Breaking the Silence on Paternal PPD

Parenthood is a time of adjustment and ongoing change in identities, responsibilities, routines, and relationships. While this is often paired with feelings of excitement and happiness, it may also come with increased stress, fear, and anxiety. The experience of this transition itself, along with the well documented hormonal changes that occur in both men and women following the birth of a child and throughout the first year of life, puts new parents at risk for mood disorders, amongst them depression and anxiety, in the months to years following childbirth.


Many have heard of maternal postpartum depression (PPD). Maternal PPD is a health condition that is commonly discussed in the media, childbirth education, and throughout the entirety of maternity care. But, did you know that new fathers can experience depression in the postpartum time period as well? Shockingly, evidence suggests it occurs in rates not that dissimilar to new mothers. It is estimated that in the United States up to 1 in 4 new dads suffer from postnatal depression. Despite this, paternal postnatal depression is still not widely recognized, researched, nor understood resulting in many new fathers suffering in silence. Similar to maternal PPD, there is a significant amount of evidence suggesting that depression in men during the postnatal period is associated with numerous adverse childhood outcomes, linked to later cognitive, emotional, and developmental delays. Because of this, the sheer lack of awareness of paternal postnatal depression, and my experiences first hand with new families at Minnesota Birth Center as a student nurse intern, paternal postnatal depression became a significant interest of mine and the key topic of my scholarly work.

What are the known risk factors for paternal postnatal depression?

In addition to known risk factors for traditional depression, there are numerous risk factors directly associated with the development of paternal postnatal depression. The most widely supported of these include:

  • Lack of social and emotional support from partner
  • Partner is suffering from a postpartum mood disorder
  • Poor quality and perception of marital relationship
  • A previous history of a mental health disorder
  • Poor physical health
  • Pregnancy or birth-related distress
  • Low income and/or current unemployment status
  • Difficult infant/child temperament or behavior  

What are the signs and symptoms of paternal postnatal depression?

While many of the symptoms of paternal postnatal depression may be similar to those seen in mother’s, men also manifest unique symptoms that often go unrecognized, including:

  • Irritability
  • Anger/outbursts
  • Inability to make decisions
  • Isolating or withdrawing from relationships
  • Self-criticising
  • Impulsivity
  • Avoidance behavior
  • Risk taking behaviors, which may include turning to substance abuse or violent behavior
  • Suicidal thoughts

What resources and support are available to new fathers and their families in our community?

For new dads, there are many different types of support may help to ease the transition process to fatherhood.

  • Evidence suggests that one of the most effective supports for both new moms and dads comes from their partner. Finding opportunities to engage in active discussion about mental health with your partner prior to the birth of a new baby can help to promote the couples involvement in parenting together. Sharing parenting roles with your partner may help to decrease feelings of paternal isolation from the mother-infant relationship.
  • Prenatal education programs in the community help fathers better understand their expected roles. These programs are found to be most effective when the content of the program revolves around both parents and when both parents attend together.
  • Postpartum Support International (PSI) is an organization whose mission is to promote awareness, prevention, and treatment of mental health issues related to pregnancy and postpartum. Their website, http://www.postpartum.net offers numerous resources for new or expecting parents.
    • PSI offers a “DADS Chat with an Expert” on the first Monday of every month at 7pm. This is a free call-in forum for dads facilitated by a perinatal mood disorder expert, Daniel B. Singley. To participate, simply call 1-800-944-8766, code 73163#.
    • Created by the coordinator of PSI, www.postpartumdads.org is an online forum to help dads and families by providing firsthand information and guidance. Postpartum Dads offers a private online dads support group via Facebook. If you would like to be part of the Postpartumdads Facebook group please send a request with your Facebook name to info@postpartumdads.org.
  • Pregnancy and Postpartum Support Minnesota, is a group of mental health and perinatal practitioners, service organizations, and volunteers who provide support, advocacy, awareness, and training about perinatal mental health in Minnesota. This website also offers a “find a provider” tool in which you can enter your zip code, and all mental health and perinatal providers in your area will appear. Their website can be located at http://www.ppsupportmn.org/
  • National Alliance on Mental Illness Minnesota (NAMI) is an organization that is dedicated to improving the lives of child and adults with mental illness. NAMI MN, offers more than 500 free classes and over 70 support groups. Their website can be located at http://www.namihelps.org/

The most important thing to remember is if you’re a new dad with paternal postpartum depression, you’re not alone! Everyone at Minnesota Birth Center sees you and supports you!

Savanha Winkel, RN, is a Clinic Nurse and Birth Assistant at MBC. She devoted her nursing school research to the topic of paternal postpartum mental health. She’s proud to be part of the MBC team in supporting all parents in the postpartum period.

