Seventy hours into the birth of his first child, Lewis was told that his wife needed to be rushed into surgery for an emergency C-section. The pregnancy had been straightforward and full of nervous excitement, but, as crisis presented itself, Lewis found himself unprepared.

“I still can’t talk about it properly now, five years on,” the 35-year-old says. “It was horrific. I didn’t know what was going on and I couldn’t do anything except stand by and watch as my wife and my baby’s lives were potentially in danger. The whole thing was a blur, but it felt like it would go on for ever.”

An hour or so later, his son was delivered. His wife was fine and the baby was healthy. Yet the memory of the traumatic birth kept replaying in Lewis’s mind, long after the family returned home. “My wife was still recovering from major surgery, so I was left alone with my child, but I didn’t feel that special connection that everyone talks about,” he says. “I just wanted to make sure my wife was OK. My baby became something I had to deal with.”

Lewis found himself going through the motions of parenting – sleeping fitfully each night, changing nappies constantly, looking on while mother and child bonded through breastfeeding – but he struggled to connect with his child. He began to feel deeply sad, as if there might be something wrong with him; so many other new fathers seemed enamoured of their babies.

As he later found out, he was experiencing the symptoms of postnatal depression (PND), which remains largely unexplored in men. PND is well established as a mood disorder that affects women, with between 10% and 15% of mothers thought to experience it. In the UK, new mothers are monitored for PND during routine NHS health visits. New fathers, however, have no access to standardised care or routine checkups on the NHS, despite research finding that up to 10% of them exhibit symptoms.

“Both parents are equally susceptible to mental health challenges during and after birth,” says Dr Sharin Baldwin, the clinical academic lead for nursing at the London north west university healthcare NHS trust. “Recent years have seen caring responsibilities become shared and there is an expectation that dads need to be more involved. That combination can create more pressure on men who want to be good dads, but might feel as if they’re not good enough or that they can’t burden their partners with their own worries.”

Baldwin, a health visitor, is one of the few researchers to study the prevalence of postnatal depression in men. Her interest in the topic began when her husband told her how he felt excluded by child health services after the birth of their first child, with each piece of literature or help for infants seemingly naming only “mothers and babies”. She began a three-part New Dad Study in 2016, interviewing 21 men from different ethnicities and backgrounds about their experiences of having children.

She found that a number of themes tied them together. “A lot of the men spoke about their exhaustion with having to go back to work and still care for their children when they were at home, as well as the difficulty in being separated from them,” she says. “There were also concerns raised about expectations not matching with reality, like dads being surprised that their partner might struggle with breastfeeding and then feeling as if they weren’t able to help. Ultimately, their issues might not feel as important as the birthing partner’s and so they often neglect their own needs.”

Lewis felt conflicted when he went back to work after two weeks of parental leave. “The office was really tiring, but I needed the break from being at home,” he says. “I felt so guilty when I got back, for missing out, as well as sometimes relieved. I didn’t want to make life harder for my wife by telling her.” Nonetheless, she noticed his apathy and his fluctuating mood; she encouraged him to seek help. “She told me that if I didn’t sort this out now it would affect our son’s life and our relationship,” he says. “She didn’t want me to work myself to the bone and not be present any more.”

After being put on a waiting list for NHS counselling, Lewis decided to pay for private sessions so that he could start immediately. “A few months in, I began to make sense of my feelings and realise that the birth had been hard for both of us,” he says. “It really helped being able to talk about it and the weight lifted. I could begin to feel unconditional love for my boy. I wish I had known earlier that, even though there might be a lack of connection initially, it would come.”

Baldwin says PND can affect men who have adopted children, as well as those in same-sex couples; there can be an expectation to parent without complaint after going through a lengthy adoption or surrogacy process. “Support is really important,” she says. “If men don’t have a social network within which they can talk or share their feelings, they might feel cut off and then things can get worse.”

***

When James, 38, became a father, he felt extremely isolated. After he and his partner had gone through two unsuccessful rounds of IVF and begun to look into adoption, she became pregnant naturally in 2019 and gave birth to their “miracle baby” at the height of the Covid pandemic. “The lockdowns meant that we were almost entirely alone, which became really hard,” he says. “We had gone through so much to have a child and I was so excited for her arrival that I wasn’t expecting how tough it might be. I felt awful.”

Sleeping only four or five hours a night, James became deeply affected by his daughter’s screams, anticipating their arrival and sometimes hearing noises when there were none. “It felt like there was no escape, especially since we couldn’t even really go outside,” he says. “Everyone else was also having their own difficult experiences of Covid, so there wasn’t much space to share how I was feeling. I kept everything inside and began to dread the long nights.”

Ian Coleman, a therapist with the Counselling Directory, describes the “doom loop” that he encounters with new fathers who come to him for help. “Men can have these traditionally masculine notions of needing to cope, which means they don’t talk about their feelings and then they feel guilt at not doing well, which makes the depression worse,” he says.

“Caring for yourself can be seen as selfish, but it’s necessary. Men often don’t have a roadmap for fatherhood and they might not want to repeat how their own fathers were, so they need perspective to understand that their lives are objectively difficult in those moments.”

James says his father was largely absent, busy at work, when he was growing up. He was determined to be more hands on with his daughter, even if he was struggling. “I didn’t even know men could get postnatal depression, but as the lockdowns lifted and I reconnected with my friends and family, I asked the other dads I knew about their experiences and they began telling me how hard it had been for them, too,” he says.

The pressure James had been feeling began to subside and he felt as if he could parent on his own terms. “Looking back now, I can’t believe there isn’t more awareness about the issue and that there aren’t more resources available, since it seems so common,” he says.

***

The PND support charity Pandas has seen its private Facebook group for new fathers grow to 800 members since it was established in 2020. There has been a “slow but steady increase” in people reaching out to its support services specifically for men, says Annie Belasco, who runs the charity. She says the mental health of new dads is often overlooked. “With 25% to 50% of fathers experiencing anxiety or depression when the mother also has a perinatal mental illness, the demand will only grow.”

Baldwin agrees, noting the need for more resources. “We need national guidance to assess fathers routinely. Health visiting numbers in England have dropped by 40% since 2015 and, with this disinvestment, we struggle to identify fathers who need more support,” she says. “Between 8% and 10% of fathers might experience PND, but those are only the ones that we know about. The real figure could be higher.”

As research into men’s mental health develops, with studies finding that fathers go through hormonal changes after birth, it seems clear that awareness of the realities of fatherhood needs to be increased. The stigma is still prevalent – as evinced by the fact that each man I spoke to about their experiences did not want to share their full name.

“It’s difficult to admit that something as natural as fatherhood has been so hard for you, but it feels important to do it,” Lewis says. “Us dads need to look after ourselves, as well as our partners and kids.” Five years after that emergency C-section, Lewis’s son has started school and Lewis and his wife have had another child. “I love them both so deeply,” he says. “Even though it has been really tough at points, they are the best parts of my life.”

Some names have been changed

• In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14 and MensLine on 1300 789 978