Disclaimer: this post discusses mental health, postpartum depression and suicidality, which may be triggering for some readers.

 

I suffered from postnatal depression with both of my children. The second time around it was delayed, but much more severe.

I didn’t struggle because I didn’t love my babies, or because I didn’t want to be a mum. My complex feelings and behaviours weren’t character flaws, or the result of an inherent lack of self-control or integrity.

They were symptoms of fractured physiology and emotional pain.

In my case, there were other layers, both physiological and psychological.

For example, at 5 months postpartum with my second baby I was diagnosed with Hashimoto’s thyroiditis after my thyroid quite literally stopped working. These were my blood results – anyone who knows how to read pathology will be gobsmacked.

In addition to this I had also haemorrhaged after giving birth, so ongoing iron deficiency was another factor in the compounding physiology. I was also still breastfeeding and not sleeping for more than 3 hours at a time during the night - which is generally the norm for postpartum mums.

This wasn’t only due to my baby waking for feeds. I had intermittent insomnia.

And looking back at my pathology, that was no surprise.

In addition to the biological layers – there were psychological and behavioural elements that felt really hard to make sense of.

The mental deterioration was like an avalanche and within another 7 months time I wound up in ED for a major mental health breakdown.

I had already been engaged with supports both from my psychologist who I’d worked with since having PPD with my first baby 4 years earlier, as well as some community outreach personnel who specialised in this area.

When it got to the point that I needed emergency help, I was discharged within hours and sent home with some medication. Told that it was not an emergency. I was sent away alone, and there was no follow up with my loved ones to confirm where I was or what was happening.

What followed from there was something I will do everything in my power to prevent from reoccurring, while also continuing to advocate for.

It took another 12 months, several more mental breaks, a lot of money spent on private therapy and inpatient mental health rehabilitation, medication, family support, and determination to keep getting back on my feet before I started to feel “myself” again.

Now, 2 years later, I can wholeheartedly say I have come out the other side of that, and am probably a more integrated version of myself as a result. However I don’t let myself forget what it feels like to get to that point.

Healing wouldn’t have been possible without help – and a lot of it.

But the help I needed didn’t come from accessibility to the public health system or from emergency care during a crisis.

How many more women will be dismissed because they don’t “look the part” or tick all the boxes that make up a typical crisis criteria, even though they are begging for help?

I remember saying to my partner on the phone while I was hysterical in my car after being dismissed from ED:

“No one is taking me seriously”.

How many more women will have to feel like this?

How many more people will be unable to access the help they need because of shame, judgement, dismissal, and rejection?

How much more systemic failure, lack of education, and public health burden is going to unfold before we change the way we support vulnerable people?

 

The physiological factors we need to talk about

In terms of perinatal and maternal health specifically, let’s have a look at some of the physiological factors that might contribute to mental health decline either during the more immediate postpartum period, or up to months and even years later...

• Hormonal changes: Female sex hormones interact closely with serotonin, dopamine, GABA and other neurotransmitters involved in mood, stress regulation, sleep, appetite etc. Neuroactive steroid changes are increasingly recognised as being highly relevant to developing postpartum depression and anxiety.
• HPA-axis recalibration: Pregnancy substantially alters cortisol and HPA-axis physiology. The postpartum transition, combined with psychological stress and infant-care demands, may contribute to dysregulated stress responsivity in susceptible women.
• Sleep deprivation and circadian disruption: Fragmented sleep is more than simply "being tired." Severe or sustained sleep loss can impair emotional regulation, executive functioning, and stress tolerance and can worsen depression and anxiety.
• Thyroid dysfunction: Postpartum immune rebound can precipitate postpartum thyroiditis, including a subsequent hypothyroid phase. Hypothyroidism may present with profound fatigue, cognitive slowing, low mood and impaired concentration, while thyrotoxicosis may contribute to anxiety, agitation, insomnia and palpitations.
• Nutrient depletion: Pregnancy, childbirth and breastfessing substantially increase nutritional demands. Iron deficiency is particularly relevant following pregnancy or postpartum haemorrhage and can contribute to fatigue and impaired cognition. Folate, B12, vitamin D, iodine, zinc and omega-3 status are also worth considering, although the strength of evidence linking individual deficiencies directly to postpartum psychiatric disorders varies.
• Inflammation and immune changes: Pregnancy involves major immunological adaptation followed by postpartum immune recalibration. Emerging evidence implicates inflammatory and immune pathways in perinatal depression, although this is an evolving area rather than a simple "inflammation causes depression" relationship.
• Brain plasticity: Pregnancy and motherhood involve measurable adaptations in brain regions and networks involved in social cognition, threat detection, reward and caregiving. These changes are normal adaptations, but they occur alongside enormous endocrine, environmental and psychological changes.
• Physical depletion and recovery: Blood loss, pain, surgical recovery, infection, breastfeeding demands, inadequate caloric intake, dehydration and chronic exhaustion can collectively reduce physiological resilience and compound psychiatric symptoms.

