Health Reporter Katie Fenton reports
A new mum who felt suicidal after giving birth has said improvements to perinatal mental health services in Wales are "urgently needed."
Laura Landeg, from Cardiff, experienced severe depression and anxiety during pregnancy and after giving birth to her daughter Ava in June last year.
The 33-year-old said the support she was offered did not meet her needs and she often found it difficult to access.
"It is vitally important and I do think it's urgent, because I'm just one new mum and I can't imagine how many other mums are still waiting," she said.
"It's going to be the death of somebody. I truly believe that somebody could take their life for not getting the help they desperately need, and I honestly at one point thought that was going to be me."
Laura has shared her experience with ITV Wales as the Royal College of Midwives sets out how services should be provided in a new strategy.
The college told ITV Wales that maternal suicide rates could increase if governments do not commit to improving perinatal mental health services.
'I just broke down. I felt completely hopeless'
Before pregnancy, Laura was on medication for emotionally unstable personality disorder, but had to stop taking it after falling pregnant with Ava.
She said during the pregnancy she experienced depression and felt "absolutely terrified of childbirth".
"When I say I was frightened, I mean I was so, so frightened I couldn't actually talk about it, so I couldn't have a conversation with my fiancé or my mum without crying," she said.
"The childbirth did go badly. It started off really well but it ended quite traumatically. Ava was safe and born healthy, I only incurred minor injuries, but it was very traumatic and that night I was just on my own in a cubicle.
"I just broke down, like I'd been holding it in for nine months. It was just so traumatising and I don't think I was ready for it."
When Laura returned home with Ava and her fiancé went back to work, she began to struggle with loneliness and insomnia.
"Things took a downward spiral. I was very anxious to go anywhere with her because I thought, 'what do I do if something's wrong?', I had no experience.
"It was just all very scary and I spent a lot of time at home because I was too scared to go out and do things. My mood was dipping quite rapidly."
Laura's mood continued to worsen, but she felt reluctant to reach out for support out of fear over what might happen to her.
"By the time Ava was seven-eight months old, my mental health was so, so bad. I didn't want to speak to professionals about it because I was scared that I'd end up being sectioned.
"But I did in the end, I told them how bad it was getting, that I'd physically harmed myself, everything was getting so stressful.
"It got as bad as it could've got really and during that time I was just begging for help.
"I felt completely hopeless. I honestly felt like I wanted to just walk out the door and disappear. I was so desperate for someone to just help me.
"All I wanted was some medication, some therapy, something, anything to make me want to still be alive because it got to the point where I was like, I don't want to be here, I can't do it anymore, but then you keep having to pull yourself back because you've got a child to look after.
"It's unbearable sometimes, the guilt of thinking of looking after your child as a chore or as something you don't want to do. But it's just so overwhelming and lonely, I just wanted help."
Laura was referred to her local perinatal mental health services but said she faced a six month wait for help.
She eventually started receiving regular visits from a health worker and was signed up to online mindfulness sessions, but she did not find either of these services worked for her and decided to stop seeing the perinatal mental health team.
She is now seeing a private psychiatrist and has been put back on medication, but is hoping to access therapy through the NHS.
"It's been a fight. I honestly at one point just thought, I am going to have to be the sacrificial lamb here to get something done.
"I've got such good support with my family, especially my mum, and if it's that difficult to me, I cannot comprehend how frightening it must be for people who don't have that support network."
Rising mental health cases and inconsistencies in access to support
Recent years have seen big rises in the number of student midwives, which has resulted in more newly-qualified midwives entering the NHS.
But the number of pregnant women reporting mental health issues is also continuing to rise.
Suicide is the leading cause of maternal deaths in the first year after childbirth, according to Public Health Wales.
There are calls for doctors to be "skilled up" in their knowledge of perinatal mental health
One in five women will experience mental health issues during pregnancy and up to one year after birth, ranging from anxiety and depression to more severe illness.
How to spot the signs and symptoms of perinatal depression:
Feeling down, upset or tearful
Isolated and unable to relate to people.
Finding no pleasure in life or things you usually enjoy.
A sense of unreality, no self-confidence or self-esteem.
Empty and numb
More extreme symptoms could be feeling hostile or indifferent to your baby and thoughts of self-harm.
Every health board in Wales now has one specialist perinatal mental health midwife, but the Royal College of Midwives (RCM) has said there are inconsistencies.
Launching its roadmap for perinatal mental health services on Wednesday, the RCM called for more investment from governments.
It wants everyone working with women during and after pregnancy to be given the knowledge and understanding of perinatal mental health.
It has also called for a minimum of one full-time specialist perinatal midwife within every maternity service in Wales.
Julie Richards, RCM director in Wales, said: "Whilst we know that we have a specialist midwife per health board in Wales, often not all of those individuals are full-time, or some of them are actually on fixed-term contracts and short-term funding, so to have this resource properly invested in is really important for the service.
"We also want to see perinatal mental health considered by everybody who's in contact during that perinatal period."
A recent report by the RCM estimated that one case of perinatal depression costs society £74,000.
It calculated that training an experienced midwife to be confident and skilled in asking patients about mental health would cost £102 - saving health and social services money in future.
"If things aren't picked up in an early position it can manifest and continue to have a long-term impact, often for many years, and could return later on in life as well," Ms Richards added.
"Equally, some people may have a very acute situation where they will need intense support through the specialist services, which costs more money."
What action has the Welsh Government taken?
The Welsh Government made perinatal mental health a key priority in 2019, allocating funding to the development of specialist services.
In April 2021, Wales' first maternal mental health unit opened in Tonna Hospital, Neath, with capacity for six mothers and babies.
Following calls for a similar facility in north Wales, another unit is due to open in Cheshire and be shared between patients in north Wales and the north west of England in 2024.
The Welsh Government has welcomed the RCM's strategy, adding that it is committed to providing support to women, birthing people and families during and after pregnancy.
A spokesperson added: "A named midwife and health visitor provide dedicated support to new families. The provision of specialist referral services and specialist midwifery expertise as part of perinatal mental health services is crucial.
"We have invested in specialist perinatal mental health teams and there are now dedicated teams within every health board in Wales."
It did not confirm whether it would be providing any additional funding to perinatal mental health services.
If you have been affected by anything in this article, help and advice can be found here.
Samaritans is available day or night, 365 days a year. You can call them for free on 116 123, email them at firstname.lastname@example.org, or visit www.samaritans.org to find your nearest branch.
The Mental Health Helpline for Wales is available to take your call any time, day or night. Freephone 0800 132 737 or text 'help" to 81066 (charged at standard network rate)