Ghosts in the Ultrasound: Paternal Trauma and the Transition to Fatherhood

Background: Almost 45 years ago, Selma Fraiberg published her classic paper, “Ghosts in the Nursery” (Fraiberg, 1975), about the influence of unresolved issues from the past as new parents establish their relationship with their new baby. Traumatic stress has been linked to decreased maternal ability to provide sensitive and responsive parenting.  Less is known about how trauma may impact upon men’s fathering and the establishment of the father-child relationship.  The prenatal period provides an opportunity to examine how paternal trauma may intrude upon men’s experiences and identity development in the transition to fatherhood, and the early father-child relationship.

Methods: We conducted semi-structured interviews with expectant fathers (n=47) who attended a prenatal ultrasound with their pregnant partner in one of two large midwestern health care systems.  Interviews addressed men’s experiences attending an ultrasound and their thoughts about becoming a father, including any changes or preparations they felt they needed to make in order to be the kind of father they hoped to be.  Interviews were recorded and transcribed verbatim.  Analysis was informed by principles of grounded theory.  Though no prompts elicited trauma history, open coding revealed that many participants described prior experiences of trauma in reference to their thoughts and feelings about fatherhood. We conducted selective analysis focusing specifically on themes related to prior trauma and its salience in the transition to fatherhood.  In an iterative process, multiple researchers repeatedly reviewed each transcript to distinguish concepts and themes.

Results: Pregnancy and specific pregnancy milestones such as ultrasound elicit unresolved pain for some expectant fathers. Though trauma experiences were not part of the interview protocol, men talked spontaneously, readily and vividly about their own traumatic experiences.  The types of trauma described range widely, including those of prior pregnancies ending in miscarriage, experiencing or witnessing an array of harms as adults, growing up with abusive parents and other adverse childhood experiences.  Men’s accounts revealed that prior trauma shapes their experiences in pregnancy, expectations of themselves as parents, and fears for their future child. 

Conclusions: Men’s openness and ready engagement in conversations following ultrasound appointment demonstrates the promise of using that opportunity to reach out to expectant fathers. The pervasiveness of trauma and the potential pernicious impact it can have on parenting demonstrates the need to provide a gateway towards supportive services to address trauma and increase capacity to be effective fathers. Given that most fathers attend ultrasound, that engagement with the health care system provides a prime opportunity for engaging, assessing and supporting fathers in ways that will promote positive involvement, optimize attachment, and foster a supportive fathering trajectory.