[00:00:00] Dr Renee White: Knowledge is power, and we are all about empowering the mamas of the world. In each episode, we will unravel and interpret the latest research and evidence-based practices for pregnancy, postpartum, and motherhood. [00:00:15] As mums and researchers ourselves, we have experienced firsthand the overwhelming complexity of information myths and those classic old wives tales. I'm Dr. Renee White, and this is The [00:00:30] Science of Motherhood.

[00:00:31] Dr Renee White: Hello and welcome to episode 195 of The Science of Motherhood. I'm your host, Dr. Renee White, and this episode is proudly brought to you by a brand I personally used and [00:00:45] loved during my breastfeeding journey. It is Cake Maternity. Cake Maternity specializes in high quality nursing bras that are not only supportive, functional, and incredibly comfortable, but [00:01:00] they're also super stylish because you shouldn't have to compromise just because you are a mum.

[00:01:07] Dr Renee White: Now, my personal soiree with this brand, oh man. [00:01:15] For all those playing at home, you don't see the, the bottom half or like, you know, you kind of see like a neck up on this podcast, but I'm quite loud and proud. I'm happy to say that I am, you [00:01:30] know, part of the big titty committee and when I, you know, had my baby.

[00:01:37] Dr Renee White: Boobies they got, they got pretty big, and I was one of those people who didn't. I [00:01:45] didn't feel comfortable enough sleeping at night, you know, completely braless. I wanted something that, you know, gave me a bit of support during the day. Just kind of move [00:02:00] around the house. I was, I produced a lot of milk, so I wanted something where I could, you know.

[00:02:07] Dr Renee White: Put my breast pads in and know that, you know, I was well supported, but equally, I didn't want [00:02:15] something that had wire. I wanted something that felt really luxe against my skin. And, you know, like I kind of, I have sensory issues as well. I'm, I'm, I'm just like, you know, you know, you know what I'm saying [00:02:30] here, ladies.

[00:02:31] Dr Renee White: That's exactly what happened and I popped into a bra shop. I think I was about five days postpartum, five, six days postpartum. And I walked in and I said, please help me, please help me. [00:02:45] And I described all of those things like clearly I, I'm, you know, a full chested kind of mum, and I wanted something really, really nice against my skin.

[00:02:57] Dr Renee White: The lady just instantly said cake, maternity. [00:03:00] Like, do not pass go, do not collect $200 cake, maternity. And I remember trying on this bra. And I just went, oh my God. It's just delicious. I don't know. I don't even know if people were like, [00:03:15] Renee, you're describing a bra. Bra as delicious. Yes, yes I am. Like it was pure lux and it was just so soft and so comfortable, and you know how people are just like, oh my God.

[00:03:27] Dr Renee White: The first thing you wanna do when you come home from work [00:03:30] is take your bra off. Can I just tell you I slept in cake, maternity bras for 15 months and not, not a peep like I was just like, this is so, so comfortable. [00:03:45] And when I, when I tried it on in the store, I said to the lady, get me two. I want two of these.

[00:03:50] Dr Renee White: Just get me two and walked out. Best decision absolutely ever. They were so, so good and so it's a no-brainer. [00:04:00] That they're part of the science of motherhood, so thank you cake maternity. And they've got something for every mum or mum to be with a wide size range. And that's what we love to see girls from six to 22 bands and [00:04:15] A to double J cups, whether you're after Seamless like I was, you know.

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[00:05:06] Dr Renee White: Alright, let's dive into today's checkin Tuesday episode and today we are exploring a maternal health [00:05:15] story that's been largely invisible in research and clinical practice. The experiences of autistic women during pregnancy, birth, and early motherhood. Now, when we think about autism, [00:05:30] many of us still picture that stereotypical image.

[00:05:34] Dr Renee White: Often, you know, a young boy with intense interests, who struggles with social interaction. But this is a very outdated view and has left [00:05:45] autistic women and children in the shadows for decades. And when these women become mothers. They face a double invisibility that they can have profound consequences for their health and wellbeing.

[00:05:58] Dr Renee White: Now I have to say that, [00:06:00] this particular, um, research that we're gonna be talking about is a literature review. So it's an combination of lots of different papers that have kind of all been brought together to kind of put a real big [00:06:15] picture look to it. And I have to say a little sneak peek. We are going to be doing a very intensive three part series on this topic early next year, so stay tuned for [00:06:30] that.

[00:06:30] Dr Renee White: So this particular research, as I said, synthesized everything that we know about autistic mothers experiences with maternal healthcare and what they found reveals essentially a [00:06:45] system. That's failing some of our most vulnerable patients, but also highlights the incredible resilience and love that autistic mothers bring to parenting.

[00:06:56] Dr Renee White: So if you're an autistic women planning [00:07:00] pregnancy, a healthcare provider, or someone who wants to understand how neurodiversity intersects with maternal health, this episode is for you. Alright now let's set the scene. Before we dive into [00:07:15] the maternal health research, we need to understand why autistic women have been overlooked for so long.

