We need to know what's really going on for our mums.

Byline: PHILIP BANFIELD COLUMNIST

WHEN Jodie came to my antenatal clinic for the first time, she couldn't look up at me.

She was 17, had been in and out of the care system, and the scars up her arm told their own story, with attempts to end her life.

My task was to gradually engage Jodie - put her in charge, empower her. Care planned together, but that sometimes takes several visits. Nods and grunts that first time, but we had made a start.

Yes, Jodie felt she should restart medication; we linked in with her GP and the community mental health team. Jodie was soon able to talk about her feelings and future.

By the time she was due, Jodie was really positive and had a beautiful baby girl. But now she was vulnerable to worsening mental health.

Exhaustion challenges us all. She became very unwell, the secondary care crisis team intervened to give treatment and support.

For most, the years of babyhood are demanding but immensely satisfying. But depression and anxiety are common, affecting some 10-30% of women in pregnancy. A past history of mental ill-health is a risk factor. Ignored, the consequences of mental illness can be dramatic and severe, with suicide a tragic end point for some.

As one of the assessors for the National Confidential Enquiries into maternal mortality I have reviewed the notes of several of the women who have lost their life tragically through suicide.

A recurring theme is a lack of recognition that the situation had deteriorated; it is all too easy for women to feel and become isolated.

Thankfully, suicide is rare, but in this context it is the third leading cause of death in pregnancy and the leading cause of death in the UK of women in the year after birth, so we need to talk about it.

Seeing your GP before your pregnancy to try to make sure you are as well as possible is a good place to start. It also means you will know how to access help if you need it . For some women pregnancy and the months after delivery are the first time they experience mental health problems.

Full postnatal psychosis is rare but a psychiatric emergency.

There are no dedicated inpatient psychiatric beds in Wales for mother and baby; separation aggravates anxiety for both. But there are perinatal mental health teams across Wales, with specialist perinatal mental health midwives.

Each woman at risk contributes to and agrees their own safety plan - actions to undertake when they need help.

Access to effective treatments remains woeful in many places. We should spend as much on mental health as we do preventing physical complications in pregnancy.

Our traditional means of gauging the likelihood and risk of suicide are inadequate. I recently saw Jodie in clinic for her second pregnancy. She breezed in with Ben, a cheeky four-year-old who 'high-fived' me.

'How was life?' 'Great.' 'What can I do for you?' 'I was the woman that went completely psychotic and suicidal and had to be admitted for weeks after delivery, but I'm fine now.' 'Okay, let's talk about safety plans...' | Philip Banfield is consultant obstetrician at Ysbyty Glan Clwyd in Denbighshire