Men find it hard to seek help when they experience perinatal distress. Simon Day shares his story of postnatal anxiety and talks to parenting advocates about what fathers need to do when they’re feeling down.
In late December 2019, our twin boys arrived two weeks earlier than expected. They were happy and healthy, but at 2.3kgs they were small and needed help learning to feed. We spent the next eight days in Auckland Hospital, guided through the needs of our newborns by the midwives and doctors of ward 96. Then suddenly we were alone at home with these two tiny humans who relied completely on us for survival.
As a new father, I felt my key role was to provide support for my wife. She was recovering from carrying the boys for nearly nine months and then giving birth, and was now charged with keeping them both alive. She was under huge pressure. My job was meant to be easy compared to hers.
But I felt deeply unqualified and unprepared. Never had I been given a more important role with less preparation or training. I’d been so excited to become a father, but suddenly, I felt overwhelmed by the responsibility.
For most days, things were fine. I’d been blessed with falling in love with our two boys immediately and I felt a strong bond with them from the day they were born. But at nights when we’d struggle to get them to sleep, in the deepest part of the pit of exhaustion, I felt engulfed by despair. I’d become frustrated, and then angry, at these tiny, innocent little boys, certain their refusal to settle was malicious.
I felt smothered in anxiety that there was something I was doing wrong that was stopping them from sleeping, that was upsetting them. I felt helpless. I didn’t know who to talk to.
In recent years, conversations around postnatal depression and perinatal mental distress have become more open and honest, but have almost exclusively focused on mothers. That’s an important development because we know one in five expecting or new mothers will experience mental distress. And we know if these issues are left untreated they can have a devastating impact on whānau.
But men still aren’t talking enough – or being asked enough – about the emotional stress they can experience as fathers. The culture around staunch masculinity still appears to be a barrier for fathers experiencing mental distress to seek support. This is in spite of growing awareness about the extent to which men are affected by perinatal distress.
A 2017 study found that as many as 6.2% of men experience symptoms of depression during the perinatal period (from the third trimester of pregnancy to nine months after birth). The research was taken from interviews with families from the contemporary, longitudinal study Growing Up in New Zealand which is tracking the development of more than 6000 children born in 2009 and 2010.
The study investigated depression symptoms in more than 3,500 New Zealand men during the third trimester of their partner’s pregnancy and then again nine months after their child’s birth. It found around one in 25 men reported symptoms of postnatal depression and about one in 50 symptoms of antenatal depression.
When the study was published, its author Dr Lisa Underwood from the University of Auckland highlighted the stark difference in experiences for mothers and fathers in the way mental distress is acknowledged and managed. While maternal antenatal and postnatal depression, along with their consequences, are slowly becoming more visible, there’s been much less research to identify perinatal depression symptoms in men.
“As in many other countries, New Zealand women are assessed for postnatal depression following childbirth. There is no routine screening of women during pregnancy and none for fathers before or after the birth of their children, since they are not usually engaged in routine perinatal care,” said Underwood in 2017.
Throughout our stay in hospital my wife’s health – physical and emotional – was tended to with care and compassion by the midwives and doctors. I was largely ignored. At the time I didn’t even notice – I was glad there were professionals closely monitoring her recovery.
But when I got home, I realised I had very little understanding of what I was feeling and how I was meant to cope with it. Much of it was normal. Becoming a new dad is an intense experience. Feeling pressure is part of the experience, its helps you respond to the demands of looking after a newborn. But I didn’t need to feel overwhelmed. I shouldn’t have had to endure severe angst.
It’s when your feelings start to impact your quality of life, and your family’s, that you need to ask for help, says parenting commentator, educator and father, Nathan Wallis. He remembers when his first daughter was born he couldn’t stop freaking out about cot death.
“I was constantly looking into her cot. That was anxiety. But that wasn’t affecting the quality of my life or the quality of my relationships with other people,” he says.
“When it starts impacting your wellbeing and the people you live with then you should seek help.”
My anxiety put huge pressure on my relationship with my wife. It amplified our different parenting styles, and instead of allowing them to be compatible, they became confrontational. It started to jeopardise the development of my relationship with my boys. I started catastrophising small issues.
It wasn’t until I recognised that something was off with how I was feeling that I was able to start to feel better. Acknowledging to my wife that I wasn’t myself empowered me to tell someone outside our family. This was the step that changed everything.
The village it takes to raise a child is there to support the parents too. During new parenthood it’s important to have a close friend who you’re constantly in touch with about how you’re feeling, says Wallis. Have that one person you trust and talk to them all the time. Share the joys of being a dad, and share the pain and frustration too.
“Listen to your community. If they think you should get help, even if you think you shouldn’t, you should,” says Wallis.
The “cultural poison” of masculinity means men find it harder to seek help than women, says Wallis. Knowing it’s OK to struggle is still hard for dads. Allowing yourself to accept help can be even harder.
“A lot of men think seeking help isn’t going to do any good. It’s not a part of the culture yet for men to seek help for postnatal depression.”
We were lucky to have a supportive and caring Plunket nurse. As much as the boys’ growth, she was concerned and invested in our health too. She wanted to know how each of us were feeling, and how we were coping as a couple. She made me feel completely comfortable in telling her I wasn’t doing great, and that although what I was feeling was normal, it was something I didn’t have to carry on my own. It immediately made me feel better.
