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Why Pregnancy Matters

A pregnant woman doesn’t just share her body with the growing baby – she shares her state of mind. To mark the start of Maternal Mental Health Month, Sue Gerhardt, psychoanalytic psychotherapist and author of the landmark Why Love Matters, explains why supporting pregnant women is vital for the physical and psychological wellbeing of the next generation.


If you’re not currently pregnant, you might regard pregnancy as a bit of a specialised concern, about as compelling as someone else’s in-growing toenail or arthritis, of interest only to those going through it. Yet creating new life is a huge undertaking for the mother and her body, demanding support not only from immediate family but also from society. The outcome affects us all.

In recent years it has become much clearer that pre-natal experiences strongly influence a child’s future health and wellbeing. Astonishingly, many of the illnesses that kill middle-aged adults in the west, including heart disease, type 2 diabetes, obesity, some cancers and depression, have deep roots in events that took place in the womb.

By now, everyone knows that alcohol and nicotine in pregnancy adversely affect the fetus. But other impacts are less well known. The pregnant woman’s diet is of great significance to the fetus. If she eats too little, especially protein, the baby may grow smaller organs such as heart, kidney or pancreas, creating the danger that these organs will not serve him well as he grows old. If she eats too much processed food or sugar, the baby has an increased risk of becoming an obese child and adult, with all the health risks that brings.

Just as important, the mother shares her state of mind with her fetus. Pre-scientific cultures instinctively felt there was a connection; they feared that touching a mouse or a frog would turn the baby into a monster, whilst looking at beautiful things would produce a beautiful baby. Today we understand that the influence probably works via the biochemicals in her bloodstream. In particular, all kinds of stress and depression can trigger the stress hormone cortisol and in some cases may also generate pro-inflammatory cytokines, which can alter the developing fetal immune system.

Many mothers feel vulnerable when they are pregnant, and about 15 per cent are depressed. Those who feel unsupported suffer a double whammy. They not only suffer from high cortisol, but are also likely to have low levels of oxytocin, the hormone of trust and safety. This deprives them of a valuable buffer, since oxytocin reduces stress and inflammation.

When mothers are exposed to stresses such as ongoing relationship problems, traumatic life events like bereavement, or domestic violence – or even everyday hassles such as coping with aggressive neighbours, living on a polluted road, or being in insecure housing – the fetus will know about it. This is because chronic stress inactivates the enzyme that normally stops its mother’s cortisol from crossing the placenta. Exposed to cortisol, the baby’s own (HPA axis) stress response system becomes more reactive, a state associated with anxiety and depression in childhood. These effects are not temporary – children born to depressed mothers are around 1.5 times more likely to be depressed themselves by the time they are 18 years old.

As psychotherapists, awareness of the impact of these early histories on our clients is valuable. For those of us working with pregnant women themselves, there is a vital role to play in supporting their mental wellbeing. This might involve encouraging the mother to build a supportive network of people around her or helping to protect her from domestic violence. It’s also a time when simple and direct forms of care such as massage, warmth, kindness and a safe space to be heard and understood, can have physiological as well as psychological effects – increasing oxytocin which itself reduces stress hormones. The mental and physical health of the next generation may depend on it.


Sue Gerhardt

Dr Sue Gerhardt is a practising psychotherapist working with adults in private practice. In the 1990s, she was the co-founder of the charity, the Oxford Parent Infant Project (OXPIP), and worked with parents and babies for many years. She is the author of Why Love Matters: how affection shapes a baby’s brain (Routledge 2004, 2014) and of The Selfish Society (Simon and Schuster, 2010). She is currently writing a new book: How to Grow Healthy People.

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