Hi
I am 32 weeks pregnant with my second child and slowly coming to terms with the fact that I have mental health issues related to pregnancy and the postpartum period.
I will be very interested in what you have to say about the medicalisation of PND and how it lays the causes for maternal distress in chemical/hormonal imbalances in the mother with little apparent public recognition of the role of past experience and current social support. The preventative side seems totally absent, is this true in lots of cases?
I think my case is probably pretty typical. I grew up in a chaotic abusive (yet solidly middle-class) home with a cruel alcoholic father and a distant, neglectful mother. I have a pretty typical psychological profile of a first-born child from this type of background: I am ultra-high achieving, perfectionistic and relentlessly self-critical with a deep sense of shame and the idea I am responsible for just about everything in the world. I've had counselling/therapy on and off and more or less manage really functionally but in pregnancy my defences lower and my desire for control and certainty, plus tendency to see threat in anything I can't control, goes haywire.
There is also a family history of mood disorders, puerperal psychosis and PND.
I had antenatal OCD and depression in my first pregnancy but never sought help. All was well during labour and birth (for which I prepared as if it were a marathon) until the second stage, when my large post-dates induced baby got stuck and there was a panic and brutal rotational forceps delivery. In a state of absolute horror at his birth and how I had "failed", I went into an anxiety state and remember nothing of his first 72 hours apart from brief, brutal flashes of an incredibly nasty midwife who basically did her best to humiliate everyone on our ward (e.g. "what do you mean it hurts? Silly girl, of course it hurts, if you think this is the least pain you will feel as a mother you are very naive indeed").
Cue a very typical story of the inevitable breastfeeding problems following this type of birth leading to "intervention" from the NHS which consisted of asking me to feed 10-12 times every 24 hours, expressing and refeeding after every one: baby losing weight, immense sense of failure, battling on regardless. Distressed, hungry baby screaming 24-7. No family support other than my husband (we live abroad). No friends available (none had kids, all drifted very fast after giving initial gifts etc). A deep snowfall combined with severe postnatal perineal trauma which meant I couldn't walk also kept me housebound for nearly 7 weeks as I couldn't drive....
It's hardly rocket science that in these circumstances, and with a history that makes me prone to anxiety and depression, I started to slide... and it's hardly amazing that now, at 32 weeks pregnant, my anxiety levels about after the birth are sky-high.
And yet, despite having a label of moderate OCD and depression, there is NO plan for my labour. I have had health professional after health professional try to terrify me with stories of how badly wrong an elective section could go (despite never asking for one) and I have had several almost promise me a wonderful, calm second birth (which they can't, and shouldn't).. I had the supervisor of midwives say "listen you may think you are, but you're clealry not one of the mad ones" 
. There is no CBT available despite NICE guidelines and my initial referral to the Perinatal Mental Health team happening at 6 WEEKS PREGNANT.
I just feel that the chances of a recurrence of PND/PN-OCD etc are absolutely MASSIVE and that there's good awareness that it might be worse this time.. and yet the whole approach is, well, let's wait and see. Go on the meds. We will just let you labour the same as any other woman despite the fact you are terrified and anxious and that doesn't augur well for your delivery, and despite the fact a poor delivery might psychologically damage me further. It's very much hands-off and "watchful waiting" just to see do I totally and utterly lose it. It's also very frustrating to have been asking for help to avoid a recurrence for this whole pregnancy and to have nothing more in place a few weeks ahead of the birth other than a handful of antidepressants. There must surely be more cost-effective ways of preventing mental health dysfunction than just letting people at it because they aren't in a total heap (yet).
I would love someone to help me plan my birth without trying to terrify me. If only they realised the extent to which I live in terror every day.. a cs is nothing in comparison but they have now successfully added it to my list of things to freak out and obsess about so that I feel totally out of control thinking of having to birth this child. Great planning, NHS.