I write this with my fourteen day old baby asleep, at least for now, in a basket at my feet. 2014 is the year I got pregnant with, and gave birth to, my third child, and, fittingly, it is also the year that I researched and wrote a book about postnatal depression in fathers. I have talked about the need for maternity services to step-up, and the need for father-focused antenatal education, and the need for acceptance and awareness of the illness in fathers - but how do maternity services really measure up?
Fathers are, for the most part, ignored antenatally. At the bottom of each space on my antenatal notes there was a place to mark whether I attended the appointment alone or with a partner - this was left untouched, even when I did attend with my husband. There aren't always two chairs in consultation rooms, there aren't always appointments at a time convenient for a working parent, and on the labour ward there is almost never any provision for fathers to stay overnight unless they want an uncomfortable sleep in an armchair. Even during labour I'm almost certain my husband was largely ignored, but I'm not sure I take issue with this - let's not forget that the purpose of a maternity unit is the well-being and safety of a mother and her child. When the baby is here and people have become 'parents,' a shift of focus, from the mother alone to the mother and father, needs to take place - postnatal care is where PND needs to be acknowledged.
Continuity of care is a distant dream for many pregnant women - in previous pregnancies I have never seen the same midwife twice for any routine antenatal appointments. This time I saw the same, excellent midwife for my last five appointments, and she made sure it was her who came to visit us at home after the birth. Not only can this make a big difference to a mother, it can also make a difference to a father - I think a mother would be more likely to confide in a midwife who was familiar if they had concerns about their partner than to one who was not, and who they was unlikely to see again.
The midwife and the health visitor are likely to be the first healthcare professionals a woman comes into contact with after discharge from the hospital so it is vitally important that postnatal depression is acknowledged by them - in both mothers and fathers. I was prepared for my husband to be ignored, and I was prepared to be outraged that his mental health was overlooked...but I was proved wrong. Both the midwife and the health visitor did acknowledge that my husband might be struggling. Mavis, the midwife, said it can be difficult to bring it up with new parents, but she always tries to do so as she is aware that PND does exist in fathers, and she is also aware that a father's mental well-being can be as important as a mother's.
The professionals, the midwives and the health visitors - the first port of call for mothers and fathers after a birth - are in agreement that PND does exist in fathers. They acknowledge it and are trained to ask about it, and this is a significant step in the right direction towards getting fathers the help they need. It will make a difference to fathers, their partners, and their families if this sort of training is consistent and the questions are asked every time. I only have my experience of one of England's NHS trusts, but this one is listening. I'm hopeful that things really are changing and it isn't the only one.