‘Would I risk it again?’ The long-term impacts of a traumatic birth, as experienced by fathers

ABSTRACT

Background

Extensive research has explored the impact of traumatic births on mothers, capturing enduring adverse outcomes as well as post-traumatic growth. The literature on fathers‘ experiences of birth trauma is more limited and little is known of the ongoing impact. The present study aimed to investigate the long-term effects of attending a traumatic birth.

Method

Semi-structured interviews were completed with fathers who identified as having a traumatic birth experience two or more years ago. Thematic analysis was conducted on eight interview transcripts.

Results

Despite the time since the birth trauma, fathers described ongoing impact, which is captured in five themes. Four of these focus on the negative impacts: their attempts to cope by boxing away emotions, which they thought they should not feel; anxieties over having further children; negative effects on parenting; and ongoing distress or negative impact on their wellbeing. The final theme highlighted some positives from the experience, primarily a strengthened relationship with their partner.

Conclusions

Traumatic birth can result in fathers experiencing difficulties beyond the perinatal period, whilst thinking that they should not feel or discuss their distress. As a result of a traumatic birth fathers can experience ongoing guilt and poor mental health, which may lead them to delay subsequent pregnancies. Most participants had not accessed support regarding the traumatic birth, instead coping by trying to avoid their memories and emotional reaction. These findings highlight the need for increased acknowledgement of the impact of birth trauma and intervention for fathers, during and after the perinatal period.

KEYWORDS:

• Childbirth
• birth trauma
• men
• fathers
• long-term
• mental health

Introduction

Recent guidance (NICE, 2020) acknowledges that traumatic births may involve physical trauma, but may also include those ‘experienced as traumatic, even when the delivery is obstetrically straightforward’ (p. 44). Mothers¹ can experience negative long-term psychological outcomes (Beck, 2006; Taghizadeh et al., 2014), as well as Post-Traumatic Growth (Beck & Watson, 2016; Ketley et al., 2022). With it being increasingly commonplace that fathers are present during childbirth, it is important to acknowledge their risk of experiencing birth-related trauma. Presence in the delivery room, even in non-traumatic births, can result in fathers feeling unsupported or excluded (Smith et al., 2024). Research exploring paternal experiences of traumatic births identifies themes including fathers feeling unprepared for the experience; a strong sense of loss of control; and feeling marginalised by professionals (Daniels et al., 2020; Delicate & Ayers, 2023; Elmir & Schmied, 2022; Etheridge & Slade, 2017; Inglis et al., 2016). Fathers can feel traumatised by witnessing the distress of their partner and the medical interventions administered (Inglis et al., 2016). Fathers may also feel side-lined and ‘stripped of their role’ of protector, subsequently triggering feelings of guilt and helplessness (Elmir & Schmied, 2016, p. 68). Fathers report internalising their distress during childbirth in order to prioritise the needs of their partner (Vallin et al., 2019) and can feel torn between the needs of their partner and baby (Etheridge & Slade, 2017). Some fathers reflect on the traumatic birth as being ‘the worst experience of their lives’ (Elmir & Schmied, 2022, p. 43), likely due to perceiving the threat to life of their partner and baby (Tsakmakis et al., 2023).

Following childbirth, fathers can report experiencing symptoms commonly associated with depression, anxiety and PTSD (Bradley & Slade, 2011; Schobinger et al., 2020). These experiences can result in adverse impacts to relationships and ongoing distress, which some fathers relate to not having had the opportunity to discuss the birth (Elmir & Schmied, 2016). Avoidance of talking about the birth trauma was also noted and linked to masculinity, stigma, and subsequent difficulties with help-seeking. Elmir and Schmied (2022) described the complexity of responses to the birth trauma itself and to help-seeking: post-birth, some fathers reported adverse impacts on the marital relationship (e.g. reduced physical intimacy), whereas others reported developing stronger relationships. They found that some fathers can feel unable to openly discuss the birth or talk about their reactions to it, viewing it as a female experience. This process is elaborated in psychotherapy literature: masculine norms which strongly reject feminine stereotypes are likely to contribute to some men’s difficulty in externalising their emotions and to engaging in help-seeking (Lorber & Garcia, 2010). Some fathers report attempting to access support for their emotional distress but face challenges receiving appropriate input or find their experience is invalidated (Hinton et al., 2014). Mental health difficulties following childbirth may be longstanding (Hinton et al., 2014). In contrast, some fathers report experiencing elements of post-traumatic growth following a traumatic birth (Inglis et al., 2016).

