Invisible Victims: How Maternal Near-Misses Result in Trauma and PTSD in Birthing Partners

What is a Maternal Near-Miss?

According to the World Health Organization, a maternal near-miss is defined as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or postpartum up to 42 days.” The United States is a developed country and far ahead in many areas; however, we are failing and literally killing women. Maternal mortality rates are ranked 55th overall, falling behind Russia, and death rates are on the rise according to AJOG. The statistics are far worse for women of color, especially Black women, who, according to the CDC, have three times the maternal mortality rate as White women. The United States’ poor ranking, maternal near-misses, deaths, and lack of postpartum care constitute an epidemic in its own right. While the United States is making small strides in improving its status on maternal deaths, there is minimal research on the impact of near-misses on partners and the overall impact on child bonding and family systems.

Maternal Near-Miss Impact on Partners

As a Licensed Mental Health Counselor, specializing in perinatal mental health and EMDR (Eye Movement Desensitization and Reprocessing), I often have clients reach out after experiencing their pregnancy or postpartum disorders and traumas. Unfortunately, it’s uncommon for birthing partners to reach out to process their experience. Whether it’s due to a lack of awareness that partners can also experience PTSD and perinatal mood disorders, not being asked the right questions, not feeling they can take care of their own needs, trying to hold it together, or pressure to be strong, they are not reaching out. We need to take note, advocate for all parents, and check in on the partners throughout pregnancy and postpartum, especially following a complicated pregnancy, near-miss, or NICU stay. If either partner suffers from a perinatal mental health diagnosis, there is a strong likelihood that the other partner will also have a perinatal mood disorder.

Birthing Partner Can Appear Avoidant, Angry, and Aloof

After completing trauma-informed care with the birthing person who experienced a maternal near-miss, they may want to become pregnant again. I often see that their partner may not be ready or willing to have another child, resulting in relational conflicts. There can be family planning before the near-miss with a goal of 2-3 kids and now the partners are in disagreement over family planning, leading to relational conflict.

Untreated trauma often manifests in partners as various symptoms and changes in behavior, including perceived disinterest/aloofness, depression, agitation, avoidance of parenting responsibilities, or avoidance of discussing future pregnancies/family planning. Substance use and behavioral addictions may arise or increase. They may also have difficulty bonding. Healthy attachment may be disrupted with their baby following a maternal near-miss. It’s almost as if they are in a mental fog, missing the key milestones in their baby’s life and not developing as a parent. This stagnation and disengagement can force the mother into primary caretaking responsibilities, making her feel overwhelmed, unsupported, and resentful toward her partner. 

Assess for Symptoms and Personality Changes, Not Diagnoses

As a counselor, I often see clients struggle with labeling and correctly identifying diagnoses; however, they can identify symptoms experienced by their partner that did not appear during pre-trauma. They may comment on a significant  “personality change” in their partner. Assess for symptoms such as, but not limited to: nightmares, flashbacks, unusual fears, hypervigilance, paranoia, avoiding outings or large crowds, avoiding talking about family planning, agitation, physical complaints, weight loss or gain, addictive tendencies, being overly protective, and experiencing intrusive thoughts, flashbacks, and unwanted images. 

The idea of family planning can overwhelm partners with untreated trauma and PTSD. It may not be that they are unwilling to discuss family planning, it may be that they are not currently capable of discussing having another child due to trauma. There are often intense and even paralyzing feelings of being overwhelmed by the fear of seeing their partner suffer again, or even worse, their partner or baby dying during childbirth. The loss is unbearable; therefore, it is avoided. It’s important to have honest and respectful conversations about family planning. If there is continued disagreement, meeting with a marriage and family counselor certified in perinatal mental health can help. 

What Can I Do as a Birthing Partner When There is a High-Risk Pregnancy?

I had the privilege of speaking with Jeff Albright, a birthing partner who witnessed the maternal near-miss of his wife. Their newborn son also experienced a near-miss after contracting a rare form of bacterial meningitis and sepsis, resulting in a three-week NICU stay. Jeff’s wife, Jordan Albright, shares her incredible story of resilience on TikTok @jordynlee_ttc and on Instagram. Jeff reported on their IVF/infertility journey, partnership, quality family support, fears, trauma symptoms that followed the near-misses, and what he believes helped him in preparation for the unknown and recovery from the experience. Below are Jeff’s suggestions on what he found helpful and would suggest to other birth partners:

1. Try to be as involved as possible with the birthing person’s appointments. Have a basic understanding of the terminology, process, medications, and procedures. Have a birth doula if it’s financially an option.
2. Build connections as soon as possible with the professionals you are working with. Ask questions that add to the conversation.
3. It was helpful for me to know about worst-case scenarios going in and potential complications. I’d rather know too much than not enough.
4. Talking about [maternal near-miss] honestly, with supportive people, was really helpful. 
5. Don’t be afraid to ask for help. Let someone in who you can talk to or who can at least listen.

3 Ways to Support Birth Partners Following a Maternal Near-Miss

1. Screen Partners in Addition to Birthing People

Attention all counselors, OB-GYNs, midwives, and pediatricians: request that the partners come to as many appointments as possible to assess their mental health. If there was a maternal near-miss, there is a strong likelihood they can have trauma and PTSD that may manifest as postpartum anxiety or depression. According to Postpartum Support International, 1 in 10 fathers will develop postpartum depression, and up to 18% will develop an anxiety disorder, including PTSD, OCD, and generalized anxiety disorder, anytime during pregnancy and the postpartum period. To self-screen, visit Postpartum Support International and discuss the results with your providers.

2. Listen to the Partner’s Birth Story

One of the best ways to support is by actively listening to the birth person’s and their partner’s birth stories and experiences. We have been telling our history through storytelling, passing down our stories in narrative form. We’ve somehow lost this beautiful process along the way. Re-telling one’s birth story and experience is an integral part of the healing process. Allowing each of them to share their story separately can be healing and allows their version to be told. One partner may feel resilient and empowered, while the other could be impacted negatively. 

If it’s too overwhelming to hear their story, ask them to write it down and/or refer them to a licensed counselor who specializes in perinatal mental health. As a licensed counselor, I inform my pregnant and postpartum clients that I want to listen to their entire birth story, without interruption, as many times as they need. I will utilize an EMDR technique called Recent Traumatic Episode Protocol (R-TEP) to listen as we use bilateral movement to desensitize the experience, allowing adaptive information to come in and empower the client.

3. Normalize and Advocate for Fathers’ Mental Health

De-stigmatize, advocate, and bring awareness to perinatal mental health for the entire family system. June 17th is International Fathers’ Mental Health Day. If you believe you are experiencing trauma or PTSD due to a maternal near-miss, please reach out for help. There is minimal research on the impact of maternal near-miss on women and babies. There is even less on partners who witness maternal near-miss, however, common feelings of “exclusion and powerlessness” lasting months to years were reported by partners in one study. 

Postpartum Support International has a helpful provider directory to get connected and a page specific to dads, partners, families, and much more. To learn more about the various perinatal mental health disorders, visit Postpartum Support International. 

Conclusion

We can do better. Partners who witness maternal near-misses often experience traumatization and feelings of powerlessness, exclusion, and invisibility. It’s up to us as a society and as providers to see these partners, making the invisible visible to provide healing, empowerment, and better health outcomes for the entire family system and society at large. Let’s advocate, do more research, and make it a standard to check in on fathers’ and birthing partners’ mental health.

Postpartum Planning for Expectant Parents

Learn More About Perinatal Mental Health Disorders

Help for Dads

Help for Partners and Families