This document discusses the impact of birth trauma on couples. It notes that birth trauma can strain the couple relationship by causing negative emotions, loss of intimacy, and a reduction in understanding between partners. While trauma impacts both mothers and fathers, their experiences of trauma may differ. The document emphasizes the importance of supporting both parents and the couple relationship after traumatic birth to prevent further distress and relationship problems that could impact family well-being.

1. The Impact of Birth Trauma
on Couples
Dr Harriet Higgins Clinical Psychologist
Dr Jane Gibbons Clinical Psychologist

2. Cultural understandings and expectations
• Important to address cultural context of the work
• What are the different cultural understandings and expectations for
couples - what is the influence of this on them as a couple, as
parents, as part of a wider family?
• Huge variations in family composition
• How might these influence a couple’s birth plan or birth story?
• We need to be curious about this in our work

3. Thinking systemically – context of the
workplace
• The importance of understanding the workplace – the organisational
culture in which staff (including ourselves) are working
• What is the ‘personality’ of the organisation – is it compassionate or
defensive?
• Do staff feel contained and nurtured – or are they feeling under
pressure and threat?
• How might this influence the birth journey of an expectant couple?
• How might this influence the way staff support couples who have
experienced birth trauma?

4. Fathers
• To understand couples we also need to understand the unique
experiences of fathers
• A cultural shift has taken place - towards expecting fathers to be
present - at childbirth, in the care of their children and all aspects of
family life
• The lived experience of fathers using midwifery and perinatal services
often appears to contradict this
• Alongside positive feedback – a recurring theme is that the unique
experience as fathers can be ignored
• Fathers report feelings of exclusion, feeling like a spectator rather
than a participant and at times invisible

5. Who’s the bloke in the room?
• The conceptual shift is slower in coming – the discourse is often still
one of fathers being regarded as the ‘partner of the mother’ -
informing research questions, models of care and clinical practice
• Implications for fathers – no available language or discourse for
fathers for their own unique experiences and relationships, no
language to describe distress
• Can feel silencing and excluding - a barrier to help seeking
• And what about same sex partners as parents? - invisible

6. Birth registration data
• In Britain 95% births are registered by a mother and father 85% of
those report living together at the same address (married or
cohabiting).
• 10% live separately - two thirds are ‘romantically involved’ or
‘friends’
• 5% not / no longer in a relationship (1:10 of these fathers attends the
birth, 1:4 enters name on birth certificate. 1:4 still in touch with
mother and baby 9 months later )
(Fatherhood Institute)

7. Research of fathers’ experiences
• Paucity of research with fathers
• ‘How was it for you? (Fatherhood Institute 2018) online survey of men
whose first child born in the NHS in previous 5yrs. 1,873 recent fathers
responded https://data.surveygizmo.com/r/
• Fatherhood Institute – review of datasets - aim of collating all research
studies on UK fathers – including 16 large scale longitudinal data sets
• Who’s the bloke in the room? : Fathers during pregnancy and at the birth
in the UK’ Burgess and Goldman (2018)
• ‘Nothing’s actually happened to me’: the experiences of fathers who
found childbirth traumatic Etheridge and Slade (2017)

8. What do fathers say about perinatal care?
• National maternity review (2016) – some fathers felt excluded from
perinatal support services – common grievance being their role as a
father was not recognized
• How was it for you survey (2018) - 29.4% expectant fathers
attending antenatal appointments said they had ‘rarely’ or ’never’
been spoken to directly and 55.6% - that they had ‘rarely’ or ‘never’
been addressed by name
• 35% reported that the fathers role was ‘always’ or ‘often’ discussed
• 28.5% fathers attending routine antenatal appointments had been
encouraged to ask questions

9. Qualitative studies of routine care
• Uncertainty about their role in a labour setting, feelings of
helplessness at inability to support partner in pain – but ultimate joy
at birth of healthy baby
• Some like they were a spectator – felt they had no role
• Excluded by staff
• Often little opportunity to ask questions or raise concerns
• Questions routinely directed at the mother
• Fathers not routinely invited to antenatal appointments – only since
April 2015 have they had statutory right to attend
• Can inform our understanding of fathers’ experiences of traumatic
childbirth

10. We need to ask……..
‘The sense of separation and detachment that men already experience
during pregnancy seem to be maintained by health services not
making them feel valued and acknowledged’ (Kowlessar, 2012)
• Preparedness and good communication with HCPs is crucial
• Research evidence points to the importance of identifying fathers
with current or previous MH vulnerabilities – seeking to keep them
informed
• We need to be curious – ask – open up a conversation

11. Policy
• WHO – set out recommendations on health promotion interventions to
engage fathers (2015)
• Royal College of Obstetricians & Gynaecologists (RCOG 2017)
• NHS England (National Maternity Review 2016)
• NSPCC (Hogg 2014)
• Royal College of Midwives – endorsed by DofH (RCM 2011)
• NICE (2-14)
• All advised healthcare practitioners to engage fathers or ‘mothers’
partners’ in maternity care and education

