t even get birthing parents properly screened,” Oh Nelson says. “We would need a total overhaul of the system where a medical professional visits patients’ homes.”
Although I was reluctant to attend my own six-week postpartum appointment, I was fortunate to have a physician who took my concerns seriously before my mental state deteriorated further. When I teared up in my obstetrician’s exam room and admitted I was mentally and emotionally struggling, my doctor prescribed Zoloft, a medication commonly given to new parents experiencing postpartum mood disorders. She also recommended I speak with the office’s mental health counselor.
Together, those solutions bought me the time I needed to get better, and over the past year, I’ve watched my daughter transform from a fragile, colicky newborn into a silly baby who has learned how to play with toys, sit and roll, and laugh. My confidence in caring for her blossomed, and I started reaching out to my friends again. As I watched this new human grow and change, it made me realize that I was a new person, too. And maybe that’s OK.