Half of all anxiety and depression cases among new and expectant mothers are going undiagnosed, according to a new report. Although 10-20% of women develop mental health problems, which can include anxiety and depression, during pregnancy or within the first year after having a baby, 50% of cases are being missed – despite contact with professionals, the report by the Royal College of Midwives (RCM) found. The report suggested that mental health needs are still secondary to physical health during pregnancy, and has called for a boost in midwife numbers to help spot more cases of mental ill health. Amanda Mansfield, professional advisor to the RCM and one of the lead authors of the report, said the 20% of new or expectant mothers who have mental health issues will experience a range of symptoms. “Often the ‘baby blues’ is normalised because it’s something lots of people get, and women are told, ‘You’ll be fine’,” Mansfield told PA Media. “That can contribute to the fact that significant numbers of women downplay their symptoms – in some reports, up to 70% of women don’t feel able to disclose how they feel, they may feel judged. “Some women feel it may affect their ability to mother, or they may be concerned their baby may be taken away.” Mansfield added that some women may feel unable to share their symptoms with a health professional, because they’re worried about how they’re going to be perceived. “But it really is ok to not be ok, rather than women playing down and diluting their feelings,” she added. It’s a good idea for everyone to be aware of mental health risks during pregnancy and beyond. Here are seven signs that somebody might need mental health support, and how to talk about it… 1. DepressionPregnant women or new mums may feel low, unhappy and tearful for much or all of the time. Mansfield said: “It’s looking for the variation in normal patterns of behaviour. Family and friends should ask, in a very compassionate, non-judgmental way, how the woman’s feeling.” If friends and family don’t feel confident about having such conversations, they should encourage the woman to talk to her health professional, Mansfield added. 2. Anxiety Feelings of anxiety can manifest in many ways, and physical symptoms can include a racing pulse, breathlessness and sweating. But whether there are physical symptoms or not, it’s vital for women to talk about how they’re feeling, said Mansfield. “A woman may say she feels particularly anxious about the birth, or relatives coming over, or the in-laws, and having the space to talk about it is really important, to share the anxiety with a midwife that she has a relationship with.” If these anxious feelings don’t improve over time, Mansfield said they can be referred to a specialist midwife who’s an expert in perinatal mental health, and who may be able to offer additional interventions and support. 3. Altered sleep patterns All new parents will of course find their sleep is affected, but if there is also an underlying mental health issue going on, exhausted women may find it even hard to fall or stay asleep. “Women may have significantly disrupted sleep patterns, but we often normalise that with later pregnancy and new parents having difficulty sleeping,” Mansfield pointed out. “It’s really important that if you’re having problems sleeping, and you may be unable to settle and find your mood is a lot lower, you talk to your health professional about that.” 4. Appetite changes “Some people do find their appetite is affected,” said Mansfield. This may mean women lose their appetite and forget to eat or, conversely, comfort eat and possibly put weight on. 5. Difficulty concentrating It’s common for women to describe having ‘brain fog’ when they’re pregnant or have just had a baby, but sometimes an inability to concentrate can be a sign of a deeper problem. Mansfield explained: “A woman’s ability to concentrate can be markedly affected, and we often downplay that – it can be a subtlety that we ally with having a baby or being pregnant, but these can be really important signs and symptoms to share with your health professional, as they may suggest there’s something that needs exploring further.” 6. Obsessive compulsive behaviour Starting to behave obsessively or compulsively, or symptoms of any pre-existing obsessive compulsive disorder (OCD) getting worse, can be linked to perinatal mental ill health too. “Some women may be excessively tidying, for example, or be fixated on something and they may become more anxious,” said Mansfield. “Very commonly, obsessive compulsive disorder may become worsened. Certainly if someone does have compulsive disorders, it’s important not to put them to one side, but share them with your midwife. Picking it up early is so important.” 7. Unusual thoughts Of course, new parents will have lots of new things to think about – but when those thoughts are perhaps a little unusual, it’s worth talking to family, friends and your midwife or health visitor about them. Mansfield said: “Women may present with different thoughts they haven’t experienced before, and often they downplay that because they’re not sure whether they’re normal or not, or they might think they’re just part of being pregnant and having a baby. “The challenge for us as midwives is when you only have 15/20 minutes antenatally to do the whole health assessment – the physical and mental health assessment. 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