Men, pregnancy, birth and transition to fatherhood

For the first-time expectant father, antenatal maternal attachment represents his first experience of his partner’s developing a new “emotional involvement” with a third party.
Counselling of the couple by midwives may assist the male to be more accepting of sharing and to develop a more positive relationship with both the baby and his partner.
The ideal opportunity for this to take place is at the first antenatal booking visit. First impressions count and to shut the partner out at this stage may set the relationship for father/midwife off on a negative footing.

The antenatal period is recognised as an opportunistic time for intervention with prospective fathers because it is a time when:

• Men are uniquely available physically and emotionally

They may be more motivated, especially when the pregnancy is planned

• Men may be more receptive to health messages

This may appeal to their 'protective' nature and they may be responsive to research indicators of good health.

• Domestic abuse and other negative behaviours by men can be challenged

Midwives are currently screening women during pregnancy for domestic violence in Australia and New Zealand. What is unclear is what impact this screening is having on the rates of domestic violence.

• Men may become more involved in care of the newborn

Once again encouragement is the key. Participation and partnership is essential.

• The patterns of behaviour established in pregnancy may continue after the birth

At this point in time I have been unable to locate the evidence in relation to this.

• Mothers childbirth experiences will be improved

Certainly the evidence exisits that suggests that women have greater satisfaction with their birth experience when their partners are present and supporting them.

There is a growing body of research evidence from around the world that a father’s involvement in childbirth has a significant impact on their partner, birth events and birth outcomes.

We can acknowledge that there are also same sex partners involved in pregnancy, birth and the postnatal period but there is very little evidence of their experiences. Much of the research evidence is looking at the male perspective of birthing.

Researchers have disagreed about what it means to be involved in fatherhood. Lamb et al first identified the man’s involvement as a multidimensional concept, that includes:

• engagement, 
• availability
•  responsibility (1). 

Many researchers define men's involvement in pregnancy outcomes as activities or practices by the man and a couple anticipating birth that ideally lead to an optimal pregnancy outcome.

Barriers to paternal involvement

Work/life balance is important for expectant fathers. Governments often acknowledge the need for reform of tax; welfare and child support polices to encourage family formation and father involvement. It is already acknowledged that paid parental leave could significantly strengthen paternal involvement in the postnatal period. The Australian government has committed to providing two weeks paid parental leave for fathers from July 2012.

Once the Paid Parental Leave Bill had been introduced into Parliament, the Bill was referred to the Senate Community Affairs Committee. The Australian Human Rights Commission made a submission and Commissioner Broderick appeared before this Committee. 
While the national PPL scheme is a welcome first step, Commissioner Broderick will continue to lobby for improvements, including:

•       Superannuation on paid leave

•       A minimum of two weeks paid leave for fathers and other supporting parents

•       Over time a full year of paid parental leave that can be shared between parents, to ensure that children receive the care they need at this important early stage

•       Within the full year of paid parental leave, a minimum of four weeks paid leave for fathers and supporting parents, available on a ‘use it or lose it’ basis, to enable them to be involved in caring during the first year of their child’s life

•       Leave paid at the rate of at least two thirds of income, so that more families can afford to take the leave.

You can read more at this web site:

http://www.hreoc.gov.au/sex_discrimination/programs/paidwork_familyresp.html

I recently emailed LNP leader Tony Abbott after his outspoken views. I stressed the importance of men being available to their partners at the birth. I also stressed the importance to father/child bonding if he is present at the birth.
I received a brief acknowledgement that failed to acknowledge any of my points and he failed to outline the oppositions position on the subject.

Promoting Paternal Involvement

In the past men have not had a role during pregnancy and childbirth. Today, an it is estimated that 95% of fathers in the U.K. now attend the birth (2). It has taken a number of years for men in Australia to become commonplace in the birthing room (3). Today, there are no published figures on the percentage of men who attend labour and birth in Australia but in 2009 there were 295,000 births registered, 65% of those occurred in a nuptial relationship, 35% occurred in an ex-nuptial relationship and just 3% of those births leave the fathers details unnamed (4).

Pregnancy offers many opportunities for men to be offered health education. Like pregnant women, expectant fathers are particularly open to information, advice, and support during pregnancy and are more likely to change their health behaviours (5).
Antenatal education programs specific to men are needed to enhance expectant fathers’ involvement in pregnancy and parenting. The development of a specialist antenatal class in Sydney by one antenatal educator for men has been successful but does this go far enough? There may be a need for a series of specialist male classes for them to attend.
The quality of involvement of an expectant father in the post-natal months may be dependent on his level of involvement during the pregnancy.