She put me in touch with Brendon Smith from father support organisation Kidz Need Dadz. Since 1998, it’s tried to bring a dad perspective into existing family services and address the lack of information and support for New Zealand fathers.
They discovered there was very little research or data on dads in New Zealand and “that many of the issues facing dads and families could be mitigated with better education or inclusion of fathers in the maternity services”. They created spaces for dads to feel safe, support services and community resources to facilitate that inclusion. Its Why Dads? booklet provides simple, basic lists for dads on how to get involved and help both before and after the baby is born, and how to handle changes in the relationship and hormones.
The pressure on new dads is unique and often misunderstood and ignored, according to Smith. Fathers can often feel left out of pregnancy and the early stages of the baby’s life. This can define his engagement with the family and his mental health.
“The maternity system is random, some midwives hook dad in, some hardly notice him; some maternity wards welcome dads, others treat him like an annoying visitor,” Smith says.
“It’s so often nowadays that mum wants dad to stay with her, especially for those first few nights to help her sleep and rest, help understand breastfeeding. If dad isn’t allowed to stay and be a part of that he feels disempowered and the mum may feel isolated or even abandoned.”
While it’s starting to improve, the whole world of new parents is pitched primarily at women. This can implicitly exclude men.
“The commercial world used to ignore dads. They target mums to sell nappies, milk powder, baby clothes, toys for babies. In fact, everything except for prams and insurance,” says Smith.
“It may not make much difference to some dads if they’re keen to get involved and help. [But] other dads get the impression that they better keep their distance, not interfere, he feels [unwanted], so he slips back to work and later gets told he wasn’t there when he was needed.”
This disempowerment and disconnect for dads can have consequences not just for their relationship with their newborn child but also their child’s development. This is because there’s a brief window when a baby is first born for dads to start a bonding process that helps kick start the child’s development.
Hormones are a hell of a drug. You get high on fatherhood. During those first days, hormones are being produced that mimic the mothers. Oxytocin is the key hormone, and that makes you feel emotional. Then there’s Prolactin, which is the same hormone produced by a breastfeeding mother to create a bond with their baby and promotes attachment. Vasopressin also makes a new dad feel protective and his testosterone drops making him tender.
Grabbing this moment is an essential opportunity to build that bond between father and child. It’s a vital period because it only happens once – if those chemical switches aren’t flicked on in the brain, hormone levels can quickly drop again and that window for creating a lasting bond can close.
“It creates an emotional connection and response and builds a relationship. It’s part of our attachment and survival,” says Wallis.
It’s also essential for the child’s start in the world too. The benefits are reciprocal as oxytocin triggers the start of the brain’s development. The parents’ behaviours and engagements with their child shortly after the baby is born are really important for that process, says Wallis.
“From neuroscience, it’s a lot to do with eye gazing. That’s why human babies are born with the ability to hold their head in one spot,” he says.
Being more aware of men’s’ vulnerability to perinatal distress is a crucial part of not missing that opportunity, according to Dr Underwood.
“Increasingly, we are becoming aware of the influence that fathers have on their children’s psychosocial and cognitive development,” she said as part of the study’s release.
“Given the potential for paternal depression to have direct and indirect effects on children, it’s important that we recognise and treat symptoms among fathers early. Arguably, the first step in doing this is to raise awareness about factors that lead to increased risks among fathers themselves.”
These risk factors include a history of depression, unemployment, relationship status and family environments during the postnatal period. The strongest predictor of paternal depression, according to the research, is no longer being in a relationship with the child’s mother. Covid-19 has amplified all these risk factors and referrals for women with perinatal distress and anxiety have increased significantly. The team at Kidz Need Dadz has seen a significant increase in demand for its services in 2020. In May, June and July, it had a record number of fathers seeking its services. It’s had to hire a new support worker and coordinator to keep up with the demand.
The first thing that made me feel better was telling someone how I felt. This immediately lifted a weight off my shoulders and when my anxiety appeared at home, I could recognise what I was feeling and start to address it.
Another important part of shifting the burden of that anxiety was trying to restore some of the parts of my life that had become buried in nappies, bottles and sleep deprivation. I found time to restart an exercise routine. I started cooking again rather than surviving on M&Ms and frozen lasagne – it was both healing and healthy. Writing about the experience of being a new dad – which felt like another way of sharing my experience – was therapeutic.
Recognising ways you can look after yourself is important, says Wallis. Be aware if you’re not leaving the house, if you’re not eating well, or if your relationship is being affected. But also make sure you’ve always got support.
“Talk to your friends all the time. Good times and bad times. Have someone you trust. Look to professional help is when your friend suggests it,” says Wallis.
I was lucky that clinically my experience was relatively mild. I was also privileged to have access to our wonderful Plunket nurse and to quickly find effective ways through my anxiety. But at the time, in those moments, it completely overwhelmed me. But it doesn’t have to be that way. Talk to someone, ask for support. There are people waiting to listen, and it’ll help.
Where to get help
Parenting tips: https://whanau.skip.org.nz/conscious-parenting/celebrating-dads/
Kidz Need Dadz: https://www.kidzneeddadz.org.nz/
Father and Child: https://fatherandchild.org.nz/
Perinatal Anxiety and Depression Aoteara: https://pada.nz/depression-in-fathers-what-is-it/
Greenstone Doors: https://www.greenstonedoors.co.nz/mens-programmes.html