 

And what about psychosocial and demographic factors?

Pre-existing psychological vulnerabilities such as personal history of depression, anxiety, PMDD, bipolar disorder, PTSD/c-PTSD, or a family history of mental illness may make women more susceptible to postpartum mental health decline, as well as;

• Birth trauma
• Infant health issues
• Domestic violence
• Lack of family support and social community
• Being a single parent
• Having other children in your care
• Caring for children with disabilities or additional needs
• Having a co-parent who works long hours
• Lack of involvement from the other parent
• Loss of identity and independence – both of which are a very real and valid experience for new mothers
• The compounding mental load
• Financial strain and cost-of-living pressure
• Limited access to healthcare and lack of continuity of care following routine postpartum health screening (if this has been carried out)
• Challenged health literacy or capacity for recognising and communicating personal decline
• Socioeconomic barriers such as geographical isolation, housing & food insecurity, being a member of disadvantaged populations resulting in health inequality
• Cultural stigma

 

The impossible standards of modern motherhood

Not to mention the societal standards women are inundated with on a daily basis on social media and in their wider communities, telling them they need to “gentle parent” and "surrender to motherhood” and stay at home with their kids until they go to school, breastfeed for years, make every bit of food from scratch, be present, stay calm and regulated, limit screens, enroll in extra-curricular activities, have well-behaved kids, find ways to maintain rest and exercise without compromising your children’s routines, be grateful...

Mothers are made to feel guilty for wanting to continue to pursue a career after having kids, and dubbed selfish and delusional for thinking they can do both, for putting their children in care so they can work or simply catch lol up on the endless to-do list without interruption.

Women are told that wanting something for themselves isn’t fair on their children.

Women are shamed for having a night out then parenting with a hangover, or a weekend away that was probably planned months in advance, meanwhile when men do these things nobody bats an eyelid.

The pressure is suffocating.

And this isn’t a new phenomenon.

 

This didn't start with our generation

In the late 19th and early 20th centuries, women’s psychological distress was pathologised as “hysteria” or “peurperal insanity” (more specific to postpartum) which would commonly have them institutionalised.

Some treatments included isolation, restriction of intellectual activity, unnecessary gynaecological interventions, electroconvulsive shock therapy, sedation, restraint...

Women having limited political rights at this time meant that they had a lack of medical autonomy and consent (usually this was provided by their husbands), social noncomformity and unconventional behaviour put women at risk of institutionalisation, institutionalisation often led to women losing access to their children, property and civil rights, medical records were based on the accounts of doctors and husbands; rather than of women’s own personal experiences, and as a whole, motherhood was heavily moralised, with a mother displaying signs of distress and impaired capacity to care for her children or behaving outside expected maternal norms having the potential to be considered both mentally ill and socially deviant.

And while the systemic frameworks have changed over the past century, many of the societal barriers still exist because the conditioning runs deep.

Women have more rights and opportunities now than ever before, yet we are still being submissive. And it is keeping us stuck and sick.

 

The current statistics

• Around 1 in 5 mothers experience a mental health condition during the perinatal period - pregnancy through the first year postpartum
• The economic cost of perinatal depression and anxiety in Australia was estimated at $877 million in 2019 through healthcare expenditure and lost economic participation
• Despite this burden, there are still no comprehensive national Australian data on perinatal mental-health screening, service utilisation or outcomes
• Depression and anxiety are approximately 4 times more common in parents of children with developmental disabilities such as speech delays and autism
• Suicide accounted for 10% of maternal deaths in Australia between 2014 and 2023
• The age-standardised suicide rate among First Nations females in 2024 was 13.3 per 100,000, compared with 5.5 per 100,000 for Australian females overall
• 1 in 3 perimenopausal women experience depression
• Women with PMDD are seven times more likely to attempt suicide
• Women with endometriosis are 48% more likely to be diagnosed with depression
• 1 in 4 Australian women have experienced physical and/or sexual violence from an intimate partner since age 15
• Among Australian mothers, approximately 1 in 3 experience domestic violence and coercive control from an intimate partner between the birth of their first child and that child turning 10

 

 

While women have come a long way, some of these statistics reflect ways that we are still existing largely within an outdated paradigm of social conditioning, unequal power dynamics and chronic over-responsibility.

