Mental health specialists are calling for expanded psychiatric support within maternity services, warning that perinatal mental illness remains one of the most widespread yet under-recognized complications associated with pregnancy and childbirth.

The concerns come amid growing attention to gaps in screening, specialist access and treatment pathways for women experiencing psychiatric symptoms during pregnancy and the postnatal period.

Experts in the field say many women continue to face delayed diagnosis and inconsistent care despite national guidelines recommending routine psychosocial screening during pregnancy.Edna Lekgabe, a perinatal psychiatrist and co-founder of WARM Health Collective⁠, said the scale of the issue remains poorly understood relative to other pregnancy-related complications.

“Mental illness is the number one complication of pregnancy and the postnatal period,” Lekgabe wrote in an analysis examining failures within current maternity mental healthcare systems.Perinatal mental illness refers to psychiatric conditions occurring during pregnancy or within the first year following childbirth. According to specialists and public health agencies, up to one in five women experience a diagnosable mental health condition during that period.

Conditions can include depression, anxiety disorders, post-traumatic stress disorder related to traumatic births, obsessive-compulsive symptoms involving intrusive fears about infant harm, and, in rare cases, postpartum psychosis.Medical experts classify postpartum psychosis as a psychiatric emergency because of the heightened risk of self-harm, suicide or harm to the infant if untreated.

Lekgabe described a recurring clinical pattern in which women initially report symptoms during routine antenatal care but are reassured that emotional distress, insomnia or anxiety are normal features of pregnancy.

According to her account, many patients eventually reach specialist psychiatric care only after symptoms have significantly worsened.One illustrative example described a pregnant woman experiencing severe insomnia, hopelessness and suicidal thinking during the third trimester after earlier concerns were dismissed as routine pregnancy-related stress. The psychiatrist noted the case was fictionalized but based on recurring patterns observed across hundreds of patients.

The issue has gained increasing attention internationally as healthcare systems attempt to integrate mental health more fully into maternal care frameworks. Public health researchers have repeatedly linked untreated perinatal psychiatric illness to poorer outcomes for both mothers and infants, including impaired maternal functioning, disrupted bonding and elevated long-term developmental risks for children.

Despite those risks, specialists say mental healthcare remains inconsistently integrated into maternity services.In Australia, national guidelines recommend routine psychosocial screening during pregnancy and after childbirth, with many providers using the Edinburgh Postnatal Depression Scale, a standardized questionnaire designed to identify women at risk of depression and anxiety.

Lekgabe argued, however, that screening tools alone are insufficient without accessible treatment systems behind them.

“A screening tool is only as good as the pathway behind it,” she wrote.Mental health advocates and clinicians have raised concerns that women identified as high-risk frequently encounter lengthy delays for psychiatric assessment or psychological treatment. In Australia’s public healthcare system, wait times for mental health services can extend for months, particularly outside major metropolitan areas.

The psychiatrist pointed to disparities between urban and regional care availability, noting that specialist mother-baby psychiatric units and dedicated perinatal mental health services remain concentrated in larger cities. Women dependent on public healthcare or unable to afford private treatment often face more limited access.

Organizations including PANDA (Perinatal Anxiety & Depression Australia)⁠ and Centre of Perinatal Excellence (COPE)⁠ have sought to increase public awareness and improve access to support services across Australia.

Lekgabe also identified cultural expectations surrounding motherhood as a barrier to early intervention. According to her analysis, social narratives that idealize pregnancy and early parenthood can lead women to interpret severe psychological distress as personal inadequacy rather than a treatable medical condition.

The psychiatrist referenced the growing use of the term “matrescence,” which describes the emotional and identity transition associated with becoming a mother. While acknowledging the concept’s value in normalizing emotional adjustment, Lekgabe warned against conflating ordinary stress or disorientation with clinically significant psychiatric illness.

“There is a vast difference between the disorientation of new parenthood and a major depressive episode,” she wrote.Specialists in maternal mental health have increasingly emphasized that early symptoms are often minimized both by patients themselves and by healthcare systems focused primarily on physical outcomes such as blood pressure, fetal development and obstetric complications.