It is difficult to understand the long-term impact a traumatic birth can have as existing literature appears to conflate short and long-term experiences. Previous studies include time periods ranging from close after the birth event to many years later (e.g. 2 weeks to 32 years, White, 2007, p. 2 months to 6 years; Etheridge & Slade, 2017, p. 4 months to 20 years; Elmir & Schmied, 2022). As response to a traumatic experience can change over time (Bryant et al., 2015), it is important to explore and clearly differentiate short and longer-term experiences, to provide a better understanding of fathers’ mental health journey after a traumatic birth event.

This study aimed to examine fathers’ long-term experiences. Ongoing adverse outcomes after trauma, such as mental health difficulties (e.g. McDonald et al., 2011; Schneider et al., 2012), as well as experiences of post-traumatic growth (e.g. Helgeson et al., 2006; Su et al., 2020), have been reported as occurring two or more years after a traumatic event. The present study therefore defines ‘long-term’ as being 2 years onwards from the birth experience. The research question addressed was: What are the long-term impacts of a traumatic birth, as experienced by fathers?

Method

Design

This qualitative study used semi-structured interviews which were transcribed and thematically analysed. The interview used a topic guide designed for the study, based on themes existing in the literature and which was reviewed by an expert-by-experience. Questions were designed to be as open as possible, for example ‘How has this birth experience continued to impact on your daily life now?’ and explored the impact of birth trauma on different areas of the father’s life including mental health and wellbeing, occupation, relationships, parent-infant bond, and subsequent pregnancies.

Recruitment and procedure

Ethical approval was granted by the University of Leeds School of Medicine Research and Ethics Committee (MREC20–058).

Participants were invited to take part in the study via online advertisements on Facebook and Twitter. The following eligibility criteria were applied: over the age of 16 years; self-identifies as a male father; birth event self-defined as a traumatic experience; and traumatic birth event two or more years ago. Men were not eligible if: they were not present at the birth event; the baby was born before 37 weeks; baby experienced significant health difficulties post-birth; baby required intensive medical treatment which was also viewed by the father as traumatic; loss of life (mother or baby) during the birth; or the father was non-fluent in English (due to funding limitations).

Eligibility screening was conducted via telephone or online call and, if appropriate, consent was taken and the semi-structured interview was scheduled. All interviews were conducted by CC, a clinical psychologist in training, via telephone or video call. Interviews lasted between 50 and 82 min.

Participants

Nine fathers from the UK made contact to express interest in taking part in the study. Eight of these met full eligibility for the study and went on to complete the interview. Traumatic birth was defined by the participant. For some it was the method of delivery, such as caesarean or forceps, but for others the trauma was seeing their partner suffer (accounts often mentioned degree of pain and loss of blood), or the sudden pace at which the birth became an emergency. See Table 1 for demographic details of participants, including time since traumatic birth.

Table 1. Participants’ demographic information.

Participant (pseudonym)	Age	Ethnicity	First experience of being present at a birth?	Went on to have subsequent children?	Time since traumatic birth (to nearest year)
Paul	31	White British	Yes	No*	2 years
Nigel	35	White British	Yes	Yes	4 years
Craig	54	White British	Yes	Yes	11 years
Sam	32	White British	Yes	No*	2 years
Brad	34	White British	Yes	Yes	4 years
Luke	49	White British	Yes	Yes	9 years
Peter	30	White British	no	No	3 years
Mark	32	White British	Yes	Yes	3 years

*Partner pregnant at time of interview.

Analysis

Thematic analysis was conducted on pseudonymised transcripts utilising the approach outlined by Braun and Clarke (2006) to identify repeated patterns within the qualitative data. This process is: Phase 1: familiarising with the data, Phase 2: generating initial codes, Phase 3: searching for themes, Phase 4: reviewing themes, Phase 5: defining and naming themes, Phase 6: producing the results.

