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The Perpetual Birth

“How exciting!” “Aren’t they gorgeous!” “How’s your sleep?!” Just a few of the typical responses new parents are greeted with after welcoming a new baby into the world. But what if, as a new parent, you don’t feel that your experience of having a baby is anywhere near the ‘typical’ experience that you had expected, or perhaps the media has led us to believe is the ‘norm’?

For many new parents, having a baby is indeed a wonderful experience, filled with many highs and an abundance of love — alongside an overwhelming lack of sleep. However, this is not always the case. A small percentage of new parents feel cheated out of these positive idealistic new beginnings with their baby, stuck in an exhausting and emotionally-demanding cycle of reliving elements of their — or their partner’s — labour and birth, over and over again.



As a Clinical Psychologist, I have focused my career on researching and supporting families during the perinatal years (the period comprising pregnancy and the first year of a baby’s life) and into the early years of childhood. I’ve been struck by the number of conversations I’ve had with families who are still haunted by their, or their partner’s, labour and birth experience, perhaps even decades later. Not only can this impact on new parents, but children grow up hearing these stories, weaving this event into the narratives of their lives.

I started my research career in the early 2000’s, jumping headfirst as a newly-graduated psychology student into a PhD looking at the experience of birth trauma and postnatal depression in mothers and fathers. At the time this was particularly novel for two reasons: (1) birth trauma was largely unrecognised, with little research having looked at this area. This was therefore an experience that professionals had very little understanding into, and was frequently misunderstood and mistreated as postnatal depression (something we now know is not the case). Subsequently, new parents had even less of an awareness of this phenomenon, which made these lived experiences even more terrifying and isolating. And (2) fathers, or partners, — despite their prominent existence within the population (!) — were largely ignored when it came to considering, understanding and supporting their mental health. Thankfully the last two decades have seen a shift in both these areas; birth trauma is now much more widely spoken about. And fathers’ and partners’ mental health needs are now recognised in their own right.

Labour and birth experiences vary widely, with many factors contributing to the ways in which a newborn enters the world. Cultural and personal beliefs will influence decisions parents make about how they wish their baby to be born, alongside healthcare needs for the mother and infant. Nowadays it is common practice for fathers and partners to be present during the birth of their baby. Partners are often seen as an important source of support during this time, offering encouragement or practical support.

However, although many parents experience positive elements of the labour and birth, for some these experiences involve aspects which can be incredibly scary, unexpected, unpredictable, and overpoweringly emotional. This can vary between an isolated instance during the event, or a long-drawn out experience involving multiple traumatic moments.

Fathers and partners often talk about being a bystander during this experience. They witness things from a very different perspective to the mother herself, often feeling like a spectator watching things unfold before their eyes, with very little control or ability to play a significant role in the event.



The diagnostic criteria for posttraumatic stress disorder (PTSD) — a psychological response to a traumatic event — defines a trauma as an event in which a person witnessed actual or threatened death or serious injury (DSM-V). When considering fathers’ or partners’ experiences of labour and birth, we can see that there are two significant individuals this could apply to — both the mother and the baby. If for just one moment the father perceives that either is at significant risk of harm, then the event holds the potential to be experienced as traumatic.

As Arran described in his personal experience blog published with InSPIre the Mind, during the birth of his two daughters there were many terrifying moments: his unborn daughters’ heartbeats dropping, the prospect of emergency caesarean sections being mentioned after long drawn-out labours, his newborn daughter Sakura not crying at birth and being whisked off to the special care baby unit, and his partner’s haemorrhage after the birth of their second daughter. And many moments being left on his own, not knowing what was happening, left to fear the worst.

Not all traumatic events lead to the experience of posttraumatic stress; some people naturally recover, finding ways to overcome these moments of fear without long-lasting distress. The research into postnatal birth trauma in fathers shows mixed findings but suggests that up to 5% of fathers may experience childbirth-related PTSD reaching threshold for a ‘diagnosis’, with many more experiencing distressing symptoms. Although this may sound like a small percentage, when considering that 2020 saw over 615,000 live births in the UK (ONS), this translates to up to 30,000 fathers or partners potentially experiencing PTSD relating to the birth of their baby, from one year alone. This is staggering and cannot be ignored.

Posttraumatic stress symptoms will vary between individuals, but typically involve experiencing intrusive, distressing memories, flashbacks or dreams, often leading to the sensation that the event is happening all over again — including smells, sounds and visual aspects replaying over and over. Many things can trigger this off, particularly if something has a strong association with the event itself. Often this will be a subconscious connection, happening automatically without conscious awareness.

For Arran this was the sequin; the bright red colour transported him back to the hospital, to the distress he experienced when he witnesses the red of his partner’s blood, and he found himself reliving the event over again. It is not hard to see that this can be incredibly distressing; posttraumatic stress involves a wealth of negative thoughts and feelings, including low mood, increased anger and irritability, and increased hypervigilance to the environment (feeling incredibly jumpy and overly-alert). This can make life with a newborn baby very challenging, when parents are already experiencing a huge number of transitions and changes, not least adapting to caring for a new member of the household and the lack of sleep that often comes along with this.



Given how distressing this is, it’s not surprising that fathers may find that they start to avoid things associated with the birth, or things that trigger the intrusive memories and flashbacks. For Arran, he was able to throw the sequin away, helping to metaphorically throw the memory — and the event — into the bin. But for others, the consequence of avoiding reminders may lead to additional difficulties in day-to-day life, particularly if the reminder is actually the mother, the infant, or healthcare providers. We can see how this avoidance could start to creep in and take over everyday life.


As Arran later recognised, just trying to ignore and throw these memories away doesn’t always work; we need to bring them back out of the ‘bin’ (or the back of our mind) and process them in a way which allows our memories to be stored differently, reducing the emotional response this has over our day to day lives. As Arran described, “going over it [the trauma] can help reduce that tidal wave feeling of emotion”.

There are many successful psychological treatments for posttraumatic stress, which help overcome these symptoms. However, perhaps one of the biggest challenges we need to overcome now is in helping fathers and partners recognise these symptoms and seek the support they need and are entitled to. Although I commented earlier that perceptions of fathers’ mental health has changed, and that recognition of birth trauma has changed alongside this, there is still some way to go in finding ways to help fathers access the support they need. As Arran said, it’s important that we break the cycle of dads who feel unable to share their feelings. And this is the challenge we — both professionals and society — need take on and change to improve longer-term outcomes for infants and their families.


 

Editor's Note:

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.

- Our blog written by Arran Williams, mentioned throughout this blog.

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.

In this piece Dr Jane Iles, a clinical psychologist with an interest in family mental health across the perinatal period, explored the mental health aspects of birth trauma and PTSD from a scientific perspective in response to Arran William’s piece.

We hope you enjoy this ITM special series as we shine a spotlight on men’s mental health and fatherhood.

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