EIMEAR* WAS DRIVING home one night during her pregnancy when she began to have intrusive thoughts.

She thought about crashing her car, believing that if she and her unborn baby died, her husband “would be alright without us”.

“After that drive home I realised I really needed help,” Eimear said.

Another woman, Louise*, said that her struggle to bond with her baby after birth left her feeling like wanting to “leave the house and never come back”.

Both Eimear and Louise are among the thousands of women who have been referred to the six maternity hospitals offering mental health support during pregnancy over the last few years.

These services, known as Specialist Perinatal Mental Health Services (SPMHS), provide support for women who are experiencing moderate to severe depression during pregnancy and after giving birth.

But our investigation found that wait times for appointments can take over a month for many women in crisis.

Hospitals have also tightened their acceptance criteria for these services in recent years as demand increases, meaning some women are being missed or are instead referred to their GP or counselling services.

Records obtained by our team show how one SPMHS had to tighten its criteria because “providing the current level of care is no longer sustainable”.

The Journal Investigates spoke with almost 40 women across the country who had experienced mental health challenges related to their pregnancy.

Some received timely interventions and care; many others did not.

Their stories highlight how, despite these services being in place, they are not always available to the women who need them, either because they live too far away, don’t fit the right criteria or sometimes simply because women aren’t told they exist.

And while some women said the care they received from SPMHS saved their lives, others felt let down by the lack of support available to them. All of their names have been changed to protect their identity.

Our investigation comes at a time when there has been increased focus on perinatal mental health globally, following the high-profile cases of Lindsay Clancy and Hayden Panettiere.

Suicide is the leading cause of maternal death and late maternal death in Ireland, according to Maternal Death Enquiry Ireland, which conducts confidential reviews into maternal deaths.

There were 17 maternal deaths due to suicide during pregnancy and up to one year postnatally between 2019 and 2024.

This was considered a “statistically significant increase” from the nine deaths due to suicide recorded during the previous decade (2009-2018).

Timely intervention in these cases can be vitally important, but the current system of care related to pregnancies in Ireland is heavily weighted towards the time before the baby is born.

• This article is part of a year-long exploration by The Journal Investigates into the issues that impact the safety of women in Ireland today. Over the course of four topics, we listen to women’s experiences, investigate the challenges they face, and explore potential solutions to improve outcomes across women’s health, safety in public, and access to justice and advancement.

Perinatal care ‘unclear’ and ‘inconsistent’

Perinatal depression is characterised as depression that occurs during a pregnancy, or up to a year after the birth of a baby.

If it starts after giving birth, it is also sometimes referred to as postnatal depression. This can sometimes start with ‘baby blues’, and for many, can resolve as time goes on.

But for others, it can develop into more serious and long-lasting mental health issues.

Symptoms include difficulty bonding with the baby, persistent low moods or frequent crying, severe anxiety, feelings of guilt and trouble sleeping.

It affects around 10-15% of women, but crucially, symptoms can appear any time over the course of the first year, sometimes peaking or emerging after six months.

Campaigners have said that because most support ends for women six weeks after giving birth, not enough is done to support those who experience postnatal depression, particularly if it develops many months later.

Aolish Gormley, a maternal mental health advocate, told The Journal Investigates that perinatal care in Ireland is “inconsistent, unclear, and very unequal”.

She added that mothers are expected to “self-identify, self-advocate [and] self-navigate” through a complex system without a “clear roadmap for postnatal care beyond that six-week checkup”.

She said having experienced postnatal depression herself, she knows the difficulties women can have simply reaching out for support.

“My child was six months old before I struggled, and at that point, there was no support,” Gormley said. She added:

There was nobody checking on me. There was nobody calling me for an appointment, and that’s the case for a lot of mothers.

Maternal mental health advocate and founder of the Year of Care campaign, Aolish Gormley, said that more needs to be done to support women after their six-week check-up. Claire Nash Claire Nash

Pregnant women receive six hospital and GP visits over the course of their pregnancy. After the baby is born, the level of support falls away dramatically.

Typically, postnatal support ends six weeks after birth, with just two GP visits for women around this time. But even these visits can be primarily focused on how well the baby is progressing.

Outside of this, women who are experiencing moderate to severe depression related to their pregnancy can be referred to SPMHS.

These are staffed by multidisciplinary teams and operate out of six maternity hospitals across the country – the National Maternity Hospital, Coombe Hospital and the Rotunda Hospital in Dublin, as well as the maternity hospitals in Cork, Limerick and Galway.

The other 13 maternity hospitals across the country are staffed by perinatal mental health midwives as part of the ‘hub and spoke’ model of care.

Our investigation found that thousands of women have been seen by the six SPMHS hubs over the past few years.

But with more women requiring help, services are struggling to keep up with demand.

The average wait time at University Maternity Hospital Limerick (UMHL) last year was 37 days, while at Coombe Hospital it is approximately 4–6 weeks.

The National Maternity Hospital tightened its acceptance criteria last year “in order to manage waiting times” in the context of increasing demand and reduced staffing.

New referrals are now not accepted if they are received six months after birth, even though the HSE’s model of care for SPMHS states they should be accepted up to one year postnatal.

