The first national study of perinatal mental health care revealed only five of Scotland’s 14 health boards offered specialist treatment in the community.
A third of women cared for in hospital were placed in general adult units, where they were often separated from their babies for prolonged periods, which is against official guidelines.
The report by the Mental Welfare Commission (MWC) found some health boards were under-referring women to the specialist units in Glasgow and Livingston, while women identified a feeling of stigma over seeking help and fears that their children might be taken away.
Some women faced a 250-mile round trip to one of the specialist units.
Dr Gary Morrison, MWC executive medical director, said: “One reason appears to be the difficult choice many women are faced with – whether to move away from their local community to be treated in a specialist unit, or whether to accept care in a non-specialist ward nearer home.
“This is a hard choice to make, and can put additional pressure on a mother, and on her family at home.”
Each year up to 11,000 babies could be born to mothers in Scotland who are experiencing mental health difficulties of some kind, the MWC says.
Dr Roch Cantwell, perinatal chair of the Royal College of Psychiatrists in Scotland, said: “This report is a timely reminder that, while Scotland has done much to develop services for pregnant and postnatal women who experience mental health problems, there are still significant gaps in service provision.
“It should not be the case that, at such a critical time for a woman and her developing child, where she lives can determine her access to specialised advice and treatment.”
Mental health minister Maureen Watt said discussions were already under way on how to develop a clinical network for perinatal care.
She said: “Mental health is an absolute priority for the Scottish Government and we are committed to improving the care and attention we give mothers with mental health problems, particularly during pregnancy and after the birth of their child.”