Over the past few decades, the presence of fathers in the birthing room has moved from being accepted to being expected.

With this evolution has come increasing pressure to be the ideal birth partner and to enjoy the birth experience regardless of personal feelings and coping skills.

The reality, however, is that bringing a baby into the world is arguably one of the most life-changing events a man can experience. Yet, as Jomeen (2017) suggests, little attention is paid to the consequences - positive or negative - for the generalised expectation for fathers to attend the birth of their child.

A Genuine Benefit or Just Conforming to Societal Norms?

Prior to the 1970s, the predominant view was that birth was a female domain and men weren’t welcome in the birthing room. Today, however, changing cultural and professional attitudes have led to the expectation that ‘good’ fathers should be present for the birth of their child.

For many men, the thought of being present at the birth fills them with joy and positive expectations. For others though, the predominant emotions around birth are of fear, tension and anxiety.

Recognising this, many midwives are now suggesting that it’s time to take a step back and ask if this is always the right decision.

Should ‘not being there’ become a real option for fathers? Jomeen (2017) suggests that it should. Not only would this allow fathers to express their true feelings without fear of censure, but it would also allow women who would prefer to be supported by someone else to do so without being judged.

Fear, Tension and Panic

Jomeen (2017) makes the point that many fathers who go into the birthing room expecting to be treated as part of a labouring couple often felt like an isolated observer or a bystander stripped of all control. As a result, many fathers became fearful of the birth but feel a need to hide these fears from their partners.

As Hazard (2010) suggests, a father who is poorly prepared to support his partner during labour or who doesn’t really want to be there can easily enter a cycle of fear, tension and, ultimately, panic. This is why it’s so important to encourage open and honest dialogue between both parents prior to the onset of labour.

Antenatal Care for Men

Howarth et. al (2017) suggests that fathers have needs similar to those of mothers during pregnancy and birth and that these needs may not be being met, especially for first-time fathers.

Bäckström and Hertfelt Wahn (2011) also call for greater support and preparation for fathers, suggesting that if they are left out, they tend to feel helpless. It’s this feeling of helplessness that can result in a feeling of panic and a potentially negative experience of birth.

Hazard (2010) takes this argument further by suggesting that the right antenatal preparation can help men feel calmer and more confident about birth.

For example, antenatal preparation for fathers could include:

Confronting the origins of mens' fears about childbirth
Teaching practical coping techniques
Encouraging open dialogue between parents.

How Do Fathers Define a Good Birth Experience?

Results of a study by Bäckström and Hertfelt Wahn (2011) into the amount of support given to fathers during labour revealed that overall, fathers perceived that they were given good support when:

They were allowed to ask questions during labour
They had the opportunity to interact with the midwife as well as their partner.
They could choose when to be involved and when to step back.

In exploring fathers’ attitudes to birth, Schytt and Bergström (2014) noted that older men also have more fearful and negative expectations during their partners' pregnancies. Postnatally, they also assess the births as less positive and more difficult than younger men do.

How Can Midwives Make a Greater Effort to Involve Fathers?

Whilst most midwives welcome the father’s presence during labour, many fathers experience their place in maternity care as being neither patient nor visitor.

As a result, many feel uncertain, excluded and fearful. Redshaw and Henderson (2013) also point out that there is considerable sociodemographic variation in partner support and engagement, as some sociodemographic groups tend to be less supported by their partner and more reliant on the hospital staff.

Knowledge about age-related differences and the experiences of first-time fathers may also help midwives give more individualised information and support. Special attention should also be given both to older mens' expectations and experiences of the birth, as well as particularly young and other vulnerable fathers who are less likely to attend parent education classes and who may have histories of exclusion.

In recognising this, the Royal College of Midwives (2018) recently called for the role of fathers in maternity care to be clearly defined. Jomeen (2017) also suggests the following tips to help fathers feel more involved in their partners' maternity care:

Document and respect the expectant mother's wish as to who will be with her during labour
The father’s wishes should be respected
Make fathers feel welcome and use their preferred name
Encourage fathers to take an active role during the birth
Encourage fathers to use techniques such as relaxation and massage to assist their partners to cope if this is what she wants
During the birth, discuss the care and inform fathers of any complications
Fathers should be the main care provider during mother-baby separation.

(Jomeen 2017)

Conclusion

The perceptions of being both uninformed and unwelcome are recurring themes in many studies relating to the father’s presence in the birthing room. Yet, encouraging the positive involvement of fathers can help to decrease fear and anxiety and increase trust and respect between the expectant parents and their carers.

A well-prepared father not only has more positive memories of the birth of his baby but can also be of significantly greater help to his partner during labour and postnatally.

Whilst the debate about the advantages and disadvantages of the father’s presence in the birthing room continues, there is an evident need for further research.

More needs to be known about the potential impact not only on the mother’s well-being but also on the father himself and the long-term impact on family care.

References

Bäckström, C & Hertfelt Wahn, E 2011, 'Support During Labour: First-Time Fathers’ Descriptions of Requested and Received Support During the Birth of Their Child', Midwifery, vol. 27, no. 1, pp. 67-73, viewed 20 August 2018, https://pubmed.ncbi.nlm.nih.gov/19783334/
Hazard, L 2010, 'Beyond Fear, Tension and Panic: Helping Men Enjoy the Birth Experience', Midwifery Today, no. 95, viewed 20 August 2018, https://midwiferytoday.com/mt-articles/beyond-fear-tension-and-panic/
Howarth, A, Scott, K & Swain, N 2017, 'First-Time Fathers’ Perception of Their Childbirth Experiences', Journal of Health Psychology, viewed 20 August 2018, http://journals.sagepub.com/doi/abs/10.1177/1359105316687628
Jomeen, J 2017, 'Fathers in the Birth Room: Choice or Coercion? Help or Hindrance?', Journal Journal of Reproductive and Infant Psychology, vol. 35, no. 4, pp. 321-3, 20 August 2018, https://www.tandfonline.com/doi/full/10.1080/02646838.2017.1361124
Redshaw, M & Henderson, J 2013, 'Fathers’ Engagement in Pregnancy and Childbirth: Evidence From a National Survey', BMC Pregnancy Childbirth, vol. 13, no. 70, pp. 13-70, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607858/
Royal College of Midwives 2018, Reaching out: Involving Fathers in Maternity Care, RCM, viewed 20 August 2018, https://www.rcm.org.uk/media/2343/reaching-out-involving-fathers-in-maternity-care.pdf
Schytt, E & Bergström, M 2014, 'First-Time Fathers' Expectations and Experiences of Childbirth in Relation to Age', Midwifery, vol. 30, no. 1, pp. 82–8, viewed 20 August 2018, https://www.ncbi.nlm.nih.gov/pubmed/23477742

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