As many as one in five women will experience a diagnosable mental health condition between conception and one year after their baby's birth. Mental illness is pregnancy's number one complication, yet it remains underdiagnosed and undertreated, according to a leading perinatal psychiatrist.
The Hidden Crisis
Dr Edna Lekgabe, a perinatal and reproductive psychiatrist, writes that mental illness is the most common complication of pregnancy and the postnatal period. Depression and anxiety are most prevalent, but the spectrum includes post-traumatic stress disorder after birth trauma, obsessive-compulsive disorder centred on intrusive thoughts of infant harm, and rare but devastating psychotic episodes.
Despite affecting up to one in five women, perinatal mental health conditions do not receive the same universal screening, funded treatment pathways, or clinician training as physical complications like gestational diabetes or pre-eclampsia.
Stories of Suffering
Dr Lekgabe describes a composite patient, Mia, who was 32 weeks pregnant and had not slept properly in two months. Her GP dismissed it as "just pregnancy insomnia," and her obstetrician suggested going to bed earlier with a pregnancy pillow. By the time she reached specialist care, she was planning how her partner and baby would be better off without her.
"That sentence is a diagnostic failure," Dr Lekgabe writes. "It means that somewhere along the way, a woman's suffering was reframed as inadequacy."
Structural and Cultural Barriers
Australia has pockets of excellence, such as dedicated mother-baby units and specialist perinatal psychiatry services, but access is uneven. In the public system, waitlists stretch for months. A woman deteriorating at 28 weeks cannot wait until her baby is three months old for an assessment.
Part of the problem is cultural. The transition to motherhood has been romanticised to the point where distress feels like failure. The term "matrescence" describes the identity shift of becoming a mother, but there is a risk that normalising language minimises clinical illness.
What Meaningful Change Looks Like
Dr Lekgabe outlines three key changes: integrated mental healthcare within maternity services, workforce investment to increase the number of perinatal psychiatrists, and public literacy so expectant parents understand that perinatal mental illness is common, treatable, and not a reflection of character.
"Mia did get better," she writes. "She started medication safe in pregnancy, engaged with a perinatal psychologist, and had a supported birth plan. Not every woman who walks the path Mia walked finds that team."
Support is available: In Australia, Beyond Blue (1300 22 4636), Lifeline (13 11 14), MensLine (1300 789 978). In the UK, Mind (0300 123 3393), Childline (0800 1111). In the US, Mental Health America (988 or 988lifeline.org).
