Introduction: According to the guidelines, health-care personnel should have routines to identify depression and anxiety,but no screening tool is required. The aim of the study is to describe how midwives in antenatal care describe strategiesand requirements when following up pregnant women at risk of developing perinatal depression. Methods: Study is designed as qualitative descriptive study. It includes authorized midwives who work in prenatal carein Western Norway (n = 11) were interviewed between October 21 and November 02, 2021. Verbatim transcribedinterviews were analyzed using manifest qualitative content analysis. The study was performed in accordance with theConsolidated Criteria for Reporting Qualitative Research. Results: The manifest content analysis revealed three categories: (1) Midwife as haven, (2) Growing into the professionalrole as a midwife and (3) Organizational challenges in antenatal care. The midwives also expressed that they feltthey were saddled with a great responsibility that could be a lot to bear. Clinical experience was highlighted as essentialsources of self-confidence in work. Conclusion: Identified categories confirm some crucial issues in midwifery-led maternity care, such as the need for continuousprofessional training, clear local guidelines, and sufficient time for consultation with women at risk of developingperinatal depression. The findings also reflect the importance of early detection of these women to offer support andassistance throughout pregnancy and after delivery.