The Dark Side of Fatherhood

by Holly Keich

There’s a secret in our culture and it’s not about how strong women are in birth, it’s that men experience postpartum depression. Every day 1,000 new dads in the United States become depressed. 1 And some studies indicate that this is a low estimate and that it could be as high as 25% of new dads that experience paternal postpartum depression (PPPD).2 What these statistics tell us is that postpartum depression in men is common. But if it’s so common, then why haven’t we heard about it before now?

IMG_7324bwTraditionally, men have been conditioned to be the strong one, the provider for their new family. In fact, I recently came across a quote by Sigmond Freud that states, “I cannot think of any need in childhood as strong as the need for a father’s protection.” Because of this societal pressure, men tend to hide their depression and withdraw from others. There can be a disconnect as well between how men feel and how they think they should be feeling after baby arrives. Depression in men may also look different. Withdrawal may mean working more and spending more hours away from home. In fact, research tells us the men often experience depression in ways that are different than women. Men sometimes cope with their symptoms in different ways too. This may be why even trained mental health professionals may misdiagnose men’s depression.

It’s helpful to first look at the classic symptoms of depression which may also be present in men postpartum. 3

  • Depressed, sad mood
  • Loss of interest or pleasure
  • Significant weight loss or gain
  • Trouble sleeping or over-sleeping
  • Restless feelings and inability to sit still or slow down
  • Fatigue, loss of energy, or tired all the time
  • Worthless or guilty feelings
  • Impaired concentration and difficulty making decisions
  • Recurrent thoughts of death or suicide

Typically a person would need to exhibit 5 or more of these symptoms over a 2-week period to be diagnosed with a depressed mood.

But as mentioned, there’s more to paternal postpartum depression in men. One thing that researchers are finding is that men don’t often acknowledge feelings of sadness, hopelessness, or guilt.4 They tend to have additional symptoms that are unique to men.

Symptoms of Men’s Depression 5

  • Increased anger and conflict with others
  • Increased use of alcohol or other drugs
  • Frustration or irritability
  • Violent behavior
  • Losing weight without trying
  • Isolation from family and friends
  • Being easily stressed
  • Impulsiveness and taking risks, like reckless driving and extramarital sex
  • Feeling discouraged
  • Increases in complaints about physical problems
  • Ongoing physical symptoms, like headaches, digestion problems or pain
  • Problems with concentration and motivation
  • Loss of interest in work, hobbies and sex
  • Working constantly
  • Frustration or irritability
  • Misuse of prescription medication
  • Increased concerns about productivity and functioning at school or work
  • Fatigue
  • Experiencing conflict between how you think you should be as a man and how you actually are
  • Thoughts of suicide

The number of symptoms may vary as may the severity between individuals. While the list may seem daunting, the important thing to know is that depression is treatable. You can recover.

Because research on paternal postpartum depression is in its infancy, we know little about what exactly are the risk factors. What research is beginning to show is that many of the risk factors are similar to that of women. 6,7

  • A lack of good sleep
  • Changes in hormones
  • A personal or family history of depression and/or anxiety
  • Poor relationship with spouse
  • Poor relationship with one or both parents
  • Relationship stress – with a partner or with in-laws
  • Excessive stress about becoming a parent or father
  • Nonstandard family (such as being unmarried or a stepfather)
  • Poor social functioning
  • A lack of support from others
  • Economic problems or limited resources
  • A sense of being excluded from the connection between the mother and baby
  • A personal history or alcohol or drug abuse
  • A major life event such as a loss, house move or job loss
  • Being a father of multiples or a baby with special needs

One risk factor that may have caught you by surprise was hormonal changes. We’ve all heard how fluctuations in hormones during pregnancy and after birth can affect women, but may not know that men have hormonal fluctuations during pregnancy and postpartum as well. Studies show that a man’s hormones also shift during pregnancy and after birth, for reasons that are still unknown. Testosterone levels drop; estrogen, prolactin, and cortisol go up. Some men even develop symptoms such as nausea and weight gain.8 According to Dr. Courtenay, a psychotherapist who specializes in men’s depression and host of postpartummen.com, one of the few websites devoted to the issue, “Evolutionary biologists suspect that the hormone fluctuation is nature’s way of making sure that fathers stick around and bond with their baby.”9

