Although full of joy and excitement, the perinatal period can be a tumultuous time for parents. Recognition of maternal mental health around pregnancy and birth (the perinatal period) is, thankfully, growing, leading to an increase in evidence-based interventions to prevent maternal mental health crises and to help mums navigate this challenging period of life. Fathers, however, are often left on the side-lines of perinatal healthcare, and parenthood, with the importance of their role in the family unit and their mental health underestimated and overlooked.
As a PhD student focusing on perinatal mental health, this International Men’s Day, I wanted to focus my attention on the often-invisible Dads, to highlight the importance of promoting and supporting their role in parenthood to protect their mental health and that of the entire family unit.
Societal Expectations of Dads
Gender roles traditionally pigeon-holed women as caregivers and homemakers and men as breadwinners, excluding women from the workplace and men from the home. Expectations of men to provide emotional support and nurture their partners and children were scarce.
A progressive shift in societal norms means that fathers are now expected and indeed wanting to be present in pregnancy, labor and birth and actively involved in child rearing, however, the necessary infrastructure to support them in this newfound role is not available.
Men are therefore having to navigate an unchartered type of fatherhood, that is different to that of all previous generations, alone. The lack of support and education offered to fathers about the perinatal period, alongside damaging patriarchal hangovers expecting them to be ‘manly’, unemotional, ‘rocks’ of the family, prevents them from seeking help and from knowing how to lean on others for support in this challenging period. This has negative impacts on the entire family unit.
Paternal Perinatal Mental Health
Depression is thought to affect 8% of fathers in the perinatal period whilst anxiety affects 5-10%. The new-parent exhaustion combined with feelings of loss of control, inability to meet expectations, low resilience and disappointment have been reported by new fathers as contributing to reduced mental health.
Furthermore, although not physically going through traumatic pregnancies and births themselves, fathers have a front row seat to the suffering of their partners, often feeling helpless or even a hindrance in delivery rooms when things go wrong. A 2017 study focussed on the experiences of fathers who found childbirth traumatic. The fathers vividly described their distress with one stating, “the really traumatic part was just, the sort of, the scream that came out of [my partners] throat was absolutely horrible too…it just really hurt to see her in so much pain.” So whilst research is increasing into the effects of traumatic births on mothers, we must also attend to the distress of the fathers.
Fathers can feel alone and unsupported, hesitant to seek help due to internalized and societal stigma perceiving male suffering as ‘weakness’, perception of paternal mental health problems as less relevant (fathers can fear ‘overshadowing’ the birthing parent), limited capacity of specialist services, skepticism, and attitudinal reluctance. Furthermore, fathers may experience, report, and present mental health symptoms as stress or externalising symptoms, rather than emotional/ internalising symptoms. Compounding this, many measures used to assess mental health may not be sensitive to the symptoms in men, leading to their mental health struggles being overlooked and characterized simply as stress.. Indeed, men are less likely to receive a mental health diagnosis than women.
Of concern, men experiencing perinatal depression have also been shown to have a 20 times higher risk of dying by suicide.
But paternal mental health is not just important in its own right. Poor mental health of dads can also impact their babies. A recent study focused on stress in fathers, to try to capture their mental health in the perinatal period. They found that 7% of fathers presented with high stress in the perinatal period with this rising to 10% at 24months post-partum (Challacombe et al 2023). This stress impacted their newborns and was found to be associated with child emotional and behavioral problems at 24months, demonstrating that paternal perinatal stress and mental health problems may be an early sign of perinatal distress. Depression and post-natal depression in fathers has also been shown to be associated with their child’s depression at 18 years of age and appears to influence emotional problems in daughters, especially if the mother also suffers from depression.
There are several ways that poor mental health in fathers may lead to these problems in their babies. Stressed fathers may have a reduce ability to parent and form attachments with the baby, have a reduced capacity for involvement in parenting and exacerbate the mental health of the mother.
However, there is good news. Good paternal mental health can act as a buffer providing protection to infants of mothers suffering from Post-Natal Depression. This period may therefore provide an opportunity for early intervention and prevention of subsequent mental health problems for fathers and infants.
Mental health interventions for fathers have shown to improve confidence, behavior and parenting style and increase the knowledge of child development, leading to greater interaction and heightened sensitivity to infant needs. Yet access to effective, evidence-based interventions specifically for paternal perinatal mental health is limited and requires GP appointments or self-referral to over-subscribed mental health services.
Adding to the difficulties dads can face in this period, fathers are often made to feel invisible in antenatal checkups, at the birth of their children and in postnatal checkups.
A British survey of fathers called ‘How was it for you?’ found that during perinatal appointments over 60% of fathers reported that the medical staff did not talk about the fathers’ role. 25% also reported either rarely or never being spoken to directly by medical staff. And concerningly, only 18% of fathers reported staff talking to them about their mental health in the antenatal period. This invisibility can exacerbate fathers’ feelings of uselessness, and disempowerment, as they are made to feel less capable of caregiving than their partners.
Encouragingly despite this low engagement by healthcare, 98% of the surveyed fathers attended the births.
It appears that the issue is not an unwillingness of dads to engage with support and talk about their role and their struggles, but rather a lack of available spaces and platforms empowering and educating dads. Indeed, it has been reported that 3 in 4 dads think there should be more support for fathers. Thus, a gap exists between the support fathers are desperate to provide and the systems in place to facilitate this.
It is understandable that mothers are often the focus of perinatal healthcare, given their role in carrying, delivering, and breastfeeding the baby. But dads are also having a baby, and thus they also require emotional support, education, and direction so that they can successfully fulfill their role and be the most supportive partners and fathers possible.
Where do we go from here?
To keep up the with the progressing role of modern fathers, we need to create a landscape where they can contribute equally to parenting. This requires systemic change in the way we view and support new fathers, starting with increased research into the experience of fathers alongside service providers better acknowledging and and advocating for fathers.
Dads are the missing piece of the puzzle in the perinatal period. Mothers and fathers are 2 halves of a whole, therefore, there is no supporting mums, without supporting dads. My hope is that the increased demand from fathers to be involved will in turn lead to a change in the healthcare landscape where their role is celebrated and empowered with education and support. Until then, we must continue to support the fathers that we know and, at the very least, simply ask them: "How are you?".