12. Fathers and birth trauma
Mark Williams video followed by discussion
• https://youtu.be/LM2PtE2CsU4

13. Experiences of fathers who found childbirth
traumatic
• Limited research into men’s experiences of being present at childbirth
• Difficult to quantify prevalence of PTSD in fathers
• This study looked at trauma – how men coped & impact on their lives
• Semi structured interviews with 11 fathers who reported finding
childbirth traumatic
(Etheridge and Slade, 2017)

14. Father’s experiences of birth trauma
• Birth experienced as a ‘Roller coaster of emotions’ –speed &
unexpectedness of events
• Described fears of death, mirroring partner’s distress
• Trying to ‘keep it together’
• Helplessly ‘watching a catastrophe unfold’
• Felt abandoned by staff themselves & ill informed
(Etheridge and Slade 2017)

15. Loss of a positive shared experience
• Medical attention on partner – father has to take over ‘I just
anticipated we’d do it together’
• Guilt at being the one having the baby so early on & being main carer
• Guilt – ‘Nothing’s Actually happened to me’ Linked with traditional
ideas of masculinity & discourse
• Little expectation of help – eg may not know HV is for fathers as well
• Men & fathers report NEVER BEING ASKED
• Men invalidate their own experience
• Tension of wanting / needing help & being seen to receive it

16. Relationship to help – accessing support
• Traditional/ cultural ideas of masculinity may make it hard for fathers
to identify when they need help and to ask for it
• Staff may maintain this by viewing father’s role as there to support
partner and not having his own needs
• Father’s may question their entitlement to help – ‘Pressured services
should focus on the mother’
• One study showed that when fathers were asked about support they
didn’t understand the question – they went on to describe the ways
in which they had supported their partner

17. The Couple Relationship
• Birth trauma can effect both partners.
• The way birthing mothers and their partners relate to, and process birth trauma
can be different
• When both partners are traumatised it can be very difficult to know how to cope,
when both are in need of understanding and support (and typically not knowing
what is happening/how to heal)
• Not surprising symptoms of birth trauma, particularly, when experienced
alongside depression are related to low couple satisfaction. Can challenge
existing roles in the relationship (man as ‘protector’, woman as ‘carer’)
• Experiencing trauma can create confusion, distance and distress between a
couple, and they can unknowingly continue to trigger each other long after the
event.

18. Impact on the couple relationship
•Limited research. Growing area of interest.
•Recent review by Delicate A et al, 2018 (7
international studies).
• 4 main themes;

19. Expressed Negative Emotions
• Anger most common reported
• Increased arguments
• Guilt around ‘letting’ the trauma happen
• Women ‘blaming’ their partners for the trauma
• Depressive mood also apparent; emotional numbness and detachment
• Highlights overlap between trauma and depression symptoms

20. Negative emotions
• “I blamed my husband for not saying anything and not asking questions
during the birth” (Sophie, How to heal a bad birth, pg 291, 2016)
• “I hated that my daughter seemed to love him more than me, that he got
to touch, meet and talk to her before me…… I have treated my partner
appallingly; I have made him crawl over broken glass, I have been punishing
him relentlessly for nearly five years over something that wasn’t his fault”
(Nina, How to heal a bad birth, pg 291, 2016)
“I felt that in some way I had let her down, had failed in my duty as her
protector….I also felt stupidly naïve, had failed to grasp just how much we
didn’t know and hadn’t prepared for. (Ben, How to heal a bad birth, 2016)

21. Loss of intimacy and strain on the relationship
• Sexual relationships often affected; loss intimacy/reduction in sexual
activity
• May have flashbacks when initiating sex
• Avoid sex; fear of pregnancy/birth
• Closeness, love and romance could also reduce
• Dynamic change to ‘friendship’
• Relationships being strained to point of breakdown

22. • “I had been having nightmares and experiencing negative mood
wings since my daughter’s birth. It was causing me to become
angry-and I didn’t know where to direct that anger. I wasn’t
getting enough sleep. And I was so worried that my girlfriend
would get pregnant again that we stopped having sex”.
(Duncan, Meet the men who got PTSD from seeing their
partner’s give birth, The Telegraph, 2016)
“There’s been lots of resentment and sideways comments from
me. I’ve felt abandoned for not really valid reasons in the present,
but it stems from feeling abandoned in the beginning of the
birth….. I become really defensive and horrible. I have been unable
to be even slightly vulnerable with him since our child’s birth. It
has placed huge amounts of strain and stress on our relationship”
(Gemma, How to Heal a Bad Birth, 2016)

23. Loss of understanding and support
• Father’s reporting irritation that women’s distress prolonged
• Birthing mothers feeling partner offered ineffective support
• Mother’s not able to offer fathers support.
• Communication reduced as result eg, trauma too painful to talk
about.

