Fatherhood Institute Research Summary: Fathers Attending Births
FATHERS AT THE BIRTH AND AFTER: IMPACT ON MOTHERS
Messages from Research
Fifty years ago, very few fathers attended their children’s births. Today 93% of fathers who live with their partners do so, as do 45% of those who live separately (Kiernan & Smith, 2003). NHS data shows even higher figures: 98% of fathers attending the birth, 48% attending antenatal/parenting classes, 85% at least one prenatal appointment with a midwife, and 86% at least one ultrasound scan (National Health Service, 2005).
Enkin et al (2000) note that fathers today have an expanded role in the birth process: they are expected to reinforce what has been taught in childbirth education, act as advocates for the mother, and fill gaps in care.
With only a very few fathers not present (and those being almost exclusively men who are not in a close relationship with the baby’s mother – Kiernan, 2006) it is difficult to make valid comparisons between the impact of fathers’ presence in, or absence from, the labour room. However being present allows many fathers to offer quality support – and this is clearly beneficial.
• Earlier studies found that women whose husbands were present and supportive during labour were less distressed (Anderson, & Standley, 1976; Henneborn & Cogan, 1975).
• More recently, Gibbins & Thomson (2001) found that labouring women benefit when they feel ‘in control’ of the birth process – and that a key component in this is experiencing support from their partner during the birth.
• Support during delivery provided by a ‘close support person’ (who can be, and often is, the baby’s father) creates a more positive childbirth experience for the mother, with a shorter duration of delivery and less pain experienced (for review, see Tarkka, 2000)..
• Enkin et al (1995) report that when labour partners (including fathers) know a lot about pain control, women have shorter labours and are less likely to have epidurals.
• This support has also been found to be conducive to a more positive attitude by the mother towards motherhood (Mercer et al, 1984).
Recent research from China differentiated between types of support, noting that level of perceived partner-provided emotional support did not result in positive maternal outcomes, while the perceived level of practical support did, including a strong correlation between duration of partners’ presence during labour and women’s ratings of perceived practical support by their partners (Ip, 2000).
However, a stressed birth partner can be counterproductive: stress, like fear, can contaminate – and maternal stress can slow down labour. Fathers’ stress levels are often very high at key points during the birthing process (Johnson, 2002). Keogh et al (2006) found caesarian mothers’ post-operative pain strongly linked to their fear-experiences during labour, and these were mediated by the level of their birth partner’s fear.
The implications for preparing fathers well for the birth are clear…
• Fathers who have been prepared well to participate productively in the labour process tend to be more active participants, and their partners’ birth-experiences tend to be better (for review, see Diemer, 1997).
• Even where fathers have been only minimally prepared, studies repeatedly show high levels of satisfaction post partum for both mothers and fathers in sharing the experience of labour and birth (Chan & Paterson-Brown, 2002).
• Fathers’ presence has been shown to help compensate for poor quality obstetric services. Klein et al (1981) found fathers five times more likely to touch their partner during labour and delivery than other support figures; and the women rated the fathers’ presence more helpful than that of the nurses.
• Spiby et al (1999) found labouring women generally disappointed by the level of midwife involvement while their partner’s involvement much more nearly met their expectations – a personal experience also reported by Llewellyn Smith (2006).
• Obstetricians greatly underestimate the psychological boost fathers give to their partners during delivery – as well as the practical support the men provide during labour, and afterwards (Hayward & Chalmers, 1990).
Claims about long term negative effects of fathers’ attending the birth have been made, particularly on the couple’s sexual relationship (e.g. Odent, 1999) but not substantiated through serious research. One well designed study showed that while negative perceptions of the birth-experience were correlated with depressive symptoms in fathers at six weeks postpartum, their effect was removed once pre-existing depressive symptoms were controlled for (Greenhalgh et al, 2000).
Does the father’s presence at the birth pay off in greater involvement later?
• Birth attendance by fathers is not correlated with higher levels of involvement in, say, nappy changing; however birth attendance followed by extensive postpartum father-infant interaction in the hospital may stimulate such behaviour (Keller et al, 2004; Palkovitz, 1985).
• Moore & Kotelchuck (2004) found a significant correlation between fathers’ attendance at the birth and subsequent involvement in monitoring infant health by participating in ‘well child visits’.
• Kiernan (2006) compared the behaviour of non-resident fathers who had signed their baby’s birth certificate with fathers who had not signed the birth certificate but had been present at their baby’s birth. She found that though roughly equal numbers of both groups later moved in with their baby’s mother, all other measures of involvement, except the payment of child support, were higher among the men who had attended the birth. Noting the many studies that have recorded the powerful impact on fathers of witnessing the births of their children, Kiernan comments: ‘Our evidence suggests that this attachment exemplified through presence at the birth carries through into infancy even among non-resident fathers’.
The quality of the couple’s relationship is key
• A woman’s fear of vaginal delivery is strongly associated with her dissatisfaction with the couple relationship (Saisto et al, 2001).
• Tarkka (2000) found that one of three predictors of a young mother’s positive childbirth experience was her perception of a positive attitude toward the pregnancy by the baby’s father.
• The best predictor of each parent’s adjustment to parenthood is the quality of the relationship between them (Fathers Direct, 2000).
