Postnatal depression – would you recognise it? I didn’t. I thought I had a fairly good understanding of how these things manifest themselves in women, until my own pregnancy proved otherwise. What followed was not smiles and love, but a growing emptiness consuming my world from the inside out.

Looking back, I can see how conspicuously absent discussion of such emotions is from our preparation for motherhood. The fact that we don’t know enough about postnatal depression, and rarely acknowledge the mental health implications of starting a family, means it’s hard to spot – in ourselves and in the women we know and love.

But a new study by the Royal College of Obstetricians and Gynaecologists has found that 81% of women surveyed had experienced at least one episode of a mental health problem during or after their pregnancy – and only 7% of women with pregnancy-related mental health problems, such as postnatal depression, received they specialist care they needed.

Postnatal depression wasn’t mentioned in the runup to the birth, so I took a cross-that-bridge approach. Not that I’d have to, of course – it was something that happened to other women. I’d imagined a palpable motherly sadness, ghoulish and more fitting in verses of Sylvia Plath than in the lives of a real woman. Even when I felt so heavy I might solidify, I didn’t recognise what was happening to me. I didn’t spot it taking root in my own mind, and neither did anyone else.

You wait so long to meet your baby, dreaming of a different flavour of love and how complete and content you will feel. When it doesn’t come you don’t want to admit it. You can’t. You feel like a freak. You feel undeserving of your child. You watch everyone around you lost in button noses, tiny fingers and baby lotion, and wonder why you’re so broken. Anything other than joy is anathema to society’s image of motherhood, so you don’t speak up. You decide to work around it until it goes away.

Except, postnatal depression is not something you can work around. It’s like waking up one day to find a mountain range between you, on one side, and your baby and everything you know and love on the other. Everything is beyond your grasp. Existing becomes a series of insurmountable peaks you must scale, ill-equipped and without warning. To admit the problem is a mountain itself. To say it out loud is another. To make a doctor’s appointment, one more. Between that moment and recovery, there is the full surface of the Earth to cross.

I remember the exhaustion of walking the path to wellness and how unprepared I was for every part of it. It has taken years to look at photos from those early days. My experience of our local hospital’s mother and baby unit haunts me when I see a pregnant woman. Even when I was through the door of that unit, I was handled with such gelid detachment I felt like a ghost – unable to be seen or believed. To learn now that I was one of the tiny percentage who got the “good” help frightens me. If recovery is hard enough with specialist care, what of the women who are turned away?

For mothers to simply reach out for help is difficult enough. My stomach lurches to think that when they do, so many are denied that care. The fear of being left to traverse the long road to their former selves alone is unimaginable. Abandonment at this critical moment is a scandal. Doctors must face the gravity of not going deeper into that plea for help, knowing the pressures that stop a woman from speaking up at all. That plea may be no more than a whisper. It could be hiding behind words about tiredness and colicky infants. The fear that you will be declared unfit and your child will be taken away is a powerful silencer.

Healthcare professionals must see through the silence. Where there is a mother, there is a child. When one suffers, so does the other. And that suffering oscillates far beyond them, to partners, other children, grandparents and friends. It’s tumultuous enough to deal with a newborn: to do the night feeds and everything else while trying to rescue a person is too much to expect families to do alone. Something has to give – but what? Mother? Child? The relationship? A life?

And what of women whose health outcomes intersect with poverty, race, sexuality, ability or other forms of marginalisation? How many of them are in the lucky 7%?

It costs almost nothing to treat a woman with postnatal depression – £83 on top of the £2,800 average maternity bill. That rockets to £10,000 if it isn’t caught early. I can’t think of these women’s lives in financial terms, but it’s a disgrace if such paltry sums have contributed to such shameful statistics.

We need a much more holistic approach to maternity care, that values women’s mental health as much as their physical health. When a woman is in labour, we respond to her bodily needs with speed, empathy and comprehensive care. It’s time we did the same for the exigencies of the mind.