Thematic analysis is a reflexive process. The authors are psychologists with interest in perinatal and male mental health. We considered our lived experiences related to birth and parenting alongside our professional values and assumptions as we engaged with analysis. During interviewing CC kept a journal of reflections and her reflexive responses to the interviews, which was discussed with AR and CM during analysis. The first stage of analysis involved becoming familiar with the data collected through actively listening to and re-reading interview transcriptions. During this stage CC made notes of initial thoughts on each of the interviews, drawing on her reflective journal. The second phase involved CC and AR generating initial codes (CC coded all eight transcripts, AR second-coded two). The discussion of these resulted in further reflections. Codes were often descriptive to begin with, evolving into more refined codes after several reviews (see supplementary material for coding example). The third stage involved CC and AR developing potential themes from the codes generated. Theme ideas were broad at this stage, whilst beginning to consider which codes would best fit into each of the themes identified. The fourth phase involved all authors reviewing and refining the themes. Within this stage, a thematic map was produced to ensure the themes and related subthemes developed and accurately reflected the coded data generated across the data set. As anticipated, expectations and beliefs around masculinity featured in multiple codes, and we initially formed a theme about masculinity. However, we considered that this was too descriptive and greater understanding could be gained by separating the way fathers narrated the effects of the pressure to conform to masculine ideals. For example, Theme 1 ‘boxed away as “should not feel”’ described the pressure experienced by men not to think about the experience, whereas Theme 3 ‘enduring distress’ focuses on ongoing feelings of emasculation.

The fifth phase involved each theme being reviewed in line with the coded data it was representing and the most fitting name or definition for each theme being established. Some codes fit within several themes. For example, the theme ‘haven’t felt like a normal dad’ contained both stories of increased anxiety as well as positive bonding through acts of care. This positive bonding could be represented in Theme 5 ‘positive changes’, but the authors decided it sat better in Theme 3, showing the complex, and sometimes contradictory, responses to participants’ conceptualisation of their role. During this phase, the thematic map was finalised and themes reviewed for clear and meaningful narrative of the data they were representing. Finally, the sixth phase involved producing the results and checking the representation of the themes as distinct. In addition, quality checks followed the guidance of Elliott et al. (1999).

Results

Eight fathers discussed the long-term effects of being present at a traumatic birth. Experiences during the birth were frequently described as involving helplessness, fear and guilt in the face of their partner’s suffering and feeling poorly informed or excluded by health professionals. They described ongoing effects related to the birth, despite the experience being 2–11 years prior to interview. The findings are presented in five themes, the first four of which describe some of the long-term negative impacts of being present at a traumatic birth. The narrative below presents quotes to elaborate the findings and describes connections between themes.

Theme 1: boxed away as ‘should not feel’

This theme captures the factors which had significantly impacted on participants feeling able to both openly talk about and access support for the traumatic birth. Participants thought that to communicate their distress would cause difficult feelings of vulnerability and shame: ‘it’s like a weakness to seek help because it’s not readily offered’ (Peter).

Traditional masculine ideologies had a detrimental influence on participants feeling able to be open about the impact, for example Nigel did not seek support due to thinking ‘generally guys are more “suck it up and see” … just get on with things’. Sam shared:

it’s the bloke thing again… it’s so toxic … when it comes to the general male population there’s no sharing of such things.

Brad commented that he no longer thought about the birth, however he considered whether this is a coping strategy: ‘I generally don’t give it a lot of thought and I suppose what’s interesting about that is trying to just avoid it in some ways’.

Several men reflected that the traumatic birth was not their story to tell, therefore to seek help would usurp their partner ‘she went through all of this’ (Mark). Sam described that societal views reinforcing birth as being a mother’s experience had contributed to him putting his experience in a ‘box labelled … “should not feel”’.

Brad described a difficult experience where he had shared with some colleagues the birth trauma, but one person questioned how this could be traumatic for anyone other than the mother and the others responded with laughter. Brad reflected that this now triggers feelings of ‘injustice maybe that, yeah, my experience isn’t validated’.

