Postnatal Depression Article

Post-natal Depression in First-time Fathers

I first came across this idea whilst listening to "Woman’s Hour" on the car radio. As usual, I had missed the beginning of the item, but it sounded interesting and, to be honest, a bit unlikely. I had reached a dead end with my MSc research project, looking at the effect of emotional support on men’s recovery from heart disease, and my tutor was suggesting I look at first time fathers. The Woman’s Hour item seemed to suggest that men who were reporting post-natal depression had inadequate support systems so I decided to think about the role of emotional support in alleviating or preventing it.

Postnatal depression in both sexes is controversial in that its causes and even its definition as a separate diagnosis are by no means straightforward. Possible causes range from the biological – genetic predisposition and hormonal imbalance – to the social – inability to conform to the role of motherhood and the attitudes and behaviour of health professionals during the birth process and neonatal period. Definition is circular, the current one being that condition which is indicated by a score of 12 or above on the Edinburgh Postnatal Depression Scale.

Much of the focus, in the build up to childbirth, is on the health and well-being of the woman. In one sense, we could say that this is how it should be since it is she who is going to do the work (labour is an appropriate word) of bringing a new life into being. However, little attention is paid to the emotional needs of the father and, if anything, there are more pressures put on him in the process of fatherhood now than there were in the days where the production of the necessary sperm was seen as the sum total of the man’s contribution.

Until recently, the birth process has been, and in many cultures, still is "women’s business" from which men are excluded. When my wife and I arrived at Cuckfield hospital in 1986 for the birth of my son, echoes of this exclusion were still much in evidence. We were much too early and Jane was offered a place on the ward whilst I was shown to the "fathers room"; a dingy, airless place reeking of cigarettes and impotent anxiety. It being a fine June morning, we decamped to the hospital garden where Jane went through the first stages of labour to the accompaniment of the dawn chorus and looks of astonishment from the health professionals arriving for the morning shift. For most men, the birth is a "Wouldn’t have missed it for the world" experience, but few of us are prepared for the sheer power of the feelings that are generated by it even when it is a straightforward delivery.

Change, for any individual, brings about destabilisation, which is not resolved, until the change has been assimilated. Nowhere is this truer than in the case of fatherhood, but it seems that its effects on men have received minimal attention in the research literature and in the resources allocated to coping with the changes involved. For example, when my wife was pregnant with my son, the course of antenatal sessions she attended had just one session to which partners were invited. The National Childbirth Trust do invite partners to their antenatal sessions, but the feedback from these is that, whilst men undoubtedly benefit from their involvement and the acquisition of vital information about the process of childbirth, they see their attendance as demonstrating solidarity with their partner rather than an opportunity to meet any of their own needs in relation to becoming a father.

Men rely heavily on their partners for emotional support and intimacy. This may not be healthy, but it is tolerable as long as the partner is available to give that support. However, during the process of becoming a mother, the man’s partner may herself be the one who needs the support and reassurance She also has another important focus for her emotional energy, i.e. the baby, both before and after the birth.

Winnicott, who was a psychoanalyst and paediatrician, describes a process, which he calls Primary Maternal Preoccupation, in which the mother’s identity becomes fused with that of the baby to the exclusion of all other relationships. This can leave men feeling "out in the cold" with no real way of getting their emotional needs met.

Increasing attention has been devoted recently to pre-conception preparation for parenthood, but most of this has focussed on physical health, i.e. diet and exercise. This is obviously useful, but perhaps we also need to pay attention to the emotional health as well. Emotional resources, are vital since parenthood will probably make more demands on both partners than can be satisfied from within their relationship.

In this respect I was lucky, in that Jane and I had a well developed support network at the time of her first pregnancy in the shape of the organisation with which I was training to be a psychotherapist. This included a men’s group, a women’s group and a couple’s group. I found this emotional support, along with the informational support offered by the NCT group we attended, absolutely invaluable. Other first time fathers I have encountered, both personally and professionally, have not been so fortunate. Listening to their experiences has left me sometimes with the unexpressed "Why didn’t you phone me?" question – unexpressed usually because I don’t want to make the man feel any worse than he already does about "not doing it right". Perhaps it is also unexpressed because I feel guilty about not fostering a relationship which makes it easy for the man to phone me. But men do find it difficult to ask each other for help, accept it when it’s offered or to acknowledge when they need it. Vicki Helgeson , writing about men’s health, cites copious evidence that men’s friendships are restricted by competitiveness and a lack of ability to ask for help. I suspect that this is just one of the factors which prevents men from building and sustaining the kind of support networks they need, particularly in the process of becoming a father.

Since I started to look at this area, an important report, Becoming a Father, has been produced by the National Childbirth Trust in association with Fathers Direct. It is clearly of vital importance that the needs of fathers are highlighted in research such as this which achieves this task excellently, but the report also raised some issues for me which I would like to address here. I was curious, for instance, to know why no men were involved in the production of the report (Other than the general acknowledgement to Fathers Direct). Also, why were the questionnaires sent to the women on their partners’ behalf rather than to the men directly? Factors such as these perpetuate the "Childbirth is women’s business" myth I referred to earlier.

The other possibility, that men could support each other, doesn’t seem to be very popular. Of all the possible additional services identified in Becoming a Father the only one which didn’t have a majority of those questioned saying they would not use it was "Local social/sports events for fathers" and this had a large number of "might use" responses. In my own research I have had extreme difficulty persuading men to take part in a brief support group even though I remain convinced that there is a need, if not a demand, for it. I have not, so far, found much evidence to support the existence of postnatal depression in first time fathers as identified by the Edinburgh Postnatal Depression Scale, but this may be due to small sample sizes and restricted sampling groups. However, I have uncovered a need for social support amongst fathers and a considerable difficulty that men experience in asking for it. In my own work with individual men and with men’s groups I have found both of these issues to be common, challenging and rewarding to work with.