Amy Hipwell can barely remember a doctor sitting down to discuss her mental wellbeing. In five years, she and her husband endured the loss of three pregnancies; their daughter Emily was stillborn at 28 weeks, followed by an early miscarriage and later, a termination after their daughter Skye was diagnosed with a fatal genetic condition. Throughout this cascade of grief, the only person to suggest Hipwell might need mental health support was her cleaner.
"I was constantly worried about what was going to happen," Hipwell recalls of her pregnancy with Julia. Her obstetrician prescribed blood thinners and ordered additional tests to manage the physical risks, yet the psychological toll went unaddressed. "The appointments and the screenings are very medical," she says. "There was nothing about my mental health."
When Julia was 18 months old and Hipwell fell pregnant again, the anxiety deepened. The family had relocated from Victoria to Brisbane, saw a different obstetrician, and had minimal support from family or friends. After learning their daughter had Trisomy 18, a genetic condition incompatible with life, they chose to terminate the pregnancy. "That was probably the most traumatic experience I've had in a hospital situation," Hipwell says. "We just got sent home and there was nothing... I don't recall any support at all."
By the time Hipwell gave birth to her son Nathan in 2010, she was isolated at home with two young children. "Gradually, I was just not coping," she says. "I would just be crying all the time. I didn't feel like I was bonding with Nathan." It was only when her cleaner gently suggested Hipwell might need help that she sought support through PANDA (Perinatal Anxiety and Depression Australia).
Hipwell's experience reflects a systemic problem across Australian maternity services. Mental health conditions during the perinatal period are common, affecting an estimated 1 in 5 mothers, yet screening remains inconsistent. According to reporting on a PANDA survey, more than one in five respondents said healthcare providers did not ask about their mental health at all. Less than half said anxiety was included in screening.
National guidelines recommend that all women are screened for signs and risk factors of mental health conditions during the perinatal period. However, this information is not collected consistently across Australia, with differences in how, when and if screening occurs. In Victoria, the picture is particularly concerning. Most pregnant people miss out on screening and only half are screened postnatally using the Edinburgh Postnatal Depression Scale (EPDS).
Women who experienced a pregnancy loss were more likely to have depression, anxiety, low mood, and stress during subsequent pregnancies. Yet women in this vulnerable group rarely receive targeted psychological support following their loss. Workforce hesitation to screen exists when timely access to the right services is not available, and clinicians are sometimes unable to identify the right referral pathway, especially for people with mild or moderate mental ill health.
Julie Borninkhof, a clinical psychologist and CEO of PANDA, attributes part of the problem to inadequate training. "GPs, child and family health nurses and midwives receive mental health training, but often it is not specific to the perinatal period, and training may only be a few hours in their whole course," she explains. Without systematic screening, anxious and depressed parents often go undetected, even though early support is proven to prevent deterioration.
The consequences extend beyond the mother. Poor perinatal mental health has a significant impact on the woman and can also have a long-term impact on her baby. When parents lack support, outcomes worsen for the entire family. Borninkhof emphasises that the perinatal period represents a critical window: "The perinatal period is also the first key stage in the development of an infant's physical and mental health."
For women experiencing pregnancy loss specifically, the gap in care is particularly stark. Women with a current or previous mental health condition may be at increased risk of worsening symptoms or relapse, while other women may experience symptoms for the first time during the perinatal period. Yet many hospitals send grieving women home without any follow-up, counselling, or referral to mental health services.
Hipwell eventually recovered with support from PANDA and went on to have a healthy son. She now advocates for systematic change. Mothers and fathers in crisis should not rely on their cleaner to notice they are struggling. With clear national guidelines recommending universal screening and validated tools readily available, the failure to implement these practices consistently represents a preventable gap in care. What changes is unclear; what remains urgent is the need for healthcare providers to ask the question Hipwell's obstetricians never did: "How are you coping emotionally?"