For many men, the realisation that they will become a father is a landmark event which provides a demarcation from being a son of their father, to being a father and provider for the next generation of their family.
However, the path to fatherhood can be quite different for many men. For some, it can be a period of great trial (such as an unplanned pregnancy, previous miscarriages or when engagement with IVF processes were required). Whilst for others, the pregnancy journey can be a relatively smooth or straightforward series of uncomplicated events.
The perinatal period is a time of great change and general upheaval across many aspects of life and living- especially the physical and psychological health of both the mother and the father involved.
When is the Perinatal Period?
The Royal College of Australian and New Zealand Obstetricians and Gynaecologists defines the perinatal period-in the mental health setting- as ‘generally from conception to the end of first postnatal year’.
Fathers’ experiences in the perinatal period
Fathers’ experiences within the perinatal period can often be mixed and variable according to global research studies.
For example, in a narrative review from Ireland, evidence suggests that perinatal depression in men could be linked to several sociodemographic variables. These can include maternal depression, unplanned pregnancy, lower education levels and paternal age.
First-time father’s experiences of perinatal services were assessed in a qualitative research study from the UK. The dads in this study expressed high appreciation for the attention paid to the mothers and babies during the perinatal phase but also remarked that ‘father-specific support’ was found lacking. Examples provided by these fathers included feeling like they were ignored or side-lined by health staff and made to feel like hospital visitors rather than a co-parent.
A United States study of perinatal experiences of men of colour whose partners were at risk for a preterm birth, reported inadequate support for decision making, differential treatment and discrimination as experiences they encountered during this period.
A large Finnish longitudinal cohort study examining perinatal stress and children’s emotions problems reported compelling findings on fathers and children’s wellbeing.
Their research revealed that ‘paternal stress measured at 3 months had the most consistent associations with child problems at 2 years’. The authors of this research conclude their findings by noting, ‘furthermore, we also found that paternal stress had an independent effect on child’s emotional problems after accounting for maternal stress, depression and anxiety’.
Paternal perinatal depression
There is far less research available on fathers perinatal depression (compared to maternal), however it is estimated that approximately 1 in 10 new fathers experience depression (and or anxiety) within the perinatal period. For women, up to 1 in 5 will experience anxiety and or depression during the perinatal period.
Paternal perinatal depression research study
A mixed methods study of Australian men discussed a number of risk factors or predictors for developing paternal perinatal mental distress. Of interest, the researchers also examined whether masculine gender roles could impact on the experiences of men with mental distress.
Study male participants
A total of 13 men engaged with the initial round of interviews in this Australian study and 5 took part in the second series of interviews.
The men in this study were-
- 9 men were from regional Queensland, and four were from Victoria.
- 7 men were of ‘Australian ethnicity’, 2 of Indian ethnicity and the remainder identified as Chinese, Portuguese, Brazilian and African.
- All men except one were either married or in a defacto relationship.
- All men except one were either in fulltime or part-time employment.
- Only one man had had previous children.
- 9 of the 13 pregnancies were described as unplanned.
Predictor 1: Sleep Disturbance
Sleep disturbance and disruptive sleep patterns resulted in fatigue and irritability which had adverse effects on the fathers self-perceived ability to provide quality engagement with his new baby.
“You are not prepared how often you have to get up. . .to feed the baby or change the baby. In first two weeks I slept for only three to four hours a day and I was constantly irritable and angry.”
For some fathers, this lack of quality engagement with baby due to fatigue transferred into feelings of guilt. Post-partum depression in men has been linked to quality and quantity of sleep.
‘I am not getting enough sleep at the moment. I wake up tired. . .when I come back home [from work], I am tired. I feel like because I am so exhausted throughout the day, I am not giving her [the baby] the attention she requires which make me feel guilty.’
Predictor 2: Unplanned Pregnancy
Unplanned pregnancies were predictors of distress among some dads in this study. The fathers reported that being financially unprepared or unemployed were the stress-points when given news of the pregnancy,
“I remember being more stressed than happy when she [partner] told me we were expecting [a child]. It was not planned, and we were not financially prepared.”
There are known increased expenses when having a child. Feelings of distress for men in lower socio-economic groups, are often compounded with an unplanned pregnancy.
“It was completely unplanned. I got to know about pregnancy while I was being laid off from my work. I had no job to support us at that time. It was very stressful.”
