Couvade syndrome, also thought of as "sympathy pain" in men during pregnancy, has a wide range of possible symptoms, some of which—like mine—can be severe.

By Christopher Dale
February 25, 2020
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As a proud yet unprepared father-to-be, in March 2016 I took a Baby Handling 101 class. Somewhere between lessons on swaddling and burping, suddenly my vision became distorted, and I couldn't see the instructor. He and my sight disappeared. Ten days later my only child, Nicholas, was born.

Suddenly I had two new, urgent jobs: fathering my son, and finding out why I'd gone partially blind, if only for a few minutes. Considering the corresponding headache, I figured the event was an ocular migraine, whose symptoms can include temporary blind spots. I was unpleasantly surprised when, following the subsequent CT scan, my ophthalmologist handed me a report headlined Lacunar Infarct. What, pray tell, did it mean?

"You had a small stroke," he said.

A minor stroke can be, as my neurologist put it, "a warning shot." What ensued was a scramble drill involving a medical team spanning neurology, ophthalmology, cardiology and hematology conspiring to find the smoking gun. After bloodwork, MRIs, ultrasounds, echo- and angio- cardiograms, my time-sensitive diagnosis-by-elimination process came back clean of solid suspects. Thankfully, nearly four years later, there has been no recurrence.

Why, then, had a healthy 37-year-old had a stroke? More likely than not, the cause was the one exploratory question that came back positive:

"Was there anything stressful going on in your life?"

Apparently an eight-and-a-half month pregnant wife with a history of miscarriage counts as stressful. And, in fact, dads experiencing negative health effects in similar situations is so common, that it has its own name: Couvade syndrome.

businessman holding his stomach
Credit: Illustration by Parents Staff; Getty Images

From Sympathy to Empathy

According to the Mayo Clinic, Couvade (pronounced "koo-vahd") syndrome occurs when otherwise healthy men whose partners are expecting babies experience pregnancy-related symptoms. Though not recognized as a mental illness or disease, research suggests it may be quite common.

Not surprisingly for so nebulous a condition (and an unofficial one at that), Couvade syndrome has become an unverifiable landing zone for a wide range of symptoms comprising both bodily and mental maladies. Physical manifestations might include nausea, heartburn, abdominal pain or bloating, breathing issues, leg cramps, backaches, urinary or genital irritation and, oddly, toothaches. Psychological symptoms range from reduced libido and restlessness to anxiety and depression.

Opinions vary dramatically concerning how many men are affected with Couvade syndrome-related symptoms. Reflecting this lack of consensus, Kristina Mixer, M.D., OB-GYN with Spectrum Health United Hospital in Greenville, Michigan, believes the figure could be as low as 10 percent but as high as 65 percent.

Determining Couvade syndrome's genesis is an exercise in educated guesswork. Mental health professionals have considered a range of hypotheses, from a man's jealousy over the inability to carry a child to possible guilt over having caused this transformation in his partner. One psychosocial theory points to the marginalization of men during the woman's pregnancy, a societal gender split whereby expectant "women have their maternity careers endorsed commercially, socially, and medically," while dads-to-be largely do not.

Other theories abound, with no clear medical consensus. Attachment theory proposes that the more a man is preparing for fatherhood—including participating in prenatal classes—the likelier he is to present with Couvade symptoms. And despite the dearth of research dedicated to this subject, the syndrome also appears to have some association with fluctuations in certain hormones, including testosterone levels, during a partner's pregnancy.

One supposition is, perhaps, prescient in its simplicity: Paternal transitional theory proposes that pending fatherhood—especially first-time fatherhood, as was my case—involves highly disruptive interpersonal struggles that are intensely stressful. It basically says that the mixed emotions and identities evoked by our partners' steadily swelling baby bumps—from pride-filled papa to homebound prisoner, and everything in-between—messes with our minds and through it our bodies.

Why some men experience Couvade symptoms while others do not is, like the root cause of the syndrome itself, not a known entity; or, rather, the circumstances are too varied for a one-size-fits-all diagnosis.

"It's definitely multifactorial," says Joyce E. Gottesfeld, M.D., OB-GYN with Kaiser Permanente in Denver. "People have different lives and different stressors, and some men might be more susceptible to hormonal changes that can be brought about by a partner's pregnancy."

Regardless of these stressors' origins, my experience suggests the run-up to fatherhood can be extremely stressful. And though my small stroke is indeed an outlier in its severity, other instances of frighteningly fierce Couvade syndrome certainly exist. One 29-year-old male reported morning sickness, cravings, an expanding stomach, and even breast growth during his girlfriend's pregnancy.

Some symptoms, of course, may be entirely circumstantial. For example, if a woman does most of the shopping and cooking while pregnant, a combination of her associated cravings and increased food intake can have spillover effects on her partner such as weight gain, heartburn, and indigestion. Expecting a child breaks established routines, which can naturally lead to unanticipated physical changes or unfamiliar mental situations.

Dr. Gottesfeld also thinks that Couvade syndrome doesn't necessarily cease with childbirth.

"In terms of Couvade-related symptoms, what I've noticed the most is actually postpartum depression, because both the pregnant woman and her partner are experiencing similar stressors, especially sleep deprivation and an overwhelming sense of responsibility," she says. "Babies are the ultimate disruptors, and of course both parents feel that stress."

And despite the lack of consensus surrounding the origins and prevalence of Couvade syndrome, the medical community does agree on one notion: When it comes to something this ill-defined and complicated, more communication is always better than less.

"For me, it is important to let both the partner and the pregnant patient know that this is a known syndrome and relatively common," says Dr. Mixer. "It helps relieve some concerns and opens up communication between all parties, and is an opportunity to direct partners to seek medical care of their own if symptoms are particularly concerning."

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