Couvade is an involuntary manifestation of pregnancy in men with a partner who is expecting a baby – sometimes called “sympathetic pregnancy”. It isn’t a medically recognised physical or mental disorder, and it isn’t explained by injury or illness.
A range of “pregnancy-related” physical and psychological symptoms include abdominal pain and bloating, back pain, pseudocyesis (euphemistically known as “phantom pregnancy”), lethargy, morning sickness, toothache, food cravings and aversions – many of which were confirmed in a study we carried out at St George’s hospital, in London. Prominent psychological symptoms include ante-natal depression and mood swings, early morning waking, anxiety, poor concentration, distraction and memory loss.
Collectively, these symptoms may signify an empathic identification with a pregnant partner and to the man’s unborn child, but the could also be a resolution of unconscious thoughts that might threaten both.
Couvade symptoms follow a chronological pattern, beginning in the first trimester of pregnancy, before temporarily disappearing in the second and then re-appearing in the final trimester. They can even extend into the period after the baby is born.
While the syndrome primarily occurs in developed countries all over the world, the number of new cases in those countries varies. Several studies have found an incidence of between 25-52% of all men with a pregnant partner in the US; 20% in Sweden, and an estimated 61% in Thailand, though this includes mild to extreme symptoms such as the physical ones above. The incidence in the UK is unknown, but estimates in the 1970s put it between 11%-50%.
A range of theories that have been proposed to explain Couvade syndrome. Along with psychoanalytical and psychosocial explanations, they also include emotional attachment to both the unborn child and partner, and hormonal influences.
Psychoanalytical theory proposes that the syndrome evolves from the man’s envy of the woman’s procreative ability. The theory also proposes that for the male partner, the pregnancy acts as a catalyst for the emergence of ambivalence and the resurgence of oedipal conflicts. The event may cause regression – the man’s retreat to childhood feelings and conflicts triggered by his partner’s pregnancy, such as rejection, exclusion, ambivalence and anxiety – with a sense of passivity and dependency that is intensified by the developing foetus and which conflicts with the man’s need for autonomy.
A second psychoanalytical theory proposes that expectant fathers may sometimes view the unborn child as a rival for maternal attention. Some have explained this as the expectant father’s interpretation of the unborn baby as a rival from whom attention is diverted. But this is expressed through a more socially acceptable outlet such as the syndrome. This interpretation would suggest that the syndrome has a protective function for the man because it enables him to identify with his pregnant partner and strengthens his protective instincts towards her and the baby.
Psychosocial theory, which takes in social circumstances, instead focuses on a marginalisation of men during the woman’s gestation and childbirth, especially among men who are having their first child. While motherhood is an important defining feature for women, the same may not be true for fatherhood and men; expectant women have their maternity careers endorsed commercially, socially and medically in contrast to the careers of prospective fathers. Since the 1970s men have become familiar figures in the delivery room and their attendance is now almost obligatory.
The fact that men can’t actually give birth or experience delivery directly can relegate men to an ancillary role where they feel marginal and sometimes useless. To resolve this ancillary status during gestation and childbirth the man inadvertently diverts attention from the woman to himself through a display of the Couvade syndrome. However, this implies that the syndrome is a conscious entity, which I and others, such as Arthur Klein reject.
Paternal transitional theory proposes that the transition to fatherhood is potentially pathological, involving disruptive interpersonal struggles that are highly stressful.
According to Klein the transition from dyad – two tied entities such as man-wife – to a triad – group of three – constitutes one of the most cataclysmic periods for the expectant man. This may be compounded by the fact that men usually accept pregnancy but without any concomitant physical changes that reinforce its reality. They lack the biological markers of the transition to parenthood and these “disembodied” experiences of pregnancy are very different from the woman’s experiences. This in turn causes multiple conflicts during transition, including jealousy and rivalry with the unborn baby, an intensified ambivalence toward their own parents and sexuality conflicts. With all of this going on, it wouldn’t be surprising to see some psychological fallout.
Yet paradoxically, men who have had preparation for their parental role – ante-natal classes, for example – show a higher susceptibility to being afflicted the syndrome. Attachment theory proposes that the man’s closeness to the foetus gives rise to the syndrome. In a seminal study published in 1983, a sample of white middle-class, first-time expectant men found a modest correlation between more paternal-foetal involvement and attachment (feeling and hearing the unborn child kicking, confirmation through the woman’s pregnancy symptoms and the ultrasound scan) with the incidence of six physical symptoms of the syndrome. These included feeling more tired (34%), sleeping difficulties (33%), indigestion (14%), stomach upsets (12%), appetite changes (8%) and constipation (6%). The investigators concluded men’s symptoms were a reflection of their level of attachment to the unborn child and involvement in the pregnancy.
