What is it?
The arrival of a baby is a time of huge change not just for mothers, but also for fathers. Fathers can be forgotten as mother and baby can receive most of the attention. A baby can bring great joy but may also add unpredictable stresses to the family.
About 10% of men can experience depression after childbirth.
- If a mother is unwell with PND or a related condition, then fathers can have their own unique problems:
The father can be forgotten as the mother struggles to cope.
- Fathers are expected to cope and provide support to mother, baby and any other children.
- Men often suffer in silence. They may feel very misunderstood during this important transitional time in their life.
- Fathers are usually working as well as helping more at home.
- Men feel under more “pressure” at this time.
Pregnancy is a challenging time for fathers as well
- What does the future hold?
- Will his partner and baby be healthy?
- Will he be able to provide for the family?
- How will his relationship with his partner change?
- Does he feel an important part of his baby’s growth and development?
Being a father doesn’t come naturally
For many fathers babies are an unknown quantity. Contrary to popular belief, how to handle and relate to a baby does not come naturally. There is no easy operations manual!
How a man copes with becoming a father depends on many factors. Some are:
- His own experience of being fathered.
- Whether he finds relationships easy or challenging.
- Whether he has had contact with babies and children before.
Fathers and mothers relationship
Modern day expectations on fathers can be stressful. Early discharge from hospital and less availability of family supports can place more burdens on the father.
Fathers can feel excluded from the relationship between the mother and the baby. In fact, fathers have felt so excluded that this has been called “the fourth trimester”. Two thirds of fathers may experience their own version of the ‘blues’. They can feel inadequate for the task in hand, less in control of their own lives and “on the outer” in their relationship with their partner.
Mothers don’t mean to exclude the father but they are trying so hard to get their own mothering right that they become preoccupied with the baby and overlook their partner. Inadvertently they may be pushing away their most valuable support.
The birth of the baby has brought about the loss of the familiar partner that he had known. It also brings theloss of the relationship that they once shared. There is the loss of control, loss of intimacy and the loss of how things used to be.
A new relationship is formed
Fathers and mothers have similarities and differences in the way they relate to their infants – dads need to find their own way. Like mothers, fathers can also experience what has been called “engrossment’ with their baby (wanting to stare at the baby for long periods of time). The relationship between father and baby is important.
This means that a safe and secure relationship has occurred between father and baby. To help this happen, a father must:
- Make a commitment to baby and mother.
- Take and negotiate responsibilities.
- Develop and maintain the relationship.
- Maintain family integrity.
- Balance activities.
- Have a strong sense of being a father.
Fathers tend to have less robust social support compared to women. It is not the “male thing” to talk about adjusting to fatherhood and the extra stresses that go with it. Men are more reluctant to seek help for emotional issues.
Fathers adjust best if they are included in the process of pregnancy, childbirth, and caring for the baby. Fathers need to spend time developing their relationship with the baby. This will also help their mood.
See also a website for fathers with information on postnatal depression, http://fatherandchild.org.nz/projects/post-natal-depression/
Condon JT, Boyce P, Corkindale CJ. The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood. Australian and New Zealand Journal of Psychiatry 2004; 38: 56-64.
Donovan J, Barclay L, England J, Ramsay A. Men’s transition to parenthood. In: Laws T (ed.), Promoting Men’s Health: an essential book for nurses. Ausmed Publications, 1998; 143-155.
Lovestone S, Kumar R Postnatal psychiatric illness. The impact on partners. British Journal of Psychiatry 1993; 163: 210− 216.
Matthey S, Barnett B, Ungerer J, and Waters B, Paternal and maternal depressed mood during the transition to parenthood. Journal of Affective Disorders 2000; 60: 75-85.
St John W, Cameron C, McVeigh C. Meeting the challenge of new fatherhood during the early weeks. Journal of Obstetric and Gynecologic and Neonatal Nursing 2005; 34: 180-9.
Listen and try to understand. It’s hard for someone who is depressed to explain how they feel.
Offer practical help. If a person isn’t sure what practical help they want offer alternatives or suggestions e.g. “I would like to help, can I cook a meal or take the older children out?” “The house looks fine but I know that you may not have the energy to do any housework, can I vacuum or hang out the washing or something?” (Don’t have your own agenda about what you think needs doing-do what she wants done!) Take over some regular jobs such as doing the washing or bathing the baby.
