Participants came from all regions of the UK. Participant characteristics are reported in Table 1. One participant reported having twins, and three reported currently expecting another child. It was the first pregnancy for 81.9% of participants, and all participants were married.
The data analysed emphasised the situations that contributed to or protected from the birth trauma experience. Three main themes were identified: ‘fathers’ understanding of the experience’; ‘life after birth trauma’; and ‘the support fathers received vs what they wanted’. The flow of themes is demonstrated in Fig. 2.
Fathers’ understanding of the experience
This first theme identifies the participants’ experiences during the birth of their child. This includes what participants believed contributed to their trauma experience as well as potential protective factors. This theme had several sub-themes: nothing can really prepare you for it; merely a passenger; not about me; and support from staff.
Nothing can really prepare you for it
Participants felt that they were not adequately prepared for the experience. They perceived preparation as information gained from antenatal classes and from healthcare professionals during the experience. Information was either not given or not provided to a standard of satisfaction. For example, one participant said “At no point was there any explanation to either my partner or myself to calm the situation.” (P16).
Information given at antenatal classes also failed to prepare fathers for traumatic birth. Participants felt they focused more on standard deliveries and lacked detailed coverage of potential negative situations. For example, “They briefed us on the basic pain relief options for labour and the basics of a birth plan. These seem almost laughable in hindsight.” (P2), and “The antenatal classes are too positive and preparation for all eventualities was poor.” (P20).
Participants explained that they were unable to understand what was going on around them due to lack of information or time to explain during the emergency. As a result, some reflected that the experience of traumatic birth may not be something you can prepare for: “To be honest, I don’t think anything could have prepared me for what happened.” (P3).
The participants knew when something was wrong during the birth experience, but they were not involved in decision making or in relaying information. Often, they were also left alone which contributed to the trauma, as one participant described “When our son was taken away there was no one to ask what had happened to him for quite a while.” (P1).
Overall, participants believed that they had not been properly made aware or given the opportunity to make themselves aware and prepared for the likelihood of a complicated birth, from antenatal classes and from staff during the experience. However, they recognised that it is not always possible to be prepared.
Merely a passenger
A lack of control during the complicated birth experience was described as a major contributor to the trauma. Participants either felt they never had control, or control was taken away from them by the situation and/or staff. For example, one participant explained “I wasn’t involved. Merely a passenger.” (P60), and another said the lack of control made him feel as if: “I had lost all control of the situation, which scared me to death.” (P10).
If any control was reported during the experience, it was from trying to help their partner, as one participant mentioned: “I did not feel in control at all, but I did feel very involved in looking after my partner’s welfare.” (P40).
Fathers who reflected more positively believed they had some level of control (even if small), which could be considered a protective factor against later developing mental health problems. While they spoke about having little control and finding it traumatic, they also noted how they probably did not want any control in that situation: “I knew I had no control and I did not feel involved. I didn’t think it appropriate that I was involved to be honest.” (P4); “Felt I had no control at all as there was nothing I could do to fix the situation just had to wait for the doctors to sort things out.” (P52).
In conclusion, this theme details how control featured in fathers’ experiences, how they attempted to create control by looking after the interests of their partner, while also exploring how having little control in this situation appeared to be most appropriate for fathers.
Not about me
This theme explores the roles fathers believed they had during the birth experience and their treatment as a result of being male. During the pregnancy and birth experience, participants suggested that being male may have impacted their treatment by professionals, family and friends, based on societal expectations around birth and the role men play in general. Participants mentioned not being listened to and their questions not being answered.
Participant 7 described how he felt regarding his role during the birth: “I felt mostly like a spare wheel to be kept out of the way.” (P7) Participants often felt that their presence in the experience was not acknowledged: “No. I’m the male. My presence was often not acknowledged let alone my feelings.” “The midwives weren’t very helpful after the birth as my wife developed depression. They ignored my concerns.” (P9) and; “However, not being made to feel like the enemy, a useless caveman that has thoughtlessly impregnated this innocent girl, would be a start.” (P13).
When fathers felt acknowledged, it was only as they were there to support their partners: “I remember feeling very emotional and almost breaking down when they wheeled her off, but quickly pulled myself together as I knew she still needed me to be strong and upbeat.” (P51).
This treatment controlled the fathers’ views of themselves and sometimes prevented them from accessing and seeking help when needed, in some cases leading to further problems long after the birth. Participant 47 explained: “I never would of brought it up to anyone even my wife how could I possibly tell her how traumatised I was when she’s the person that had the ordeal of having a baby.” (P47).
Overall, participants’ experiences of being male in this female dominated experience meant that they felt unimportant (like a spare wheel), with their role in supporting their partner. As a result, they felt they could not explore or discuss their thoughts and feelings during and after the experience.
Support from staff
When participants reported that staff were calm and communicated with the couple, this appeared to ease the father and act as a protective factor in their overall view of the experience and how they felt after the birth, as described by participant 26: “as the midwives and consultants were extremely calm, clear and communicated every stage with us.”. This was also reflected by participant 51: “While, what seemed like muted panic or urgency was erupting around my wife, he [surgeon] calmly explained what was going on and what would happen. Not much of what he said went in, but his calmness was infectious.”. This behaviour from staff helped fathers to feel calmer about the situation and therefore more relaxed.