Couvade syndrome also appears to show a relationship with hormones, but there is a dearth of research investigating such an association. To date only two studies have supported a hormonal basis for the syndrome, one published in 2000 and another in 2001. The findings of both indicated a significant increase in men’s levels of the hormones of prolactin and oestrogen in the first and third trimesters of pregnancy, but lower levels of testosterone and the stress hormone cortisol. These hormonal changes were associated with the display of paternal behaviours as well as Couvade symptoms of fatigue, appetite changes and weight gain.
So a plethora of different theories have offered accounts for the origins of the syndrome. However, some of these, such as the hormonal explanation, have not been investigated sufficiently. And those that have, psychosocial reasons for example, clearly show disparate findings, which weakens a definitive conclusion that the syndrome has roots in this. Suggested directions for future research in the area might focus more hormonal associations with the syndrome.
By Arthur Brennan, St George's, University of London
Arthur Brennan does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.
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However, their claims have been called into question by other cosmologists. There is growing evidence that at least part of what BICEP2 saw might be much more mundane, coming instead from dust in our own Milky Way galaxy.
At the heart of the discussion is the theory of “cosmic inflation”, which suggests the universe underwent a period of very fast expansion, when a microscopic region was stretched to be larger than our observable universe. Inflation provides a mechanism for explaining why matter is spread out evenly throughout the universe, even though some of it forms large lumps in the form of galaxies.
However, the theory also predicts the creation of gravitational waves in the process of inflation. This is what BICEP2 – which stands for the Background Imaging of Cosmic Extragalactic Polarisation telescope – was built to seek out. The March results from BICEP2 were based on observations of remnant light from the big bang, known as the cosmic microwave background (CMB).
CMB observations have always been troubled by noise in the form of foreground signals like glowing dust, which was left behind by dying stars in interstellar space. However, the strength of these competing signals depends on the wavelength of light that we observe. Cosmologists have been fortunate that, when we look away from our galaxy and in the right microwave wavelengths, these foreground signals are smaller than the radiation from the early universe. Controlling for these foregrounds is why satellite experiments, such as European Space Agency’s Planck mission, have played a crucial role in improving our understanding of the early universe.
The BICEP2 team made their claim based on seeing a particular kind of pattern, or handedness, in the direction of the CMB polarisation, called B-modes. (The CMB is linearly polarised, just as sunlight is if reflected off of a flat surface.) Their case for B-modes seemed very strong, and few questioned that authenticity of the signals. However, what is in doubt is whether the B-modes they have seen actually imply the existence of primordial gravity waves.
In order to see the CMB signals produced by gravity waves, B-mode experiments must be much more sensitive. However, at this sensitivity, our understanding of foreground signals that could contaminate the actual signal is much poorer. In particular, it is possible that the B-modes seen by BICEP2 could actually be coming from galactic dust. This viewpoint has been supported by a study of the dust B-mode signal obtained by the Planck space telescope.
BICEP2 only observed in one wavelength, which made it difficult for them to prove the B-modes they saw were truly from gravitational waves. To compensate for this, BICEP2 focused on a part of the sky where the dust signal was predicted to be smaller than the gravity wave signal – and so that is why they interpreted their B-modes as evidence of gravity waves.
However, using new data taken at wavelengths dominated by dust, the Planck team has shown that the dust models BICEP2 used were inadequate and the dust B-modes could actually be comparable to the signal that BICEP2 found. This is not to say that BICEP2 didn’t see some gravity waves, as the models are still uncertain, but it is clear that we need to understand dust better before we can have confidence that we have seen the primordial gravity waves.
To fully resolve this uncertainty, we must compare in detail B-modes seen in different microwave wavelengths. This is already happening, as BICEP2 and Planck are now collaborating to see how similar the dust maps from Planck are to those from BICEP2. The BICEP2 team are also now observing the same part of sky with new set of telescopes, which are sensitive to two wavelengths and will provide a way to filter out the dust signal.
For the moment at least, the detection of primordial gravity waves seems to be clouded by interstellar dust. BICEP2’s interpretation of what they saw seems to have been premature. But the opportunity is there to soon settle the question much more definitively and when the dust finally settles, we may be left with much more confidence that the elusive gravity waves have finally been seen.
By Robert Crittenden, University of Portsmouth
Robert Crittenden does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.
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