Determinants of Women's Wellbeing Across Pregnancy, Childbirth and the Postpartum Year: A Critical Review

Background: Women's wellbeing during childbearing cannot be inferred from survival or the absence of obstetric complications alone. Pregnancy, childbirth and the postpartum period involve transitions in bodily functioning, psychological health, social relationships, autonomy and economic security, while access to effective and respectful care is unevenly distributed. Objective: This critical narrative review examines how clinical, psychological, interpersonal, structural and health-system factors interact to shape women's wellbeing from pregnancy through the first postpartum year. Methods: A targeted, non-systematic synthesis of verified peer-reviewed research, evidence reviews and international clinical guidance was organised around conceptual distinctions, determinant pathways, methodological limitations and implications for action. Findings: Physical morbidity, nutritional deficiency, sleep disruption and prior psychiatric illness are relevant, but their effects depend partly on material resources, partner and community support, exposure to violence, discrimination and the quality of care. Evidence supporting interpersonal counselling to prevent perinatal depression, continuous support in labour and midwife continuity models is more directly intervention-based than evidence linking paid leave, social position or individual psychosocial factors with wellbeing. Studies differ markedly in definitions, timing, measurement instruments and populations; symptom screening is often mistaken for diagnosis, and birth outcomes are frequently used as proxies for maternal functioning. Recent evidence highlights persistent morbidity beyond the conventional six-week postnatal window, while relatively few studies assess social participation or women's own priorities longitudinally. Conclusions: Maternal wellbeing is best understood as a time-varying, multidimensional outcome generated within a social and clinical context rather than as an individual attribute. Integrated, person-centred care and structural measures are complementary, but intervention effectiveness and transferability require careful, setting-specific evaluation. Future research should prioritise longitudinal multidomain outcomes, intersectional analysis and implementation studies that measure benefits, unintended effects and equitable reach.