The perinatal period is uniquely vulnerable. Mothers navigate profound biological, psychological and social changes often while carrying histories of trauma, discrimination and inequity. In recent decades, the field has rightly moved toward integrating maternal and infant mental health, recognising their inseparability. This shift has been transformative. Yet the challenge now is balance: ensuring mothers are supported as individuals with their own histories, needs and complexities.
Donald Winnicott, a paediatrician, psychoanalyst and clinical researcher, reminds us that “there is no such thing as a baby. There is a baby and someone.”1. Babies exist in relationship, and those relationships depend on the health and autonomy of the mother.
In the drive to ensure babies are safe and thriving, mothers risk being eclipsed by the very role that connects them to care. When we focus more on attachment or parenting outcomes than on the woman’s own reality, we lose sight of the person whose wellbeing makes those outcomes possible.
The stakes of overlooking maternal mental health are not abstract. In Australia and globally, suicide is the leading cause of death in the post-natal period. For too many women, overlooked or poorly supported mental health issues in pregnancy and the period following risks their lives, not just their wellbeing. Obstetric and midwifery teams work with extraordinary dedication and urgency to ensure that women are discharged after complex pregnancy and birthing journeys in the best possible physical condition while mental health concerns or deteriorations may be missed.
When complications arise, even well-meaning family and friends can misunderstand the mother’s wellbeing and any potential trauma she may be experiencing. In some ways, motherhood can be seen as a checklist of sorts — pregnancy, birth and then parenting. There is nothing inherently wrong with the idea of this list, except that too often, mental, emotional and social health aren’t on it or at least given the same priority.
St John of God Raphael Services strives to acknowledge and support mothers when they are exhausted, grieving, ambivalent or afraid. We see those breastfeeding on our couches while finding words for what was once unspeakable. This is the everyday complexity of motherhood: emotional, physical and psychological labour unfolding all at once. This capacity is what makes mothers extraordinary. But it’s also what makes their needs easy to miss.
We accept referrals for women with diagnosable mental health conditions and, while they hold their babies, we hold them at the centre of care. Perinatal support is not just about parenting, it is about guiding women through a profoundly vulnerable and transformative stage, recognising that safety, rest and recuperation are often out of reach.
Holding mothers at the centre of their care reclaims the full complexity of women’s experiences in the perinatal period and validates their needs beyond their parenting role. It acknowledges the full ‘mother lode’ of biological, psychological, social and systemic burdens mothers carry. Parenting support and infant-focused interventions remain essential, but holistic healing demands that perinatal services check their therapeutic ambition and hold space for addressing what women in the perinatal period bring into the consulting room. Doing so is both a matter of justice and efficacy: mothers who receive safe, specialised care for their mental health are more able to nurture themselves and their children.
That’s the work we do at St John of God Raphael Services. We understand that centring mothers means doing more than asking about physical recovery or how baby is feeding. It means asking about safety, shame, violence, race, identity and inequity. It means creating services that are safe for disclosure, equipped for complexity, and grounded in the dignity and autonomy of mothers themselves. We offer trauma-informed, client centred support that validates the full spectrum of maternal experience.
We feel privileged to play our part in the sector and encourage those working with new mothers to join us as we continue advancing services that integrate infant outcomes with a whole-of-mother approach and expand the definition of what is true ‘perinatal care’.
1 Winnicott, D. W. “The Theory of the Parent Infant Relationship”, in The Maturational Processes and the Facilitating Environment (Studies in the Theory of Emotional Development). Routledge, 1965 (original papers from around 1960)
