Amy Hipwell can't remember anyone sitting her down for a serious conversation about her mental health.
In five years, Hipwell and her husband Chris endured a rollercoaster of heartbreak, anxiety, grief and joy, welcoming two healthy children into their family, but also losing three to stillbirth, miscarriage and a rare genetic disorder.
Despite the devastating and compounding grief, the first person to suggest the new mum might need some support for her mental health, apart from her husband, was not a doctor. It was her cleaner.
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The couple's firstborn daughter Emily was stillborn at 28 weeks due to a suspected clotting issue in the umbilical cord.
Soon afterwards, Hipwell suffered an early miscarriage.
During her third pregnancy with Julia (now 17), Hipwell recalls being wracked with anxiety.
"I was constantly worried about what was going to happen," Hipwell told 9news.com.au.
While her obstetrician took precautions with her physical health, prescribing blood thinners and ordering additional tests, that only went so far in calming her anxiety.
"The appointments and the screenings are very medical," Hipwell said.
"There was nothing about my mental health and how I would look after myself in the pregnancy."
Her anxiety only worsened after Julia was born.
"I was obviously so happy that I had a healthy baby, but then so worried that I was going to lose her," Hipwell said.
"I didn't let people hold her, I was really hyper vigilant… but it was never talked about or questioned, like, you know, 'maybe you want to go and get some support for how anxious you're feeling'."
When Julia was 18 months, Amy fell pregnant again with another girl, Skye.
The family had moved from Victoria to Brisbane, were seeing a different obstetrician and had little support from family or friends.
At the 12-week scan, they learned Skye had Trisomy 18, a genetic condition. Further scans showed a hole in her heart and an umbilical hernia.
The couple was told Skye would have a less than 1 per cent chance of surviving more than a week after birth.
They decided to terminate the pregnancy and Hipwell was induced around 17 weeks.
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"That was probably the most traumatic experience I've had in a hospital situation and losing another baby girl was devastating for us," Hipwell said.
"We just got sent home and there was nothing… I don't recall any support at all."
The family moved back to Victoria and Hipwell fell pregnant with her son Nathan in 2010.
Despite her history of three pregnancy losses, Hipwell doesn't recall any discussion about her mental health during that pregnancy or after Nathan was born.
"I was on my own at home with a baby and a toddler, and I guess, gradually, I was just not coping," Hipwell said.
"I would just be crying all the time, I didn't feel like I was bonding with Nathan."
It was Hipwell's cleaner who eventually spoke up, echoing her husband's concerns.
"I was just sitting there crying and crying… she did a clean for an hour then sat there and said, you know, 'it sounds like you really might need some help'."
An internet search then led her to PANDA (Perinatal Anxiety & Depression Australia).
"I remember calling them and crying, and just going, 'I don't know what's wrong, I don't want to even be at home anymore, I don't want to look after this baby, I just can't do it'.
"I just wanted to get on a plane and leave and never come back."
Hipwell's experience is not isolated.
More than one in five (22 per cent) of respondents to a recent survey by PANDA say healthcare providers did not ask about their mental health at all.
Less than half (43 per cent) said anxiety was included in screening.
"Healthcare providers should be regularly asking expecting and new mothers, dads and partners how they are feeling emotionally," Julie Borninkhof, a clinical psychologist and PANDA CEO said.
She said some healthcare professionals will only have received a few hours of mental health 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," Borninkhof said.
"Picking up anxiety and depression among expecting and new parents can be difficult.
"Matrescence is a time of huge adjustment, changing hormones and sleep deprivation.
"Many people struggle to cope but don't think what they are experiencing is anxiety or depression.
"Symptoms are so different for each person that we recommend reaching out if you are finding it hard to cope or you don't feel like yourself, regardless of the reason why."
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Borninkhof said without support, a parent's mental health will often worse before it gets better and that can impact the child's well-being and development.
"For some parents, when their mental health isn't supported, it can become life-threatening for themselves, and/or their baby and children.
"While this is rare, PANDA wants parents to be the best they can be, and this means getting help early.
"The perinatal period is also the first key stage in the development of an infant's physical and mental health.
"Prioritising the well-being of parents, while simultaneously and intentionally responding proactively to the needs of the infant, can impact intergenerational well-being by setting parents up well to model good mental health and build strong foundations for their children."
Anyone having trouble coping with pregnancy or new parenthood, or wanting to help someone who may be struggling can visit panda.org.au or call the PANDA Helpline on 1300 726 306 (Mon-Fri, 9am-7:30pm and Sat 9am-4pm AEST/AEDT)
If you or someone you know is in need of support contact Lifeline on 13 11 14 or Beyond Blue.