Four other SPMHS hubs – the Rotunda, the Coombe, Cork and Limerick – have all introduced similar restrictions, though Galway still accepts referrals after six months.

“Providing the current level of care is no longer sustainable,” an email obtained by The Journal Investigates from the Master of the Rotunda said, explaining the change.

A spokesperson for the HSE said “there has been a significant increase in demand for specialist services” and that it was focusing on “improving equitable access” across the country.

They added that additional resources recommended by a new model of care “would enable services to extend the timeframe for service provision to one year postpartum”.

Labour TD Marie Sherlock told The Journal Investigates, “it is completely unacceptable that access is being tightened.”

“At a time of growing demand, there should be an expansion, not a tightening in the access to these vital services,” she added.

Struggle to access care

The impact of these changes is being felt by the women struggling with mental health difficulties after their pregnancy.

One woman, Ashling*, told our team that during her first pregnancy she disclosed her history of mental health difficulties but was never informed “about any perinatal mental health services or supports”.

When her baby was six months old, she was diagnosed with postnatal depression, but wasn’t seen by SPMHS.

Ashling hadn’t fully recovered from the first experience when she became pregnant again. She again disclosed her mental health history and previous postnatal depression diagnosis. She said:

I was told that the mental health team would contact me to check in, but they never did.

She later received a letter saying that she had to contact the service or she would lose access, but as she was dealing with severe sickness during her pregnancy, “contacting the service fell by the wayside”.

Her mental health deteriorated again after giving birth. She was referred to SPMHS by her GP, but she was told that because her baby was now six months old, she was no longer eligible for the service.

Another woman, Muireann*, told our team that she was seen by SPMHS during her pregnancy, having previously suffered from anxiety and depression.

She said that she found their care to be excellent, but after she gave birth her mental health “took a drastic nosedive due to birth trauma, lack of sleep and an unsettled baby”.

Muireann said that “all of the GP checks and [public] health nurse visits focused solely on [the] baby’s health and my physical health” despite being “in a deep, dark depression”.

She said a subsequent visit from the public health nurse who pressed her on how she was feeling allowed her to let it all out. She added:

I sobbed while she held my baby for me. It was one of the moments I felt saved my life. I was suicidal and very close to acting on it.

She returned to the care of SPMHS but said, “as it came closer to my baby’s first birthday, I could feel they were trying to pawn me off”.

This is because some SPMHS do not see women after one year postnatal, even when they still need help.

Muireann said she was “still deeply unwell with literally nowhere left to turn” while the SPMHS suggested that she seek therapy.

A spokesperson for the HSE told The Journal Investigates that where additional care is required after being seen by SPMHS, “appropriate referral and handover arrangements are made to the relevant mental health service”.

Travel to hubs a major barrier

Among the other issues with SPMHS raised by the women who spoke to our team was the difficulty of having to travel to a hub unit where a multidisciplinary team is in place.

Orla* told our team that she had to travel almost 90 minutes from her home because her nearest maternity hospital was only a spoke site staffed by mental health midwives.

Another woman, Emma*, said that if you live in a more rural part of the country, travelling to the nearest hub SPMHS can take hours.

“This is an incredibly long journey to be expected to travel,” she said.

“Not to mind commitment to work, other children and the physical discomfort of travelling while pregnant or caring for a newborn baby.”

The HSE is currently working on a refreshed model of care for SPMHS.

Minister of State Mary Butler TD told The Journal Investigates that she intends to “explicitly define the perinatal period as from beginning of pregnancy to 12 months postpartum” so that all women can receive the support they need.

“These supports must be available before birth, during childbirth, and after the birth of the baby,” Butler added.

The goal of the refreshed model of care will also be to “expand consultant-led multidisciplinary teams to all 19 maternity hospitals”, Butler said, with additional resources also provided to existing teams. 

A spokesperson for the HSE said that this work is “at an advanced stage” but did not provide a timeline for completion.

This would greatly reduce the travel time for women needing to attend hub sites and also decrease the pressure that the current services are under.

Gormley told The Journal Investigates that “strengthening the service at local maternity sites could make a meaningful difference” but cautioned that it shouldn’t be seen as “solving the wider problem.”

She added that recognising the perinatal period up to a year was good progress, but she worries that with women struggling to access SPMHS “we obviously need to see huge investment and commitment of resources into expanding that service”.

Gormley said that the Minister has offered to meet her to discuss her campaign for improved supports for women up to a year after birth. She added:

“It’s not just as simple as saying we’re now going to acknowledge it’s going to be up to a year. It’s about ensuring that the service can meet the need of mothers.”

If you need to talk, contact:

• Pieta House 1800 247 247 or email mary@pieta.ie
• Samaritans 116 123 or email jo@samaritans.ie
• Teen-Line Ireland 1800 833 634 (for ages 13 to 19)
• Childline 1800 66 66 66 (for under 18s)
• Text About It: https://www.textaboutit.ie/
• www.YourMentalHealth.ie

*Names have been changed.

This article is part of a project supported by the News Reporting Scheme.

The Journal Investigates

Reporter: Conor O’Carroll • Editor: Noel Baker • Social Media: Cliodhna Travers • Main Image Design: Lorcan O’Reilly