I knew the question was coming. This was my fifth pregnancy. Care providers always ask it at the end of every prenatal appointment.

And my heart pounded in my chest.

“Is there anything else you would like to discuss?”

Nine and a half times out of ten, my answer was the same: “Nope! I think I’m good!” I was pretty much a pro at pregnancy. I’d read all the books and the articles—I’d even written some of the articles.

But this time, as my first prenatal appointment for my unexpected, fifth pregnancy came to a close, my palms started to sweat. I looked at my husband, thankful he was there for emotional support.

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When the midwife asked, “Is there anything else you would like to discuss?” I reached out my hand to him, and he reached back, gripping my fingers tightly.

I took a deep breath, bringing the words to the surface that I had practiced over and over again in my mind.

“Actually, yes,” I said, my voice quivering with emotion. “I’m . . . not doing very well. I’m really . . . really struggling.”

I told her how we were stunned by the positive pregnancy test only three weeks after we moved from the United States to England with our four sons.

The pregnancy, combined with culture shock, adjusting to military life, international move exhaustion, setting up a home, enrolling all four boys in school, and hyperemesis gravidarum pushed me into a significant mental breakdown.

I was in a bad place.

The midwife was kind and thorough. She asked a lot of hard questions, and I answered them honestly as I twisted damp tissues in my hands. She sent me to the mental health office immediately after my prenatal appointment to see a counselor.

The deep darkness of my depression lasted until around 20 weeks of my pregnancy. Medication for my debilitating nausea and vomiting greatly helped my mental state improve and counseling provided strategic check-ins for me to be honest about my mental health. I still had bad days off and on during the last half of my pregnancy but nothing like the intensity I endured during the first few months.

Telling my care provider the honest truth about my mental health at my prenatal appointment was one of the hardest conversations I have ever had.

I felt emotionally stripped naked, bearing my weaknesses and vulnerabilities to a stranger as I shook from emotion and fear.

But I knew I had to show up for myself. I had to admit I was struggling, to say out loud, “I am pregnant and depressed” for my life and mental health to go in a different direction.

I had to do it—for myself, for my husband, for my four boys, and for my unborn baby.

It was only when I was honest with myself and others, inviting them in to help me, that I had hope that things would get better.

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The day my baby was born, the midwife I saw at my very first prenatal appointment was coming off the night shift and decided to stay and help with my C-section.

“It just felt very appropriate,” she said, smiling at me with a knowing gaze. Tears filled my eyes as I smiled back.

Yes, it was so very appropriate.

She was there at the beginning when I was dealing with so much darkness, despair, and depression. It felt so very right and good that she was going to be with me to celebrate the joy-filled birth of my precious daughter.