These behaviours, which previously had been adaptive - maintaining relationships, avoiding conflict, ensuring safety or meeting cultural expectations – have perpetuated harm as modern day women continue to consistently suppress their own needs.

The Self-Silencing Theory

This can be observed in The Self-Silencing Theory, which describes a pattern in which a woman may suppress her thoughts, emotions and needs, prioritise other people's needs and evaluate herself according to external standards in order to maintain relationships, uphold image or avoid conflict.

This isn't simply a feminist theory without empirical investigation.

A 2026 review synthesising 126 studies across more than three decades found self-silencing was particularly associated with unequal or hurtful relationships, traditional gender-role beliefs, relationship conflict and power imbalances, and supported self-silencing as one mechanism connecting these environments with depression.

Earlier reviews have similarly associated self-silencing with depression, eating disorders, poorer psychological wellbeing and aspects of women's reproductive health, including PMDD.

 

The “good woman” paradox

Then there is the “good woman” paradox.

Modern day women have gained enormous freedom compared with previous generations, but many of the old responsibilities never disappeared.

As a result, the modern woman is now be expected to:

• Work like she doesn't have children
• Raise her kids like she doesn’t have to work
• Maintain her relationship with her partner
• Manage the household
• Remember everyone's appointments
• Manage the children's health and wellbeing
• Cook nutritious food
• Maintain friendships
• Care for ageing parents
• Practice “self-care”

And don't complain about any of it.

Women's autonomy has increased enormously over the last 100 years, but many of the systems surrounding motherhood, caregiving, employment and healthcare still operate on assumptions that women's time, labour and health can absorb the cost.

 

What are some ways this could be improved on a systemic and societal level?

• Make healthcare genuinely accessible - affordable GP, psychology, psychiatry and women’s health services with shorter wait times and better rural/remote access, and ensuring appropriate mental health screening is carried out by all healthcare personnel in their practice
• Provide continuity of maternal care beyond birth - routinely assessing the mother, not only the baby, throughout the first postpartum year and beyond
• Integrate physical + mental healthcare - investigate thyroid dysfunction, anaemia, nutrient deficiencies, sleep, reproductive hormones and chronic disease alongside psychological symptoms
• Create safer spaces for disclosure - reduce stigma around intrusive thoughts, depression, anger, birth trauma, difficulty bonding and maternal ambivalence so women can speak honestly without automatic fear of judgement
• Improve perinatal mental-health screening - with clear referral pathways so screening actually leads to timely treatment
• Better recognise unpaid caregiving - acknowledge the economic and societal value of raising children and caring for family members
• Strengthen parental-leave payments - enable families to take adequate leave without significant financial hardship
• Encourage genuinely shared parental leave - reduce the assumption that mothers will automatically become the primary caregiver and absorb the associated career penalty
• Make childcare more affordable and accessible - supporting women's ability to work, study, attend healthcare and maintain financial independence
• Protect women's long-term economic security - address the motherhood penalty in earnings, career progression and superannuation, as well as the pay gaps between men and women
• Increase workplace flexibility without career penalties - flexible hours, remote work, breastfeeding support and family-friendly rostering
• Reduce the invisible mental load - normalise equitable sharing of childcare, domestic work and household administration between partners
• Strengthen domestic-violence and economic-abuse protections - including housing, financial assistance and pathways that allow women to leave unsafe situations without facing poverty
• Improve culturally safe and inclusive care - particularly for Aboriginal and Torres Strait Islander women, migrant/refugee women, women with disability and other underserved populations
• Provide greater support for carers - respite, financial assistance and mental-health support for mothers caring for children with disability or complex medical needs
• Educate adolescent women about health & financial literacy - arming them with information to empower their autonomy
• Invest in prevention, not just crisis intervention - identify biological, psychological, social and socioeconomic risk factors before women reach crisis point
• Challenge unrealistic expectations of motherhood - dismantle the idea that being a “good mother” requires endless self-sacrifice
• Stop individualising systemic problems - resilience, mindfulness and “self-care” cannot compensate for inadequate sleep, poverty, violence, unaffordable childcare or inaccessible healthcare
• Give women permission to retain an identity beyond caregiving - motherhood should not require surrendering financial independence, relationships, ambitions, health or sense of self

Ultimately...

