By Liam Mannix

Reana Gallichio was 36 weeks into a pregnancy with twins, and it was wearing on her health.

She had a cough that refused to get better, and her legs were swollen with fluid – an early sign of potentially deadly pre-eclampsia.

Reana needed her partner, James, to advocate for her at antenatal appointments. But he was struggling too – with being ignored. James said: “It felt like, because I was saying it, it wasn’t taken very seriously, which was a bit of a strange experience.”

After the twins were born, when James would ask questions of nurses, they’d answer to his wife. They screened Reana for depression, but did not test James, which made him feel “more depressed and uncared for”.

James was having an experience unusual to men in general, but common when their partners are pregnant.

More than 80 per cent of Australian men say they aren’t engaged with crucial pre-baby appointments and classes. When they do attend, they often report being made to feel helpless, like secondary parents, or simply like “complete idiots… the bloke at the end of the bed who got [mum] into this mess”, as one study reports.

It sets up a situation right at the start of new life where the mother is the primary carer and dad is just “helping”, says Dr Karen Wynter, who researches perinatal depression at Monash University and convenes the Australian Fatherhood Research Symposium.

“Why should he help with the baby? It’s his baby. He’s not helping. He’s a parent,” she said. “This is something our system unfortunately does. Fathers do end up feeling secondary.”

The issue reflects a new tension at the heart of the Australian family.

Equal Parents

Until the 1970s, men were banned from the birthing suite. But fathers are now moving from breadwinner and disciplinarian to involved parent.

“Fathers want to be equal parents. They want to be treated as equal parents and not secondary caregivers,” Wynter said.

That desire for increased involvement is coming into conflict with a system that remains focused on mother and child – not unreasonably, as they bear all the medical risk.

Dr Nicole Highet, executive director of the Centre of Perinatal Excellence, says: “Hello! They are the one giving birth and going through the pain.”

Victoria continues to label its after-baby-care “maternal and child health”, for example. Other states use the term “child and family health”.

Cultural factors remain. Not all fathers want to take part, seeing it as a woman’s place. Sometimes mothers hold that view, too. There’s some evidence mothers’ views about gender roles have a stronger effect on a father’s engagement than the father’s own beliefs.

“Cultural change is the hardest thing,” says Dr Chris May, head of the “dad lab” at the University of Newcastle.

What this produces is a caregiving relationship typically characterised by inequality.

Fathers still spend about half the amount of time with kids as mothers, and nearly all that time is spent with mum present. Nearly two-thirds of Australian mothers of infants think they do more than their fair share of child-rearing.

This focus also means services struggle to spot and treat a key risk for new families: postpartum depression, which affects about one in 10 fathers. There is a strong link between a father’s mental health and the quality of his parenting.

Fresh Perspective

Indeed, while maternal healthcare workers can refer a mother to mental health services, they can often only recommend a father see a GP, says Linda Sweet, professor of midwifery at Deakin University.

That may be on the verge of changing. New guidelines from the Centre of Perinatal Excellence, to be released in coming weeks, will for the first time include screening tools for depression in fathers.

“We often assume depression in pregnancy is related to hormones – that’s not the case,” says Highet, the centre’s director.

“Fathers often talk about it impacting on their feeling of responsibility – they are now the provider, so there’s extra stress.”

However, unlike for mothers, the guidelines will not recommend universal depression screening for fathers pre-birth, because the maternity system is not yet set up for it. The mother is technically the enrolled “patient”, not the father. “Our system is not set up for fathers,” says Highet.

Catching paternal depression matters because, as parenting researchers have discovered in the past two decades as they turned their lens towards men, fatherhood matters.

Studies suggest the mental health of fathers appears to buffer children against ill effects if their other caregiver is struggling with depression.

And making men part of the pre-natal process may set them on the path to an equal parenting relationship. Systematic reviews show the more engaged the father is with the child, the better the child does, particularly in the things influenced by the brain: cognitive development and psychological stability.

“Research suggests that if dads are involved early, they’ll be a lot more involved,” says Dr Jennifer Baxter, a leading researcher at the Australian Institute of Family Studies, “and that bodes well for the rest of the child’s life.”

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Originally published in The Sydney Morning Herald.