Unfortunately, this level of support was not always possible, in some cases due to system issues:
“Unfortunately, the shift changes right before things escalated, so we didn’t have much opportunity to build a rapport with the new midwife.” (P2).
Life after the birth trauma
This theme explores the participants’ postnatal experiences, including expectations of and from fathers, their mental health and the way in which their birth experiences impacted their relationships. Sub-themes include perceptions of manhood after birth; inability to be happy; and impact on relationships.
Perceptions of manhood after birth
This sub-theme explores changes in the participants’ roles going into fatherhood and how this impacted their health. Some fathers found that as a result of the traumatic birth, they became the primary caregiver for their child and sometimes their partner, as this quote shows: “We didn’t expect the difficulties we would face with my wife’s recovery. She ended up with a few issues and I spent a bit of time off work looking after her.” (P12) Participant 13 also reflected on his experience of becoming the primary caregiver for his child and partner that eventually impacted his work role and friendships: “The trauma of my son’s birth put me immediately into what felt like sole-responsibility for my entire family 24/7, ultimately excluded me from colleagues and friends and I struggled to cope.” (P13).
The trauma also impacted the participants’ expectations of fatherhood, where they felt that they did not meet the standards or expectations that society had given them. For example, they did not experience an instant bond with their child and in turn felt guilt and shame about themselves as fathers:
“I expected to feel an instant bond with the baby and I didn’t. I came to have a very strong bond with my daughter and I think not getting it initially was a combination of an unrealistic expectation of a romanticised version of what it is to have a child and the situation I was in. Had my wife been fine I wouldn’t have felt so conflicted and it may have come easier at the start.” (P57).
Participants also explored their role of being a ‘man’ and what their experiences meant in a female dominated experience. This also impacted how they coped with their experiences postnatally. They saw being a ‘man’ as being quiet and avoiding discussion of their experiences: “A man’s role in the birth is nothing to talk about really. Be quiet and man up, etc,” (P11). This was partly because they were aware of their partner’s trauma and believed it was greater than their own: “I chose not to think about it for some time; as a man, it does feel churlish to go on about your trauma when the female involved has this harrowing experience happening within her own body.” (P13).
However, participants also acknowledged the stigma around discussing emotions with other men, and not wanting to burden their friends, preventing them from speaking up and seeking support. For example: “As a lad it’s not easy to talk to male mates. I’m sure they’d listen but I don’t want to be a burden or a downer.” (P31).
In conclusion, this theme identifies how preconceived expectations of birth and the postnatal experience for men as men and fathers can contribute to feelings of unimportance around their own experiences. This in turn, leads to less support seeking and reinforces these expectations.
Inability to be happy
Participants described how the postnatal period affected their daily lives and how the trauma still affected them in the present day. Traumatic births negatively affected their mental health during the postnatal period, leading to difficulties coping with everyday functioning: “Upset, distressed and unable to cope very well. It was a feeling about the fragility of life during the birth and the overwhelming nature of the birth and the subsequent days.” (P14) Some participants experienced the development of mental illness in some cases: “… develop [ed] OCD within weeks of the birth. That might have been about the life changes that becoming a father involved but it might be rooted in that birth experience too.” (P1).
Most participants reported feelings and experiences during and after the birth trauma that can be linked to symptoms of PTSD. Participant 47 was diagnosed with PTSD and described flashbacks, triggers and avoidance: “I had flashbacks that seemed so real it was like I was there again, I deal with it better now but going back to the maternity wing of that hospital caused great anxiety, walking past the theatre doors etc the sound of a heart rate monitor sets me off even when it’s on the TV, I can’t watch things like Call the Midwife or One Born Every Minute or anything involving childbirth on the TV either.” (P47). Participant 60 also discussed flashbacks that were directly linked to the birth experience: “I regularly have flashbacks and see the number 61 on the heart rate monitor in my mind.” (P60).
Overall, participants described a range of mental health problems in the days and weeks following the birth, with some incidences leading to mental health disorders, which continued to impact their lives up to the present day.
Impact on relationships
This theme explores the impact the traumatic birth had on the fathers’ important relationships with their partner, children and friends. Most participants reported that the experiences brought them closer to their partner. Going through such a traumatic experience, including the fear that they could have lost their partners, created a stronger bond between couples: “Maybe there’s an extra layer to us as we survived such a difficult experience and we know that whatever happens in life we’re unlikely to encounter anything as testing.” (P3); “It’s made us closer because I know I could have lost her.” (P8).
However, many fathers discussed struggling to form a bond with their child (and feeling guilty): “I wanted to be with my wife but I felt guilty that I didn’t want to be with the baby. When I was with the baby I didn’t feel the level of love that everyone says you do and I felt guilty about that. I was just really confused and frightened.” (P57) Participants also expressed having fears around more children. “Only in the way that I’m reluctant to have sex in case she accidentally gets pregnant.” (P51) These feelings also manifested as difficulty celebrating their children’s birthdays, and fears about emotional intimacy with their partners, which impacted their relationships long term: “We don’t talk about what went on that day, each birthday is very difficult and not a celebration.” (P16).