Shift the question from “Why isn't she coping?”

to 

“What does she need in order to be supported?”

 

If anything discussed in this article feels familiar to you, please know that you do not need to wait until you are at crisis point to ask for help. Mental health struggles during pregnancy, postpartum, motherhood and other major periods of hormonal or life transition deserve to be taken seriously.

Consider reaching out to someone you trust and speaking with your GP, psychologist or another qualified healthcare professional. Where appropriate, assessment should consider both psychological wellbeing and physical health, particularly where symptoms such as profound fatigue, insomnia, cognitive changes, anxiety or low mood may have multiple contributing factors.

If you feel that something is wrong and you do not feel heard, you are allowed to keep asking for help, seek another opinion, and advocate for a more comprehensive assessment.

There are Australian services specifically dedicated to maternal and perinatal mental health:

PANDA — Perinatal Anxiety & Depression Australia
PANDA provides specialised support, counselling, information and referrals for expecting and new parents experiencing perinatal anxiety, depression and other mental health challenges.

PANDA National Helpline: 1300 726 306
Visit PANDA

Gidget Foundation Australia
Provides specialist perinatal mental health support for expectant and new parents, including individual psychological therapy, telehealth services and group support. Support is also available following pregnancy or baby loss and traumatic birth.

Explore Gidget Foundation support services

COPE — Centre of Perinatal Excellence
COPE provides evidence-based information about emotional and mental health throughout pregnancy and early parenthood. Their national directory can also help you find specialised perinatal mental health practitioners and services in your area.

Find perinatal mental health support through COPE

If you need urgent support

If you are experiencing a mental health crisis or need someone to talk to immediately, Lifeline provides 24/7 crisis support on 13 11 14.

If you or your baby are in immediate danger, call 000 or attend your nearest emergency department.

And if you have asked for help before and felt dismissed, please keep asking. Seek another practitioner, another service, another opinion, or bring someone you trust with you to help advocate for you.

You do not have to prove that you are struggling enough to deserve support.

 

References & further reading

• Australian Institute of Health and Welfare (AIHW). Perinatal mental health screening in Australia.
  
• Australian Institute of Health and Welfare (AIHW). Maternal deaths in Australia 2021–2023: Trends in causes of maternal deaths.
  
• Australian Institute of Health and Welfare (AIHW). Perinatal mental health screening and identifying risk of suicide and intentional self-harm.
  
• Prasad, D., Wollenhaupt-Aguiar, B., Kidd, K. N., Cardoso, T. A., & Frey, B. N. (2021). Suicidal risk in women with premenstrual syndrome and premenstrual dysphoric disorder: A systematic review and meta-analysis. Journal of Women’s Health.
  
• Balasubramanian, I., et al. (2026). Prevalence and incidence of depressive, anxiety, and insomnia symptoms in perimenopausal and postmenopausal women: Systematic review and meta-analysis. General Hospital Psychiatry.
  
• Estes, S. J., et al. (2021). Depression, anxiety, and self-directed violence in women with endometriosis: A retrospective matched-cohort study. American Journal of Epidemiology, 190(5), 843–852.
  
• Scherer, N., Verhey, I., & Kuper, H. (2019). Depression and anxiety in parents of children with intellectual and developmental disabilities: A systematic review and meta-analysis. PLOS ONE, 14(7), e0219888.
  
• Australian Institute of Health and Welfare (AIHW). Intimate partner violence.
  
• Australian Institute of Health and Welfare (AIHW). Mothers and their children: Family, domestic and sexual violence.
  
• Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander people: Family, domestic and sexual violence.
  
• Maji, S., & Dixit, S. (2019). Self-silencing and women’s health: A review. International Journal of Social Psychiatry, 65(1), 3–13.