Fathers in the birth room: choice or coercion? Help or hindrance?

In the last century the role of the father in the business of birth has changed exponentially. Pre the 1970s the dominant view was that birth was a female domain and not a man’s place (King, 2012). Changing cultural and professional attitudes around the emotional bond between a man and a woman, family structure and the more proactive involved role of men in the family have encouraged fathers’ attendance at birth. Indeed, societal discourse that promotes the import of a close father–child relationship dictates that ‘good’ fathers are present in the birthing room, at the start of that relationship (King, 2012). Hence it is now rare that a father is not at the birth of his child and fathers who choose not to be present often find themselves subject to censure, highlighted in the media (Wallis, 2013). The role of fathers in this context is seen as one of support to the mother to promote a better birth experience, but this fails to interrogate whether this is always the right decision for any or all of those involved.

The presence of men in the delivery room has never been straightforward. The claims that it was good for women and aided relaxation in labour began as far back as the early 1960s. Post the Peel report of 1970 and increased hospitalisation for birth, away from the home surroundings, the need for a supportive birthing partner led men to increasingly play a key role. Research demonstrates that women express preferences for their partner to be present in the birthing room (Dellmann, 2004), but it is perhaps interesting to speculate how much of this is considered and a real desire or reflects more a need to adhere to societal expectations and norms of fatherhood involvement in child-rearing (King, 2012).

Evidence now suggests that paternal factors may influence birth outcomes through a number of pathways, including factors that act indirectly through maternal dynamics on birth outcomes. Misra and colleagues (2009) suggest that fathers’ attitudes to the pregnancy, father behaviours across the perinatal period and the relationship between them and the mother are significant in relation to adverse birth outcomes. Misra et al. (2009) also claim that these factors have to date been largely ignored in favour of direct paternal outcomes such as age, anthropometry (height and weight), own birthweight, occupation and education (Misra et al., 2009).

From a psychological perspective many authors have written negatively about partner presence in the birth room. Most famously, the French obstetrician, Michel Odent, was cited in the media as blaming fathers for increasing the rates of caesarean section, stating his belief that a male partner in the birth room can raise a woman’s anxiety, which through its concomitant impact on oxytocin, impedes labour progress (Murphy, 2009). The role of maternal stress on adverse outcomes such as preterm birth has already been identified (Hobel, Goldstein, & Barrett, 2008) with suggested associations between stress and suboptimal birth outcomes as well as it potential to affect infant temperament (Austin & Leader, 2000). Hence the impact of fathers in the birth room may be more far reaching than has been previously considered.

A recent study suggests that attachment style might influence the experience of partner support in the birth room. While a small study, the findings suggest that women who have less emotional intimacy with their partner actually experience more pain when their partners are present. This is interesting to consider when even in non-romantic relationships fathers are often present in the birth room as an expectation. The implication of this study is that partner support during pain experiences may be better tailored to individual relationship types and potentially women’s own coping preference. It is feasible to suggest that fathers may disrupt some women’s preferred methods of coping, heightening their pain experience. This is significant when increased pain has been linked to more negative birth outcomes such as fetal distress, caesarean section and postpartum haemorrhage (Ye, Jiang, & Ruan, 2011), although this may not be a direct mechanism.

The traditional focus of the birth context exemplified by the work above is on the maternal experience and associated outcomes for the baby. Bringing a baby into the world, however, is arguably one of the most life-changing events that a man will experience, yet little attention has been paid to the consequences, positive or negative, for men of the blanket expectation to be there at birth. Some fathers feel unable to attend the birth of their babies. This highlights the psychologically charged nature of birth for men. The thought of being present at birth for some men fills them with fear and anxiety. That fear can be triggered by many things – of the unknown, of the sight of blood, of seeing their partner in pain and feeling unable to act effectively. However, Chan and Paterson-Brown (2002) highlight that a good experience of being in the birth room can enhance a positive transition to fatherhood. The psychological well-being of men is as relevant as women’s psychological health in this context.

Chandler and Field (1997) in their ethnographic work identified that although fathers went into the birth room expecting to be treated as part of a labouring couple, they found that they were relegated early on to a supporting role. Initially, the fathers were confident of their ability to support their wives, but they found that labour was more work than they had anticipated. They became fearful of the outcome, but felt a need to hide these fears from their partners. On entry to the birthing suite, fathers, while not exclusively, often feel isolated, an observer, a bystander and stripped of all control (Longworth & Kingdon, 2011). Little work to date has explored the implications for men transitioning to parenthood of this lack of control; arguably as for women, it seems feasible to assume it impacts satisfaction with the birth experience and has the same potential deleterious consequences as reported in the maternal literature (Gibbins & Thomson, 2001; Jomeen & Martin, 2008). Greenhalgh, Slade and Spiby (2000) demonstrated depressive symptoms at six weeks in men with negative perceptions of the birth experience. However, the effect was removed once existing depressive symptoms were controlled for (Greenhalgh et al., 2000). Similar findings with relation to pre-existing vulnerabilities were evident in men who reported psychological and sexual scarring after watching their partner give birth (White, 2007).

Overall there remains a dearth of literature in this field and some key issues are worthy of attention. Practitioners need to discuss what meaningful engagement for fathers in the birth room looks like and how that can be facilitated, so the benefits can be captured. It is time to return to the debate about whether this is the right option for all couples. Should ‘not being there’ become a real option for Dads, allowing them to express their desire not to be present without censure? This option also allows women who feel they would better benefit from the support of others to be able to articulate that wish without feeling judged on the status of her relationship or as not fulfilling the construct of a ‘good mother’. We need more research into fathers’ presence in the birth context to provide a clearer picture of the potential impact on a woman’s well-being, the labour and birth outcomes and the father himself.

Professor Julie Jomeen
Faculty of Health Sciences, Professor of Midwifery, University of Hull, UK
Chair: Society of Reproductive and Infant Psychology
[email protected]