NHS maternity services’ engagement with fathers has always been piecemeal. In Who’s the Bloke in the Room, our 2018 Nuffield Foundation-funded review of evidence about fathers in the antenatal period, we explored the UK evidence about expectant fathers’ impact, including around labour/birth
In the accompanying survey, How was it for you?, conducted by the Fatherhood Institute and Fathers Network Scotland, we asked fathers to share their experiences of maternity services in detail. The stories they told were of occupying an uncomfortable position – neither patient nor visitor. In almost all cases, men felt that their role was, rightly, secondary. But secondary all too often translated as unwelcome, ignored or sidelined.
Fast-forward to 2020 and the widespread imposition of restrictions on fathers’ access to maternity services during the Covid-19 pandemic: men not being allowed in to accompany their partners to antenatal appointments or scans; to birthing units; to postnatal wards. Although we had no funding to support a well-resourced programme of research about this, we felt that we should do something to capture what was happening in those most challenging of times.
So we set up an online survey in October 2020, with questions aimed at three groups:
Mothers
Fathers / partners
Maternity professionals
The survey remained open until July 2021, and was filled in by a total of 1,731 respondents. Of these, 1,240 were expectant/new mothers; 247 NHS practitioners; 167 expectant/new fathers; 18 female partners of expectant/new mothers; and 59 other people.
These are the main headlines of what, collectively, they told us:
Fathers / partners: More than four-fifths of fathers/partners [Note 1] said they had been shut out from antenatal appointments (81%), ultrasound scans (80%) and antenatal classes (83%). Only a fifth (19%) were allowed to stay with their partner for the whole labour/birth, and half (49%) were banned from maternity wards afterwards. Two-thirds of fathers/partners (67%) said they felt less well-prepared for fatherhood as a result, with four-fifths (84%) less able to support their partner.
Mothers: More than four-fifths (84%) of mothers [Note 2] said that the restrictions meant they had received less support than they needed or wanted from fathers/partners.
Maternity professionals: More than four-fifths (84%) of midwives/healthcare professionals [Note 3] reported that parents had complained about fathers’ restricted involvement, and a quarter (24%) said mothers’ and/or babies’ health had been put at risk
Parents: Both mothers and fathers said the maternity restrictions had badly impacted their mental health: 88% of mums and 79% of dads were more stressed, 88% of mums and 77% of dads were more anxious/fearful, 86% of mums and 62% of dads felt more isolated, and 57% of mums and 44% of dads felt more depressed as a result.
Survey respondents' comments
Here are some of the comments that survey respondents added in the free text boxes we had provided:
Mothers
Women gave harrowing accounts of giving birth and recovering without their partners' support.
“I was left alone during labour and I honestly was not thinking about the midwives and how to call them to the ward where I was because I was in so much pain from the contractions, my only goal was to get over the pain without losing it. My partner would’ve been my best advocate in those moments.”
“My baby’s father not being able to stay with us out of visiting hours in the postnatal ward made me feel very isolated and alone. It made it harder for me to rest after a very difficult birth, as I was alone with baby overnight. Also, my partner felt underprepared for looking after me and baby when we came home, as we had spent so much time apart while I was in hospital for 3 days after delivery. I believe this will have some serious impact on mother-infant mental health in the future.”
“My mental health concerns were dismissed by the midwife on my very first appointment. I was in a very vulnerable position and not being able to attend any appointments with my partner made it quite difficult… I didn’t have a community midwife contact… I ended up in A&E with a depressive episode and a panic attack on two separate occasions."
Fathers
Men described the emotional impact of being excluded, on themselves and their families.
“I have been allowed to attend only one scan. My wife has had to attend all other scans tests and consultations on her own. I have totally missed out on this vital support to my wife and in developing a bond with our baby son. The system has been in disarray and the emotional toll on us is telling…. no account has been taken of the family unit and the stress caused to both parents by the draconian measures… There must be a better balance.”
“Mum now has postnatal mental health issues due to all the stress and trauma of being alone for so long during labour and birth. Poor postnatal care also has contributed to this.”
“I’ve been made to feel like I don’t matter.”
“I feel like I missed out on vital bonding time with my son and this has caused undue mental impact to us as a family unit.”
Maternity professionals
Healthcare professionals recognised the negative impacts of fathers' exclusion during the pre- and post-birth period.
“It is difficult to provide the level of emotional and practical support that some women need when partners are absent.”
“I have seen the severe emotional and psychological effects for fathers missing out on important interactions with both their partners and their new-borns. Lots of professionals have commented on how easy it has been without fathers/men to attend to, but this is not my view.”
“Our service has encountered parents who have been traumatised by their birth experience. The lack of support has had a negative impact on their mental health.”
“It concerns me that relationships, birth experiences and family bonding are impacted”
Encouragingly, within the period of the pandemic, new and powerful antenatal and postnatal guidelines from the National Institute for Health and Care Excellence (NICE) have been published that now require healthcare professionals to enable fathers/partners to attend appointments (including remotely), offer them a chair in the consultation room, and provide them with information about pregnancy, breastfeeding, infant care, bonding and supporting their baby’s mother.
But as we write this, in November 2021, we know that in some places in England and Wales, pandemic restrictions remain in place. Only this week, we joined Birthrights, AIMS, Pregnant then Screwed, But Not Maternity, Birth Trauma Association, Doula UK, Queer Birth Club and Paternal Mental Health in calling on the Welsh Health Minister to revise maternity service visiting restrictions in Wales (for more details on this, see Birthrights’ press release).
So we’re publishing the results of our survey today for two reasons:
To show, on International Men’s Day, that improving support for men can have huge implications for the women and children around them – and that father-exclusion must not be allowed to slip into ‘normal practice’ unchallenged
To help foster a recognition, at societal level, that as we move out of the pandemic, maternity and family services need to be redesigned in ways that ensure dad are ‘brought in’ systematically to receive key information and support – for their own, mothers’ and babies’ benefit
Notes
1: 183 fathers / partners responded to the survey
2: 1240 mothers responded to the survey
3: 247 NHS practitioners responded to the survey