Understanding and Supporting Autistic Mothers: With a focus on late-discovered, misdiagnosed and unheard women in perinatal care

Motherhood is a journey filled with love and joy, but for some women it also brings unseen challenges. For many, the path to understanding themselves as autistic begins only after becoming mothers. Sometimes this recognition emerges when observing a child’s neurodivergent behaviours. For others, the overwhelming demands of new parenthood, without appropriate support, may lead to autistic burnout. A late diagnosis or self-realisation can be a pivotal moment, shedding light on lifelong feelings of not belonging or struggling with everyday life.

There are many women who are late-realised as autistic, and likely many more who remain unaware they are neurodivergent. Historically, those raised as male have been diagnosed at a ratio of four to one compared to those raised as female, yet there is no biological reason for such disparity¹. Research shows that nearly 80% of autistic females remain undiagnosed by age 18². Females without intellectual disability are particularly likely to receive a diagnosis later in life, often in adolescence or adulthood³.

Much of this delay is rooted in how autistic traits are interpreted through social expectations. Women are more likely to mask, or camouflage, which makes their autistic traits harder to detect⁴. Cultural and structural factors also play a role. Working-class women may be less likely to access assessment, and autistic traits in women of colour are often overlooked or misinterpreted through stereotypes. This intersection of gender, class and race creates further invisibility, meaning many autistic women never receive timely recognition or support.

This article focuses on autistic mothers, with particular attention to those who are late-discovered, misdiagnosed or unheard, not to marginalise other groups, but to highlight an under-recognised area of need.

Birth Trauma and Unheard Voices

An overlooked aspect of autistic mothers’ experiences is birth trauma. Many women emerge from labour carrying trauma that is dismissed or never formally recognised. For autistic women, this can be compounded by differences in pain processing, sensory sensitivities, or communication styles.

Autistic people may experience pain more intensely, or may process and express it differently⁵. Some become very quiet, others vocal. Both responses can be misinterpreted by professionals. A woman who does not react in an expected way may not be taken seriously, leading to delayed interventions or inadequate pain management. Conversely, if she does express pain loudly, it may be minimised as “overreaction.” Both scenarios leave women feeling unheard, unsafe and traumatised.

Research indicates that autistic women are at significantly higher risk of obstetric complications and negative birth experiences compared to non-autistic mothers⁶. Yet midwives, obstetric teams and GPs often receive little to no training in recognising or responding to the needs of autistic women in maternity care.

When birth trauma is unrecognised, it contributes to poor postnatal mental health, mistrust of healthcare, and reluctance to seek support later. For women who only discover their autism after becoming mothers, these experiences can deepen self-doubt and make it harder to advocate for themselves and their children.

A doctor discusses prenatal care with a pregnant woman, highlighting the importance of collaboration between healthcare professionals and mothers for a healthy pregnancy.

Unique Challenges Faced by Autistic Mothers

• Masking fatigue: Adults who only discover their autism later in life often have decades of experience camouflaging, which can be deeply draining and difficult to unravel.

• Misdiagnosis with postpartum conditions: Signs of autism in mothers are often mistaken for postnatal depression or anxiety. The overlap can delay appropriate support.

• Sensory overload: The demands of motherhood expose women to sensory stimuli that can feel overwhelming, leading to stress and anxiety.

• Sleep difficulties: Around two-thirds of autistic people experience significant sleep problems⁷. For autistic mothers, sensory sensitivities and disrupted routines can intensify exhaustion.

• Loss of structure: Parenting is unpredictable. For autistic women who thrive on routine, this constant change can increase anxiety and fatigue.

• Hormonal changes: Pregnancy and the postpartum period involve major hormonal shifts, which can interact with autistic sensitivities and emotional regulation, creating additional vulnerability.

• Birth trauma: Autistic women are at higher risk of negative maternity experiences⁶. Health professionals must recognise that pain and communication may present differently and must adapt their care accordingly.

  
  

A Call to Midwives, GPs and Perinatal Teams

We need a culture shift in perinatal care. Midwives, GPs and health visitors must:

• Screen for birth trauma rather than assuming silence means safety.

• Acknowledge different communication styles, recognising that not every woman will express pain or distress in “typical” ways.

• Offer sensory-aware support, such as reducing unnecessary touch, dimming harsh lights, or explaining every procedure in advance.

• Recognise the role of masking: autistic women may appear calm while internally experiencing overwhelm or terror.

• Validate lived experience: if a mother says her labour was traumatic, it is. Listening and believing is the foundation of trauma-informed care.

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This is not about creating a special category for autistic mothers, but about making perinatal care more inclusive and responsive for all women. When care teams are trained to listen without assumptions and to support varied needs, everyone benefits.

A healthcare professional provides comfort and support to a relaxed expectant mother during a water birth, highlighting the importance of listening to and addressing the needs of pregnant women.

Why This Matters

Late diagnosis not only delays support, it also affects mental health. Adults diagnosed later in life frequently report poorer quality of life and well-being⁸. Autistic women, particularly those without intellectual disabilities, face a higher risk of suicidal thoughts and behaviours, often linked to masking and exhaustion⁹.

This is not a minor issue. It is a systemic failure that continues to leave autistic mothers unseen and unsupported.

Conclusion

Recognising and supporting autistic mothers is vital for their well-being and for the health of their families. Awareness among professionals must improve, resources must be tailored, and inclusion must be intersectional. All mothers deserve to feel seen, understood and supported, regardless of neurotype, class or skin colour.

Many women do not ask for help because they fear judgement or have spent a lifetime masking. Our role is to open the door, create safe spaces and keep these conversations alive.

About Me: I am a late diagnosed autistic woman, a mother, and a practising counsellor since 2016. My personal and professional journey has given me a deep passion for raising awareness of neurodiversity, trauma and mental health. Alongside my therapy work, I am also a CPD trainer, offering specialist training to professionals on recognising and responding to unseen and unheard trauma, including the experiences of Adult Children of Alcoholics, autistic women and girls, and others who are too often missed in systems of care.

I believe in creating spaces where people feel understood, supported and empowered to come home to themselves.

I offer individual therapy sessions both in person and online, and training designed to help professionals better support those whose stories are rarely heard.

For more information on my CPD training and upcoming courses, please visit www.evetrue.com.

References

1. Loomes, R., Hull, L., & Mandy, W. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry.

2. UCLA Health (2022). Understanding undiagnosed autism in adult females.

3. Harrop, C. et al. (2023). Later diagnosis in autistic females without intellectual disability. Autism Research.

4. Hull, L. et al. (2019). Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism.

5. Moore, D. (2020). Pain perception in autism spectrum disorders. Frontiers in Psychiatry.

6. Camm-Crosbie, L. et al. (2019). The experiences of autistic women during pregnancy, childbirth and postnatal period: A systematic review. Autism.

7. Richdale, A. & Schreck, K. (2009). Sleep problems in autism spectrum disorders. International Review of Research in Mental Retardation.

8. Mason, D. et al. (2018). A systematic review of quality of life in adults on the autism spectrum. Autism.

9. Cassidy, S. et al. (2014). Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome. The Lancet Psychiatry.