Birth Trauma Awareness Week rightly encourages important conversations about difficult births and traumatic deliveries, but as both a midwife and a neurodivergent woman, I believe we also need to pay greater attention to what happens long before labour begins. Many women spend months during pregnancy feeling frightened, anxious or overwhelmed while convincing the people around them that they are coping perfectly well. For neurodivergent women in particular, that pressure to appear calm and in control can become exhausting.

Throughout my years working as a midwife, I have become increasingly aware of how many women apologise for their feelings during pregnancy. They apologise for being anxious, for asking questions, for needing reassurance or for becoming emotional. Many autistic and ADHD women have spent years learning how to mask discomfort, suppress anxiety and present themselves as coping, even when they feel anything but. Pregnancy does not necessarily remove those coping mechanisms, rather in many cases it strengthens them.

At Cocoon Healthcare in Harrogate, where we support women through fertility, pregnancy and maternal wellbeing, I regularly meet women who are carrying far more than they allow themselves to show. Some have experienced miscarriage or previous birth trauma, others have spent years trying to conceive and feel guilty for struggling during a pregnancy they wanted desperately, and some are living with significant anxiety but feel unable to talk about it because they worry they will be seen as ungrateful or negative.

For neurodivergent women, pregnancy can bring particular challenges that are not always obvious to those around them. Many women tell me they rehearse conversations before appointments, carefully consider how they express concerns, or spend considerable energy trying not to appear overwhelmed. Some become highly skilled at masking their distress because they fear being misunderstood or judged, and the result is that women who are struggling the most can sometimes appear to be coping the best.

The pressure to perform pregnancy in a particular way can be incredibly powerful. Society often presents pregnancy as a time of excitement, anticipation and celebration, leaving little room for fear, uncertainty or emotional struggle. Women frequently tell me that they feel they should be enjoying every moment, even when they are privately dealing with anxiety, previous loss or overwhelming worry about what might happen next.

I have supported women who delayed telling family members they were pregnant because they were too frightened to believe the pregnancy would continue. Others avoided buying baby clothes, refused to discuss names, or counted down the days between scans while quietly convincing themselves that something would go wrong. Some became frightened to go to the toilet after previous loss, while others spent long nights checking movements or lying awake because they could not silence their fears. However many of these women looked calm to everyone around them.

What neurodivergent women often reveal is that pregnancy can become a performance, women learn to say they are fine because they do not want to worry other people, appear difficult or seem unable to cope. Yet behind that mask there may be anxiety, grief, sensory overwhelm, intrusive thoughts or profound uncertainty. Pregnancy can sometimes become something to endure rather than enjoy, particularly for women who have experienced previous trauma or loss.

I really believe we need to start broaden our understanding of what trauma can look like, it’s not always a single event that happens in a delivery room, sometimes it develops gradually through months of fear, pressure and emotional exhaustion that remain largely invisible to everyone else. When women feel unable to speak honestly about how they are coping, they can become increasingly isolated during a period when they most need support.

As a midwife, I believe one of the most important questions we can ask pregnant women is not simply whether everything is going well, but how they are really feeling. Neurodivergent women have taught me that many women carry far more than they show, and that the appearance of coping does not always reflect the reality underneath. If Birth Trauma Awareness Week encourages more honest conversations about the emotional reality of pregnancy, then many women may finally feel able to stop pretending that they are fine.



Kate Mortimer is Lead Midwife at Cocoon Healthcare, a Harrogate-based pregnancy and women’s wellbeing clinic. For more information, visit www.Cocoon-Hgt.com