This baffling syndrome makes fathers feel pregnant

Couvade syndrome is experienced by almost half of all partners. It is changing how scientists think about how non-pregnant parents-to-be are affected by their partner's pregnancies.

Four years ago, when his wife was six months pregnant with their first child, Alex Jones started feeling sick almost every night.

"I first noticed a nausea," says the 34-year-old content creator from the East Midlands, UK. "I have a very high threshold for vomiting and sickness. It takes a lot for me to experience nausea. So when it started… I immediately noticed it."

Heavy fatigue, tender skin across his arms and chest, along with a general sense of "just not feeling myself", soon followed. "The weirdest thing was that I woke up frequently with numb arms," says Jones. "When I told my wife, she said that it had been happening to her too."

After some late-night Googling, Jones realised his symptoms matched a little-known condition called Couvade syndrome.

"The best way to describe it is sympathetic pregnancy," says Catherine Caponero, an obstetrician-gynaecologist at the Cleveland Clinic in Ohio, US, who has seen a few cases. "Essentially, it's when a non-pregnant partner experiences pregnancy symptoms despite the fact that they're not biologically pregnant."

A growing body of research suggests that the syndrome is more widespread than previously thought – and some scientists wonder whether its bizarre symptoms warrant rethinking how bearing a child affects both parents.

Pervasive but unclassified

Couvade can affect dads-to-be, same-sex partners and even grandmothers-to-be who live with the pregnant person and are closely involved in their care, says Caponero. Symptoms run the gamut from nausea to fatigue, backaches to dental pains, mood swings to food cravings as well as weight gain. Their onset mimics that of a physical pregnancy and typically peaks during the first and third trimesters before disappearing post-partum.

As Couvade can manifest in many ways and has a nebulous definition, estimates of its prevalence vary drastically. One study, for instance, found that up to 52% of US fathers said they experienced some signs of the syndrome during their wife's pregnancy, with similar figures reported in Jordan at 59% and Thailand at 61%. Other studies have found higher numbers in Poland and China, where seven in 10 expectant dads said they experienced Couvade symptoms. Other research indicates prevalence may be lower in Sweden (20%) and Russia (35%).

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Despite this research suggesting it's fairly common, Couvade syndrome isn't officially classified as a medical disorder, says Ronald Levant, a professor emeritus of psychology at the University of Akron in Ohio, US. Neither the International Classification of Diseases nor the American Diagnostic and Statistical Manual of Mental Disorders – two authoritative tools referred to by clinicians globally – recognise Couvade. Few medical textbooks mention it.

"I think I learned a sentence about it [in medical school]," says Caponero. "Even in our resources as clinicians, there's not a lot of information there."

Today, much about this poorly-studied syndrome remains a mystery. "Its mechanism is not well-understood," says Daniel Singley, psychologist and director of the Center for Men's Excellence in San Diego, in the US. "Maybe it's a way to try to sublimate and deal with emotional issues, maybe there's a neurobiological underpinning. I don't think it's known."

Most researchers, though, agree that Couvade syndrome is "multifactorial", involving both biological and psychological components, says Levant.

'Brooding' men

The word Couvade derives from the French verb couver, which means to brood or hatch. An English anthropologist, Edward Burnett Tylor, first popularised the term in 1865, when he used it to describe what he felt was a peculiar sight he witnessed while travelling through the Basque countryside: peasant men lying in bed with their newborn infants.

The derogatory phrase was meant to ridicule the men, says Richard Powis, a medical anthropologist at the University of South Florida, in the US. "It's the broad idea of men acting like women," says Powis.

But Couvade can actually be traced as far back as 50BC, when expectant fathers in Corsica, Cyprus and Iberia would lie in bed and express labour pains or mime aspects of childbirth, sometimes while wearing their partner's clothing. Anthropologists would later describe seeing similar rituals being practised throughout the world by groups in the West Indies, South America and East Asia.

These were performed as rites of adoption, wrote Tylor in 1889, noting that "among certain tribes, Couvade is the legal form by which the father recognises a child as his". In other instances, it was believed to draw the attention of evil spirits away from the mother to the father instead. 

In that light, says Powis, Couvade was viewed by academics at that time – who were by and large wealthy, elite, Victorian and male – as an intentional set of rituals practised by new fathers in "exotic places" to keep their pregnant partner and the unborn child in good health and spirits.

But when the lens shifted to their own industrialised Western societies in the mid-to-late 20th Century, Couvade began to take on a different slant "as a psychological pathology", says Powis – an involuntary experience of pregnancy syndromes with biological and psychosomatic underpinnings.

For instance, Sigmund Freud, anthropologist Mary Douglas and others put forth various psychoanalytical theories. "One was that the men were mimicking pregnancy on purpose to steal attention from his partner," says Powis, or that symptoms of Couvade were rooted in subconscious envy, with fathers-to-be perceiving the unborn child as a rival for their partner's attention.

