What Perinatal Mental Health Training Taught Me About the Gaps in Maternal CareI recently completed advanced perinatal mental health training with Dr Silvia Wetherell.

I recently completed advanced perinatal mental health training with Dr Silvia Wetherell. I went in expecting to deepen my clinical knowledge of postpartum depression and anxiety. I came out with something I hadn't anticipated: a fundamentally different understanding of what maternal care is actually for.

That shift is worth examining, because I think it points to something that goes well beyond my own practice.

What I thought I already knew

Perinatal mental health has always been part of how I practise. I screen for postnatal depression. I ask about anxiety. I refer when I'm concerned. I know the Edinburgh Postnatal Depression Scale the way most physicians do, as a tool, a threshold, a clinical checkpoint.

What this training made visible is how much that framing misses.

A mother presenting with breastfeeding difficulties at six weeks postpartum is not simply a lactation problem to be solved. She may be simultaneously navigating a complete identity reorganisation — the loss of a professional self, the disorientation of matrescence, the gap between the birth she expected and the one she had. She may be carrying intrusive thoughts she is too ashamed to name. She may be sleeping in fragments, operating under hormonal flux, managing the expectations of a partner and a family and a culture that has decided she should be grateful, radiant, and coping.

The breastfeeding struggle is real. But it is not the whole picture. And if the clinician or lactation consultant in the room is focused only on latch and milk transfer, the rest of that picture goes unseen.

The moments that matter aren't always the formal ones

One of the most important things I took from this training is something that confirmed what years of clinical practice had already shown me: mothers rarely disclose their deepest struggles in formal clinical encounters.

They share them sideways. In the moment after a feeding assessment, when the tension finally drops. In a comment made almost in passing while getting ready to leave. In the way a question is asked, or not asked. In the body language of someone who has rehearsed saying "I'm fine" so many times it has become reflexive.

This means that the touchpoints that matter most in perinatal mental health are not always the ones we've designated for it. They are the lactation consultation. The childbirth class. The postnatal group. The routine six-week check that runs twelve minutes behind and feels like a checkbox but is, for some women, the only appointment where someone asks how she is doing rather than how the baby is doing.

The lactation consultant who notices that the anxiety in the room is disproportionate to the feeding challenge. The childbirth educator who normalises the emotional weight of early parenthood before the baby arrives, not just after. The physician who pauses, makes eye contact, and asks not "Is feeding going well?" but "How are you holding up?" — and then waits for the real answer.

These moments have clinical significance. The language we use, the questions we ask, the degree to which a woman feels genuinely seen rather than efficiently processed — these are not soft add-ons to maternal care. They are the mechanism through which women either do or don't feel safe enough to tell us what is actually happening.

What this means for how we work

At Mother & Child, our multidisciplinary model has always been built on the understanding that maternal and infant health cannot be separated into neat clinical silos. But this training gave me sharper language for something we have always practised intuitively: mental health literacy needs to be embedded in every clinical touchpoint, not housed in a separate referral pathway that women have to be explicitly directed toward.

That means our lactation consultants are not just assessing milk transfer. They are holding space for the full complexity of what a new mother brings into the room. Our childbirth educators are not just preparing women for labour. They are building the psychological foundations, realistic expectations, emotional resilience and a sense of agency, that protect mental health through the transition into parenthood. And when I sit with a woman to discuss breastfeeding challenges or postnatal recovery, I am not only the physician in the room. I am sometimes the first person who has asked her, without agenda, how she is really doing.

A note to fellow healthcare providers

If you work anywhere in the orbit of maternal care as a physician, midwife, lactation consultant, physiotherapist, counsellor, or childbirth educator, your role in perinatal mental health extends further than your job description suggests.

The clinical encounter you are trained to deliver is one part of what you offer. The other part is harder to measure: your presence, your attentiveness, your willingness to sit with discomfort rather than move efficiently to the next item on the agenda. These things have impact that no outcome measure fully captures.

Perinatal mental health is not a separate category to be handed off to the right professional at the right moment. It is woven through every aspect of maternal care. Recognising that changes what you notice, what you ask, and what becomes possible in the room.

Dr Mythili Pandi is a Family Physician, IBCLC, and Director of Mother & Child Singapore. She offers multidisciplinary support for families from pregnancy through the early years of parenting at motherandchild.com.sg.