We don’t all want to have children. Childbirth is bad enough, let alone a lifetime of bills, worries and demands.

As more women seek fulfilment in careers they postpone both marriage and kids, the fertility rate has dropped across the Western world, even in societies that were previously seen as conservative such as Greece.

In Japan just under a half of woman of childbearing age will remain childless. In Australia it is closer to a quarter of women, and with in a decade childless couples are tipped to be the most common family unit.

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But I see many women who thought they never wanted to have kids, only to find themselves conflicted as their biology was nearing closing time on any opportunities.

Bettina* is a woman in her early forties strongly committed to the environmental movement. She used to refer to herself as a GINK: green inclinations, no kids. She arrives to appointments with a recyclable coffee cup and attends anti Adani protests.

“I just don’t think I can be a good mother, and I don't want a child to have my experience.”

For years she was vocal about not wanting to have children for the good of the environment, believing the consumption habits of wealthy Westerners were a break on acting against climate change.

Her partner supported her, but suddenly in her forties, she found herself having second thoughts. Faced with waves of panic she could not explain, but which were crippling her sleep and work, she was referred to me only to discover that an absent mother with multiple failed partners had left her with a pessimistic view of parenthood. “I just don’t think I can be a good mother, and I don't want a child to have my experience.”

Bettina thought she didn't want kids for her own environmental thoughts. (Getty Images/iStockphoto)

Despite Bettina being adamant she could not have children, when her reasons were explored beyond her outward political persona, it turned out she was fearful of being a failed, rejecting parent much like how she experienced her own mother.

Another woman Salma* pursued her career in marketing at the expense of romantic relationships. She saw having children as a symbol of her overprotective parents who only wanted her to settle down with a partner of their choosing.

But Salma fell in a psychological heap after a company restructure that skittled her trajectory. She had defined herself too narrowly in terms of work. When that took a hit, it had a disproportionate effect on her mental health. She realised she did want domesticity and romantic love after all.

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The female body is fundamentally designed to bear and raise children.

There are many people who have adjusted to not having children. They are not the ones likely to visit me for help. This is especially true given contraception, superannuation and a welfare state.

In the past, you needed children to look after you when you were old and sick. Many will complain there is still stigma against childless women, whether it was their choice or not. I don’t doubt it.

But my work dealing with inner conflicts of how people behave have taught me there are limits to how much we can betray our biology. The female body is fundamentally designed to bear and raise children. While it is perfectly fine to not want children, it requires some psychological pain and adjustment, some of it which you might not see coming.

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Bettina’s partner was overjoyed when she suggested they try for children. She became pregnant quickly and says she has never felt more in tune with Nature. Her friends tease her about her failed GINK status, but she still runs a community garden and recycles everything.

Salma tried IVF multiple times and failed. She did so alone. She remains my patient and is coming to terms with the prospect she may never be a mother. A new job has helped soothe her career jitters. However, she is a devoted aunt to her nephew and prefers to channel her late blooming nurturing instincts through him.