Another risk factor that may be surprising is that if your partner is depressed, there’s a good chance that you are too. Up to half of men whose partners have postpartum depression are depressed themselves.10 So it’s important that it’s not just the mother that gets assessed for PPD after baby, but their partner’s should too. The same tool can be used, the Edinburgh Postnatal Depression Scale – or the EPDS, for short. It is the most widely used assessment for postpartum depression and anxiety. It has been tested and found effective with men. You can find the PPPD assessment here.

*The instructions for completing the EPDS are different for women and men. If you are a woman and concerned that you have postpartum depression please use the following EPDS assessment from the postpartumstress.com.

According to the Journal of Parent & Family Health, fathers are most likely to experience the first onset of paternal postpartum depression in the first 3 – 6 months after the birth of their baby.11 This isn’t just a coincidence. It’s around this time that women in the U.S. end their maternity leave and head back to work, adding more stress to what is already a major life transition. As if figuring out how to parent isn’t complicated enough, returning to work adds one more thing to balance on an already teetering plate.

If you identify with the risk factors and are not yet pregnant, there’s time for preventative measures. Consult a mental health professional if you have a history of depression to prepare should you have a recurrence. If you have relationship issues or poor communication in your relationship, seeking help before the child is born can help you learn new skills which can lessen the stress and reduce your risk of PPPD. If there are economic concerns, it’s time to address them and set up a budget. Setting aside time to think through the logistics of postpartum can also be helpful. Postpartum Support Virginia offers an excellent, detailed plan for adjusting to life with a new baby.

If you’ve identified yourself or your partner in the symptoms for PPPD, then it’s important to get help. Depression is a very treatable condition, but if left untreated can result in damaging, long-term consequences for you, your kids, your marriage, your career, and your finances. Finding a therapist that is skilled in working with men is key in order to get an accurate diagnosis and appropriate treatment. You can ask your doctor or pediatrician for a referral. Be sure to ask when making an appointment if they have experience in treating paternal mental health. Therapy can also help you with stress management, juggling home and work responsibilities and relationship issues that can often come up when you and your partner are transitioning to parenthood.

There are other coping strategies as well that can be useful in conjunction with therapy:
Medication may also be suggested as a strategy and can be used short term to help to recover.

Tackle Isolation by reaching out to others. Talk with your partner or friends about the challenges of parenthood. This isn’t just a problem that effects you, it’s a family problem and sharing your feelings is a step to reaching out to develop a support network in your journey toward healing. If talking to those you know is too difficult, utilize online resources. postpartummen.com has a forum where men can share their feelings anonymously.

Take Care of Yourself physically and emotionally. Exercise, eating well, journaling, yoga, meditation, acupuncture – anything that reduces stress should be on every new parent’s to do-list.

Get Rest. Yes, we mean sleep.  We know it’s at a premium these days, but figuring out a plan that works for both parents is imperative.  Mood disorders can happen to anyone who is sleep deprived.  Alternate nights taking care of the baby, hire a postpartum doula for a few nights or ask a family member to help so you can get some sleep.  Allow yourself a break. Many men do double duty by going to work and then taking over childcare as soon as they get home. Discuss how you can share childcare and chores so you can have some down time.

Despite the secretive nature of PPPD it’s still a very treatable condition.  Seeking help is imperative not only for your health, but also the well-being of your marriage and child(ren).  If left untreated, research shows it can cause a negative impact on the emotional and behavioral development of your children years later.12   So the best thing you can do to provide for your children’s future is to get help for yourself today.

