New dads are often expected to stand in the delivery room during labor, holding a stopwatch and telling their significant others to push. But when something goes wrong, the joyful stress of labor can turn grisly — fast. If medical complications arise, studies suggest that fathers who insist on staying in the birthing room may exit with a case of post-traumatic stress disorder, a chronic condition in which a trigger can bring traumatic memories to the surface unexpectedly.

“Childbirth can bring serious complications from uncontrolled hemorrhaging to unexpected emergency C-sections,” Mark Williams, a lecturer and advocate for fathers’ mental health, told Fatherly. “We must remember PTSD can occur following the experience of witnessing of a life-threatening event. We must remember its the fathers’ loved ones in the labor room and feeling they cannot help them can make them feel helplessness and failure.”

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Williams had his own near-miss in 2004, when he descended into a panic attack after his wife required an emergency C-section during labor. “I had never heard of an emergency C-section. I wasn’t prepared, and certainly didn’t think PTSD could happen to fathers in the labor ward,” he says. Williams isn’t alone. A 2014 study of ten male partners who had witnessed serious birth complications suggests that men are indeed susceptible to PTSD — despite the fact that most patients and doctors share Williams’ misconception that dads watching the action are immune.

Still, relatively little is known about PTSD in fathers following birth, beyond anecdotal reports from men who have suffered after traumatic birthing experiences. (“The symptoms are often vivid flashbacks, nightmares, and intuitive thoughts which can make the father angry and upset,” Williams says. “Many fathers I have spoken, including myself, used drink to block it out”).

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Preliminary studies have identified some risk factors. “PTSD is obviously more common in men who have experienced births which are objectively traumatic, where there is risk to life, use of emergency procedures, or significant blood loss,” Anna Machin of the University of Oxford, who studies postnatal depression in dads, told Fatherly. “However, my experience is it is really how the man perceives the birth which is the most predictive element. Even an objectively straightforward birth can be the cause if the man has experienced past trauma for which it is a trigger.”

Machin adds that some men experience trauma simply due to lack of control in the delivery room, while others because they cannot cope with seeing their partner in pain.

The issue is compounded by the fact that men are often hesitant to visit a doctor to discuss the possible symptoms of PTSD after their child is born, perhaps because many assume that PTSD is a condition for soldiers on the battlefield or car crash victims — not new dads who saw some blood. “But if you re-position a birth as equivalent to watching your partner have a major car crash, in some cases, and being unable to help, then it doesn’t seem as much of an overreaction,” Machin says.

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Of course, this raises an important question for new dads. If you don’t have to be in the room, and doing so puts you at risk for long-term mental health problems, is it really such a good idea to insist on coaching your wife to “push” (especially since, c’mon, she knows)? Do dads belong in the delivery room, or should we hearken back to a simpler time when soon-to-be fathers sat far off in the waiting room, wringing their hands and smoking cigars? It depends, according to Machin.

“Men in the birthing room are a huge benefit all round, to their partner, the baby and themselves. It increases the likelihood of a successful birth, it cements the idea that two parents — rather than just a mum — are being born and it allows the dad to begin bonding as soon as possible,” Machin says. “However, we have just assumed that all men want to be there and not given them a choice. We judge men who say they don’t want to be there and we shouldn’t.”