The first time I gave birth, I brought a 3.1 kg baby boy into the world - and the fetal remains of his twin.
Twenty weeks before that moment, in an emergency room outside of San Diego, I was told that Twin A - who had a name, nappies and at least 10 sets of matching onesies waiting for him at home - had died inside of me.
The news, as any pregnant person or parent could imagine, was devastating. It overwhelmed me, broke me, blinded me with a type of tunnel vision that made it nearly impossible for me to focus on anything other than the future I had lost.
Which is why it took me five years and the birth of my second child for me to realise how much the loss and traumatic birth had harmed my partner, too.
In a 2017 study of 11 British fathers who found childbirth to be traumatic, men described "fears of death, mirroring their partner's distress; trying to 'keep it together' and helplessly watching a catastrophe unfold.
Fathers felt themselves abandoned by staff with a lack of information. Men were subsequently distressed and preoccupied with the birth events but tended to feel that their responses were unjustified and tried to cope through avoidance. Men described the need for support but reluctance to receive it."
But a distressing event doesn't have to happen to you for it to be traumatic. "The first diagnostic criteria listed for PTSD is that the person has been exposed to a traumatic event in which both of the following was present," says Shara Brofman, a licensed clinical psychologist in New York City specialising in reproductive and perinatal mental health.
"The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. And the person's response involved intense fear, helplessness or horror."
The helplessness my partner felt when he heard that one of our twin sons had died was, and is, unimaginable to me. The inadequacy he must have felt when he watched me cry through a birth that should have been joyous - him doing what I couldn't and viewing the remains of a twin we had mourned for 20 weeks as my belly continued to grow - pains me to even consider.
But in the wake of the loss and as I tried to find peace with our new normal, I actually grew jealous of his perceived uselessness. It wasn't his body that seemed to fail the future we were so excitedly planning, so he was freed from the guilt and the endless barrage of what-ifs. I envied him - was even angry at him - completely unaware of how he was hurting.
And unlike my partner, I had people who were checking in on me, people who expected me to be devastated and act accordingly, people who were part of an established system that, yes, notoriously fails new mums in a country with a rising maternal morality rate and no mandatory paid family leave, but at the very least exists.
"If people are going to have mental health or physical symptoms related to outcomes of traumatic events around pregnancy and birth ... partners don't have any structure.
There's no medical billing code for like, 'OK, now there's a postpartum visit for the partner,'" Brofman says. "There's such a focus on mum and baby, but we're trying to be more inclusive. Everyone who is taking care of someone needs to be taking care of themselves, too."
So while my partner silently suffered, I focused on the baby who lived and my deteriorating mental health. I didn't realise my partner was isolating himself, closing himself off to me, stoic when I wanted him to be responsive.
We fought, we stopped showing any kind of physical affection toward one another; we passed by each other like ships in the night, tending to our child in shifts while we battled feelings of depression and anxiety that were as foreign to us both as they were overwhelming.
"A partner could exhibit a more anxious presentation, or it could be a more withdrawn presentation," Brofman says. "It's 'I have to be strong for my partner. I shouldn't show my feelings.' All the while, internally, they're really struggling and maybe not even recognising it."
It wasn't until I found out I was pregnant with our second son, five years later, that I realised just how profoundly that loss and traumatic birth had impacted my partner. He was hypervigilant - constantly waiting for the other shoe to drop to the point that his presence, concern and reflexive disaster thinking were suffocating.
If I described a twinge, it was certainly a miscarriage. If I wasn't experiencing as much nausea and vomiting as I did with our first, something was horribly wrong. And when I fell walking home from work and was admitted to the hospital so doctors could monitor our son's erratic fetal heartbeat, my partner was catapulted back into the past - helpless, terrified and alone.
My partner was suffering because I was suffering. I was suffering because my partner was suffering. And to break that cycle and move forward as individuals, partners and parents, we needed outside support from a community that, quite frankly, does not exist in the United States. Fathers are more involved in pregnancy, birth and beyond than ever before. It's time we start acting like it, and caring for them, too.
Our children are now five and one, and in many ways it feels like my partner and I have experienced a few lifetimes' worth of trauma and, somehow, are embarking on a brand new relationship with entirely new people.
His hypervigilance has, in many ways, subsided, though I see flickers of it if our oldest takes a longer-than-usual nap or our youngest coughs a rougher-than-usual cough. And as we've worked through our issues (with the help of counselling and, for me, antidepressant and anxiety medication) I've realised that what overwhelmed new parents need the most - constant communication - is often the first to go.
Now that we've once again made it through the newborn phase, and have the time and energy and mental capacity to communicate as often and as truthfully as we should, I'm gaining a better understanding of what he experienced and, when triggered, what he relives all over again, too.
I recently asked him whether he feels like he'll ever be free of that feeling - that suffocating, helpless feeling that overcame him when we lost our child - and he said, "No, not entirely. But that's part of loving someone, right? Worrying? That's part of being a parent, right? Kidding yourself into thinking you can control everything. We can't. I couldn't. You couldn't. And that's OK." Somehow, after all we've endured, I know we're going to be OK, too.
The Washington Post