1 http://postpartummen.com/

2 http://postpartummen.com/

3 http://drsarahallen.com/paternal-depression/

4 http://postpartummen.com/mens-depression/

5  http://postpartummen.com/postpartum-depression/

6  http://drsarahallen.com/paternal-depression/

7 http://postpartummen.com/postpartum-depression/

8  http://www.parents.com/parenting/dads/sad-dads/

9 http://www.parents.com/parenting/dads/sad-dads/

10 http://postpartummen.com/postpartum-depression/

11 http://drsarahallen.com/paternal-depression/

12 http://postpartummen.com/get-help/

 


Holly Keich, LSW supports family connections through Om Baby Pregnancy & Parenting Center in Camp Hill, PA since 2008.

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Why Breastfeeding is the Hardest and Best New Dad Experience

by Andy Shaw

Andy with is son, Elliott, the day after he was born!

Andy with is son, Elliott, the day after he was born!

My son, Elliott, was born a month ahead of schedule. The night before Mother’s Day 2013, I was up late applying wall decals and finishing touches to his ocean-themed nursery

My wife, Sara, was going to help, but she was just not feeling it. She went to bed early, and I kept plowing through.

I go to bed around 11 pm. An hour later, Sara taps me on the shoulder and lets me know she thinks she’s having contractions eight minutes apart. As if that’s something you tap someone on the shoulder about.

You tap someone on the shoulder to say, “Hey, did you leave the light on downstairs?” You don’t tap if you want to say, “I think a baby may be exiting my vagina rather quickly.” Smack me in the face.


I can see her, calmly sitting with an iPhone app, timing things out. She’s not sure yet if it’s a false alarm. I, on the other hand, freak out.

I start throwing things in a bag. We had planned to put together an overnight bag that very Sunday, figuring a month ahead ought to do it. Nope.

“I’m not going to be the a-hole husband who sits around while his wife is going into labor!” I said excitedly, trying to get things ready.

Fortunately, my zen-like wife made me realize that even if this was the real deal, we were far from having to go to the hospital (You may hear in a birth class about waiting until contractions are about five minutes apart, lasting a minute long, as a good indicator it’s time to go. If a baby pops out… you waited too long.)

We stayed up all night watching Mad Men and the Cosby Show. In hindsight, questionable show choice. Thanks, dirty Bill Cosby.

Around 7 a.m., we went to the hospital. Just before pulling away from the house, I looked at Sara and said, “Let’s pause for a moment just in case this is the last time it’s ever just the two of us.”

It was.

And yet here we were, sitting in a tiny office, with a consultant looking at a scale and then telling us that our son wasn’t gaining enough weight. While I’ll get into the delivery details another day, I’ll just say our son was born at six pounds, five ounces – not bad considering he had a month to go!

Officially, that timeline meant he was “late preterm.” Not an official premie (he avoided the NICU), but not quite ready for showtime.

Why was this important?

Breastfeeding.

If you ever want a reminder that your girlfriend/wife is a miracle worker, watch her breastfeed. It doesn’t even make SENSE.

There is milk coming out of her body! Food! Just, right there! Where you used to hang out!

The thing is, although we were extremely into the idea of breastfeeding our son, late preterms don’t have the mouth size and skills yet to be great at latching.

And that’s when, just days into fatherhood, I had my first serious case of “I want to help with the baby, but I don’t know how’s”.

The good news is that our hospital had incredibly helpful lactation consultants. (Insurance covers this, by the way, in many cases).

The bad news is that doesn’t mean our son magically became great at latching on.

His weight was dropping, partially because he wasn’t getting enough through breastfeeding. He was down under 6 pounds, and he was jaundiced.

We had done everything we were supposed to do ahead of time. We went to a breastfeeding class. We read up on the subject, and had the Boppy pillow. Turns out, you can only be so ready: Parenting is a series of realities that harshly, rudely knock down expectations.

Elliott didn’t care if we had talked to experts. He just wanted food.

Not long after we had left the hospital, we had an appointment to see the lactation consultant.

We were exhausted. We were bewildered. We were so happy to have Elliott there, and yet so baffled about what he needed and wanted.

The way the appointments are set up, Elliott was weighed at the start, then my wife would nurse him until he was done, and then he would get weighed again to see the different in weight. When you’re a late preterm, weight is basically everything.

Yes, they could tell when it’s a matter of ounces. I hope to God it’s not like that after I eat Chipotle burritos.

