We identified four major themes pertaining to men’s experiences and views of perinatal mental health:
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i)
legitimacy of paternal stress and entitlement to health professionals’ support;
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ii)
protecting the partnership;
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iii)
navigating fatherhood;
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iv)
diversity of men’s support networks.
Theme 1. Legitimacy of paternal stress and entitlement to health professionals’ support
Common across fathers’ accounts was a tacit acceptance of the existence of paternal stress which was often combined with a questioning of their entitlement to having these feelings, and to its recognition by others.
Articulating and attributing stress
Men predominantly couched their discussion around ‘stress’ rather than mental health. Descriptions across the time course indicated that their stress during pregnancy had mainly been connected to anxieties around the birth, this was particularly the case for those who had experienced a previous difficult birth. Overwhelmingly, men reported greater stress in the postnatal period, adjusting to the demands of early parenting (specifically, those associated with sleep and feeding) and their altered relationship with their partner. Men’s descriptions centred on ‘role strain’ and ‘role conflict’, noting the loss of their former life and activities – and associated relaxation - and ongoing struggles to balance competing roles and priorities at work and home; struggles that were often compounded by being geographically distant from theirs and their partner’s families.
I think for me it’s just - the never having any time to relax, it’s just not possible. I’ve got a stressful job then I come home and I tend to get … the tired, stressed baby … I think the stress for me is just the non-stop-ness of it (Father 12)
Some men made reference to specific stressors; including discrete events (e.g. traumatic birth) and ongoing difficulties (e.g. chronic health of a parent or child); three spoke of financial pressures since becoming parents.
There was a tendency for men to minimise the difficulties that they had experienced and emphasise the challenges faced by their partner, with some questioning the legitimacy of their own mental health needs:
I’m always conscious that [partner]’s got it a lot worse, so I just sort of get on with it. (Father 2)
Whereas some men spoke of their partner’s postnatal depression, none used this terminology in describing their own experiences. Two men – both first-time fathers - did however report recent and ongoing depression for which they had seen their GP and been prescribed anti-depressant medication.
Symptoms and manifestation
Asked to describe their stress and its nature, men spoke more readily of their cognitive, as opposed to emotional, symptoms of distress. This mainly concerned guilt about being unable to support their partner due to being at work, but some also reflected on their guilt about their feelings, believing that they ‘shouldn’t’ be struggling. Minimising feelings and becoming more irritable with their partner were common reactions to stress, particularly in the early postnatal period.
I felt guilty actually, guilty going back to work and leaving [partner] with everything. …I was like, I’ve left them all day on their own. I don’t think that’s how she felt but that’s how I felt. (Father 3)
I tend to do the typical man thing of hiding it until I can do so no longer. … I’m not the sort to wail and shout and whatever. … I probably just get grumpy and a bit snappy about stuff. That’s pretty much it really. (Father 12)
More commonly, the men volunteered that they had experienced physical and behavioural signs, including difficulty concentrating at work and suffering with headaches. Men mostly attributed their symptoms to exhaustion, and often found it difficult to disentangle their mental stress from symptoms that were seen to link with fatigue.
… something physically is going on, on top of the mental stress.... I felt mentally drained as well and tired, but once the physical aspect came into the whole situation as well, that’s when I went to the GP. (Father 19)
In the majority of couple interviews, disclosures about the psychological and emotional challenges men had experienced were prompted by discussions between partners. For example:
Partner of Father 6: You went into yourself, I feel.
Father 6: Yes, I could feel myself withdraw, so I wouldn’t communicate as much and I would get snappy when sometimes I wouldn’t do. It was something that if I was already close to it, it would be the minutest of things that sometimes would just make me lose it, not lose it, but kind of just [pause]
Partner of Father 6: You’d just go off and be very quiet, don’t you, and don’t speak.
Partner of Father 7: I don’t think you slept very well [in pregnancy].
Father 7: No. I never sleep very well.
Partner of Father 7: I don’t know whether I didn’t sleep because I was stressed or because I was pregnant, I don’t know, but I think you didn’t. It probably affected you in that way, didn’t it?