24. • “I think my outcome of the birth was quite different from Melissa’s. I
felt really empowered and validated. I felt I had performed my roles
as husband and father really well. It was like emerging on the other
side of a ‘rites of passage’ empowered. I felt I had grown as a person.”
• “It felt like I was the only person who had collateral damage’ after the
birth. Like everyone else was able to leave it at the hospital….I was in
complete turmoil. I was grateful, of course, but confused, bitter,
fragile and just so deeply jarred. My husband’s cheerful disposition
only made me feel more desolate and inadequate-an angry.”
Ben and Melissa, How to Heal a Bad Birth, 2016

25. Traumatic growth
• Possible for some couples
• Working together to recover and heal
• Can strengthen the relationship
• Research not clear why some couple relationships strengthen and others
don’t
• Suggest; linked to pre-birth quality of relationship, attachment history, and
support they receive postnatally (formal and informal)

26. New Parents
• Recent review (Delicate A, Ayers S, Mc Mullen S, 2017)
• Suggest similarity between impact of birth trauma to relationships to the changes
new parents experience.
• Adjusting to the numerous changes commonly leads to frustration. Report
decrease in satisfaction in their relationship after having a baby (at least in the
short-term) and increase in disagreements.
• Proposed birth trauma magnifies further the problems new couples face
• Birth trauma appears to have more negative, severe effect on couple

27. Why is this an important Issue?
• Research tells us that the quality of the couple relationship has
impact:
• emotional, cognitive and physical development of our babies and
children.
• Parents’ physical and mental health, relationships, capacity to work.

28. Couples in conflict
• 92% of couples report an increase in conflict postnatally.
• Exposure to couple conflict can affect children of all ages (including babies).
• Impact; increased anxiety, depression, aggression, hostility, anti-social behaviour and criminality
as well as deficits in academic attainment (Harold & Leve, 2012).
• 6 month old babies; exhibit higher physiological symptoms of distress (elevated heart rate) in
response to overt, hostile exchanges.
• The effect of inter-parental conflict on children depends both upon the way it is expressed and
resolved; Destructive/constructive conflict (Grych & Fincham, 1993), (Cummings et al., 1991)
• Sadly, we know that pregnancy and having a baby are associated with an increased risk of
domestic violence for women and an increase in the severity of any violence.

29. What helps couples reconnect?
• Knowing that they both have their own experience of baby’s birth.
• Knowing that your partner may not be against you, but may not be
able yet to understand the others experience.
• Getting help individually to process the birth trauma and
understanding negative emotions towards each other.
• Hearing partners experience of birth, with the aim of moving towards
more connection. Challenging to do, depressed state of mind easy to
feel sensitive and criticised.
• Getting help professionally to reconnect as a couple can help with
defensiveness and encourage sharing

30. Summary
• Birth trauma can effect all areas of life, including making it hard to
cope with caring for a baby and create strong parent-child bond
• A supportive couple relationship can be a vital foundation to help
overcome trauma.
• However, birth trauma places a great strain on a relationship, leaving
couples feeling isolated and misunderstood.
• In order to prevent breakdown the whole family needs support

31. What you can do to help
Antenatally;
• Invite couples to talk with you together about their relationship (models their relationship and parenting is important).
• Encourage thinking about their existing way of managing relationship difficulties. What works/doesn’t? What else might
they need? Importance of listening to one another/others perspective
• Help prepare both parents for birth; to think about their individual needs and what support they might need if birth plan
doesn’t go as hoped
• Invite both parents to contribute to the birth plan.
• Review both parents mental health. Do they have a history of trauma (increases vulnerability).
Birth:
• Plan how to include fathers/same sex parents in the birth
• Who and what support will be offered to fathers/same sex parents if the birth is not going well
Postnatally:
• Review both parents mental health, encourage both to get professional support if you think they are experiencing birth
trauma/perinatal distress
• Review the couple relationship. If couple relationship is in distress refer for professional help.

32. Staff support
• The importance of effective leadership
• The importance of reflective practice to contain and enable staff –
this is emotionally challenging work
• Support staff to grow and develop and remain curious about the
influences on their practice
• Enable a culture where difficult experiences and emergency
situations (and when things go wrong) can be processed and
learning takes place

33. Services for Couples
• Relate offer counselling services for couples nationwide
• The NHS IAPT Talking Therapies service offers couples counselling for depression,
where one or both partners are experiencing depressive symptoms.
• The Coupleconnection is an online web service for couples providing information,
guidance, courses and activities and an online forum where people can talk to
each other and share experiences (www.the coupleconnection.net)
• In London; The Tavistock Centre for Couples Relationships, The Institute for Family
Therapy and Parenthood in Mind offer couples therapy and group programs.
• Where there is domestic abuse in a relationship then it is recommended the
perpetrator/s addresses their abusive behaviour and the survivor is offered
support/counselling with the help of specialist domestic abuse organisations such
as Respect for perpetrators, Womens Aid or Mens Advice Line for those
experiencing abuse.