One of the most difficult situations expectant parents can face is the decision to not proceed with a pregnancy due to detected abnormalities with the unborn baby.
The lived experience of fathers involved in pregnancies which have a traumatic outcome are not often heard or discussed. As advocates for improved men’s health outcomes, it needs to be acknowledged within healthcare settings that a seismic amount of grief and distress affect both the mother and father in these situations.
With fathers becoming increasingly more involved in pregnancy care, it is important to hear the voices of men who have faced this traumatic situation with their partners.
This article provides a description of foetal anomalies and the experiences of men who have faced the decision with their partners to terminate a pregnancy.
What is a foetal anomaly?
An anomaly is something that is different from what is expected or normal. Foetal anomalies are unexpected or atypical conditions occurring during a baby’s growth and development.
Foetal anomalies fall into two categories–
Structural: examples include heart defects, spina bifida and missing limbs.
Functional: examples include developmental disabilities, muscular dystrophy and blindness.
Foetal structural conditions affect 2-3.5% of all pregnancies, with routine screening via ultrasound offered during prenatal care. Ultrasound assessments to assess for foetal anomalies are generally attended between 18-22 weeks of the pregnancy.
Termination of pregnancies in Australia
Termination of pregnancy (also known as an abortion) legislation is variable across Australian states and territories.
Abortion is legal in all states and territories dependant to certain circumstances and conditions. For example, in the ACT abortions can be performed at any stage during the pregnancy, whereas in New South Wales- abortions can be performed at up to week 22 of the pregnancy, and any time period after week 22 requires two doctors to approve the termination procedure.
A termination of pregnancy after 20 weeks of pregnancy is classified as a ‘late term abortion’.
Men & termination of pregnancy for foetal anomalies research study
Australian research published in the Journal of Clinical Nursing has examined termination of pregnancy for foetal anomaly (TOPFA) from the perspective of Australian fathers.
The aims of this research was to- ‘explore men’s experiences of grief and support following TOPFA including how healthcare providers, systems and policies can best support men and their families’.
Male study participants
The participants in this research were 10 Australian men ‘who experienced a termination of pregnancy for life-limiting anomalies.’
- The men were aged between 24-44 years of age.
- The time since TOPFA (11 months- 6 years).
- All participants babies were diagnosed in the second or third trimester.
- The terminations occurred between 19 and 37.5 weeks of gestation.
- All pregnancies ended in an induced labour.
- 2 of the 10 men had no other children.
Men & TOPFA research findings
Following interviews with the 10 men in this study, 3 overarching themes, each with two sub-themes were identified which are discussed below. All quotes contained have been taken verbatim from the original manuscript.
Theme 1: The most difficult choice.
The diagnosis of a foetal anomaly and the subsequent decision of the parents to proceed to a termination of pregnancy was described as a traumatic and difficult choice by the fathers involved.
Sub-theme: Challenges of decision-making– all men reported strong support and adequate information provided by healthcare professionals regarding their decision choice,
‘I felt the doctor and the technicians were all very good. Because they didn’t try to […] you know, go, oh, it’ll be alright. They just went, look, it’s not good, you know, [baby]’s got a very low chance of surviving […] they gave us time to be in the clinic […] we were in there for probably 45 minutes or so before we could gather ourselves […] our obstetrician, he was good enough to be available for us to talk to, and, you know, unfortunately we just had to decide what to do’.
Sub-theme: Stigma surrounding TOPFA– in comparison to other forms of pregnancy loss (e.g. miscarriage or stillbirth), some fathers articulated the stigma surrounding a termination,
‘…not a lot of people knew that it was a medical termination like of our choice, they just knew that it was a miscarriage. And it was very select people, only be- because we didn’t want people’s opinions of it’.
One father described how he chose to speak about his experience as a means to break down the stigma and silence surrounding TOPFA,
‘…it’s not something that I’ve shied away from, um, you know, talking to people about doing a late-stage termination. It’s probably not something that you ever hear. You know, you kind of hear about stillbirths and stuff like that, but um, yeah, it’s not something that I’ve shied away from being open about’.
Theme 2: Neither patient, nor visitor.
The response by healthcare staff to their situation was generally reported as supportive and sensitive,
‘[The midwives] took so much care, treated [baby] like a term, newborn baby. Dressed her, made sure to get all her finger and toe prints so we could get, if we wanted to, casts and moulds made to remember her. Um, real gentle. Um, they gave us details for some services that do up like commemorative […] prints into these moulds […] with her name and a photo of her. Um, and just things like that that really quantify her and make her like a tangible person, not just a memory’.
Sub-theme: Where do men fit? –the men in this study stated that their primary priority was for the health and wellbeing of their partner. However, it was observed that resources and targeted support was solely female-focused,
‘In the hospital, I was certainly very much acknowledged in the room, I wasn’t just an outsider […] but it was very much geared towards my partner and her experience. Only really the one pamphlet about men and a support group, which I really wasn’t keen in that moment, or any moment following, to go and actually join’.
In addition, mental health assessments for mothers are routine in hospital settings following TOPFA, however some men felt overlooked and unacknowledged for the grief they were experiencing,
‘I have clinically diagnosed anxiety disorder […] all of these mental health issues, are on my, in my records […] which, to me, is kind of concerning that after such a traumatic event as losing a son, the hospital didn’t go, hang about, the dad has anxiety and depression, we should maybe do something about that. We should maybe follow-up on that, we should maybe get him to go in and see his local GP for a check-up’.
