“It’s a lot of pain you’ve got to hide”: a qualitative study of the journey of fathers facing traumatic pregnancy and childbirth

Abstract

Background This study aims to explore the emotional and behavioural responses and coping strategies of fathers or expectant fathers who faced a significant traumatic event during a partner's pregnancy, labour, or the postpartum period. Methods This prospective qualitative study of 24 fathers was conducted at a public teaching hospital in Brisbane, Australia. ‘Traumatic pregnancy’ was defined as a pregnancy complicated by life-threatening or severe risk to the mother and the fetus, termination of pregnancy, intrauterine fetal death or stillbirth. Semi-structured interviews of participants were conducted 3-4 months after the traumatic event. An initial qualitative analysis with automatic coding was performed using Leximancer and later followed by a six-phase manual thematic analysis. Results A pregnancy-related traumatic event had significant mental and physical impacts on fathers. Participants' reactions and coping strategies were varied and influenced by their background history, pre-existing vulnerabilities, and the gap between expectation and reality. Most fathers described a fluctuating state between their needs 'not being met' and 'being met'. These needs were conceptualised using Maslow’s hierarchy and Calman’s gap theory to construct a composite thematic model to depict the universal requirements of men facing a traumatic pregnancy or childbirth. Conclusions A greater understanding of the needs of men and gaps in their care is urgently needed. A targeted effort is required to make maternity services father-inclusive. This approach may assist in preventing long term consequences on fathers, partners, and their children.

Fathers attending the birth of their baby: Views, intentions and needs

“…30 Furthermore, as previously published by the authors, unexpected complications during pregnancy and childbirth may contribute to psychological trauma in fathers, resulting in significant mental health consequences with a potentially increased risk of post-traumatic stress disorder. 21,33 Therefore, the perinatal mental health of expectant fathers should be an essential consideration for maternity care providers.…”

“…Father‐inclusive obstetric and midwifery care that confirms the importance of fathers provides adequate information and creates access to both expectant parents is perceived as a positive influence on the couple's relationship 7 . Father‐inclusive antenatal care recognising the unique role and needs of fathers 20 and including them in discussions, especially in the event of maternal, fetal and neonatal complications, 21 is also perceived positively by fathers.…”

The forgotten fathers in obstetric care

“…Even a normal birth may be perceived as traumatic, and the stress of a complicated pregnancy and childbirth may be extreme, with long-term consequences. [25][26][27] Traumatic events during pregnancy and childbirth are everyday events. 28 Unexpected complications during pregnancy and childbirth contribute to significant psychological trauma in fathers, resulting in grief, guilt, shame, and substantial ongoing distress with a potentially increased risk of post-traumatic stress disorder.…”

“…27,29 Fathers' experiences and coping strategies are influenced by their background history, vulnerabilities such as pre-existing mental health conditions, traumatic life events and unpreparedness for the birth. 27 Healthcare providers must be conscious of providing counselling that considers men's needs. 30 Evidence-based guidelines on caring for families after a stillbirth recommend developing and implementing meaningful, non-pharmacological care strategies, including appropriate training for healthcare practitioners.…”

“…32,33 Several studies have identified that fathers wish to be included in perinatal healthcare and be engaged by health professionals about their health and well-being. 20,27,34,35 Although there is ample literature on paternal interventions that positively impact maternal-child outcomes, the postpartum role of the father is often ignored as an essential contributory factor in maternal decision-making. 1 Routine paternal screening and interventions can encourage positive perinatal care choices, health-seeking behaviours, and supportive maternal health decisions (eg reduced smoking and improved breastfeeding).…”