Other participants invalidated their ownership of the experience throughout interviews, despite anticipating, and fearing, the same invalidation or judgement from others: ‘You can almost hear the response, “yeah well I bet it was worse for your wife”’ (Sam). Peter commented ‘that’s pretty much my views on my own feelings; there’s always people worse off. You know, you might feel bad that you witnessed it, but your partner actually went through it’ [our emphasis].

The enduring effects included burying or distancing from the feelings: ‘my emotions probably became more withdrawn and probably still are really’ (Peter). However, for some there was evidence of a positive change of perspective in the long-term:

I think if I’d seen this research a year or two ago, I probably wouldn’t have engaged because I wouldn’t have been ready. But now I am … which ties in with me looking for therapy… I’m getting to a point where I’m more able to face it. (Brad).

Theme 2: can’t face it again

The impact of the traumatic birth had a significant effect on men’s willingness to have subsequent children: ‘Would I risk it again? No, I just don’t think, I couldn’t do it’ (Peter). Despite all experiencing these thoughts and feelings, most did finally choose to have further children. Participants expressed anxiety leading up to the subsequent birth, which was not always shared by their partners:

‘She actually wanted a home birth, and I, my anxieties were like, please don’t put me through that. I want the hospital like right there if there’s any problem’. (Nigel)

Luke, also recalled his anxieties related to the risks to his partner:

I wasn’t bothered about witnessing anything again … I would be happy to see as much blood as you need, you know, that seems to be part of the process … I just didn’t want her to be injured or killed.

Paul talked about an unplanned current pregnancy:

I really hope that this is our last. Umm, obviously difficult traumatic birth the first time, c-section, this time. We definitely don’t want to have any more and it’s not, it’s probably not the babies and the children, it is the birth process. I think we always wanted two and then after the birth I didn’t want another [pause, signs, laughs] this one is an accident so yeah … in some ways made it more difficult because it was like we realised that [partner] was pregnant and that just brought everything flooding back again and it was like we didn’t want this[our emphasis].

Planned caesareans helped some fathers feel prepared, in that the subsequent birth was more controlled: ‘second time round, knowing we were having a planned section, we always knew it would be an entirely different experience’ (Brad). Mark shared that a positive experience of the second birth enabled him to feel more open to having further children:

As soon as we had the second one … no doubt because it was a lot more, it was a lot more simpler, it was, yeah, we were up for having more straightaway then.

Theme 3: haven’t felt like a ‘normal dad’

This theme explores the impact of the traumatic birth on aspects of participants’ parenting approach and bond with their baby. While many participants described their experience of fatherhood as having been affected by the traumatic birth, it is important to note several described a closer bond with their child due to the mother being unwell.

Some participants described heightened anxiety resulting in behaviour not in line with their anticipated parenting:

It’s made me really anxious and really over-cautious on er [sighs] worrying about stuff that could happen to the kids. Like worrying what if a car’s gonna come off the road and hit me and the pushchair and, or just something horrible’s gonna happen to them. I can’t just shake that. I don’t know if that’s just natural or if that would’ve been natural anyway or if it’s been induced from the birth experience but I’m really over-protective of them (Nigel).

Luke described noticing that his responses towards his child can be ‘more extreme and more urgent’. Peter described that his fears about his children’s safety could trigger the same panic he felt during the birth experience. However, other participants reported that over time their feelings changed, with Craig reporting his overprotectiveness had ‘adjusted itself to a normal level now’.

For some, this anxiety and over-protectiveness acted as a barrier to bonding with their child. Some reported delayed bonding experiences: ‘about the six to eight months where things start to get back to normal’ (Peter); ‘somewhere between one and two [years]’ (Brad). Yet, in contrast, others described despite their anxiety, bonding quickly and closely with their child because they had to do a lot of the routine caring. Paul said: ‘I bonded with him because it was me feeding him, changing his nappy, everything like that. [Partner] couldn’t do a great deal’.

Only one participant disclosed ongoing difficulties in the father-infant bond and that despite some positive bonding, his current reactions to his child are at times connected to the traumatic birth experience ‘you do get this sort of feeling of, which is not rational, of, you know, you nearly killed one person, you could kill another. Which is clearly not rational, because it has nothing to do with him’ (Luke).

