The struggle of fatherhood is real - so why are new dads often invisible in NHS advice?
Date: Saturday 05 Nov 2022
We hear so little about the impact pregnancy and birth can have on men, particularly those with a history of mental health problems
By Rhiannon Lucy Cosslett
Before Elliott Rae developed PTSD after the traumatic birth of his daughter, no one had told him that dads could experience birth trauma, too. “It was a really tough time that included moments of insomnia, anxiety and flashbacks. I became really emotional,” he says. Like many men, he found it difficult to speak about what he was going through. In the years since, he has come to understand the “societal and cultural norms which contribute to dads feeling pressure to deal with everything by themselves and not talk about the challenges they are going through”.
“I think part of it was imagining an older child, rather than a baby,” another dad, Tom Spencer, tells me, reflecting on his experience of postnatal depression (his daughter is now four). “There were struggles around breastfeeding. It was really hot that summer. The lack of sleep. Maybe something about the permanence of being a parent? I just felt sad a lot. I remember my partner and me commenting on a day that neither of us cried. I remember putting her in a sling for the first time and being terrified that she had stopped breathing and I’d killed her.”
Dark thoughts began to enter Spencer’s mind, followed by guilt. “I never thought about harming our daughter, but I remember thinking that I might be better able to deal with the grief of her death than the responsibility of keeping her alive and trying to support my partner,” he says.
One in 10 men experience anxiety and depression symptoms in the first six months after the birth of a baby, and one in five will experience a mental health problem during pregnancy and the first year after birth. The biggest killer of men under 50 in the UK is suicide – studies have shown that fathers with mental health problems during the perinatal period are up to 47 times more likely to be classed as a suicide risk than at any other time in their lives.
Yet we hear so little about the impact that pregnancy and birth can have on dads, particularly when they have a history of mental health problems. I’ve heard women say privately they are concerned about how their partners are coping in the postnatal period, but that the possibility of paternal mental health problems was never mentioned in NCT classes or during engagement with maternity services.
“We need a paradigm shift in how the NHS thinks about fathers and other non-birthing parents; services should be redesigned to ensure routine, systematic engagement from the first antenatal appointment onwards.”
The idea of the strong and silent paternal figure who provides for his family still holds a lot of sway. “Firstly there was just the shock of responsibility, something I’ve successfully steered clear of for most of my life,” says Tom Huddleston, a journalist and author who struggled with depression after the birth of his son. “Secondly, it was just really hard – no one tells you that, or if they do, you don’t listen. But as you know, it’s just utterly relentless, and the emotional toll is huge. You think – well, this is it now, for 18 years, and however much friends tell you it gets easier, you again don’t listen.”
The pressure on men “to provide unyielding, unidirectional, rock-like support for their partner” is compounded by the feeling that the emotions men are experiencing are not legitimate, according to the sociologist's Paul Hodkinson and Ranjana Das, whose book New Fathers, Mental Health and Digital Communication is based on interviews with new dads who have experienced mental health problems. These feelings – that their emotions are invalid – mean that they often don’t reach out for help until things have reached crisis point. Throughout the pregnancy and birth process, they are framed as being peripheral.
According to Adrienne Burgess, the head of research and joint CEO at the Fatherhood Institute, their recent evidence review, Bringing Baby Home, revealed a “dad-shaped hole” in perinatal NHS services. “They’re not being engaged, let alone assessed or referred for support at this crucial time – even though their impacts on mothers’ and babies’ health and wellbeing are well-evidenced, significant and wide-ranging, as well as being important in their own right as the child’s other parent,” she says. “We need a paradigm shift in how the NHS thinks about fathers and other non-birthing parents; services should be redesigned to ensure routine, systematic engagement from the first antenatal appointment onwards.”
Peer support is also important. “I tried talking to a friend about it once, while on a car journey, and he asked me to talk to someone else,” says Tom Spencer, who didn’t feel able to confide in his partner or parents. “I never really asked for help … I like to think I’m not too caught up in trying to be masculine and strong, but once I was in that mind space I didn’t feel able to talk about it.”
“Often, male friendships can be surface level, or ‘shoulder to shoulder’,” Rae points out. Men, he says, need face to face relationships, especially when their social circles get smaller as they age. “More social and community groups where men can talk about fatherhood and mental health are really important.”
Huddleston was lucky that his sister is a GP and was able to advise him about postnatal depression in men; his own doctor prescribed him antidepressants, and he gained confidence as a father by taking responsibility for bedtime, which had become a source of anxiety. Spencer shifted his work-life balance and went freelance to spend more time with his daughter.
Rae, meanwhile, set up the platform Music Football Fatherhood for new dads, has edited a book, DAD: Untold stories of Fatherhood, Love, Mental Health and Masculinity, and works with NHS trusts to better support fathers during pregnancy and postnatally, as well as running a number of support events.
Partners can play a crucial role, too, in examining their own expectations around fatherhood. “Just a couple of days ago I was talking to a dad in the gym who said that he is still trying to deal with the trauma of his son’s birth five years ago, but his wife and his mum just tell him to get on with it, to stop complaining and be the man of the house,” Rae says. “We need to challenge and shift our beliefs around what fatherhood is, so we see fathers as caregiving, empathic and nurturing, not just as the stoic breadwinner.”