[00:07:22] Dr Renee White: So autism affects approximately three boys for every one girl diagnosed, but [00:07:30] researchers now believe this ratio reflects diagnostic bias rather than true prevalence. And so girls and women with autism often present differently than the male stereotype we are used to [00:07:45] seeing. Now, where boys might show that kind of obvious signs like delayed speech or repetitive behaviors, autistic girls often develop what researchers call masking.

[00:07:59] Dr Renee White: So [00:08:00] they observe others and mimic social behaviors to blend in. So I guess imagine spending your entire childhood and adolescence performing a social kind of script, a complex social [00:08:15] script that doesn't come naturally, all while experiencing the world with heightened sensitivities to sound and touch and light and texture.

[00:08:27] Dr Renee White: This masking [00:08:30] comes at an enormous cost. So studies show that 36 to 40% of autistic women experience severe depression, anxiety, or stress, and they're often misdiagnosed with [00:08:45] conditions like borderline personality disorder, leading to years of inappropriate treatment and misunderstanding. And I guess what we're seeing is by the time many autistic women reach motherhood, [00:09:00] they've likely spent decades navigating medical systems that really don't understand them, advocating for themselves without proper support and managing sensory and social challenges that are [00:09:15] largely invisible to others.

[00:09:17] Dr Renee White: So I guess now, imagine this complex neurological profile, you know, bringing that into an intensive medical environment of pregnancy and [00:09:30] birth, and essentially the stage is set for significant challenges. So let's have a look at the research. This was conducted by, uh, a researcher out of the University of [00:09:45] Michigan, and they found that, you know, it, it was kind of the first, I guess, comprehensive review of autistic maternal health literature, analyzing 17 studies involving hundreds of autistic mothers from the [00:10:00] uk, the US, and Australia, and what emerged was six major themes that paint a very troubling picture of healthcare disparities.

[00:10:10] Dr Renee White: Now, the first theme was negative experiences with [00:10:15] staff. The most pervasive findings was stigmatizing treatment from healthcare providers. So picture this scenario an autistic woman discloses her diagnosis to her midwife [00:10:30] and is then asked, quote unquote, how can you be a mother if you are autistic?

[00:10:37] Dr Renee White: Now, this wasn't an isolated incident. It reflects a pattern of disbelief, dismissal, [00:10:45] and discrimination. And most autistic women in the studies chose not to disclose their autism at all, fearing negative bias. And when they did disclose, providers rarely understood how autism [00:11:00] affected their experiences.

[00:11:02] Dr Renee White: Now during labor, autistic women were more likely to have their pain dismissed, especially if they appeared calm and providers didn't understand that autistic people [00:11:15] might not experience pain in typical ways. The second theme with, I guess inaccessibility. So the healthcare environment itself created barriers.

[00:11:29] Dr Renee White: While [00:11:30] 14% of non-autistic women found prenatal appointments overwhelming, 76% of autistic women did. So things like fluorescent lights, unexpected physical [00:11:45] contact, gel for fetal monitoring and noisy environments really triggered sensory overload. And actually, you know, speaking of lights like. I, I visited, um, [00:12:00] Juno, which is an amazing women's health clinic in Richmond, in Victoria.

[00:12:04] Dr Renee White: And Dr. Nicole Gale leads the charge over there. And when she was setting up her practice, this was some of the things that she was so aware of and [00:12:15] it was fascinating doing the walkthrough of the practice and she was describing to me about the textures and the light placement and where things were gonna go in relation to the positioning of [00:12:30] mothers and their babies, and really having a deep understanding and respect for people who have neuro diversities because of these sensory overwhelms.

[00:12:43] Dr Renee White: So bravo to you, Dr. [00:12:45] Nicole Gale. And along this theme, you know, information were delivery was particularly problematic that they found in the research that compared to non-autistic mothers, autistic women were less satisfied with both the [00:13:00] amount and the presentation of information they received.

[00:13:03] Dr Renee White: Prenatal classes were too loud, too large, they had too much pressure to socialize and only 67% felt they [00:13:15] knew when to seek help compared to 89% of non-autistic women. The third theme that they found was sensory and physical impacts. So I guess [00:13:30] pregnancy really intensified existing sensory sensitivities.

[00:13:34] Dr Renee White: And while all women experience sensory changes during pregnancy, autistic women reported these changes affecting more senses, lasting [00:13:45] longer, being more debilitating, and things like, you know, simple tasks like grocery shopping became unbearable for some. After birth, baby [00:14:00] crying, physical contact during breastfeeding, and I guess the unpredictability of infant care created ongoing challenges, and while 87% of autistic mothers wanted to breastfeed, nearly half found the [00:14:15] intensity overwhelming most of the time.

[00:14:17] Dr Renee White: The fourth theme is inadequate support. So autistic mothers receive significantly less support across all areas, and they were less likely to see the same [00:14:30] midwife, consistently, less likely to receive accommodations even when disclosed and more likely to feel judged and isolated. I guess the executive functioning demands of New [00:14:45] Parenthood, you know, managing complex routines, multitasking, adapting to that constant change, um, with our newborns were particularly challenging and only 47% found they were [00:15:00] coping with parenting responsibilities compared to 85% of non-autistic mothers.