• Women who enjoy the full support of their partners are more closely bonded to their children, and more responsive and sensitive to their needs (Feiring, 1976).
• The quality of mothering provided to an infant has been linked with supports the mother receives from her partner; and the quality of the relationship between the parents has been shown to predict how both mother and father nurture and respond to their children’s needs (for review, see Guterman & Lee, 2005).
• This is also true for teenage mothers: a young mother’s perception of support from her baby’s father correlates with a range of attachment behaviours by her (Bloom, 1998).
• Firstborns with highly involved fathers are more positive and accepting towards their second-born sibling (Dunn & Kendrick,1982).
• Frequent care-taking of a firstborn by the father is associated with a large increase in the firstborn’s positive behaviours toward the mother, after the birth of a second sibling (Kojima et al, 2005).
Anderson, B.J., & Standley, K. (1976). A methodology for observation of the childbirth experience. Paper presented at the meeting of the American Psychological Association, Washington, D.C.
Chan, K. K. L., & Paterson-Brown, S. (2002). How do fathers feel after accompanying their partners in labour and delivery? Journal of Obstetrics and Gynaecology, 22(1), 11-15.
Diemer, G. (1997). Expectant fathers: Influence of perinatal education on coping, stress, and spousal relations. Research in Nursing and Health, 20, 281-293.
Enkin, M.W., Kierse, M.J.N.C., Neilson, J., Crowther, C., Duley, L., Hodnett, E. et al (2000). A Guide to Effective Care In Pregnancy and Childbirth,(3rd ed.). Oxford: Oxford University Press.
Enkin, M.W., Kierse, M.J.N.C., Renfrew, M., & Neilson, J., with the editorial assistance of Enkin, E. (1995). A Guide to Effective Care In Pregnancy and Childbirth, (2nd ed.). Oxford: Oxford University Press.
Gibbins, J., & Thomson, A. M. (2001). Women’s expectations and experiences of childbirth. Midwifery, 17(4), 302-313.
Greenhalgh, R., Slade, P., & Spiby, H. (2000). Fathers’ coping style, antenatal preparation, and experiences of labour and postpartum. Birth-Issues In Perinatal Care, 27(3), 177-184.
Hayward, J., & Chalmers, B. (1990). Obstetricians’ and mothers’ perceptions of obstetric events. Journal of Psychosomatic Obstetrics and Gynaecology, 11(1).
Henneborn, W.J., & Cogan, R. (1975). The effect of husband participation in reported pain and the probability of medication during labor and birth. Journal of Psychosomatic Research, 19, 215-222.
Ip, W.Y. (2000). Relationship between partner’s support during labour and maternal outcomes. Journal of Clinical Nursing, 9, 265-272.
Johnson, M. P. (2002). The implications of unfulfilled expectations and perceived pressure to attend the birth on men’s stress levels following birth attendance: a longitudinal study. Journal of Psychosomatic Obstetrics and Gynaecology, 23(3),173-182.
Keller, W. D., Hildebrandt, K. A., & Richards, M. E. (1985). Effects of extended father-. infant contact during the neonatal period. Infant Behavior and Development, 8,
Keogh, E., Hughes, S., Ellery, D., Daniel, C.D., & Holdcroft, A. (2006). Psychosocial influences on women’s experience of planned elective cesarean section. Psychosomatic Medicine, 68,167-174.
Kiernan, K. (2006). Non-residential fatherhood and child involvement: evidence from the Millenium Cohort Study. Journal of Social Policy, 35(4), 1-19.
Kiernan, K., & Smith, K. (2003). Unmarried parenthood: new insights from the Millennium Cohort Study. Population Trends, 114, 26-33. London: Office of Population, Censuses and Surveys.
Klein, R.P., Gist, N.E., Nicholson, J., & Standley, K. (1981). A study of father and nurse support during labour. Birth and the Family Journal, 8, 161-164.
Llewellyn-Smith, J. (2006). Hard Labour. First Person. July. London: The Observer Newspaper.
Mercer, R.T., Hackley, K., & Bostrom, A. (1984). Relationship of the birth experience to later mothering behaviors. Journal of Nurse Midwifery, 30, 204–11.
Moore, T., & Kotelchuck, M. (2004). Predictors of urban fathers’ involvement in their child’s heath care. Pediatrics, 113(3), 574-580.
National Health Service (2005). NHS Maternity Services Quantitative Research (October), Prepared by TNS System Three for Kate Hawkins, Department of Health, London
Odent, M. (1999). Is the father’s participation at birth dangerous? Midwifery Today, 51.
Palkovitz, R. (1985). Fathers’ birth attendance, early contact and extended contact with their newborns: a critical review. Child Development, 56, 392-406.
Spiby, H., Henderson, B., Slade, P., Escott, D., & Fraser, R.B. (1999). Strategies for coping with labour: does antenatal education translate into practice? Journal of Advanced Nursing, 29(2), 388.
Tarkka, M.J,, Paunonen, M., & Laippala, P. (2000). Importance of the midwife in the first-time mother’s experience of childbirth. Scandinavian Journal of Caring Science, 14, 184–190.Tags: Maternity, Parenting education