Two months after the birth of his twins, Ben Orrah was driving to work when he found himself sobbing uncontrollably. He and his wife, Paula, were thrilled to have become parents, and their babies, Polly and Logan - born two months early - were home and doing well after six weeks in special care. "I should have been so happy," he says.
In addition to continuing bouts of unexpected tearfulness, Ben, a biomedical scientist from Sheffield, began to experience frightening nightmares and vivid flashbacks to moments in the special care unit. "They were so real. I could be at work, looking down my microscope and suddenly I was back there. My heart was racing," he says. He now knows he was ill, with post-traumatic stress disorder (PTSD), severe depression and anxiety, triggered by the difficult circumstances of the twins' early weeks.
Eventually Ben sought help and received treatment. Now, as Polly and Logan approach their first birthday - with babies and father happy and healthy - he is keen to share his story in the hope that fewer men will suffer alone.
Awareness of perinatal mental health problems - including PTSD, depression and anxiety - and of the ways they can affect both parents, is growing.
The UK's National Childbirth Trust research found that about one in three new fathers admitted concern about their mental health, with one in 10 receiving a diagnosis. (The equivalent figure for mothers is one in five.) The number of fathers affected by PTSD is not yet known - it is diagnosed in 20,000 mothers each year, but is thought to affect many more - and it is an area of growing research interest.
"This is a particularly vulnerable time for men and their mental health," says Sarah McMullen, head of knowledge at the NCT. "And we need to know more about PTSD generally. We know it is happening in men, too."
Changes in relationships, lifestyle, financial worries and the pressure of feeling unable to support a partner - a kind of provider/protector anxiety - are all factors. "The experience of witnessing a traumatic birth or illness in mother or baby can be key," McMullen adds.
Men are also not only less exposed to healthcare services that might identify problems, she adds, but also often more reluctant to ask for help.
For many men, agrees Ben - "convinced that, as fathers, they have to be strong, always able to cope" - this is very difficult.
"We need to be honest about our feelings," he continues. "I have now discovered many other dads who have struggled after the birth of children, even when on the outside everything has seemed fine.
"I saw myself as a failure and I wrongly assumed everyone else would as well," he says of the silence that resulted in a damaging spiral of self-reproach and distress.
He felt not only that his feelings were unjustifiable - "other people had it much worse" - but also that to share them with his wife, Paula, would be selfish. "I didn't want to burden her," he says. "She had so much to do already, looking after two premature babies. I didn't want to be a responsibility for her or to distract attention from the babies and I thought that if I was feeling so terrible it might be worse for her. I was supposed to protect her."
In retrospect, says Ben, his problems had begun to build soon after the birth - which had been a natural and uncomplicated experience for Paula, and had actually proven less frightening for Ben than he had expected. "Polly came first and she was a feisty little thing, looking around the room. Then Logan came out screaming. They were both over 3lb, breathing well and they looked healthy," he says. "I think I developed a false sense of security."
The next time Ben saw his babies, by then transferred to the special care unit - something the couple had known would happen - he felt very different. "It was traumatic. I was immediately hit by how busy it was, all the beeping machines," he says.
"We were led to the end of the corridor and I knew from experience [working in the hospital's haematology lab] that this was the area reserved for the sickest babies."
Arriving in Logan's room, Ben discovered a team of people around the incubator. "We were told they were stabilising him and to come back in a while. I later discovered they had suspected sepsis."
Next door, Polly had briefly stopped breathing. "She was blue," says Ben. "They both looked so fragile, with tubes and wires and machines everywhere. I realised we wouldn't be getting our babies home soon. It was a terrible shock."
Over the following weeks, the babies' health fluctuated. "You could never relax. One day was brilliant and we felt a step closer to the door, then the next there was a setback and we wondered if they would ever be coming home. I always worried there would be a call in the night."
In addition to anxiety over Polly and Logan's uncertain prognoses, Ben found the situation of other families on the unit extremely upsetting. "We were always hearing about babies that had died," he says. One incident - in which the baby in the incubator next to Polly's heart stopped - affected him so deeply that it became the focus of distressing flashbacks.
"I kept reliving it again and again, he says. "It was absolutely awful. I could see the expression on the parents' faces. Everything." Although Ben was increasingly aware that his experiences were not typical, he tried to carry on as normal.
"The routine was exhausting. We were up before 5am to drive to the hospital so I could spend time with them before work," he says. "There was no time to take stock of how we felt. I was trying to be professional at work and I was worried about Paula and how she was coping. I just swallowed all my feelings."
While the twins were in hospital, Ben began to worry about how Paula was coping, and then with the stresses of caring for them at home. "I had concerns about her developing depression - because of how I felt, really - but she was fine. When we got the twins home, she was actually the happiest I had ever seen her," he says. When he couple talked about their feelings, Paula said that "having the babies to make her smile all the time" was ample antidote to any low moments.
Having previously experienced bouts of mild depression, Ben researched his symptoms online. "I knew I wasn't coping and I knew it was ten times worse than anything I had felt before," he says.
He came across information about PTSD after birth. "It described how I felt exactly but every single thing was about mothers. There was nothing about fathers, and that made me feel even worse," he says.
When, a few weeks later, Paula found Ben crying by Polly's cot, the relief at telling her how he felt was huge. "I just came out with it all. It changed everything," he says.
Ben underwent counselling - which focused a lot on his sense of guilt and lack of self-compassion - and learned to use mindfulness and meditation techniques.
He does not know, he admits, what might have happened if he hadn't sought help. "After the first therapy session, I was having thoughts about harming myself. That was terrifying. Luckily, I wasn't yet sick enough to go further."
Ben and Paula are now planning a celebration to mark Polly and Logan's birthday. "Everything is totally different now," he says. "I still worry sometimes but they are doing well and I am able to enjoy it. I now know I can make mistakes and still be a good father."
- The UK Telegraph
Where to get help
If you are suffering from anxiety or depression, or know someone who might be, contact BeyondBlue.org.au (call 1300 224 636), LifeLine (call 13 11 14 or chat online after hours), or PANDA National Helpline (1300 726 306).