As part of being depressed, your partner will probably lose interest in sex. Be reassuring about this. Talk about it. It will pass. Make sure you still give her cuddles and kisses and tell her how much you love her. She needs your affection, even if she doesn’t reciprocate.
Help her to get out and have fresh air and exercise. She may not feel motivated to do so but will often feel better if they do.
Help get regular meals/snacks especially if breastfeeding
Help her to have time away from her baby doing something nice such as getting her hair done, having a massage but not doing the groceries
Arrange family/whanau for help and support. You may have to be specific about what sort of help you want such as, coming over and looking after the baby so that your partner can have a rest, have a shower, or take a walk. Ask them to do the shopping (give them a list), make a meal, do the washing, do some housework.
Remember some people are willing to help, but don’t know what they can do. They are happy to be told exactly what you want.
Tell your employer what is happening. Your partner may ring you frequently at work or even demand that you come home. It will help if your employer is understanding. Take some sick leave if you need it.
Take time to educate others about your partner’s illness. It will help them to be more supportive.
Take the time to go with your partner to her doctors appointments. Ask questions. Ask for information about PND. If you feel unhappy that the doctor is not listening, see someone else. One study found that 50% of men whose partners had PND found that health care professionals tended to minimise the problem and be reassuring. They felt that they were not taken seriously.
If your partner needs medication, try and be involved with this decision and be supportive. A mother will worry about taking medication and she will feel unsupported if you are negative and critical
Get support for yourself – it can be scary or depressing living with someone who is depressed.
What to say
When reassuring, be careful not to dismiss a persons concerns – rather than saying something isn’t a problem say “ I will be with you to help with that” or “ I can see that is really worrying you but I think we can get through that”.
Due to the indecisiveness of depression a person may need guidance and support with decision making. Sometimes you need to take responsibility and make the decision for them – this can be very hard to do. However, don’t jump in too quickly with what seems like an obvious solution; take the journey with the person to help find the solution.
Encourage her, tell her that she will get back to her “old self”. It will take time.
Be positive about her accomplishments no matter how small things such as hanging out the washing or managing to have a shower.
Offer ‘space’ if that is wanted.
What not to do
- Avoid judging or getting angry – it’s no ones fault.
- Don’t tell her that she is lazy or a poor mother. Be positive about her ability as a mother.
- Don’t be critical of her or compare her to other mothers.
- Don’t be upset when she is negative and grumpy. Remember she is unwell and will get better.
- Don’t make any major decisions or take on new projects, such as shifting house or starting a new job.
- Your partner is unwell and may say things that she does not truly believe. This is part of her illness.Don’t take what she says personally.
- You can’t make her better. By listening to her and being supportive, you will be helping her.
- If your partner needs hospital admission – remember it will be best for mother and baby – be supportive.
- It will be hard for her to believe that she will ever feel better and be a good mother. She will get better but it will take time.
“She got to the stage where she was doing the bare minimum for Ryan and probably doing even less than that for herself and I’d rank probably way down the line. I was working and taking time off from work as she wasn’t coping and the daily routine for me was that I would go to work, come back and do everything that hadn’t been done during the day. As soon as I walked in the door she basically turned off the key to herself and the kids and handed over to me”.
How to help yourself
You will be feeling confused, tired, and worried about your partner and baby. You have a higher risk of becoming depressed or getting anxiety symptoms during this stressful time. You will have high demands of your time. You may be working and trying to do extra tasks around the home, as well as trying to support your partner and baby.
You may feel a loss of your own supports, such as going out for a drink with your friends. You may not be able to play sport. You may not be available to entertain or travel as usual for your work.
You may find it hard to discuss what is happening to friends and family. Your partner may want to “keep it secret”.
It is important to look after yourself by;
- Getting extra help.
- Telling others what is happening.
- Telling others how it is for you.
- Watch your alcohol and drug inkake It is very easy at this stressful time to find refuge in alcohol and drugs which can lead onto other problems
- Negioate specfic times to have time out for yourself
- If you feel overwhelmed, see your own doctor and tell him/her how you are.
“It took a long time for Ruth to acknowledge she needed help – well, she probably knew something was wrong but didn’t have the motivation or couldn’t face up to it and things got really bad with us. We got to the point where we were heading in the wrong direction and were very close to separating. I knew that this wasn’t us but I didn’t recognise depression. It was a big weight off my shoulders when she was diagnosed – that she wasn’t going crazy. That it wasn’t our marriage but it was something that we could resolve”.
