When Mia* was referred to me, she was 32 weeks pregnant and had not slept properly in two months. Her GP had told her it was “just pregnancy insomnia”. Her obstetrician said it was normal and suggested she try going to bed earlier with a pregnancy pillow. By the time she sat in my consulting room, hands clenched around a damp tissue, she had been quietly planning how her partner and baby would be better off without her.

Mia is not a real person. She is a composite – an amalgam of the hundreds of women I see each year in my perinatal psychiatry practice. But her story is so common it could be a template. A woman develops psychological symptoms during pregnancy or the postpartum period. She mentions them, tentatively, at an antenatal appointment. She is reassured that what she feels is normal. Weeks or months pass. By the time she reaches specialist care, she is freefalling into a crisis.

Mental illness is the number one complication of pregnancy and the postnatal period. Not gestational diabetes. Not pre-eclampsia. Up to one in five women will experience a diagnosable mental health condition during the perinatal window – the period from conception to one year after birth. Depression and anxiety are the most prevalent, but the spectrum extends to post-traumatic stress disorder after birth trauma, obsessive-compulsive presentations centred on intrusive thoughts of infant harm, and the rare but........

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