In some cases, participants also felt this negatively impacted their relationships with friends, due to others lacking comprehension of the situation. As one participant explains: “I tried to talk to my friends, but most of them have no idea of children, or what it involves, so it’s hard for them to relate.” (P10).
Overall, negative birth experiences made the relationship with partners stronger in some cases. However, it also had a negative impact on partner relationships through affecting bonds with their children and leading to avoidance of physical and emotional intimacy. Relationships with those outside of the family were also negatively impacted in some cases, as friends did not share the same experiences and could not understand.
Support fathers received vs what they wanted
This theme consists of the levels of support fathers felt they received either personally, as a couple or for their partner, in relation to what support they believed would have been beneficial. It is split into three sub-themes that explore different time periods of the experience: prenatal support; birth support; postnatal support.
During the pregnancy, participants reported receiving a good level of support, where all concerns raised were answered: “As much support as was needed. The pregnancy was pretty good to be honest so we didn’t require any additional support but whenever we had questions then we got the answers.” (P11) However, they did note that antenatal classes were very much tailored towards mothers. For example, when participant 51 was asked about the support he received prenatally, he said “Personally, none. But my wife was well looked after and supported. However, I never felt left out or unwelcome.” (P51).
However, in retrospect, participants felt antenatal classes only discussed normal births, which they felt created an idealised experience. Participants reported wanting antenatal classes to expand on the breadth and depth of the childbirth experience, to cover departures from the norm: “… in retrospect, I see these as “idealised“ birth training classes. Breathing exercises, birth pool options, stages of normal labour etc,” (P29) and “More information on what a birth plan could involve, and learning about how variable each pregnancy is, as any change from the norm made us quite nervous.” (P10).
Furthermore, participants felt that ideally antenatal classes would include more information around being included as a father. For example, one participant felt that: “I should have been more included from the beginning. A mother and father should both complete questionnaires regarding depression and a father should be asked how he is feeling or if there is anything that he wants to ask or doesn’t understand. These questions are solely aimed at the expectant mother whilst a father has to butt in and speak during a conversation he is only there to witness.” (P21) Participants also explained the importance of peer support for partners during the prenatal period: “Peer to peer support from other fathers, an antenatal session for partners on supporting birth & the early days and information tailored to males (language, imagery & context).” (P55).
Overall, fathers felt they could have been provided with more information and involved more in sessions such as antenatal classes during the prenatal period.
Participants described the levels of support varying throughout the birth as generally less positive than prenatal support. For example: “In the 70ish hours before the actual birth support levels went up and down.” (P1).
However, the fathers often reported that this was understandable due to the emergency situation. They were aware that the lack of support for them meant that their partners were being saved: “Emotionally/mentally, I remember receiving very little support. Can’t fault them too much though - they were busy saving my partner and baby!” (P30).
Nevertheless, participants would have liked to be informed and involved throughout the birth. They felt that being involved would have made them feel more useful: “I would have liked to have had someone to stay with me or at least pop in regularly to see if I was okay and to tell me what was happening with my wife.” (P8) and “To be made to feel like a useful part, to be involved and kept updated on what was going on and why” (P58).
In some cases, they felt that the lack of support received contributed to them labelling the experience as traumatic: “More support in making decisions regarding this [implications of delivery] – this was a major contributor to the trauma of our delivery.” (P2).
This theme explored how a lack of support was perceived by participants as a contributor to their traumatic experience. Participants wanted to be involved in making decisions and wanted someone to support them but were aware of the need to focus on the mother.
Participants discussed support received in the months after the birth, plus what they felt would have been beneficial. Many fathers felt there was minimal support for themselves or their partners: “We had some follow up care for our daughter and 2 discussions with doctors regarding the delivery and what went wrong. These were minimally informative.” (P2). Some participants sought professional help as a result: “I paid for private therapy. My wife had no follow up from her mental health team except a 20 min meeting alone with them …” (P4).
Participants felt a chance to discuss their experiences and receive explanations after the event would have helped them make sense of the situation. As participant 2 explains: “More information from doctors about what happened to us – and an interview, possibly with administration or some other body to help us understand what happened and to give feedback – this we would not get unless we took the initiative to pursue such an opportunity. I think this kind of debriefing should be standard when things go outside the parameters of a normal delivery.” (P2) Many participants reported wanting support from other dads, which could be provided via support groups, even mental health support/therapy themselves: “Maybe I could have joined a group of dads to discuss.” (P42); “Advice from other dads.” (P56).
However, participants acknowledged that men do not always seek help: When asked how much support he received, one father replied “Very little, but I could have sought more help, so I put no blame there.” (P30) Participants suggested that help could be explicitly directed and made easier to find in an attempt to break down barriers that prevent men from seeking help: “Perhaps it would of been nice to be told about the support rather than having to seek it.” (P43).
This final theme described the lack of or minimal amount of support for fathers in the postnatal period. Fathers felt that support could be given in the form of debriefs, ‘dad groups’ and support being made explicit to encourage fathers to seek support when they needed it.