[00:15:06] Dr Renee White: So I guess the mental health outcomes were stark autistic mothers had significantly [00:15:15] higher rates of postpartum depression and anxiety, lower life satisfaction and greater overall stress. But here's what's remarkable. Despite all these challenges, 86% of [00:15:30] autistic mothers still found motherhood rewarding.

[00:15:33] Dr Renee White: They described intense bonds with their children, deep empathy and protective instincts that contradicted stereotypes about autistic people lacking emotion or [00:15:45] connection. Come on guys, let's get to the party here. Like, you know, this is, yeah. I'm so glad this research is out. So, many developed creative coping strategies, touring birth rooms beforehand, bringing [00:16:00] advocates to appointments like a doula, seeking out other neurodivergent parents for support and finding ways to make their environments more manageable.

[00:16:11] Dr Renee White: So with all of the research that we always analyse here [00:16:15] at the Science of Motherhood, we always look at the limitations and. You know, while this research provides crucial insights, we need to examine it thoughtfully. So a couple of the limitations in this study were only 17 studies met the [00:16:30] inclusion criteria, suggesting this field is very much still emerging, we know that.

[00:16:36] Dr Renee White: Heavy geographic bias towards white English speaking Western populations, small sample sizes in [00:16:45] many individual studies, kind of limit that generalisability and most research was conducted without autistic researchers leading the work. Only one study disclosed having an autistic author, so that is [00:17:00] something that we kind of need to reflect on.

[00:17:03] Dr Renee White: So, you know, this research likely reflects the experience of autistic women privileged enough to access healthcare and participate in studies. But [00:17:15] we're still missing voices from, you know, women of color who face additional barriers to autism diagnosis, low income women who might not access specialized care, women in non-Western healthcare [00:17:30] systems, and women who don't identify with formal autism diagnoses, but you know, experience very similar kind of conditions.

[00:17:40] Dr Renee White: So what does this research mean for autistic women and their families and healthcare providers? [00:17:45] Well, first of all, for autistic women disclosure decisions are complex, right? We saw that from the research. It really validates concerns about discrimination while also showing benefits of [00:18:00] appropriate support.

[00:18:01] Dr Renee White: I think the key here is building a support team before pregnancy, including autism informed providers when possible, uh, developing sensory management strategies and [00:18:15] communication plans, definitely up there and connecting with other autistic parents for peer support, learning how they navigated the system and what worked best for them.

[00:18:27] Dr Renee White: For healthcare providers, you know, basic [00:18:30] autism education is desperately needed in maternal health training absolutely. Simple accommodations can make enormous differences. Like I said at Juno, dimmer Lights, consistent providers, written [00:18:45] information, extra time. These are game changers. Understanding that autism presents, you know, very differently especially in women and you know, across the spectrum as well.

[00:18:59] Dr Renee White: And so [00:19:00] that needs to be accommodated and recognizing that appearing high functioning, quote unquote, doesn't mean someone doesn't need support okay. Um, so I guess the research on autistic women's [00:19:15] maternal health experiences, it reveals both uh, systemic failures and remarkable resilience. You know, while autistic mothers face significant barriers to quality care, they also bring [00:19:30] unique strengths to parenting.

[00:19:31] Dr Renee White: This intense empathy, deep connection with their children and creative problem solving skills. And so I guess, the path forward really requires recognition [00:19:45] that neurodiversity is part of human variation that deserves accommodation and respect, not stigma and discrimination.

[00:19:54] Dr Renee White: And when we create inclusive, accessible maternal healthcare, we don't just [00:20:00] help autistic mothers, we create a better system. For everyone. And most importantly, this research demonstrates that autistic women are not just capable mothers. They're loving, dedicated parents who deserve the same quality of care [00:20:15] and support as any other woman bringing life into this world.

[00:20:20] Dr Renee White: So if you are an autistic woman considering pregnancy or currently expecting, know that your concerns are valid. Your needs matter, and [00:20:30] there are providers and communities working to make things better. You deserve care that honors both your neurological differences and your fundamental humanity. Alright, until next time, I will see you [00:20:45] bye.

[00:20:46] Dr Renee White: If you loved this episode, please hit the subscribe button and leave a review. If you know someone out there who would also love to listen to this episode, please hit the share button so they can benefit [00:21:00] from it as well. You've just listened to another episode of The Science of Motherhood proudly presented by Fill Your Cup, Australia's first doula village.

[00:21:10] Dr Renee White: Head to our website I fill your cup.com to learn more about our [00:21:15] birth and postpartum doula offerings where every mother we pledge to be the steady hand that guides you back to yourself. Ensuring you feel nurtured, informed, and empowered so you can fully embrace the joy of motherhood with confidence. [00:21:30] Until next time, bye.