The Importance of Maternal Wellness:

Working as a doctor in General Practice in South-West London has given me the opportunity to connect with hundreds of patients a month for years. Over the last 15 years I have become increasingly interested (and concerned) regarding the huge strain on women around matrescence. Seeing the same patterns over-and-over again, I started reflecting on why this is happening but more importantly what we can do to prevent this and optimise this critical (and hopefully beautiful) time of a woman’s life. A woman has the right to happiness, but aside from this, if a mother is physically or mentally unwell, significant pressure spills over onto every other member of the family. Childhood mental illness is increasing alongside maternal mental illness and I suspect this is not a coincidence.

A scientific paper published in 2024 reported that maternal happiness boosts child brain development and there is a plethora of evidence to support this idea – a happy and well mother has numerous lifelong positive effects on their children’s physical and mental health. The reverse is sadly true also. Undiagnosed and untreated maternal mental illness has catastrophic consequences for their children. Associations have been made between low birth weights, structural neurological changes and poorer cognitive development in children who are exposed to maternal mental illness. The negative outcomes in these children are far reaching and can be lifelong.

Recorded perinatal mental health diagnoses, such as post-natal depression, are sky-rocketing in the UK and we know that many more women are suffering undiagnosed. Maternal suicide is rising and even if things don’t reach this catastrophic level, the road that leads there is gradual, insidious and dark. A home life affected by maternal mental illness causes life-long trauma for everyone around them. Fathers can support to some extent, but the reality is that the breast-feeding woman on maternity leave often bears the brunt of this huge life change, at least at the beginning. The children in these situations lack a stable loving care giver in the early months and years when it is so essential, leading to life-long trauma responses in them that are well documented. By the time women have presented to a doctor, often there has already been months of significant suffering at home. Why could this be happening at a time when women have never been more independent, educated and free?

There are the classic risk factors for maternal mental illness that medics are trained to look out for: history of mental illness, preterm birth, unexpected pregnancies, domestic violence to name a few but, for multiple reasons, there are a huge number of women going under the radar and being missed. National funding and awareness programmes have never been higher but numbers of maternal mental illness are not decreasing.

When I first started consulting in general practice, I was shocked at the number of women who were outside the expected cohort of the ‘at risk’ group but I was equally fascinated at the number of women coming to see me who had no idea that they may be experiencing symptoms of peri-partum mental illness. These women present to a healthcare professional after encouragement from family members or partners, they may repeatedly book appointments for their newborn needing reassurance or checks, they may present during a sudden deterioration associated with psychosis or harm to themselves or their baby. When I gently suggested there might be signs of depression, anxiety, post-traumatic stress, burn out, obsessive compulsive disorder or psychosis, their reactions could vary enormously.

There is a cohort of women who can be highly professional and successful in every sense of the word: career, relationships, socio-economic status, fashion and are very much in control of their world. They are thriving and hitting every target expected of them on paper and yet things sometimes aren’t as perfect as they seem. After years of structure, logic and order, the chaos, lack of control and sudden shift change into motherhood can derail women causing huge issues in their home life.

London, like other cities, is a dynamic multi-cultural society. Many young families do not have family support close enough to practically help. Communities like antenatal classes have been invaluable in creating support networks but they have been created from absolute necessity and they are not enough. Most of my patients have no idea what the first two weeks post-partum will be like, let alone the first five years of motherhood. It’s not discussed or publicly acknowledged. Even medic colleagues of mine, having been through years of medical school and training, were completely shocked by the actual experience of childbirth and the first 2 years of motherhood, and the psychological scars remain years after. Girls are no longer exposed to a female community in the way they once were leading to many arriving at motherhood with little idea of simple basic things that can make everything move in a smoother way. Books are helpful to some extent but cannot replace real hands-on nurturing and education from the wider community. Women are marching through their teens, twenties and thirties without an idea of what is waiting for them and in some circumstances the consequences can be catastrophic.

Modern life holds some accountability. Women and mothers try to maintain the seemingly perfect life of organic food, smooth styled hair, parent-teacher associations and gym memberships whilst working full time jobs and sleeping 2-4 hours a night. Some women put pressure on themselves from a background of anxiety or low self-esteem. Some pressure comes from societal expectations, social media and, disappointingly, other women. Workplaces can be hostile and unsupportive. On paper, businesses may promote flexible working, late start times, part time work but in practice many mothers who work ‘part-time’ in professional roles are doing a full-time role squeezed into 3-4 days with a lower salary.

Professional women may wait to start a family. In vitro fertilisation offers miracles but the journey can be arduous and emotional, sometimes leaving irreversible scars on an individual and the relationship. Ironically, the peri-natal time is sometimes not what was imagined or dreamed of, causing much pain and leading to mental illness. Additionally, the ways that women tend to subconsciously manage their mental health – strenuous exercise like running, meditation, de-cluttering, socialising – will suddenly and unexpectedly not be possible for a period of time post-partum. This occurs in a moment of real stress and sleep deprivation, alongside hormonal, physical and emotional change. This storm can cause significant mental instability even in the strongest person.

In many cultures the post-partum time is seen as the fourth trimester and is a precious time that must be honoured. In the Western culture this is perhaps less understood and some women I meet are back at work within 6 weeks. I advise all my patients to ‘take a moment…breathe…and transition’. If you resist the change and adaptation, often months and years later things can unravel. Society must respect the huge changes that new mothers are going through – hormones, stretching and surgical scars take several months to heal and equilibrate. The process to adapt psychologically may take longer than expected. Compassion – from self and the wider community – is sometimes lacking.

Neurodiversity like ADHD and ASD are classically under-estimated and undiagnosed in women. Many of my patients present with relevant symptoms late in their 40s and 50s as their children are diagnosed and they gain insight into their own behavioural traits. They begin a journey of discovery which casts light over a lifetime of struggles. Imagine the burn out and depression rates in a woman caring for a new-born 24 hours a day, who already has issues with organisation, procrastination and social connections. She is suddenly unable to mask these characteristics, as she is stretched beyond capacity, sleep deprived and drowning in responsibility and perceived failure. Neurodiversity, especially when undiagnosed, is major cause of anxiety and depression and it can emerge at a time when the woman is put under significant pressure such as having a new baby. Personal relationships can suffer as a result, in a moment when they are most important.

It is absolutely fundamental to prepare our girls to walk into this journey strong, empowered and well. To start motherhood with no understanding about the process is like running a marathon with no prior training – you may complete it but there will be intense pain along the way. If there are traits of anxiety or low mood, family history of mental illness or any physical concerns address these preferably before or during pregnancy. Importantly, if you have a ‘type A’ personality’ – high achieving, professional, busy, a ‘perfectionist’ – prepare for a change of pace. Prepare for possible chaos and think about how you might deal with this. Consider what changes may be essential for your wellbeing and health.

Previous balance has been lost and in the last 20 years and the trends we are seeing are going in the wrong direction. We need to understand that prevention is better than cure and it is our duty to honour our foremothers to promote choice and balance for ourselves and our daughters. We need to empower the women of our society to be physically and mentally well as they approach matrescence with their eyes wide open, ready for the change that needs to come with the journey. Women, and their children, deserve better and the first step on this journey is via maternal wellness.