Theme 4: the enduring distress

All participants reported ongoing distress regarding the traumatic birth. Seeing or visiting hospital was a common trigger ‘if I go to, past the hospital which is literally two miles down the road, it’s the first thing I think about is the birth’ (Peter). Representations on TV of birth or ill children were difficult for some: ‘I do get upset’ (Mark). For Paul memories of the birth triggered feelings of ‘helplessness’, while for Nigel the thought ‘I let [partner] down’. Sam shared how his partner’s current pregnancy has also been a significant trigger: ‘Now moving into, into the second pregnancy … that’s been the trigger. That’s the thing that’s just brought it back because it’s that fear of what’s going to happen … yeah, it’s going, sort of going back into, into that zone’.

Ongoing guilt was a strong theme in the narratives, linking to theme one, with Mark reflecting: ‘I remember being like useless, it is a guilt … I know it’s three and half years later … but they’re still there’. For some participants, they appeared to replay the birth event in their mind, contemplating how they could have said or done things differently in the moment:

I do still play it, you know when, when this er doctor came and said this, should I have piped up, should I have said something, could all this have been avoided? … she didn’t have to be in that much pain … I do still play it back (Mark).

Paul felt ‘emasculated, that I can’t protect, or couldn’t protect and help my family’. He also said: ‘I never forget the little boy with the black eye. I mean, whenever that comes up the birth comes up, you do think about it quite a lot’, and that these memories still trigger feelings of ‘helplessness’. These feelings seemed to compound the ‘boxed away’ theme, reinforcing men’s silence and undermining their perception of their entitlement to support.

This enduring distress was linked to lower resilience (Nigel) and heightened anxiety (Luke). Brad disclosed having gone through a very difficult period during the first 18 months after the birth event: ‘it impacted on my mental health because it triggered me to have suicidal thoughts’. Whilst no participant identified the traumatic birth as the standalone cause of mental health problems, all who discussed it reflected on how birth trauma contributed to making their child’s early years much harder:

we were so physically and mentally emotionally tired and then my baby didn’t sleep, it meant I didn’t have any resources or I couldn’t draw upon anything (Brad).

Theme 5: positive changes

All participants described at least one positive long-term outcome. Some shared an increased appreciation for life. Luke described reducing his hours at work, because the birth experience had highlighted to him:

‘how precious and brief life is and that, how you want to spend as much of your time as you can doing things that are valuable and as least time as you can doing unnecessary work or kind of time away from people that you care about (Luke)

Some participants reflected an increased awareness and empathy for others. Sam shared: ‘I think it’s made me more empathetic to what women have to go through’. Nigel said, ‘It’s changed my mindset really…I can be more sympathetic to people who are struggling’. Peter also noticed an increase in empathy and had suggested to others that they seek help for problems, despite having been unable to accept this support himself.

Participants mostly described their relationships as negatively impacted soon after the birth, with increased arguments or reduced engagement in intimacy. However, these often resolved over the longer term:

‘that first year and a half we argued a lot more … maybe partly from the adjustment from a couple to parents…but I am very pleased that we are a very strong couple (Brad).

In the long-term, most participants reported that having gone through a traumatic birth had led to them developing a closer bond with their partners. Luke shared: ‘it made us closer … because of sharing that raw emotional experience’. Paul reflected:

‘I think it made us approach parenting a little bit different … it feels like we have probably been a bit more grateful because of what went through and sort of a closer bond because of what we went through.

Discussion

A traumatic birth can result in fathers experiencing varying levels of enduring distress, extending far beyond the perinatal period. The findings align with other studies in demonstrating that a traumatic birth results in an array of difficult feelings for fathers, including anxiety, helplessness and guilt. The current findings demonstrate that many of these feelings endure for years after the birth experience, impacting on well-being and mental health, in addition to affecting decisions about subsequent pregnancies. Yet the interviews also revealed experiences of improvements over time in parent–child bonding and couple relationships.