Father 7: Yeah. I haven’t slept as well since you got pregnant … It could be worry, or just concerned for her, thinking about the future, about how it would pan out and how we would do things, and just like not being able to switch off properly more than anything.
It was notable that the two men who reported having consulted their GP in relation to their mental health described more marked symptoms:
In the end I just couldn’t function… I wasn’t myself. I couldn’t even make simple decisions. (Father 6)
I felt so ill, I just wanted to die. I just thought this is awful. (Father 10)
Entitlement to health professionals’ support
Whilst there were examples of men having felt included by health professionals (for example, by being given breakfast on an antenatal ward), many felt excluded and unclear of their own role when in contact with maternity services, particularly at the birth. Men who had described feeling alienated/left out tended to qualify this by emphasising that the focus ‘should’ be on the mother and baby:
I think at the birth I felt a bit more like a spare part, but then again I mean they were really good with [partner], I just felt in the way sort of thing. (Father 2)
[The midwife]’s interested in [partner] and knowing that I was supporting her, but not so much as me, which, they can’t involve everyone, or take a responsibility for everyone … I very much felt like it’s certainly not about me, this. But at the same time, I do very much appreciate the limited resources. They can’t be responsible for everyone. The pregnant woman is the priority, isn’t she. (Father 18)
Evident in men’s descriptions were feelings of conflict about wanting to be more involved, and a questioning as to whether this may detract from the support provided to women; a situation compounded by limited contact with health professionals and the short, ‘rushed’ appointments often highlighted by men (and their partners, when present at the interview).
I didn’t feel like I could raise it [questions about previous difficult birth] when I went to the sessions with the midwife beforehand because I thought it was mainly focusing on [partner] and the baby and measurements and all that sort of thing … I think I was thinking, well, [partner]’s pregnant here, they’re focusing on her, I don’t want to sort of drag it out by 15/20 minutes, because of appointments and that, with me asking maybe what seem trivial questions but to me may be important … I was lost there, I suppose. (Father 3)
Having an unmet need in the context of a perceived under-resourced health service meant that whilst most men were receptive to and often welcomed the suggestion that fathers’ emotional wellbeing might usefully be addressed alongside that of mothers’, in the future, almost all expressed concerns about the impact this may have on existing provision to support women’s mental health. Of note were a minority of men who did not feel the need to ask fathers about their mental health and wellbeing, with one describing it as “surplus to requirements” (Father 17).
I would be thinking are there going to be the funds to like assist (.) even if I wanted some assistance, how are they actually going to be able to-? There is a shortage of [GPs] nationally so therefore me then going to the GP and saying, you know - if it was affecting me mentally, I’d feel almost like bad about it, I think I’m wasting their time right here, they’ve got people to see who are in more immediate need or something and, you know, so I probably just like hold it in a bit more. (Father 14)
Men were also conflicted as to which health professional would be best placed to have these conversations, given fathers’ limited contact with services and their perceived role of midwives (both an emphasis on the woman/pregnancy and on physical rather than emotional health). Some also questioned whether men in general would give ‘honest’ answers to questions about their mental health, although emphasised that they themselves would. It was notable that the two fathers who had accessed mental health support in the perinatal period did so via their GPs, not maternity services.
Theme 2. Protecting the partnership
Central to the majority of men’s accounts were reflections on how their relationship with their partner had evolved during the perinatal period and been affected by their baby’s arrival. Here, men placed great emphasis on their perceived need to protect both their partner, and their partnership. Most spoke about having less time as a couple since their baby’s birth but it was striking that for many men – both those interviewed individually and with their partners - their primary support and confidante continued to be their partner and not friends or other family members. Some men recognised an altered emotional connection with their partners, including feeling more distant. Such comments alluded to having lost some of their own emotional support from their partner; however this was rarely explicitly articulated by men, possibly reflecting their feelings of not being ‘entitled’ to support as indicated in the first theme.
