The dad dilemma - The Age newspaper, published 13th Sept 2013
Most Australian men are present and active at the birth of their children. But not
everyone believes this is a good thing, writes Thea O'Connor.
The birth of Prince George to Kate Middleton made history in Britain. William was
reportedly the first royal father to be at his wife's side during labour. This makes the royals about 40 years behind Australia and the rest of the developing world, where more than 90 per cent of births are attended by men, says Professor Hannah Dahlen, the national spokeswoman for the Australian College of Midwives.\
Since the 1970s when women started inviting men in, blokes from all walks of life have
opened the door to the delivery room, and seem unlikely to leave any time soon. Now it's expected that dad will be there, too – "If she's going through all of that, the least you can do is be there".
Most fathers want to be at their child's birth, Dahlen says, and most mothers want
them there, too, but not everyone is in favour. Michel Odent, a French obstetrician known for advocating water births, claims men "disturb" the birthing process. Odent, who has 50 years of birthing experience, justifies his position with physiology. A labouring woman, he says, needs to be protected against any stimulation of the thinking part of her brain – the neocortex – for labour to proceed with ease. But the man's questions, reassurance, advice and anxiety denies her the quiet mind that she needs. Odent has also observed that at the time of birth, men cannot help but say something or try to touch the baby. But this is when the mother needs a few moments alone with her infant so that her oxytocin levels can peak to assist delivery of the placenta.
The problem isn't men themselves, argue several Australian birth educators, it's the
fact that men aren't properly engaged, educated and supported.
"We've gone from zero men present at births to over 90 per cent in such a short space
of time, but the space hasn't evolved along with it," says Darren Mattock, a birth educator for expectant fathers. "Antenatal education is still focused on mother and baby, leaving men on the fringe."
No wonder many men don't know where to stand or what to do when labour sets in, so
fidget, text and pace the room instead, as Dahlen's research has found.
Other men can try to take over, as midwife and childbirth educator Pip Wynn Owen has
observed. "Some dads try to be Mr Fix-It or Super-Coach, constantly talking and asking questions. But his real job is to make her feel calm, loved and safe, and if he can't do that, he can slow the labour.
"If a man is not helping the woman relax, or if he's getting very anxious, then that increases her stress levels triggering the release of adrenalin, which increases pain and tension, interferes with the release of the labour hormones and slows down labour."
However, with support and education, a father's involvement with the birth "is lovely to watch", Dahlen says. "When dad is part of a continuum of care model, knows the midwife, feels listened to and has attended training and education with his partner, he comes in really engaged and not feeling like a spare part in the room. He'll suggest things, offer food to eat, know the right pressure points to push and when to leave off. These dads engage quickly with the baby and with parenting. They also have great admiration for the mother's power."
That's what Dahlen's own father, Peter, felt when he was present for two of his six children's births. Disappointed that the British administration forbade him to be at Hannah's birth, which took place in Yemen, he was keen to be there at the next.
"It never entered my mind not to be there, it felt very natural," says Peter, now 85. "Having that intimate fellowship with Margaret in her pain and watching what mothers go through – it brings you into a deeper connection, love and affection with your wife."
So what does modern, man-friendly birth education involve? For Alex Booth, 22, a
medical student and father of a nine-month-old boy, it involved attending a Beer & Bubs group at a Lismorepub. "There were men of all ages and in different types of relationships," he said. "It had structure, but was also fluid, allowing us to talk about our fears and expectations. An hour later, I walked out feeling more prepared. This confidence had a roll-on effect when our baby was born in establishing a bond." This is the type of antenatal preparation dads want, according to a 2002 survey of 140 New Zealand men. All wanted a dads' group with advice from men who had been there.
Mattock, a former facilitator of Beer & Bubs who now runs "Becoming Dad" groups for
expectant new fathers in the Northern Rivers of NSW and online, says it's easy to overdo the practical preparation and under-do engagement with men. "Attachment science says that the greatest opportunity for bonding is in the birth space," he says. "Levels of oxytocin [the "love" hormone] are never going to be so high, including in men, so I aim to give men the presence and confidence to get in there. To do that, they need to address their own fears.
"The most basic fear men have is whether birth is safe and if partner and baby are going to be OK. So we talk about that.
"Some are concerned that being at the birth might affect the way they view their partner sexually. I get them to think about where they want to stand at the time of birth – at the woman's head or the other end? When they stop and think about it, it usually becomes pretty clear – either, 'I think the head will be just fine!' or, 'No way – I want to be there!' "
Even though the male libido is considered robust, for some couples the experience can be sexually scarring, especially if the birth is traumatic. One father, who took part in research conducted by the School of Health Sciences, Massey University, New Zealand, spoke of needing to indulge in sexual fantasy in order to perform after witnessing the "playground massacre" of the birth scene.
"After that experience, my relationship with my woman's sex organs was profoundly affected," he recalls. "The woman is biologically equipped to forget that experience; the male carries the memory perfectly and vividly."
Another father recalled how sex with his wife was seriously restricted after the birth. He witnessed the placenta being released with lots of blood. "I have never discussed how it impacted on me . . . it interfered with sexual activity for years . . . I can still see that 'gush' today."
When the birth isn't easy, Owen believes fathers can play a critical role in stemming rising intervention rates. She prepares them for this job by role-playing what they can say in different situations.
She suggests that if medical staff think it's time to intervene, the father should ask four questions. "These are: If you do intervene, what are the risks? Are there any alternatives? What happens if we do nothing? How much time to do we have to decide?"
But what if the father isn't up for this role or simply doesn't want to be there? "Whatever the reason, don't pressure him into it," Dahlen says. "It'll potentially do harm, especially if we don't prepare him."
And what if the mother doesn't want him there? "It should be the right of the woman to invite the man to the birth, and the right of the man to refuse and be given a 'safe out'," Mattock says.
After all, it's hardly a risk-free experience. Men can be hard-hit, especially when things go wrong. Being present at a traumatic birth is not formally recognised as a risk factor fo depression or post-traumatic stress (PTSD) in new dads, but some qualitative researchers are discovering links.
Midwife Dr Rakime Elmir from the School of Nursing and Midwifery, University of Western Sydney, is interviewing men who were present at a traumatic birth. Common themes
include the men feeling powerless or impotent as they were unable to fulfil the male role of supporting their partner, and often felt distant and disconnected from the infant as they weren't able to bond properly.
"Some men experienced flashbacks and nightmares and one man spoke of bursting into tears while driving as he vividly recalled his partner having an eclamptic fit [seizure], due to high blood pressure and haemorrhage," Elmir says. "Another father spoke of his experience 22 years ago and was clearly still affected."
This echoes the findings of Professor Marian Knight, of the National Perinatal Epidemiology Unit, Oxford University, who found that witnessing a life-threatening birth had a profound impact on men's long-term health. This included experiencing depression, flashbacks, a breakdown or PTSD even years after the event.
The mental health of new dads is a critical element in the health of a family. "If dad is depressed, the mother is more likely to be too and vice versa," Dahlen says. "Poor psychological heath of mum and dad means the child is more likely to have development problems and anxiety."
Providing men with opportunities to talk about their experience can aid their wellbeing, Elmir says: "Many fathers said it was cathartic for them to talk to a researcher because they felt they couldn't talk about it with their partner, and that it was a sign of weakness if you showed emotion about the birth."