More than half (59%) of women say they experienced feeling down or depressed after giving birth. The finding comes from surveys carried out by the Royal College of Midwives (RCM), the results of which are included in a new RCM report.

Introducing the report Cathy Warwick, chief executive of the Royal College of midwives, said: "One thing is certain, our members cannot continue to paper over the cracks in an underfunded and under-resourced postnatal environment, without there being detrimental effects on the health of women and children". She added, "It is also having an impact on the midwives themselves who find it stressful and demoralising not to be able to give women the time and attention they deserve."

The report makes a number of recommendations to help improve the care for women with mental health issues. These include ensuring there is a specialist perinatal mental health midwife in each maternity service provider, and establishing more mother and baby units to care for mothers with mental health difficulties. It also highlights the serious midwifery shortage and the need for 4800 more midwives in England.

The Government has stressed the need for improvements in the care of women with maternal mental health problems in the postnatal period. The NHS Mandate requires NHS England to 'reduce the incidence and impact of postnatal depression through earlier diagnosis, and better intervention and support'.

A survey of student midwives carried out for the report raised some concerns about whether their training is helping them effectively to deal with postnatal maternal mental health issues. When asked if they had been taught enough theoretical knowledge on this nearly a quarter (24.1%) said no. A similar number (29%) also said no when asked if they felt confident to recognise emotional wellness or mental health issues in postnatal women. The report recommends a review of midwifery training to ensure that they are equipped with the knowledge and skills to deal with these issues.

The survey of women – carried out in collaboration with Netmums – also showed that of those that responded and who did feel down or depressed over three quarters (75.4%), did not seek help from a midwife or other member of the maternity team.

Women completing the survey were also asked if the maternity team discussed with them about how they were coping during their post natal visits. A quarter said that they had not been asked. 

In a survey of midwives nearly two-thirds (60%) said the main focus of postnatal care should be on emotional support. It is a concern that nearly two-thirds (64.9%) said that the main reason determining the number of postnatal visits was organisational pressures.

Midwives are concerned about the amount of time and resources they are able to offer women. Just over a third (40%) of midwives who responded to the question said that they had enough time and resources to support and inform women about emotional wellbeing. Also a concern is that well over a third (40.6%) said it was quite or very difficult to refer women to the appropriate health professional if they had concerns about maternal mental health.

Warwick said: "The quality of postnatal care that women receive appears to be a lottery. We have serious, longstanding concerns about the levels of care for women with mental health problems. It is clear this is a high priority for maternity staff and it is clear they want to deliver a high quality service. However, they are often prevented by doing this either by the system itself or a simple lack of resources.

"The RCM is worried that postnatal care is suffering and women are getting a poorer service because of the continuing shortage of midwives in England. Midwives are often moved from this crucial area to cover shortages in other areas particularly on labour wards. This means that midwives often do not have enough time when they visit women to spot the signs and support women with problems such as postnatal depression.

"We are calling on the NHS organisations responsible for maternity services to respond to our recommendations and to implement them."

Sally Russell, co-founder of Britain's biggest parenting site Netmums, said: "While there is a strong focus on a women's physical heath after giving birth, there is an urgent need for more support for new mums' mental health.

"With over half the new mums in the UK suffering baby blues, we are in danger of letting vulnerable mothers slip through the net and suffer serious mental illness. Post natal depression and anxiety is a condition which can devastate the whole family, not just the new mum. But many women who are struggling often blame themselves for 'not coping', and so don't necessarily know their midwife can help.

"As the RCM report shows, it's vital we train more midwives to help vulnerable women at this crucial time. Every mum deserves to be treated with compassion and have the chance to talk about their mental health as well as their physical health."

The report is the first in a series of five to be published during this year looking at different aspects of postnatal care. It forms part of the RCM's 'Pressure Points' postnatal care campaign focusing on the importance of high quality care after pregnancy. To view a copy of the report visit www.rcm.org.uk/pressurepoints.