Elliott, with a tinge of yellow on his skin, was the most beautiful thing I had ever seen at that point, and all I wanted to do was take care of him like my dad took care of me or like all the dads in the TGIF lineup took care of their sitcom kids, at least.

Sara became emotional, as you might expect. I felt tears in my eyes looking at my wife, who I loved so much for so many different reasons, feeling helpless, like she wasn’t going to be a good mom because she “couldn’t do the thing moms are designed to do,” as she and others often put it during breastfeeding struggles.

But here’s the thing.

Parenting, you find out quickly, isn’t about having all the right answers. It’s about adapting. You are going to be so good at adapting that your Xbox games will work on a Playstation. Except swap a diaper change for Xbox and a mechanic’s bathroom for a Playstation.

We got a plan from the consultant. A plan that, looking back, I can’t believe we actually pulled off. A plan that I can now say not only helped me get super involved right away, but also gave me confidence that yeah, sure, I can do this dad thing.

HERE WAS OUR NEW BREASTFEEDING SCHEDULE:

  • Sara would nurse Elliott as long as she could. This would take anywhere from 10-20 minutes. And he wouldn’t get much, cause his mouth just wasn’t big enough.
  • When she was done, she’d continue pumping as much as she could.
  • Meanwhile, I would take a plastic syringe and fill it with an ounce of breast milk. I’d attach a thing plastic tube to one end, and tape the other end to my index finger. Then, holding Elliott, I’d slowly feed him by putting the tubed finger in his mouth – giving him something to suck on – while pressing down on the syringe. We’re talking ultra slow on this. I’d take 20 minutes to get him to take maybe half an ounce. It was hard for him to keep up, and some days he wouldn’t really take anything and we’d feel like crying again because we just wanted him to grow and be healthy. On a side note, this kid now eats two cups of yogurt, two bananas, guacamole, rice, and beans, and fig bars in on sitting like it’s nothing now. I am glad I don’t need to push guacamole through a tube.
  • Someone would clean up the pumping supplies and the syringe to be ready for the next feeding, while the other would change him.

Did you add up the time? About 15 minutes for the first part, plus about 20 minutes for the second, and another 10 for cleaning equals 45 minutes. We were supposed to feed him upward of 12 times a day. So about 45 minutes out of every two hours was taken up with nothing but the feeding process.

The other hour was taken up trying to get him to sleep – he slept in 15-20 minute chunks in the early weeks – or trying to eat something ourselves or maybe get something else done as our very helpful in-laws were on hand to keep up with housework so we didn’t end up on “Hoarders.”

When you add all that up, there was quite literally no time to do anything. I remember being so tired I couldn’t speak complete sentences.

“Man, Andy,” you’re thinking. “This doesn’t sound like a pep talk.”

It’s not.

It’s the reality of one newborn baby. My newborn baby. Today, my son is one of the biggest toddlers around, at the 90+ percentile for height and weight after being at the opposite end of that spectrum at the start. All of that breastfeeding struggle early on? We can see the results as he started gaining a pound a week at one point and became a nursing pro for the next year.*

Yours might end up being entirely different! You may breastfeed, or use formula, or have a premie, or have a full-term baby. So many factors. So many babies.

Just know that when I talk about the newborn experience, I’m not coming from a “everything was puppies and rainbows” background where I’m being unrealistic about what you can expect. I’ve been through some things – a little harder than some, a little easier than others.

And you know what? I got an awesome, awesome kid out of it. Like, my favorite person. But you can’t get to that point – the part where he’s playing games with me and saying funny things and  being adorable –  unless you go through the hard early stuff. You gotta earn your stripes.

* Not every baby picks up breastfeeding. It can be a problem that never really meets a solution for some parents. The good news is there are other options. Don’t let people make you feel bad about what you need to do to keep your baby healthy. Breastfeeding worked out for us. Another option might be better for you. Trust me – you’ll hear a lot from either side!


This post originally appeared on Andy Shaw’s site, Instafather.com, where he offers resources and advice for new dads. Andy is a dad of a 2-year-old boy and twin baby girls.