Predictor 3: Work-Family Conflict
Balancing work commitments and a new child can have unexpected pressures for fathers and their families. Not having the time available off employed work to participate in the new child experience caused anxiety for some men,
“I am a shift-worker. . . I have irregular shifts . . .it can be challenging to spend quality time with her [partner]. . . She [partner] has already raised concerns about how my work is impacting our relationship. . .I feel like when the baby comes, it will be very hard for me to spend time with my family. . .if I don’t strike a work-family balance”.
Predictor 4: Masculine Gender Role Stress (MGRS)
MGRS was described as the principal predictor of paternal mental health distress.
The pressure a man feels to be the (financial) provider was reported by some men in the study. An example given was the duress to return to employed work earlier than desired so that the costs of living could be met (usually as the sole income earner),
“I was back at work a week later [after birth] . . .I wanted to take some more time off, but I had no choice. During my off week, I was continuously reminded [by family] how I am the only one working. . .the typical conversation of how a man should make sure there is always food at home. . .so I went back [to work] a week early. . .I am unhappy. . . but I have to fulfil my financial responsibility to my family. . .like every man has to do”.
Predictor 5: Marital Distress
A few study participants reported marital strain and spousal difficulties during the perinatal period,
“Since the birth of our baby, our relationship has become a bit shaky. We have been constantly fighting and arguing. I feel like I walk on eggshells around her so as to not say anything which will upset her.”
A longitudinal study of 130 couples from Hong Kong researchers revealed that the ‘physical component of quality of life showed gradual improvements from pregnancy to 1 year postpartum for the women, but a decline for the men’.
This same study also reported that, ‘the women showed more stress and poorer marital relationship and quality of life than their partners, and the women’s levels of stress, marital relationship and mental component of quality of life were closely related to those of their partners’ across the perinatal period’.
Predictor 6: Maternal Depression
Maternal depression has been reported as the most common predictor of paternal perinatal distress. The National Mental Health Commission (Australia) reports that 16% of new mothers will experience depression in the first year after birth.
As one father in our study revealed,
“She [partner] was diagnosed with postnatal depression. . .it has been very stressful. . .All of a sudden I had to take care of her and the baby. . . I couldn’t ask her to help me. . .[I] felt stressed, sad, and angry, all at the same time.”
The researchers theorised that both maternal and paternal perinatal distress is likely due to the intertwined circumstances they both share.
Paternal perinatal depression study conclusion
The researchers concluded their study into perinatal depression in men, by stating, ‘that fathers during the perinatal period should be screened for anxiety and depression within a clinical setting.’
In particular they state that men with ‘dominant masculine norms’, may display depressive symptoms differently and therefore may not engage with help-seeking’.
Expert Opinion: Dr James Brown- Clinical Psychologist, Men’s Health and Fatherhood Advocate.
While maternal mental health has received significant attention, paternal perinatal depression is only now starting to be recognized. As noted in this article, studies show that up to 1 in 10 new fathers experience depression during the perinatal period.
When left unaddressed, depression in young fathers can have a negative impact not only on their well-being but also on their partner’s mental health and the child’s emotional development. There is growing awareness that highlights the need for healthcare providers to screen fathers for mental health concerns. Increasing education and awareness around this issue will help normalize men’s experiences and encourage them to seek help early.
Workplaces Provide Critical Support
One of the key challenges for fathers during the perinatal period is balancing work and family life. Many fathers feel pressured to return to work soon after their child is born, due to financial and societal expectations. Workplace supports, such as flexible work arrangements and parental leave policies, are essential to reduce stress and provide fathers with the opportunity to bond with their child and support their partner. These supports are crucial for both emotional and mental well-being, as they enable fathers to be present during this critical period without compromising their role as providers.
Supporting Dads Supports the Whole Family
Research consistently shows that supporting fathers in the transition to parenthood period has a positive ripple effect on the entire family. Fathers who are present and emotionally available reduce the burden on mothers, which helps to ease the stress and tension that can arise during the perinatal period. This mutual support between parents fosters a healthier family dynamic, improving not only the couple’s relationship but also the long-term well-being of the child.
Support
Excellent resources for fathers can be accessed from the PANDA site. PANDA stands for Perinatal Anxiety & Depression Australia which supports mental health for parents and families during pregnancy and the first year of parenthood.