[our] communications have gone through peaks and troughs. … During her pregnancy we were. I think we probably found ourselves closer actually during it, not that we were far apart before but I think it did… You’ve obviously come together to see this thing growing…. [Now] I probably don’t get the interaction so much with her (Father 13)
I think trying to juggle all of that and this child and you know, your relationship is the thing that takes the biggest hit. So I think it’s finding the time…and I think on the surface you probably think you’re okay, because you have a chat when you get in, but … before you know it you’ve not spent any time with each other or spoke to each other … we were probably just not really talking or not interacting with each other, we were just kind of existing … we sort of just never really reconnected … It’s really just facing it, just talk and be honest with them. But you need time to do it and also you need to both be in the same receptive mood. (Father 1)
The loss of a previous ‘closeness’ was entwined with men’s perceived need to support their partner with her new or altered role, identity, and, for several fathers, her distress and altered mood. Men’s sense of their role as a supporter was overt and often drawn upon when trying to reconcile the legitimacy of their own stress with their feelings that it ‘should’ be the mother who is the focus of supportive care.
…not being able to see as much of [baby] as I would like to [is] stressful as well trying to - worrying about looking after both of them. … kind of giving [partner] support, as well, with her return to work. She is obviously quite upset about having to leave a 1 year old. (Father 15)
For most fathers, the parents’ ‘team work’ was viewed as fundamental to coping with the demands of parenting and ‘navigating fatherhood’.
There’s always been the shared responsibility of if we see the other person getting a bit stressed up by it then the other person takes him away. (Father 13)
She’s been very stressed and when she’s stressed I’m stressed, that’s how it goes … I try to make life easy for her and that means I do more and get more. It’s a team. So it’s been a bit fraught but I think we’re kind of coming out of it a bit now. (Father 12)
Less common were reports of participants struggling to understand their partner’s perspectives and experiences, both physical and emotional, which could be a source of strain in the relationship. Such tensions were apparent in the interviews involving men’s partners, although not necessarily articulated explicitly. Feeling lost as to how to support their partner’s mental health, some men drew on practical approaches and problem-solving strategies:
I struggled at times because whilst I could see of the physical effects on [partner], I couldn’t understand the emotional and mental effects it was having on her, so I struggled with that, and I probably did become a bit more snappy, definitely low mood at times and struggling to sort of sleep properly, and you have a lot to think about as well so you’re trying to do everything, trying to make sure that we’re ready but also ready with the house and you’ve got so much to sort of think about (Father 6)
There’ll be times when she’s positive and absolutely fine and sometimes it goes the other way and she can’t cope and then we just argue …I try to do longer hours, just get up early and go to bed very late and work as hard as I can all the time. (Father 8)
Theme 3. Navigating fatherhood
Rather than engage in conversation about how they managed their mental health and wellbeing or accessed support, most men preferred to emphasise what had ‘worked’ in managing stress, focusing on their strategies for bolstering resilience and successfully navigating fatherhood. With the exception of one man (who stated that he had not wanted to be a father), men judged their performance against their aspiration to be a ‘good father’. Being a good father included being a ‘provider’ and ‘protector’ and was seen to extend beyond stereotypical ideals around financial responsibility, to encompass a ‘hands on’ role with their baby and providing effective practical and emotional support to their partner. Thus, for these men, being a ‘good father’ was synonymous with being a ‘good partner’, and ‘protecting the partnership’ (Theme 2) was inherent in navigating fatherhood.
Feeling prepared and (changing) expectations
Reflecting on their early perinatal experiences, men spoke of their role in preparing for the birth of their child and for being a parent with examples of reading books, watching TV, talking to others, attending antenatal appointments and antenatal education classes, alongside practical preparations around the house. Most noted however that they had not felt ‘truly’ prepared and parenting only became ‘real’ once they were ‘doing’ it. Whilst this was an observation shared by both fathers and mothers in the couple interviews, the lack of preparation appeared heightened for men, who often noted an absence of information and resources that were tailored and targeted towards them.
In comparing the experiences of first-time fathers and subsequent fathers it was evident that past experience could offer some learning but could also provoke anxiety, such as those concerning the birth.
We wanted to extend the family, have another child but at the back of my mind I was thinking, oh, we’re going to go through this labour again, which was hell last time, basically. … As we approached due date, I was getting less sleep due to worrying about it, but once it was there, we just got on with it. (Father 3)
In addition, subsequent fathers faced new challenges in meeting the needs of both children.