Many researchers recommend the following:

•       The expansion of antenatal education programs to include promotion of men’s involvement in pregnancy and parenting

•       The promotion of best practice models for improving men’s involvement in pregnancy and childbirth

•       The promotion of father-friendly hospital/birth centre settings, practices and policies

•       The establishment of additional resources that teach men how to be responsible husbands and fathers, and to build stronger relationships

•       The promotion of early antenatal care that includes an integral role for the expectant father

•       The provision of services that welcome and empower the expectant father, and develop education materials to help sustain paternal involvement after going home

Parental Involvement in Birth

In the current climate of maternity care men are often with their partners from the onset of labour. Maternity service care providers in Australia offer fathers instruction and advice focused on supporting women through labour and birth based on meeting the needs of their pregnant partners during labour.

Attendance of fathers at the birth of their babies has increased (2, 6, 7). Men have reported differing motivations for their attendance (6, 8-10) and assume different roles during labour and birth (11).

There is growing research interest from around the world about father’s involvement in childbirth and how birth events impact on men’s emotions, father-child bonding and adult relationships. Positive results include a strengthened new parent relationship(9, 12) and a quicker establishment of an emotional bond with the newborn (9, 13). However, following attendance at the birth it has also been found that men’s emotional response is varied and supporting women through labour and birth for some men has a negative impact. Some men complain of symptoms of posttraumatic distress, depression, and anxiety and lower quality of life. (14-18).

Motivations

It has been demonstrated in other studies from around the world, that most men are present during labour and birth at the wishes of both partners (9). However in another study from the United States, Palkovitz (10) found that when questioned, some men stated they felt pressured to be present by their partners.

Feelings & experiences (Closer baby bonding)

Men who are present during labour and birth feel they have a closer emotional bond with their babies (9, 13). Sapountzi-Krepia (9) in a study of Greek men, suggested that the men’s positive feelings towards their baby demonstrated a closer emotional bond. Bowen (13), found that the father’s presence at the birth, demonstrated more observable attachment behaviours and positive language towards their babies.

Roles

Men assume different roles during labour and birth. Chapman (11) identified three main roles in her interviews of twenty men from the San Francisco Bay area. The ‘birth coach’ identified as a man who actively assisted his partner during and after labour contractions. The ‘team mate’ identified as responding to requests for physical or emotional support or both. The ‘witness’, the largest of the three groups identified as companions to provide emotional and moral support, present to observe and witness the process of labour and birth.

Strengthened Relationship

Men’s presence at the births of their babies has been found to strengthen the couples’ relationship (9, 12), with men expressing a feeling of having ‘solidified their relationship with their partners’(12) and by expressions of love and gratefulness following the birth engendering positive feelings of ‘closeness’ (9).

Emotional impact

Although participation in the birth can result in men having positive feelings of pride and happiness(9) there are also reports of negative impacts. Nolan (14) identified in her U.K. survey some men were distressed to see their partners in pain. Greenhalgh et al (17) in the U.K and Bradley et al (18) found men who reported  postnatal depressive symptoms could be identified as having experienced distress, fear and lack of confidence during labour and birth.

The transition to fatherhood

New mums often have the opportunity to learn the basics of newborn care in private: how to put on the nappy and how to dress them. When men are given the same opportunity they often are doing it for the first time under the watchful eyes of their wives and partners. Receiving critique at this stage can destroy confidence in their abilities and can sometimes result in the man withdrawing from vital interaction with their newborn baby.

Fathers often state that they appreciate time alone with their babies to find out what works for them (19). In this environment they can prove to be capable caregivers. It also gives them time to enjoy what they view as a miracle.

Often during this period of transition a man will reflect upon his own father. They gain an appreciation of their fathers’ role and this can lead to the need to father differently without any clear idea of how to do so.

More research

Measurements of men’s involvement in pregnancy are under-developed, as are methods for recruitment and retention of men, particularly Indigenous Australian men in research. Pathways to paternal involvement are poorly understood, as are the mechanisms linking paternal involvement to pregnancy outcomes. More intervention research is needed to identify effective strategies for enhancing paternal involvement and pregnancy outcomes. This is most important if the Australian government is to achieve its' targets in relation to 'closing the gap'. Where the following statistics for life expectancy exist:

• Indigenous males live 11.5 years less
• Indigenous females 10 years less
• Infant mortality rate is 7.7-13.6%
• maternal mortality is 21.5 deaths per 100,000 three times higher than non-Indigenous women.

