Fathers and Perinatal Loss - Why we still have a long way to go
“I was so anxious and couldn’t enjoy being pregnant, because I was so worried to attend every scan in case it was bad news; I couldn’t bear to think about history repeating itself and us losing another baby”.
As a researcher working in the field of Perinatal Psychiatry, with mothers who have experienced mental health problems during pregnancy or postnatally (the period after childbirth), this is, unfortunately, a sentiment I have heard more than once. Therefore, it comes as no surprise to me, when reading Jamie’s powerful blog, that stillbirth (the death or loss of a baby before or during delivery), along with other types of pregnancy loss and complication, can be related to poorer mental health in parents. In my own work, these awful experiences are one of the most common reasons that women give for feeling particularly anxious or low in any subsequent pregnancies they may have, and there are studies to support this too.
But, the studies I work on, along with many others in the field, including the one above, are primarily focused on the mental health of mothers, as this seems like the obvious place to start.
Don’t get me wrong, we are not close to being finished with our understanding of mothers’ mental health and developing solutions that might help. However, I am not proud to say that we are still even further behind in our understanding of what the mental health impacts for fathers might be. But, reading Jamie’s story, and others’ written so eloquently and emotively in their book ‘DAD’, it is clear to all of us just how important it is to keep the mental health of fathers at the front of our minds, right there next to mothers.
I would like to pause here to mention that while in this blog I will refer to ‘mothers’ and ‘fathers’, I am acutely aware that these issues extend far beyond this, and are perhaps even exacerbated in some groups who identify as ‘birthing’ and ‘non-birthing’ parents in the broader sense, to include parents of other gender identity and sexual orientation groups.
Nevertheless, the notion that we should be focusing on paternal mental health is nothing new — a study from 1995 reported that paternal anxiety and depression were still high when measured two months after a pregnancy or neonatal loss.
Even in 2006, researchers conducted a review of papers published from 1966–2005 about the psychological effects of stillbirth and neonatal death on fathers. This paper found just 17 studies that were suitable to include, and the authors concluded that more good quality research is needed. Importantly, though, it also stated that “the social role of fathers as carers for their partners needs recognition when planning care for bereaved families”. So why, like Jamie, are so many fathers left out of psychological support provisions after the loss of a pregnancy or newborn?
Some of the reasons include things that have already been spoken about by Jamie, and by Elliott Rae in an earlier blog where he is interviewed by Professor Carmine Pariante, the Editor in Chief at InSPIre the Mind. The lived experience stories of these fathers are telling us the same as the scientific literature: “in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent needs.”
Another summary of studies reported that men were typically more hesitant to disclose their feelings and had increased use of avoidance and distraction techniques, such as throwing themselves into their work to avoid thinking about painful experiences. While this may work for many people, it is possible that this outward appearance of being able to work effectively might lead to the false assumption that the person requires less emotional support. Men may also turn to other coping and self-support mechanisms, such as heavier alcohol consumption.
You might be surprised to read that men score higher on some grief scales than women following perinatal loss, but they are less likely to score highly in terms of “active grief”, that is, overtly showing sadness and crying. It is often these overt sadness behaviours that elicit support from others, so this may be another reason why women are typically offered more support following a loss. When asked to describe their experiences, many of these men reported that they felt “overlooked, alienated and marginalised” in comparison to their female partners.
All of the results of these studies point to a need for increased accessibility of support services for men (in fact, the whole family) following pregnancy or neonatal loss. Importantly, not only should men talk about their feelings for their own benefit, but studies show that if fathers are unwilling to talk to their partners following a stillbirth, then the mothers are 5 times more likely to develop depression. Although this study was conducted to investigate the effect of fathers talking on the mental health of mothers, it is likely that the same is true in reverse, so support to get couples talking together could be incredibly beneficial. If these services were more widely available and open to fathers, perhaps men would feel more validated in their feelings of grief.
Instead, during the height of the COVID-19 pandemic, things were made worse for fathers, as they were not even able to be by the side of their partners when they received such devastating news. Countless stories have been told of men sitting in the car parks while their partners are being told that there’s a pregnancy complication, or that they cannot find a heartbeat. Unfortunately, the pandemic seems to have widened the gap between the medical care the mother (or birthing parent) receives, while the co-parent is left outside, feeling like a secondary parent.
If you ask most people, they’d probably tell you that mental health problems during the perinatal period are far less common in men than women — but is that true, or are we just not asking them the right questions? In fact, a recent review of studies estimated that rates of paternal depression are about 8.4%, which isn’t too far from the estimated rates of 17% in pregnancy and 13% postnatally for women.
During pregnancy, all medical care is focused on the mother. Only recently has it become best practice that all women are asked about their mental health during antenatal appointments. This is one of the main ways that we are learning more about the mental health needs of mothers during the perinatal period. Why are we still not asking men or co-parents how they are feeling too?
Even without the need for medical care themselves, fathers are still going through the same psychological transition processes as mothers, as they prepare to become a parent or add another child to their family. The perinatal period is a time of huge upheaval for the whole family, not just the mother. More needs to be done to ensure that men don’t just feel like a support system for the mother, but feel valued as individuals with their own needs. Only then will men feel like they “deserve” (to use Jamie’s word) the same psychological care, particularly when pregnancy goes wrong. After all, we know how important social support can be for preventing anxiety and depression in parents experiencing a pregnancy loss.
As I sit here, writing this blog during ‘Baby Loss Awareness Week’ (9th-15th October), I am struck, as I am every year, by the number of stories that people in my network post on social media, sharing their pain as they remember their lost babies. More than ever, we are getting better at speaking about these painful experiences, rather than just the joy of when pregnancies go right. As Jamie has said, the healing power of talking and sharing stories cannot be underestimated. Let’s just always remember to ask Dads how they are doing too.
If you have enjoyed this blog, do not miss the full 10-part series that will explore aspects of modern-day fatherhood, men’s mental health, and the science behind it — running through to the 19th of November — which is also International Men’s Day UK.
As part of this series, please find our already published blogs including:
Our blog written by our Editor in Chief, Professor Carmine Pariante, where he interviews Elliott Rae, the founder of Music.Football.Fatherhood (MFF) and publisher of the book DAD.
A blog written by Arran Williams where he discusses the emotional impact his partner’s two traumatic birth experiences had on him.
A blog written by Clinical Psychologist, Jane Iles, in response to Arran’s blog, where Jane explores the impact traumatic births can have on fathers’ mental health from a clinical point of view.
A blog written by Joseph Straker, mentioned throughout this piece, where he discusses his own personal experiences of postnatal depression.
A blog written by Vaheshta Sethna, a lecturer in Psychiatry and Mental Health (Education) at King’s College London, where she discusses her research in relation to the topics discussed by Joseph Straker in his blog.
The blog written by Jamie, mentioned throughout this blog, where he discusses his experience of learning to live with trauma after the loss of his son during his wife’s pregnancy.
Every Wednesday we will publish a lived-experience piece from one of the fathers who have contributed to the recently published book DAD or the Music. Football. Fatherhood. (MFF) online platform, an online community of Fathers. This will be followed on the Thursday by a scientific piece from one of our contributing scientists exploring the associated mental health aspects.
We hope you enjoy this ITM special series as we shine a spotlight on men’s mental health and fatherhood.