The first time round I didn’t have a clue, the second time round you have a clue but it’s still really scary … Losing the world we had before them was quite scary the first time round, and it hit me quite hard again … your world starts to come back together and then you have another one and it’s harder again because you’ve got two kids and two parents really … so the other one in a way has to kind of entertain [the older child]. (Father 1)
You didn’t know how the [older child] was going to react with the new born … it’s not just coping with the pregnancy but it’s coping with explaining to the first (Father 11)
Most men spoke of the reassurance that they took from coming to have the perspective that many of the challenges were ‘just a phase’; this was particularly voiced by subsequent fathers in comparing their experiences with their younger children. Some men reflected on the importance of changing their expectations, acknowledging that some of their stress reflected an unrealistic standard that they and their partners had set for themselves.
Even though it wasn’t by the book, but it made our lives a lot easier and that I think helped as well, not listening to what everyone told us (Father 6)
We felt this pressure building up the more we read, so that’s why we said, like, just trust our instincts (Father 19)
Managing stress through distraction, denial and release
Taking a practical approach to coping with and managing stress was common in men’s accounts. Some fathers reported finding that the stresses relating to pregnancy and parenting differed to those encountered elsewhere, testing their usual coping strategies and sometimes leaving them feeling powerless:
I’m probably the sort of bloke who actually just says, ‘oh I’m quite forgetful, so I can forget I’ve had the worst night ever’. I just try and forget it. So that’s probably my coping mechanism. It’s just, trying to forget it and I generally do. And then, I guess, I’ve found in some ways, work quite helpful in that respect, because you can have a crazy night where you have no idea what’s going on with [son’s name], but I can go to work and I feel fine. I’m in control here, I know what to do. There’s people who I can actually communicate with, they’ll do what I ask them to do and vice versa. So I’m probably not the best example, the best person to ask, because I think I just choose to ignore. I’m probably more of an ignorer, which isn’t probably that helpful for [partner]. (Father 18)
I think the way I deal with things in general and in work and things, I tend to think quite far ahead. Like I said, I’m quite regimented. So where there’s something like that, like, fatherhood and things that I can’t control and I can’t regiment them and put in a plan and things like that, I find it quite hard to digest. If there’s something I can control, a plan and put in a Gantt chart, great, I can deal with that. And things outside of that, you know, are a bit more chaotic. I find I struggle when I have to think them through a lot and maybe verbalise them with [partner]. (Father 17)
Where task-oriented strategies to tackle the sources of stress were deemed unavailable or inadequate, men managed their feelings of stress in practical ways, with mixed success. This included using sport as a way to relieve stress, offering distraction and physical release of tension, as well as a form of peer support. Several men spoke of using work as a distraction whereas for others work was a source of stress, limiting their ability to help at home.
I like my work because it’s technical stuff, I know I can bury myself in it and that will take my mind off it. (Father 7)
Another, who was unemployed, spoke of housework as a welcome distraction:
I was just pottering about, just trying to keep occupied with anything I could, the flat was sparkling when she got home, just anything to keep my mind off the fact that I wasn’t with her. (Father 9)
Whilst most men acknowledged teamwork with their partners and sharing of practical tasks, they often noted that they ultimately resorted to taking a self-reliant and stoical attitude when deemed necessary. Here, perceived expectations of masculinity as well as negative attitudes towards depression were evident in some accounts:
I’d just get on with it. I would just deal with it myself. That’s what I’ve always done. I think it tends to be a male reaction for most people (Father 8)
… there’s always the fear, if you open yourself up and you explain how you are feeling emotionally, like blokes will, sort of, ridicule you … don’t be so airy fairy, you know, that, sort of thing … just because blokes try and act all macho and stuff (Father 14)
I am a depressive, I’m depressed right now, have been for a few days. … I don’t think, in any stretch of the imagination, I’m the image of the stereotypical man, and yet I’m never going to be able to break out of the, man up, get on with it thing. And I don’t know where that’s come from, just it’s there. And I think generally, that’s my approach. It’s just a case of head down, battle on through
(Father 10)
Strength through fatherhood as rewarding
Men’s coping capacity was often strengthened through their positive and rewarding experiences of fatherhood; something that grew with the child’s development and her/his increasing ability to interact:
I think you cope through him as well, as he gets older. I mean, just smiling to himself and being able to come back and he recognises your face, that kind of stuff is a huge coping strategy. It’s really rewarding, so that makes it worth it. (Father 16)
The sleepless nights do take their toll on you, but I don’t know if it’s just the way that I think … but I tend to look at the bigger picture. I just think I’m happy because she’s healthy, she’s smiling… So I think, well, I must be doing something half right for her to be trotting around as she does, and she’s happy with me. (Father 7)
Fatherhood could also bolster men’s capacity for managing other external stressors:
But I think as much as having [baby] has caused me to feel more susceptible I think to everything going on, at the same time having him has given me a focus because when I’ve had the energy doing things with him has just taken my mind completely off everything because there’s nothing more sort of enjoyable sometimes than when you’re just doing things with him, whereas other times you just are thinking you just want to switch off and have a bit of break. (Father 6)
Occasionally men admitted their feelings of rejection or being ‘pushed out’ by the closeness between their baby and partner, and spoke of the importance of having ‘father-baby’ time or activities.