Participants discussed the detrimental influence of traditional masculine ideologies on their well-being, and the impact it had on their ability to talk about their traumatic birth and seek support. Some feared that externalising feelings of distress would be seen to represent an inability to cope or attributed as weakness (Mahalik & Dagirmanjian, 2019; O’Brien et al., 2005). This was compounded by a narrative held by participants: that the traumatic birth was not their story to share. Similar findings were reported by Etheridge and Slade’s (2017) participants who expressed that ‘nothing’s actually happened to me’ (p. 9). Current participants used the analogy of putting the trauma or their feelings in a box, also described by fathers in Attard et al. (2022) study. Avoidance is known to be a common reaction to a trauma event (Ehlers & Clark, 2000) and is commonly reported by fathers after a traumatic birth (Delicate et al., 2022). This avoidance of talking or thinking about the traumatic birth appeared to be a long-term coping strategy in the current study. An encouraging finding is the participants’ willingness to engage with the study itself, and some indicating that they are increasingly ready to seek therapy.

Fear relating to subsequent births, particularly the risks associated, was reported by several participants in the present study and have been noted in other studies (e.g. Delicate & Ayres, 2023; Inglis et al., 2016). Participants who had or were going through the process of having another child voiced a need for the subsequent birth to be well planned and for the couple to feel better prepared. The study’s long-term focus captured that fear of subsequent childbirths reduced with time, resulting in all but one participant going onto have further children.

Perceiving birth experience as negative is known to negatively impact partners’ bonding with baby (Seefeld et al., 2023). The current participants described differing and complex bonding experiences. As described elsewhere (e.g. Elmir & Schmied, 2022) a strong father-infant bond following a traumatic birth sometimes resulted from their role as primary caregiver. Other fathers reported a delay in bonding with their infant immediately after the traumatic birth, but that this improved with time. Although positive bonding experiences were reported by most, one participant in the present study reported ongoing relational difficulties with his child, nine years on from the birth. Symptoms of PTSD postpartum may be a contributory factor to negative parent-infant bond occurring (Parfitt & Ayers, 2009) and the barriers to fathers seeking help are likely to compound this problem.

The current participants reported that during a traumatic childbirth fathers can feel unprepared, ill-informed and marginalised by staff. Although this is not unique to traumatic births (Smith et al., 2024), it led to participants retaining long-term powerful memories of feeling helpless within the birth event. Fathers can feel inconsequential and fearful within this predominantly female-orientated life event (Daniels et al., 2020; Steen et al., 2012), which contributed to the current participants dismissing their own experiences. In addition, guilt and low self-esteem appeared to stem from fathers feeling they have failed in their responsibility to protect and advocate for their partner during the birth. Guilt also related to feeling distressed by something which they interpreted as being their partner’s experience and this persisted in the longer term. Similar experiences are reported in other birth trauma studies (e.g. Etheridge & Slade, 2017; White, 2007) but the current findings demonstrate that despite the passage of time, fathers can continue to reflect critically on their responses during the birth, resulting in enduring negative feelings.

Previous studies have documented adverse outcomes on the couple relationship, for example in areas such as feeling emotionally disconnected and reduced desire to engage in physical intimacy (Daniels et al., 2020; Elmir & Schmied, 2022; Nicholls & Ayers, 2007; White, 2007). An interesting finding from the current study is that most participants reported significant improvements in these areas of difficulty over time. These findings provide helpful insight into the long-term impact of a birth trauma on some couple’s relationships, where difficulties initially developed but for couples who have remained together, fathers report the relationship as strengthened by the experience.

Clinical implications

Fathers in the present study reported they had not been offered support after their traumatic birth, had likely reinforced the message that this is not something men require. Despite some changes in the recognition of the impact of birth trauma on partners, there is no routine screening for father’s mental health postnatally. It is vital that this poor acknowledgement around paternal experiences changes, as all parents may benefit from support following a traumatic birth. The NHS long-term plan (NHS, 2019, p. 49) introduced the commitment to offer ‘fathers/partners of women accessing specialist perinatal mental health services and maternity outreach clinics evidence-based assessment for their mental health and signposting to support as required’. Following this NHS England (2021) published a report entitled: ‘Involving and supporting partners and other family members in specialist perinatal mental health services’. These are positive and welcome steps to fathers’ needs being better met. Further improvements may result from use of the newly developed City Birth Trauma Scale Partner Version (Webb et al., 2021), which assesses for PTSD in fathers and other partners. However, gaps in support remain evident in the UK, primarily for those fathers whose partner does not access perinatal mental health services. In addition, the current findings suggest that it may take some fathers a long time (often years), before they feel ready to seek help. When fathers do feel ready to seek support, they should be met with empathy and validation from those they share their experience with. It would likely be beneficial for staff awareness and training to be available in relation to this, and for this to be trauma-informed (Attard et al., 2022; Ayers et al., 2024).

