‘I was in a really negative terrible place’
"I was in a really negative terrible place…. and couldn't see a way out."
This was the experience of one woman who suffered from depression and obsessive compulsive disorder during her second pregnancy.
A quarter of pregnant women suffer from mental health problems, a study by King's College London suggests.
Anxiety and depression were not the only conditions to affect these women, with some suffering eating disorders, OCD and bipolar disorder.
Liberty suffered with OCD and depression during her second pregnancy after experiencing no problems the first time she was pregnant.
"I think I had started to become unwell in the first year of my first child's life, but I was sort of getting along with it not very well and nothing got diagnosed.
"When I became pregnant with my second child, I got progressively more and more unwell.
"It was really truly awful to be pregnant and unwell and also in my case to have a young child at the same time.
"You are trying to be healthy and well and you are worried about the well-being of your unborn child and about your toddler crying all the time and feeling that even though I was doing my best and really trying hard, sometimes I couldn't engage in the way I wanted to engage.
"My mind was occupied with obsessional thoughts about harm coming to my family and I was in a really negative terrible place, where I thought I was ruining everything for my baby, child, family and myself and couldn't see a way out.
"The hospital midwife at my usual check-up was really good and she could tell I was very anxious and not very well.
"She wanted to refer me to a more specialist midwife team at the hospital, but I was opposed to that because I didn't want something going on my NHS record.
"I wanted help but not to sort of admit something like that, but she was good and said 'come in any time you want' and not to queue, but to come straight in and see her.
"She left the door open and gave me her phone number and was really nice so, eventually I agreed to go, although not until the very last week of my pregnancy.
"I went after the birth and said I thought I was very unwell and I was worried about anything – the health of my baby, toddler and husband and the well-being of my family and I felt I was becoming more hopeless.
"In the couple of weeks before my second child was born I had become really desperately unwell but I was very lucky to have very supportive parents and husband.
"After agreeing to see a specialist, I had weekly appointments with a psychiatrist and a psychologist and they were brilliant. They gave me a diagnosis and as soon as I got that I was able to get the right treatment.
"Now I am at a point I never ever thought I'd be at – I'm well again, working, enjoying my life very much and satisfied with my home life.
"For me the midwifery services were brilliant. It depends partly on the individual's capacity for asking those difficult questions and interpreting people's reticence and being open and non-judgemental. That's what they did so well."
The study, funded by the National Institute for Health Research, covered the condition of 545 pregnant women over the age of 16 attending their antenatal booking appointment at a south-east London clinic between November 2014 and June 2016.
It evaluated how well two questions (known as the Whooley questions) asked by the midwives and a 10-item self-completed questionnaire did at identifying mental health conditions in the women.
It found that both methods worked similarly well, although identifying depression was harder in older women.
Anxiety affected 15% of those surveyed, with depression found in 11%, eating disorders and obsessive-compulsive disorder (2% each), post traumatic stress disorder (just under 1%) and less commonly, bipolar disorder and other disorders.
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The proportion of pregnant women with mental health problems in this study was higher than the one in five of women of this age in general reported in the Adult Psychiatric Morbidity Survey, but the figures cannot be compared directly.
Report author Prof Louise Howard, from King's College, told the BBC the study showed disorders were more common in pregnancy than often realised "as there is a tendency to focus on post-natal illnesses i.e. pregnancy is not protective".
She said the study supported the recommendation by health watchdog NICE that women should be asked by a non-judgemental health professional, during pregnancy and after birth, about their emotional well-being.
Stephen Buckley, head of information at charity Mind, said: "There is some evidence which suggests many women are afraid to tell health visitors about the way they are feeling because they are afraid it will lead to social services taking away their children, or that they would be seen as bad mothers.
"Pregnant women may also find it difficult to tell people they are feeling bad because they might feel like they are under pressure to be happy and excited, on top of everything and showing they are a good parent.
"People with mental health problems can and do make good parents, but it's vital anyone who is expecting is able to access the help and support they need."