Sub-theme: Dual need to support and be supported– fathers described challenges balancing being a support provider (to their partner), whilst also requiring support for the shared trauma,
‘I wasn’t spoken to separately. It was a, [wife] and I sort of thing. When we were in the recovery room, the day after, um, they sent two counsellors in to speak to us together […] she spoke to [wife]. Unless I spoke up and said something in response to a question, she looked at [wife] […] So, I’m sitting there, and all I’m hearing is: I have to look after her. I have to support her. I have to make sure she’s okay. I have to be strong enough to bear the weight of my own grief, as well as support the weight of my wife’s [grief].’
The men expressed a desire for specific information on how to support their partners and themselves,
‘[I needed information on] ways to manage, you know, look after myself, but also look after [wife] because […] I definitely felt way out of my depth with how to help her […] and it just made me feel kind of useless.’
Theme 3: Meet me where I am.
In addition to the hospital environment, the fathers in this study also reported a lack of follow-up once home.
Sub-theme: Contact men directly- the absence of targeted support from health clinicians in the period of time following a TOPFA was noted by the men,
‘We did have a follow-up appointment with [obstetrician]. Um, but that was primarily about the physical wellbeing of my wife […] he sort of talked a little bit about counselling to her but not, ah, not to me […] yeah that wasn’t something I was involved in at all’.
One father acknowledged that social norms on how a man ought to respond to crisis may play a role,
‘There’s this sort of, societal thing, this pressure to be the bloke, be the dad […] I didn’t want to go and look for help after losing [baby] […] I needed someone to check on me, to push me to do something. And that can’t be my wife. Because my wife is in the middle of it too’.
Sub-theme: Tailor support and services– how grief was managed by these fathers varied; from drinking more heavily to immersing in surfing and exercise activities. One dad described how engaging in counselling provided personal insights into his grief,
‘[Counselling helped me realise] that things aren’t black-and-white […] [loss] affects everyone differently. And you’ve got to acknowledge what’s happened and not just try to push through it. And remember it’s not a straight line – you know, like a wave, it’s going to go up and down and […] some days it’s going to be a burden that you’ll handle, and it’ll be something you’re confident in dealing with. And then the next day it won’t be. And, um, you know, try to be mindful of your mood.’
The strong desire of having a support group was significant for many men,
‘…if there was a small group of guys that you could get together […] um, at a social setting, like even at a pub or something, um, where it doesn’t feel like a counselling session or a self-help session you know, it just feels like let’s get together and just chat […] just see how you’re both dealing with things and how you’ve both, what ways you’ve found to deal with the grief, as well. Um, and how to deal with your partner and help your partner out, too.’
Men & TOPFA research conclusions
The researchers of this study into Australian men who have experienced a TOPFA noted that, ‘because men were not admitted to the hospital as a patient in the same way as their partner, they described feeling overlooked by current services, particularly in relation to the pro- vision of support and assessment of men’s needs’.
‘They described a need for specific support services which are tailored for men, as well as follow-up services directed to men following a termination of pregnancy’.
Expert Opinion: Rachel Ficinus, Red Nose Director Bereavement Services, Psychologist
We understand that the devastating decision to terminate a much-wanted pregnancy due to foetal abnormalities is a decision that no parent expects to face. As a community, we do not talk about pregnancy loss so when the unthinkable happens, parents find themselves experiencing feelings of isolation, guilt, shame and anger that are hard to understand.
Acknowledging men’s grief after the loss of their baby is important as it helps them recognise their grief as valid, important and worthy of support. We all grieve differently, and we know there is no right or wrong way for men to experience their grief.
Providing opportunities for men to talk about their grief – such as through community and peer support, counselling or online groups – and including them in decision making and conversations around grief encourages their connection to their baby and their partner, has ongoing benefits to their health and wellbeing.
Comment from bereaved father Aaron, father to Sonny Tasman
“We lost our son, Sonny Tasman, in February 2022 following a TFMR at 18-weeks’ gestation.
I found it really hard to sit in the corner of that hospital room as my wife went through labour and delivery (and feel like I wasn’t there or was in the way), but at the same time I didn’t want to voice how I felt, as that moment was about the best care for my wife.
I didn’t receive any support from the doctors leading up to our TFMR, the hospital or after Sonny’s death.
My wife met fellow loss mums through support groups and online, but I never looked for support on social media because I didn’t want to talk about my feelings – in my head, the man needed to be the one who held it together and I didn’t think there were any other dads going through this or talking about it.
I still feel anger, isolation and a deep sadness and I still cannot look at photos or videos of our son after his birth.
I’m not much of a social person and I’m not sure if support groups are for me, but I do think if a support service was able to make the first contact with bereaved dads (maybe through details obtained by the hospital), rather than us reaching out to them, that would help a lot, and make dads feel more comfortable.
I think whoever we talk to, needs to be someone who can talk to us in a way that we can feel safe in talking about our vulnerabilities, someone who truly understands loss and TFMR from a dad’s perspective.”
Support: If the conversations featured in this article have caused distress or triggered traumatic memories, please reach out to the MensLine (1300 78 99 78) or Beyond Blue (1300 22 4636).
Red Nose Grief and Loss supports anyone affected by the loss of a pregnancy, stillbirth, baby or child death. Reach out to our 24/7 Support Line on 1300 308 307.
Real Men’s Health would like to sincerely thank Aaron for sharing his experiences and insights- we urge healthcare providers to read his words and start meaningful steps in addressing the unmet psychosocial needs of fathers following a loss of pregnancy.