Lekgabe said many women internalize the belief that struggling emotionally reflects failure as a parent rather than evidence of illness requiring treatment.“I thought I was just a bad mother,” she said patients frequently tell her.The psychiatrist argued that statement reflects systemic diagnostic failure, particularly when women interact repeatedly with healthcare providers without receiving meaningful psychiatric evaluation or referral.

Mental health professionals have advocated for a more integrated care model in which psychiatric services are embedded directly within maternity clinics and obstetric care settings. Under such systems, psychiatrists, psychologists and mental health nurses would work alongside obstetricians and midwives rather than operating through separate referral systems.

Lekgabe identified three priorities for reform: integrating mental healthcare into maternity services, expanding the number of trained perinatal psychiatrists and improving public understanding of perinatal psychiatric illness.Australia currently has relatively few psychiatrists specializing in perinatal and reproductive mental health compared with overall demand, according to clinicians in the field.

Training opportunities within the subspecialty also remain limited.The psychiatrist stressed that perinatal mental illness is highly treatable when recognized early and managed appropriately. Treatment options can include psychotherapy, medication considered safe during pregnancy, supported birth planning and coordinated postpartum care.

The fictionalized patient example described in Lekgabe’s analysis ultimately improved after receiving psychiatric medication, psychological treatment and coordinated maternity support tailored to her mental health needs.However, the psychiatrist argued that many women never receive that level of coordinated intervention.

“Not every woman who walks the path Mia walked finds that team,” Lekgabe wrote.

Mental health organizations globally have increasingly highlighted maternal suicide and severe psychiatric illness as major public health concerns linked to inadequate perinatal care systems. Several countries, including the United Kingdom and Australia, have expanded investment in specialized maternal mental health programs over the past decade, though advocates argue access remains uneven.

Lekgabe said greater public literacy around perinatal psychiatric illness could help reduce stigma and encourage earlier intervention among expectant parents and their families.

“We need expectant parents and their families to understand that perinatal mental illness is common, treatable and not a reflection of character,” she wrote.

For years, she wanted a child. After a decade of waiting, hope and uncertainty, pregnancy finally arrived carrying both joy and fear in equal measure. What followed, however, was not the soft, instinctive transition into motherhood that culture often promises, but a physically traumatic birth, emotional numbness and a long struggle to recognise herself in her new life.

During pregnancy, she found herself largely alone. Her husband, though supportive and loving, was frequently absent, consumed by the demands of a startup consultancy he had recently founded with two academic partners.

Medical appointments, including an amniocentesis prompted by concerns over possible chromosomal abnormalities, were often faced without him because he was abroad for work.

She attended prenatal classes, but support systems felt limited. Only one person in her close circle had children, and her relationship with her own mother, who lived in Italy, was strained. The isolation deepened her anxiety, particularly because childbirth itself frightened her.

When she raised those fears with her general practitioner, she recalls receiving a familiar reassurance that did little to ease them.“Don’t worry, birth isn’t an illness,” her male GP told her. “It’s all perfectly natural.”She felt the dismissal ignored her lived reality. She was asthmatic and suffering from undiagnosed endometriosis that caused severe pain every few weeks.

Pregnancy did not feel simple or natural. It felt uncertain and medically significant.Still, she felt deeply connected to the child growing inside her. She recognised her daughter through movement alone—the shape of limbs pressing against skin, strong kicks in response to passing sirens, a physical presence both strange and intimate.

She imagined a temperament already forming: long legs like her father, a temper like her own.She expected love to be immediate. After waiting so long, how could it not be?Her due date passed. Then another week.

Then another. At more than 44 weeks pregnant, she says she had to insist repeatedly before her GP agreed to induction. Only when hospital monitoring showed signs of fetal distress did medical staff finally intervene and break her waters.

Labour lasted 20 hours.

She describes induced labour not as a gradual progression but as a sudden collapse into nausea, pain and exhaustion. Hours passed with no progress. She was unable to receive an epidural at first because she was not dilating. The pain became all-consuming.

At one point, fearing the worst, she asked her husband to make a promise: if doctors had to choose between saving her life and their child’s, he should choose the baby.“I am not going to lose either of you,” he replied.