[For women] it becomes about me and bump, and then me and baby. Whereas fathers, it’s about them, you know, them two over there and me. You feel part of that unit but nonetheless, you’re always separated slightly… that’s just how it is. (Father 10)
Paternity leave was valued highly, and most men commented that it had not been long enough. Whilst none had chosen to share parental leave some changed their working hours to spend more time with their baby and to relieve their partner from caring for their child. Several men voiced the need to ensure not only time with their baby but also to protect their time, “keeping that family unit strong” (Father 6), again noting the significance of the partnership.
Theme 4. Diversity of men’s support networks
There was a great deal of diversity in fathers’ support networks, including difference in their relationships and interactions with other men. Whilst a minority spoke of ‘keeping themself to themself’ (coupled with self-reliance), most described a range of people they drew support from, although they varied in the ways that they used this support.
Despite the apparent support networks available to men, their accounts revealed a lack of resources, with several lamenting the absence of tailored and targeted information and some noting the paucity of groups for fathers and male-friendly parenting environments.
Pre-existing networks - friends, family and the wider community
Men spoke of existing relationships that offered ways to ‘casually’ explore concerns and gain reassurance, without the need to access formal support. Several men mentioned family - either theirs or their partner’s - who provided reassurance about common complaints and health anxieties with young children. Often this support and advice came from siblings or mothers, rather than fathers, with some men acknowledging the changing involvement of fathers between generations.
We didn’t know what was wrong [when baby was teething], and I think neither of us was able to reassure the other. But, in those situations, we’ve had other people that have been able to add a bit of a perspective. (Father 4)
Several men relayed conversations that they had had with other fathers in their wider social networks; including colleagues and neighbours. Sometimes, these were brief conversations in passing, whereas others were ongoing, in-depth discussions. For these men, the discussions allowed them to talk about babies and relationships, alongside topics that did not include these aspects and offered a welcome distraction.
It was just like, how is your respective other half getting on? … a couple of blokey conversations of, oh she’s doing my head in today, kind of thing … It was just nice just to have that male bonding really, which perhaps my dad and [partner]’s dad didn’t really have. It was almost they had their male friends but they didn’t talk about it… it was nice to have them as a support if you needed or more likely just to have a normal conversation. You didn’t have to be talking about babies and pregnancy and nurseries and everything that goes with it all the time. It was there if you wanted it but you could have a bit of a normalised day to day conversation with them without it. (Father 13)
[At work] I can cover an awful lot of different things with them… And in a lot of cases, it is bloke banter. You wouldn’t think that it [but] you’re in the middle of an engineering workshop surrounded by blokes, and we probably spend half the day talking about babies and kids and that sort of thing. But I feel more comfortable with it, because I know that there’s guys there that have had similar experiences or they know what it’s like. They know how I’m feeling if I say, oh, we’ve had a rough night … Some people have had worse experiences, so you think, what we’re going through is normal. (Father 7)
‘Formal’ peer support and opportunities to meet other fathers
Men were split on their attitudes towards formal peer support and groups. Some discussed their experiences of mother and baby groups and the lack of equivalent groups for fathers.