Complex emotions

Today, most experts agree that there's a psychological aspect to Couvade and that the symptoms likely arise because of the stresses a partner experiences as a soon-to-be new parent, even if they're not childbearing themselves.

"Having a baby is one of the most significant development milestones in adult life," says clinical psychologist Kevin Gruenberg, founder of the California nonprofit Love, Dad. "That can feel very stressful and overwhelming sometimes, so Couvade could be a way of reflecting this major transformation that's happening."

The postpartum period introduces new stresses for both parents, such as sleep deprivation and the relentless demands of caring for a newborn. "There are also different aspects of sexual identity, physical intimacy or family logistics," says Singley.

Roughly one in 10 new dads develop prenatal or postpartum depression, while up to 18% of men report experiencing high levels of anxiety during that period, with 7% displaying symptoms of post-traumatic stress disorder (PTSD). Studies show that if a new mum has postpartum depression, her partner is at least twice as likely to develop it too.

Part of the psychological shifts may indeed be Freudian-esque. "I see a lot of dads who show up and talk about elements of their experience, like jealousy of a newborn infant, or grieving the life they used to have, or having to share their partner," says Singley.

Showing support

Jones certainly experienced a slew of complex emotions when expecting his daughter in 2022. "But my wife didn't appreciate my Couvade symptoms – she saw it as an attempt to 'muscle in' on her trauma," he says.

Yet some experts suggest that Jones and other men involuntarily experience pregnancy-like symptoms as a deep-rooted, subconscious form of empathy for their pregnant partners. It's a reflection of "the deep emotional involvement and identification with the pregnant partner", says Levant. 

In fact, it often comes hand-in-hand with intentional actions of support, too. If an expectant partner develops a sudden aversion to the sight and smell of meat, a partner might choose to go vegetarian in a show of support. If the pregnant person cuts back on exercise in favour of spending more time resting on the couch, the partner might do the same to keep her company.

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Powis, for one, compares it to how people historically performed Couvade rituals. "My definition of Couvade is when anyone does anything during pregnancy or postpartum to contribute to the support of pregnant people," says Powis. "When we call it a syndrome, we pathologise it. But there's nothing wrong with it or particularly unique in it. It's just human empathy.

"At the end of the day, what we're talking about is how people take care of each other and what happens when they do."

Shifting hormones

Still, evidence also suggests that Couvade could have a biological underpinning that spurs the psychological and intentional factors that follow. In a series of experiments – one of the most extensive investigations to date – Robin Edelstein, a psychologist at the University of Michigan, in the US, examined how hormone levels of first-time expectant couples, both straight and gay, changed across pregnancy.

While expectant women showed large prenatal increases in cortisol, progesterone, oestradiol and testosterone, men had notable declines in the latter two hormones. This isn't surprising, says Edelstein. "Lowered testosterone is theorised to orient men toward caring for the infant and investing in the family, rather than seeking new partners or being aggressive. And lower levels of oestradiol may facilitate caregiving," says Edelstein.

When surveyed three and six months postpartum, fathers who showed larger prenatal declines reported contributing more to both household chores and infant care, which their partners confirmed when asked separately. "Hormonal changes seem to come first, which then predicts greater investment [in postpartum care]," says Edelstein.

That's why hormonal shifts may account for some Couvade symptoms, says Edelstein. Lower levels of both testosterone and oestradiol, for instance, are associated with weight gain in men, while the latter has been linked to depression. What triggers these changes in the first place, however, remains unknown.

This aligns with numerous neurological studies demonstrating that parents' brains change after the birth of a child. A 2024 study, for instance, found that the volume of grey matter shrinks in fathers postpartum, as it does in mothers, as a form of synaptic pruning, enhancing brain areas relevant to reading an infant's cues, bonding and caregiving. Men with larger reductions reported spending more time with their newborns and experiencing greater feelings of bonding, reflecting successful adaptation to parenthood.

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Given all the elements at play, Singley rejects the common notion that Couvade is simply a mirroring, whether conscious or subconscious, of the pregnant partner's symptoms. "It's a pretty old-school way of looking at the parenting experience," says Singley. The partner, he says, "is going through a variety of different psychological, social, neuro, endocrine and interpersonal adjustments as well, because he's his own person".

For expectant fathers, it may be harder to accept, though, given the societal expectations of how men should behave. "Guys may think: 'I'm a dude, I can't be depressed – no, that's weak. I'm a dad – I have to be on point and provide for my family," says Singley. Instead, he argues, we should make it okay for them to say, "I can have migraine, I can have muscle tension, I can have gastrointestinal issues. I can feel like there's this weight on me."

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