Jennifer Johnson wishes someone had warned her about how relationships evolve after the birth of a baby and encouraged her to not be afraid to ask for help.

Johnson, who is the founding chair of the Charles Stewart Mott Department of Public Health, C.S. Mott Endowed Professor of Public Health and chief translation officer in the Office of Health Sciences at Michigan State University, has seen the success of the Reach Out, Stay strong Essentials (ROSE) program.

Jennifer Johnson“It's not screening. It's not treatment. It's prevention,” Johnson says of the evidence-based program that helps prevent postpartum depression.

The program works with women during pregnancy, before postpartum depression sets in. Johnson says that half of the participants who would have gotten postpartum depression didn't.

Cultivating a village and asking for help

Preparing for a baby is often an exciting time, acknowledges Diane Wisnieski, facilitator for the ROSE Program at the Center for Health Policy and Health Services Research, Henry Ford Health. While classes for labor and delivery are available, she says little education on what happens after the baby comes home is offered.

“As soon as you're done with labor and delivery, you're like ‘What do I do now? I don’t even know how to change a diaper,’” Wisnieski says. “That's a very common experience.”

New parents are often overwhelmed and overtired. Mental health issues start to emerge as their needs are not being met. According to the federal Office of Women’s Health, at least one in eight women experience postpartum depression in the year after they give birth.

“Especially for first-time moms, you feel like your whole life is the baby. That's just completely your identity, and you lose yourself,” Wisnieski says, 

She recommends new mothers try to retain some of their identity independent of motherhood. 

"Maybe that’s having certain goals that are important to you as a persona,” Wisnieski says. “We talk about what those goals could look like for that person.”

Broken into four sessions, the ROSE program trains expectant mothers on how roles and relationships change postpartum and teaches assertiveness skills so expectant mothers can ask for the support they need. A fifth session after birth follows up to see how the mother is doing. 

Diane Wisnieski“A lot of times when we think about having a baby, [we say] it takes a village. The idea is to cultivate that village because a lot of new moms don’t feel like there is a village anymore,” Wisnieski says, 

The goal of the program is to help moms identify what their village is and who is in that village. This could mean identifying people outside of the immediate family, such as neighbors, friends, in-laws, or siblings. It could include a person who delivers groceries or cleans their home. Maybe it is simply having someone who helps them get out of the house or take time for self-care — exercising or reading a book.

Wisnieski has witnessed the program’s success through the mothers she has worked with. One told her that because of the ROSE Program, she was able to recognize when she needed to reach out for help. 

“This postpartum experience has been way different from my last because I’ve cultivated my village, and I’ve asked for help and received it from them,” the participant said.

“I really enjoy being a facilitator for the ROSE program,” says Rachael Norwood, who also works at Henry Ford Health. “I get to see pregnant people develop their support systems and advocacy skills. Even if they end up developing postpartum depression, at no fault of their own, I hear their stories on how they have felt more confident to ask for help when they need it.”

One in eight women experience postpartum depression in the year after they give birth.
Expanding ROSE to all expectant parents

A partner with many federal public health entities, the U.S. Preventive Services Task Force states that counseling interventions, such as interpersonal therapy programs like the ROSE Program, are effective in preventing perinatal depression. The task force lists the ROSE program in its report as an example of a preventive postpartum program for moms at risk.

Through clinical trials with at-risk women, Johnson and Brown University faculty member Caron Zlontnick, who developed the ROSE program, were able to prove it reduced postpartum depression by 50% among participants.

Currently the program is only offered to at-risk mothers. Because of its proven success, Johnson is working to expand the program to all expectant mothers. In fall 2024, the ROSES II project was launched at MSU with collaborators from Brown University and Henry Ford Health and funding from the National Institute of Mental Health.

The project is looking for healthy pregnant people in California, Connecticut, Illinois, Maine, Massachusetts, Michigan, New York, Ohio, Oregon, Rhode Island, and Washington to participate in virtual interviews before and after birth. Some participants may have the opportunity to participate in the ROSE Program. Pregnant people interested in participating can submit a form online or visit ROSEmom.org to register.

By administering the ROSE Program to a large selection of study participants, whether they are high-risk or not, Johnson hopes the study will confirm the program's effectiveness and make the case that ROSE should be made available to everyone who is expecting a baby.

Johnson says that it makes sense to offer the program to all expectant mothers. The 98 clinics currently offering the program are already doing so since it is easier than trying to determine who needs it. 

“People don’t want to be singled out,” Johnson says.. "For that reason, it seems more equitable to just say ‘Hey, this is something we offer to everyone,'"

Because it is preventative, the program also would help to reduce health care costs. Johnson estimates that it could cost the health care system upwards of $30,000 for a mom with untreated postpartum depression while the cost of having a mom attend a ROSE Program is between $100 to $150. 

Wisnieski says that pregnant people need to know that they were never intended to "do it all by themselves, and that it is OK to ask for help." Help is always available through local health departments, hospital systems, and community mental health. Those who need support can also call the 988 Lifeline, which can connect them to resources, or contact Postpartum Support International, which offers virtual support groups daily free of charge.

Joanne Bailey-Boorsma has 30-plus years of writing experience having served as a reporter and editor for several West Michigan publications, covering a variety of topics from local news to arts and entertainment.

Photos of Jennifer Johnson and Diane Wisnieski courtesy subjects.
Other photos by Polina Tankilevitch, Laura Garcia, and Keira Burton via Pexels.com

The Yours, Mine, and Ours — Public Health series highlights how our state's public health agencies keep us healthy, safe, and informed about issues impacting physical and mental health in our communities, homes, workplaces, and schools. The series is made possible with funding from the Michigan Association for Local Public Health.