It seems that many fathers express an avoidance of opening up to others about their traumatic birth experience. In order to overcome this, services could encourage proactive sharing details of support for fathers, through flyers and social media, and during both antenatal and postnatal periods. By publicly reinforcing that support and information are available, associated stigma could be reduced and fathers empowered to access this input.

Strengths and limitations

During the interviews, many participants commented on the lack of awareness and support available for fathers in the UK after a traumatic birth experience. Fathers were motivated to participate to promote better awareness of this experience from the paternal perspective and they appeared to find it useful to have the opportunity to share their birth-related narratives within the study. The study recruited a good number of participants and rich data was derived from the interviews. However, the sample was all highly educated, White men, who had remained with the partner of their baby. Possibly by only recruiting through social media, the study did not reach out to more marginalised groups of fathers.

Data collection took place during the COVID-19 pandemic, therefore all interviews in the present study were conducted by telephone or on Zoom. It could be argued that face-to-face interviews would have enabled a better rapport with participants. However, no participants commented on finding the remote format of the interview impacted on their ability to engage.

Further research

As indicated above a valuable sequel to the present study would be to recruit a more diverse sample of fathers to expand on the current findings regarding long-term impacts: it is currently unclear if marginalisation or other forms of disadvantage would mitigate the positive outcomes reported here. Further work should also explore the long-term impact of birth trauma on other non-birthing parents as birth trauma has been implicated in the poor mental health of non-birthing mothers (Howat et al., 2023).

Current participants felt their traumatic birth experience had impacted on their mental health long-term, however, this study did not use standardised measures. Other literature has also captured fathers reporting symptoms associated with mental health conditions (Daniels et al., 2020; Elmir & Schmied, 2016). It would therefore be valuable for a future study to explore the long-term mental health experiences of fathers who have gone through a traumatic birth, utilising standardised measures over time to explore patterns of problems and recovery.

Given the current findings indicating some long-term positives, future work may usefully explore the process of paternal post-traumatic growth (PTG) after a traumatic birth. Previous findings show that mothers can experience PTG after a traumatic birth (Ketley et al., 2022) and recent work has explored this process in couples (Attard et al., 2022). It would be valuable to explore this in greater depth, potentially utilising mixed methods, where a PTG measure is utilised to capture specific domains of growth as experienced by fathers.

Conclusion

A traumatic birth experience can result in varied levels of enduring distress beyond the perinatal period. Fathers may experience ongoing guilt and trauma memories, which lead to difficulties considering further pregnancies. Participants reported ongoing struggles with being open about the experience and its impact. Most had not accessed any support, despite the experience having ongoing negative impact on their mental health and wellbeing. Masculine ideologies appeared prevalent within many of the interviews, forming a barrier to fathers feeling validated in their experience, being able to talk about the event and to seeking support. Although some participants reported not often thinking about the birth at the time of interviews, most reported triggers which could reignite their memories of the traumatic birth. Some reported that the experience had contributed to them becoming an over-protective parent, however most also felt that in the long-term, the experience had strengthened their parent-infant bond. Despite the negative experience, most had gone on to have other children. Several positive long-term outcomes were acknowledged, which included developing a closer relationship with partners, increased empathy towards others and a greater appreciation for life. Despite these positives, the findings highlight a need for increased acknowledgement of the impact of birth trauma on non-birthing parents.

Acknowledgments

We would like to thank the eight fathers who shared their experiences. Thank you to Mark Harris who consulted on the design and materials for the study. We also would like to thank all the organisations, support groups and individuals, including Mark Williams, who publicised this study during recruitment.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. We have used the gendered terms mother and father in this paper due to our focus on the experience of non-birthing parents who self-identified as ‘father’.