The $2,000 fix nobody’s using for postpartum depression
The prevention program that works, but almost nobody gets.
Let’s set the scene: Your baby is en route to it’s beautiful new home for the very first time and all you keep thinking while you’re staring out the car window is: this is supposed to be the happiest time of my life. But something inside is pulling at you. Why doesn’t it feel like that immense amount of joy your best friend described? Why are you crying in the kitchen at 2a.m heating up a baby bottle? Why do you feel numb and empty when your mother told you stories of how happy she was when you were born? Why do you feel like you’re some terrible mother before your years as one haven’t even started yet? You start to think: something is wrong with me. I can’t be a mom. I’m not ready for this. I’m already failing.
Roughly one in eight women in the States will experience postpartum depression in the year after giving birth. And for many of them, the signs were there months before baby even showed up.
But why don’t women know this? It’s not because doctors don’t care. It’s because the maternal healthcare system is built to only notice you’re sinking when you’re already underwater.
Have you ever heard of ROSE?
Probably not. It stands for: Reach Out. Stay strong. Essentials for mothers of newborns. It’s a program that does the one thing maternal healthcare does not — it tries to save you from drowning in postpartum depression before you even get into the water.
THE BREAKDOWN
Founder of the program, Caron Zlotnick, a researcher — created ROSE and it’s only five sessions administered during pregnancy. Not after you give birth. Not after you have this sweet baby in your hands. And not after your thoughts are already being consumed with negative affirmations.
The program takes mothers-to-be, and they go through the basics of what the postpartum period actually looks like. The program isn’t therapy sessions. It’s almost like a woman who went through PPD, sits you down, and says: postpartum can be amazing, or it can look like this. Whichever way it happens for you, you should still know what the other side looks like.
It’s sessions that prepare you for what’s to come. Mothers learn how to build a support system before you need one, how to fit in those personal moments for self-care, and how to actually ask for something you need, instead of feeling like you’re being selfish while everyone else’s attention is on the new baby. Moms become trained on the honest reality of having a newborn versus the perfect Instagram scene “everyone else” seems to be living.
ROSE trains women on the things they wouldn’t normally foresee or expect way before all that exhaustion and those hormonal shifts kick in. Think of it like a little booklet someone gives you before your first baby. A little guide to get you out of the deep end before it swallows you up.
Five separate randomized clinical trials showed that ROSE cuts postpartum depression rates by roughly half. So the numbers aren’t lying. In 2019, the U.S Preventitive Services Task Force named it one of the most effective tools available for preventing PPD. Health researchers don’t say ‘prevents half of cases’ like it’s no big deal. It’s a huge number for only a five-session program.
And you know the part that made me angry? It costs around $2000-$4000 in staff time across an entire clinic to set up. Compare that price to the cost of a single untreated case of postpartum (estimated at $33,000 when you take into account — lost productivity, medical care, and downstream effects on the child). The math doesn’t match up.
An average birth in America costs around or over $20,000. The U.S is the most expensive country in the world to have a baby. An Advil runs you $50+. The list can keep going. In that massive cost to give birth, there’s no way a hospital can absorb the cost of the ROSE program for women?
The program isn’t a money problem. It’s not even a science or research problem. We know it works. It’s not a program that has to do with any injections or pills being swallowed. It is an information style program on PPD preparation.
So what’s the hold up? Why don’t more hospitals and birth clinics offer this?
The problem isn’t that clinics don’t offer ROSE; it’s that it is only offered to women labeled as ‘high risk for PPD’. If you don’t score high enough on that screening test, you’ll most likely never see this program.
But who constitutes as high-risk? Somewhere in the healthcare system, it decided that some moms are worth throwing a life vest to, while the rest of us try to swim to shore and hope we make it there safely. If we start getting tired, then a doctor would screen us, diagnose us, and finally offer help. But it’s too late by then. Those intrusive thoughts already made their way into our mind, when they could have been prevented miles back from the shoreline. The system is built to help us after we drown. It’s not meant to help us before the hard part has a chance to start. This is an odd way to handle PPD — when we already have a program that has proven it can prevent half of these cases.
Zlotnick and Jennifer Johnson, over at Michigan State University, have been testing whether or not this ‘gate-keeping’ logic even stands. Their new study — Roses II — offers ROSE to a broad group of pregnant women, regardless of how high they score on that PPD screening test. The point is to see whether universal access creates better birth outcomes. There’s only 12 states that joined in for this trial: Connecticut, Cali, Illinois, Massachusetts, Maine, Michigan, Minnesota, Ohio, New York, Washington, Oregon, and Rhode Island. Not one state from the south is part of this. The program’s efforts are focused up in the Northeast, Midwest, and out on the Westcoast. A huge part of the country is left out altogether. And it’s not a random gap. The states that are missing from the list are some of the highest rated places who struggle the most with maternal health outcomes. The places that could probably use this preventative program the most haven’t been reached yet.
THE BIGGER PICTURE
One program isn’t going to save every mom going through PPD — though we wish it did. The bigger picture is about real support during pregnancy and postpartum. It shouldn’t feel like something you have to qualify for. We already know that when we feel truly supported — not just checked up on, but actually held down by the people we trust — it changes how we move through our pregnancy, the birth, and all the after. Fears turn into strength, and those days that feel like we’re about to lose it become more survivable.
But unfortunately, this isn’t how our system works. They have women waiting to feel all types of scary emotions. Then we wait for the screening test to tell us how bad it is. Then we wait until we’re sick enough to ‘become a statistic’ to be allowed to enter the program.
If ROSES II confirms what prior studies already say — that every mom can benefit from this — then there’s no real justification left as to why this program can’t be offered to all pregnant women. We can’t keep believing that a $2000 program is only for the ones who need it most, when it turns out every mother deserves the chance to know what lies ahead for them. The real question was never whether ROSE works or not. The question we should be asking is why, for over a decade, we’ve treated something this simple and effective as optional for high-risk moms— instead of something every mom should be allowed to have.