Warning signs to watch for
You will be worried about your partner and baby. Trust your own instincts if you feel that she may be a danger to herself or the baby. Get help urgently.
Some early warnings can be:
- Talking about harming herself or the baby.
- Severe changes in mood.
- Very unusual behaviour that is out of character.
- Bizarre thoughts, risk taking behaviour.
- Morbid thoughts, “you would be better off without me”.
- Extreme despair.
- Disordered thoughts.
If your partner has any of these symptoms, she needs urgent help from your doctor or the Emergency Psychiatric Service (number in the front of the white pages under Mental Health Services).
Planning for the future
Try and remain positive that your partner will return to her normal self and that you will all enjoy a happy family life together.
PND can return in future pregnancies. Your doctor will discuss this with you. Treatment may be useful in pregnancy or immediately after delivery to help prevent problems.
“We’re OK now and we look back at it now as our year from hell. It was a major relationship challenge but we’re in it together – it tested us and we almost lost it.
He suffered from postnatal depression
John was 32 years old when he and his wife had their first baby. He wondered what had struck him when the first 9 months of living with the new baby became sheer hell. He had moved house, started a new job, and now the baby had colic for the first nine months
The 9 months dragged on and on with his partner and him sharing no meals together, always taking turns holding baby. Despite feeling exhausted, sleep eluded him and his life felt out of control.
He felt overwhelmed with stress and worry. He felt a huge responsibility being a father who should financially support the household and keep things together.
While his GP tried to help and put him on medication John didn’t improve. Finally, he went to a psychiatrist and John remembers feeling a huge sense of relief. The psychiatrist seemed to understand how John was feeling. John felt he had come to the right person. With new medication and new hope, John noticed a turnabout within a few weeks he was improving and more in control.
He found weekends were worst when there was no schedule in place. Simple tasks like buying milk at the local dairy could become a huge ask. He and his partner resolved this issue by planning some tasks to begin straight away upon waking in the weekends.
For John, it was confidence eroding, relationship-testing time. He had panic attacks, and experienced a very fine line between being well and being unwell. He remembers the advertisements of John Kirwan admitting he had depression and felt relieved that other men felt as he had. He admired John Kirwan’s courage to admit this so-called “weakness”.
John now believes that most people don’t recognise that men can get postnatal depression and how serious this can be and feels that it is largely undetected and untreated.
Finally now John is able to talk about his PND and has found that there are many more men like him. When he was sick he had difficulty admitting that he was unwell and now he is more open. He realises that it takes time to recover but it is worth the long hard journey and that personal strength can be gained.
His wife had postnatal depression
“Leading up the birth of my first child everything seemed happy and normal as we did not know what sex the child and it was going to be a surprise. We were so excited and could not wait to be first time parents.
After a birth that was long and stressful for my wife, we had a beautiful little girl. Going home we settled in and whilst we were both so tired, life initially was great.
I did not know anything about Postnatal Depression and never ever thought that my wife would suffer from it. She was such a happy positive person and was a very maternal woman. It was me that was always down and depressed and feeling low. When my wife became unwell I did not know what to do to support her and was no help at all.
As a couple we really never have been very open about how we feel. I know that I have always kept my feelings to myself, even some times not wanting to live any more!
During this time I felt that everything in our lives had turned dull and grey. Even although we had this beautiful baby, life was a struggle. My wife’s depression and anxiety was really eating away at her but I did not know how to deal with it or how bad it really was for her.
I deeply regret now not being there for her when she needed me. I did not understand why she was always low, grumpy and tired. It seemed that there was no time for me anymore and no matter what I did, it was not good enough.
When my wife was depressed I was just as bad, if not worse. Because I was not strong for her, she would sink lower. It was as though we both needed a happy positive partner to help us through this time, but we didn’t have one.
My wife finally went and got help and was diagnosed with postnatal depression and anxiety. She went onto medication and slowly improved.
My wife is still taking medication. With the birth of our second child, mother, father and baby are well. My wife and I are a better couple for having gone through this experience and we now know the symptoms to look for. We are both a lot more relaxed and open, enjoying the baby experience the second time around with both of us working together as team.”
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