I think in some ways it would be helpful before and after to make sure that dads are prepared and that they’re coping and maybe even if it was just away from the mums for some people maybe, because I think some dads might find it a bit embarrassing to sort of say I don’t know what I’m doing. (Father 6)
Some men described positive experiences of ‘gendered’ events and gatherings with members of their antenatal education classes, after their baby’s birth; however this was limited to experiences of classes accessed privately via the National Childbirth Trust (NCT).
Men’s descriptions indicated that conversations in these groups were characterised as ‘war stories’ and ‘banter’ (Father 16), rather than overtly tackling the emotional aspects of pregnancy and parenting; nonetheless, these could offer venting and validation from peers with similar experiences.
You know we do talk to each other about parenting stuff but … it’s never a serious conversation, it’s all, done over a beer you know and a few jokes, which is good. (Father 1)
If people haven’t got, like I’ve been fortunate enough to know other guys going through a similar thing. I can imagine, yeah, you probably do want to just at least know that you’re not alone. Even if you don’t want to talk about it, just to know, actually, he hasn’t had any sleep either. (Father 18)
Again, there was evidence of some men feeling conflicted about wanting or needing emotional support.
I’d feel like I maybe shouldn’t want to want some support, and that I should be fine and I should just get by, and actually I have so did I need it? Probably not. Would it would be nice? Yes, maybe. Would I have gone? Different question again, maybe not. (Father 16)
If I’m there and I say, you know, I’m feeling down or whatever they’ll more than likely punch me in the arm and get me a beer and tell me to shut up, which is what I need I think. (Father 17)
Some men vocalised that they would view fathers’ groups as ‘forced’, questioning their value and preferring to use their own informal support; these pre-existing relationships appeared to enable greater expression and discussion of more sensitive topics, where it was wanted.
Lack of information resources tailored to men
There was a common desire among fathers to have more information about pregnancy and parenting, and most expressed a preference for information that was geared towards fathers.
I wouldn’t have a clue how to go about [accessing groups for fathers]. … with [partner], she can go online and find 28 different chat rooms … I don’t know if those things even exist [for fathers] and I wouldn’t know where to look. (Father 1)
Father 3: Yes, what I’m saying is I need pointing in the right direction of going onto MUMbler or whatever.
Partner of Father 3: You’d have to join it.
Father 3: Well, yes, but as a man, I would not necessarily know to go on to that site to find that information. I wouldn’t even have given it a thought.
A few men were content accessing existing online resources despite them being oriented towards mothers (e.g. netmums), saying they were accessing it “as a parent” (Father 4); of these one noted not wanting the ‘jokey’ communication used in male arenas.
I didn’t really get on with the dads’ [forums] … they were quite jokey …I guess I wanted just someone to say, ‘yeah, this is normal, that’s fine, you know, it gets better’, or whatever. (Father 2)
I wouldn’t know if there is anything, the equivalent for dads, I’ve not really set out to look that specifically, I’ve just come at it more as being a parent … I absolutely would [feel comfortable using netmums] more than happy to look for help, advice, and other people’s experience anywhere really. (Father 4)
Many spoke of the value they placed on examples that were based on other men’s experiences, and the need for more information that was not just about being a father but also about supporting their partner – including with their psychological health. Fathers also acknowledged that some men did not feel comfortable accessing classes and recognised that written materials may be more acceptable to some men, offering a route to further information and support, as needed or wanted.
I really enjoyed reading [the Dads’ handbook] … because a lot of it was based on other people’s experiences so you realise you’re not in the boat by yourself, that there are other people that have been through it and obviously it’s a natural thing that everyone does every day… it made me think about things that I hadn’t thought about or think less about things that I had been thinking about. So that was probably a big thing for me. (Father 6)
Perhaps if there was some sort of dads thing, like a bounty pack [information pack provided to mothers in England] which is just for dads. Okay, yeah, it’s got baby stuff in it as well, but it’s baby stuff that the dads would - and I know it’s hard because it shouldn’t matter whether you’re a male or a female really should i … So I don’t think you necessarily want to say right, here is a thing just for dads. But I do think you need something that’s quite directed at them. (Father 1)