References
Anding, J. E., Röhrle, B., Grieshop, M., Schücking, B., & Christiansen, H. (2016). Couple comorbidity and correlates of postpartum depressive symptoms in mothers and fathers in the first two weeks following delivery. Journal of Affective Disorders, 190, 300-309. doi:10.1016/j.jad.2015.10.033
Bergström, M. (2013). Depressive symptoms in new first-time fathers: Associations with age, sociodemographic characteristics, and antenatal psychological well-being. Birth: Issues in Perinatal Care, 40(1), 32-38. doi:10.1111/birt.12026\
Biebel, K., & Alikahn, S. (2016). Paternal postpartum depression. Journal of Parent and Family Health, 1(1), 1-4. Retrieved from http://escholarship.umassmed.edu
Don, B. P., & Mickelson, K. D. (2012). Paternal postpartum depression: The role of maternal postpartum depression, spousal support, and relationship satisfaction. Psychology: Research and Practice, 1(4), 323-334. doi:10.1037/a0029148
Goodman, J. H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1), 26-35. doi:10.1046/j.1365-2648.2003.02857
Melrose, S. (2010). Paternal postpartum depression: How can nurses begin to help? Contemporary Nurse: A Journal for the Australian Nursing Profession, 34(2), 199-210. doi:10.5172/conu.2010.34.2.199
Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA: Journal of the American Medical Association, 303(19), 1961-1969. doi:10.1001/jama.2010.605
Philpott, L. F. (2016). Paternal postnatal depression: How midwives can support families. British Journal of Midwifery, 24(7), 470-476. doi:10.12968/bjom.2016.24.7.470
Pinheiro, R. T., Magalhães, ,P.V.S., Horta, B. L., Pinheiro, K. A. T., da Silva, ,R.A., & Pinto, R. H. (2006). Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil. Acta Psychiatrica Scandinavica, 113(3), 230-232.
Rosenthal, D., Learned, N., Liu, Y., & Weitzman, M. (2013). Characteristics of fathers with depressive symptoms. Maternal & Child Health Journal, 17(1), 119-128. doi:10.1007/s10995-012-0955-5
Roubinov, D. S., Luecken, L. J., Crnic, K. A., & Gonzales, N. A. (2014). Postpartum depression in Mexican American fathers: Demographic, cultural, and familial predictors. Journal of Affective Disorders, 152-154, 360-368. doi:10.1016/j.jad.2013.09.038

MBC Announces 2018 Doula Internship

The Minnesota Birth Center is now accepting applications for its next Doula Internship session, which will run from March – September 2018.

Qualified doula candidates must:

  • Have completed a workshop for certification through DONA, CAPPA, or other reputable certifying body;
  • Practice within the DONA Scope of Practice;
  • Have attended at least one birth in a support capacity;
  • Be available to attend a total of at least six MBC births for the duration of the internship.

doulasupport

Application materials and information on how to apply are located here: Doula Internship Requirements and ApplicationComplete applications will be accepted no later than 6 pm on Friday, February 23rd.

Qualified applicants will contacted for interviews.

For more information email karen@theminnesotabirthcenter.com.

Opening the Birth Room – A Prayer

One of the many things that is unique about attending births at the Minnesota Birth Center is that the midwives are tasked with readying the birth rooms for families about to meet their babies. We arrive before the mother-to-be, before she’s moaning with the pressure of contractions-waves-rushes-surges; before the father-to-be looking on in awe as this person who he has loved for so long shows the strength he has never imagined to bring forth their child; before the mother-to-be helps calm her partner by whispering birth affirmations in her ear.

We walk into the space; potential crackling, anticipation building, and we ready it for the miracles about to happen there.

My favorite time to enter that space is at night or late evening. No one is around. I’ll most likely be humming whatever song is in my head. I always start by filling the tub. As I turn the taps, my mind usually turns to a recent birth I’ve attended in that tub. I think of seeing the shock of newborn hair in between surges-waves-rushes-contractions and the delight on that last person’s face as they reached down to feel the baby emerging from their body. I run my hand under and through the water hoping the tub will give the person giving birth a sense of safety, warmth, containment, relief. I turn the lights so they sparkle invitingly above the tub. Not too bright. Just enough.

As the tub does its noisy business, I move to the counter. I take out the heating pad and baby blankets. I select my favorite blankets. There is a white one in our St. Paul location that is larger than the others and especially stretchy. It is my favorite swaddling blanket. I always wonder briefly where the baby blankets my mom made my son ended up. I’d love them to be here – they were so good for gathering up a newborn. I nestle the blankets within the heating pad. I bring out the birth kit. Clamps. Scissors. Gloves. Sometimes a lab tube. All in a little silver box covered in a white shroud. So simple. It’s nice to know that the main tools of my trade are at the ends of my arms.

I begin to ready the bed. I remove the fancy linens, leaving only the easily laundered sheets and blankets behind. I try to recall the last birth that happened in that bed. They tend to be few and far between as most of the births in the birth centers take place on a stool or standing at the side of the bed or a yoga mat or the tub. But you never know, so I cover the bed with pads to soak up the liquids of birth. After 17 years of getting beds ready for births, I’m still working on getting that placement just right.

I check the emergency equipment. The oxygen tank is full, the resuscitation equipment is in place. I run through the steps in my mind: the what-ifs. I do this as a mantra against the potential. It is both intellectual exercise and warding off of bad luck.

If I have time, I like to set up the essential oil diffuser. My favorite labor concoction is 10 drops clary sage and 5 drops grapefruit. It’s a combination of bright earthiness that people tend to really like. The drops entering the water of the diffuser take their time. You can’t really shake them and hurry the drops along. I take this as my birth lesson and stay patient for those 10 clary sage drops as I stay patient for the languorous labors that often come with first births. Grapefruit comes faster. Grapefruit must be having its second baby.

The room is ready, inviting. I try to infuse my intentions for a safe, fulfilling birthing time into each action. Now is the time I take some deep breaths, center myself, grab some coffee, and wait for the soon to be new parents.

The headlights shine, the doorbell rings, there is a knock. Another family is welcomed to Minnesota Birth Center to continue their birth journey.

Katie Ireland is a midwife and clinical co-director at the Minnesota Birth Center. She finds joy in readying the birth rooms for each of our MBC clients. Read more about Katie.