Like any expecting couple, Brett Pipitone and his wife, Laura, knew that having a child would upend their daily routine. But no research or planning prepared them for their biggest challenge: postpartum depression.
“It was an incredibly stressful situation,” Brett said. After giving birth to their daughter in 2014, Laura found herself “wanting to disappear” and completely disengaged from her surroundings. She’d call Brett at work in tears, and he’d rush home to help. He wound up taking much more time away from his job as an aerospace engineer than he’d expected, without any idea of how he could fix things.
As many as 1 in 6 women suffer from postpartum depression and/or anxiety. In such cases, the partner who didn’t give birth relies on paternity leave or parental leave to be the primary caregiver and manage the household, a sharp contrast to social-media-worthy pictures of dads strolling with the Baby Bjorn, coffee in hand. When partners don’t have access to paid parental leave but need time to help at home, they may be forced to take unpaid time off under the Family and Medical Leave Act. FMLA provides job protections for eligible workers who take time off for their own illness or to care for a family member. Eligibility factors include the size of the company or an employee’s tenure, and people who work for small businesses or in high-turnover positions are often penalized. The nearly 40 percent of workers who do not have access to unpaid family leave are left in a drastic bind, potentially losing their jobs.
“This is not a role that the husband has any precedent for,” said Lynne McIntyre, the manager of Maternal Mental Health Program at Mary’s Center in the District and the Mid-Atlantic regional coordinator for Postpartum Support International. “Traditionally, men were not the perinatal caregivers. They didn’t take care of us physically or medically when we were pregnant. Before we became so mobile and started living far from our families, our mothers, sisters and aunts would take care of us after having the baby. [Today’s men] are thrown into the wolf pit, like ‘Good luck with that.’ ”
McIntyre understands from personal experience the stress that partners are put under. After her son Calvin was born in 2004, McIntyre suffered from postpartum depression, and the caretaking role fell to her husband, Herb Caudill.
“I was a completely different person,” she said. “It was really scary for him on so many different fronts. ‘Is this the person I married? Is this our life from now on? Am I going to lose my wife? Did having a baby ruin our life?’ On top of all that, he was expected to keep going to work and keep performing.”
Caudill wished he had known more about what to look for and expect when dealing with postpartum depression and anxiety. “I had my own prejudices about mental health, that it was someone else’s problem that happens to other people,” he said. “I didn’t have the idea that it was possible that something like that could happen to someone like her.”
Julie Bindeman, a psychologist who treats perinatal mood disorders and who is the co-director of Integrative Therapy of Greater Washington, says that partners will often get between one or two paid weeks off from work for family or paternity leave but that that is not adequate time, even with a standard delivery and recovery period. Add postpartum depression or anxiety into the mix, and partners might find themselves in unfamiliar, stressful roles. Many lack the instinctual ability to fight through.
“The reaction depends on the individual,” Bindeman said. “There is a certain type of man for whom the additional stress of just the baby is too much for them. They might retreat into work because it’s a safer place, a place of control. Some men might be sympathetic to the point and try and work with their wife. Other men might be Florence Nightingale and swoop in, take on the job of both parents, caring for both the wife and the baby.”
Both McIntyre and Bindeman noted the additional societal expectations that are heaped on men: to return to work as the primary breadwinner and, once back in the office, to act as though everything is normal. “Your colleagues may want to see the wrinkly baby picture on your smartphone, but then you’d better be done with that,” McIntyre said.
The partners themselves also face a greater likelihood of developing depression if the new mother suffers from postpartum depression. “It’s nearly eight times greater,” said James Paulson, an associate professor at Old Dominion University who has studied the effects of perinatal and postpartum depression on both men and women.
“We found that 10 percent of fathers experience depression during pregnancy or postpartum, as compared with 13 to 14 percent of mothers,” Paulson said.
Both postpartum anxiety and depression are “very treatable,” Bindeman says. “These are not the same as other mood disorders,” she explained. “With a competent clinician, you can start with therapy. If it’s severe depression, you can add in medication.” A recent government-appointed health panel has called for screening women for depression during pregnancy and after giving birth.
Bindeman stressed that women can be treated for postpartum disorders while still breastfeeding and that the Washington area has wonderful psychiatric resources and clinicians with knowledge and background in perinatal mood disorders.
The Pipitones have become outspoken about the unexpected effects of postpartum depression on a spouse, sharing their experience with the It’s Working Project, an online forum, and have also been speaking candidly to their friends about what postpartum depression looks like and how to seek treatment. When their daughter was born, they sought treatment right away, and Laura improved within a week of getting a prescription.
Although most experts are in agreement about the importance of parental leave, many are now seeing just how important that time is for the parent’s health and for the family to function.
“When people say paternity leave, they think, ‘Bond with your baby,’ but that’s not what you’re doing,” Brett said. “In more cases than not, it’s just not possible for the mother to manage the household on her own.”
●Understand the experience as an illness: A mother with postpartum depression might feel “irritated, angry and even jealous” of the normalcy her partner appears to have, said Aimee Danielson, founder and director of the Women’s Mental Health Program at MedStar Georgetown University Hospital and an assistant professor of psychiatry. Marital conflict is common. “Husbands feel they are at fault, or their wives try to blame them when they are not at fault. Understand this is an illness and these are a set of symptoms.”
●Help her get more sleep: “There isn’t enough therapy or medication to get [a new mother] well without consolidated blocks of sleep,” Danielson said. Partners can step in and help with night feeds to give the woman a longer stretch of uninterrupted sleep. “We recommend that women try and get a four-hour block of sleep combined with two two-hour blocks of sleep: one at night, one during the day,” she said. For families with more financial resources, Danielson recommends hiring a night nurse.
●Help find treatment: Danielson recommends that partners help set up appointments and even come along for support. “The partner can join in the therapy appointment and discuss ways to be supportive, or he can keep the baby in the waiting room so the baby is nearby but the wife still gets that protected space with the therapist.” In some extreme cases, Danielson recommends the partner step in and call the doctor on the mother’s behalf.
●Be supportive: “The number one way a dad can support his partner is to educate [himself] and be aware of what is going on,” Danielson said. With a better understanding, a [partner] can provide emotional support through listening and validating “rather than going at this as a problem that he needs to fix,” she said.
For additional reading, Danielson recommends “The Postpartum Husband: Practical Solutions for Living With Postpartum Depression” by Karen R. Kleiman and “This Isn’t What I Expected: Overcoming Postpartum Depression” by Kleiman and Valerie Davis Raskin.
If you are in the Washington area, check out the Perinatal Mental Health Resource Guide at dmvpmhresourceguide.com.
And in Virginia, try Postpartum Support Virginia at postpartumva.org.
Rebecca Gale is a staff writer for Roll Call and a contributing editor for the It’s Working Project. Follow her on Twitter at @beckgale.