She remembers University College Hospital at the time as a place that inspired little confidence—a crumbling Victorian building with filthy bathrooms, blood on the floors and junior doctors exhausted by punishing shifts. Around her, the maternity ward echoed with the sounds of women in labour: groans, cries, gasps and fear.Eventually she received an epidural, but the baby remained stuck.

Just before midnight, an emergency forceps delivery and episiotomy were performed. Her husband later told her there were 13 people in the room.Then their daughter arrived.She weighed just under 4.5 kilograms—almost 10 pounds.

The mother had lost so much blood that the experience felt, in her words, like surviving a car crash. Her husband, standing in blood-soaked jeans, was overwhelmed with joy.“Isn’t she wonderful?” he said.She felt nothing.

She describes the absence of emotion not as rejection, but as total numbness, as though the epidural that had numbed her body had also severed access to feeling. She spent the night awake in the recovery ward waiting for the expected rush of maternal love that never came, listening to other women crying as anaesthesia wore off.

Instead, she felt transported back to boarding school dormitories, where she had learned early to suppress everything except anger.“Rage has served me quite often as a stimulant against exhaustion,” she writes. “Every woman who goes through childbirth has, I believe, been through the equivalent of war.

”She compares childbirth to trauma rather than celebration, arguing that many women leave the experience carrying symptoms closer to post-traumatic stress than to joy.

She believes poor maternity care intensified that reality.Her experience took place during years of severe strain on Britain’s National Health Service, when long-term underfunding and overstretched staff affected standards of care.

But she also sees a broader cultural issue: motherhood itself, she argues, is often insufficiently respected.At the time, general practice and obstetrics were still dominated by men.

She does not argue that male doctors cannot provide excellent care, but believes many failed to understand how dangerous childbirth could still be, or how often women’s pain was normalised rather than addressed.She was discharged the next day after a blood transfusion and severe physical trauma. She could barely walk.

Her husband worried about her physical recovery, but neither of them recognised the mental damage taking shape beneath it.When the baby began crying—night after night, almost without pause motherhood became a contest between exhaustion and fury.

“Once our baby began to cry relentlessly every night, all night, it felt like a battle between my rage and hers,” she recalls.Then one day, something changed.Her daughter, whose eyes had until then seemed distant and unfocused, suddenly looked directly at her. Then came a smile—clear, unmistakable and full.It was not simply recognition. It felt like acceptance.

“She seemed not only to recognise me, but to greet me with unconditional love and delight,” she writes.She understood intellectually that infant smiles are biological survival mechanisms, but the emotional impact was overwhelming.

The joy felt so sharp it was almost painful.“Oh!” she remembers saying. “It’s you. It’s you.”That first smile altered everything.The sleepless nights did not disappear. The crying continued. But something fundamental shifted in her understanding of motherhood, of love and even of her own mother.

Her relationship with her mother, long marked by pain and distance, softened. She began to understand her mother’s own unresolved grief and emotional absences not simply as cruelty, but as the result of childhood bereavement and wounds never healed.Motherhood brought not only responsibility, but perspective.

As a writer, she found that literature had offered little preparation for the reality of childbirth. Victorian novels she loved moved quickly past pregnancy and motherhood, treating them as narrative transitions rather than lived experiences.

Even contemporary women writers often avoided describing the devastation of birth itself.When she included the physical brutality of childbirth in her 1996 novel A Vicious Circle, critics attacked what one reviewer called “revolting details.”

Yet she says she had still softened the truth, giving her fictional heroine an instant maternal bond she herself had not felt.Years later, much changed. Hospitals improved. Her GP practice became staffed by younger, mostly women doctors. She had a second child, a son, whose birth was entirely different and with whom she bonded immediately.

Her daughter, Leon, grew into a novelist herself—healthy, loving and brilliant.Looking back, she says motherhood brought both unimaginable suffering and extraordinary love.

Public conversation often reduces it to either sentimental joy or unbearable hardship. The truth, she argues, is both.And if the early days felt like darkness, what remained was not the trauma alone, but the light that followed.