 Researchers recommend looking at the following:

•       More research into parental involvement and pregnancy outcome in Indigenous and lower socio economic groups who are know to suffer marked disparities in health and healthcare

•       Greater funding for researchers to develop more effective methods for recruitment and retention of men in communities with high levels of poor pregnancy outcomes for parental involvement and pregnancy outcome

•       Funding to be made available for researchers to conduct studies that advance the understanding of cultural variations in parental involvement in pregnancy

•       Further research into physiological and behavioural changes in expectant fathers

•       Further research into fathers’ perspectives of pregnancy and parenting

•       Further funding and research into identifying effective clinical and population-based strategies for enhancing parental involvement and pregnancy outcome

Conclusion

Research has demonstrated that men are important to maternal and child health. We know that parental involvement can have a positive influence on maternal health behaviours during pregnancy (20) and that further research is necessary to develop our knowledge regarding the roles of the expectant father in pregnancy outcome. It is necessary to instil the understanding of equal participation of men and expectant fathers across all aspects of midwifery practice and promote full paternal involvement in pregnancy to reduce and eliminate any racial and ethnic disparities in pregnancy outcomes in Australia.

REFERENCES:

1.         Lamb ME, Pleck J, Charnov E, al. e. A biosocial perspective on paternal behavior and involvement. In: Lancaster JB, Altman J, Rossi A, al. e, editors. Parenting Across the Lifespan: Biosocial Dimensions. New York: Aldine de Gruyter; 1987. p. 111-42.

2.         Somers-Smith MJ. A place for the partner? Expectations and experiences of support during childbirth. Midwifery. 1999 Jun;15(2):101-8.

3.         Vernon D. Men at Birth. 2nd ed. Sydney: Finch Publishing; 2011.

4.         Births Australia [database on the Internet]2009 [cited 14/6/2011]. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Products/4D11AD4B275567B4CA2577CF000DEEC6?opendocument.

5.         Lupton D, Barclay L. Constructing Fatherhood: Discourses and Therapies. London: Sage Publications Ltd; 1997.

6.         Madsen SA, Lind D, Munck H. Fathers' involvement with infants. Copenhagen: Hans Reitzels Forlag; 2002.

7.         Organisation WH. Fatherhood and Health outcomes in Europe.  2007 [cited 2011 16/7]; Available from: http://www.euro.who.int/document/e91129.pdf

8.         Eriksson C, Salander P, Hamberg K. Men's experiences of intense fear related to childbirth investigated in a Swedish qualitative study. jmhg. 2007;4(4).

9.         Sapountzi-Krepia D, Lavdaniti M, Dimitriadou A, Psychogiou M, Sgantzos M, He HG, et al. Fathers' Feelings and Experience Related to their Wife/Partner's Delivery in Northern Greece. The open nursing journal. 2010;4:48-54.

10.       Palkovitz R. Changes in father-infant bonding beliefs across couples' first transition to parenthood. Maternal-child nursing journal. [Research Support, Non-U.S. Gov't]. 1992 Fall-Winter;20(3-4):141-54.

11.       Chapman L. Searching: expectant fathers' experiences during labor and birth. J Perinat Neonatal Nurs. 1991 Mar;4(4):21-9.

12.       David M, Aslan G, Siedentopf JP, Kentenich H. Ethnic Turkish fathers in birth support roles in a Berlin labour and delivery room--motives, preparation and incidence in a 10-year comparison. J Psychosom Obstet Gynaecol. 2009 Mar;30(1):5-10.

13.       Bowen SM, Miller BC. Paternal attachment behavior as related to presence at delivery and preparenthood classes: a pilot study. Nurs Res. 1980 Sep-Oct;29(5):307-11.

14.       Nolan M. Caring for fathers in antenatal classes. Modern Midwife. 1994;4(2).

15.       Veskrna L. peripartum depression - does it occur in fathers and does it matter? jmh. 2010;7(4):10.

16.       Ramchandani P, Stein A, Evans J, O'Connor TG, team As. Paternal depression in the postnatal period and child development: a prospective population study. The Lancet. 2005;365:5.

17.       Greenhalgh R, Slade P, Spiby H. Fathers' coping style, antenatal preparation, and experiences of labor and the postpartum. Birth. 2000 Sep;27(3):177-84.

18.       Bradley R, Slade P. A review of mental health problems in fathers following the birth of a child. Journal of Reproductive and Infant Psychology. 2010;29(1):19-42.

19.       Jordan PL. Enhancing Understanding of the Transition to Fatherhood. ijce. 1990;22(2):3.

20.       Teitler J. Father involvement, childhealth and maternal behaviour. . Children and Youth Services Review. 2001;23:22.