Professor Anthony McCarthy:

There were plenty of interesting questions there. The Deputy is an unusual politician in that he has read Bowlby.

I am an unusual psychiatrist in that I trained as a psychoanalytical psychotherapist and a cognitive analytical therapist. I have read Bowlby as well.

We could talk all day about the baby being inside or outside, whether is it lonely and that separation issue that was mentioned, but it is especially important that we see an individual mother. For some mothers, when the baby is inside, they feel that it is safe in there. When the baby comes out, they are terrified or worried or there is a sense of loss. For others, they feel completely out of control with the baby inside and want the baby out so they can hold it. A mother who has lost a baby before from a stillbirth or miscarriage wants that baby out. Some women are desperately attached to the baby inside. Some are not because they have three other children and people are telling them they should be attached, but they do not have time. Those women know that once the baby is born and they have a few weeks of sleep and toast and tea, they will love their baby in the long run. Everybody is different and it is desperately important to deal with the individual mother and not think that this is traumatic. It is about what is the issue for this particular woman with her history, circumstances and family, etc.

The Deputy made a reference to clinical depression to being almost normal. To be challenged by birth is very normal. All of the experiences are demanding. Some 60% of mothers are struggling. When we use the term "post-natal depression" for 11% of women, that is a very useful label simply to highlight that it is a serious time of struggle for so many women. Post-natal depression is not a thing. It is a very useful label that says, "This is a struggling time." Some women are depressed, anxious, distressed, adjusting, traumatised or have had a very difficult birth experience. For the majority of those women who are depressed, it is understandable depression, not clinical depression but it triggers clinical depression in some women. One of our jobs in terms of risk assessment is to ask if it is the normal depression everybody has had at different times in their lives if they are sensate human beings who have any cop on and life experiences versus clinical depression that we need to address. Understanding the difference is important.

On speed of delivery and leaving hospital, some women cannot wait to get out. They did not want to be in there for the birth in the first place and they want to get home, and that is a good place. Others want to get out because they are terrified and anxious; that is a sign of something else. For still others, they could benefit from the support in the hospital and, yes, because the wards are very overstretched, they are leaving earlier than they should and things are missed because of that. Again, it is always about looking at the individual person in front of us.

We could talk about mental health versus well-being until the cows come home. It is sometimes a bit like changing the name of the Windscale nuclear reactor. You can change the names, but at the end of the day, there will be a lifelong issue regarding how to name normal mental distress and difficulty and not stigmatise that versus recognising that sometimes it has moved into a situation where someone's brain is in trouble. In one person stress gives them an ulcer, in somebody else it makes their eczema or psoriasis come out or their immune system crash, and sometimes stress and challenges get into the brain and create a brain problem. It is about trying to find labels that are going to catch that accurately without stigmatising or making people react to it. I would love the time to come when people will recognise that it is not just equivalent to physical health difficulties, but equally important and valuable, and we will not get hung up about the approach to it;, we will just want to make it better, rather than worrying about stigmas. Within the five minutes we had today, I would have loved to talk about dads. When I first started in the National Maternity Hospital 26 years ago, my wife's first question was, "Will you do anything for dads?" I said, "Oh my God, the services for women are so appalling, I am just starting. Dads are going to have to wait". They are a hugely important part. We see dads frequently and accessing and supporting them is also a key part. We should have much more resources for them.

I will finally deal with maternal death. There is a difference with a death caused by birth. This classification occurs in the first six weeks after the birth or within the first year - there are different classifications. The second most common reason a mother died during the first year after birth last year was suicide. It varies from year to year. There have been years where in Britain and Ireland suicide was the most common cause, but it is always one of the top two or three causes of maternal death. That is a death within the first year after the birth of the baby.