Mother & Baby, July 2004
Dads at Delivery
The one major difference between childbirth today and childbirth a generation ago is that fathers are now almost universally present in the delivery room, whereas once the only man present would have been a doctor.
According to Margaret Fanagan, a midwife at Holles Street, and Georgina Farren, a midwife at the Rotunda, the change in fashion happened in the late 1980s. The official arrival of the current vogue can best be dated to the start of antenatal classes, specifically targeted at couples at the National Maternity Hospital in 1991.
However, Marie O'Connor, a research sociologist active in the National Birth Alliance, an organisation campaigning for reform of maternity care, says that in the home birth movement having father's present at childbirth became common in the 1970s. She says she has found plenty of evidence from research with the folklore department at UCC that fathers were routinely present at home child births at the start of the last century.
"There is one letter from the early 1900s where its recorded that a father was not only present, but he physically supported her during the child birth and there is nothing in the letter to suggest that this was seen as unusual," she says. "I was amazed to find another letter where a father could not be present and the midwife asked another man, a neighbour, to be present. In interview I have found that a very close relationship between father and child ensues if he is present at the birth. A similar relationship ensues when other members of the family are present, in one case I found that an uncle was at the delivery and that subsequently he was like a father to the child."
Interestingly, in cultures such as Orthodox Judaism, where religious prohibitions prevent fathers from touching or observing a woman immodestly exposed or who has vaginal bleeding, women report a strong sense of support from their partners in the form of prayer and spiritual comfort. Even when men were not present at Irish births, they too provided spiritual support with specific prayers and invocations, says O'Connor. "There was a tradition in Ireland where the woman giving birth would wear a garment belonging to her husband, usually his jacket, so that she could get some of the strength of the man."
Allowing fathers into the delivery room was strongly resisted by the medical profession. One objection raised was that men might be prone to Couvade syndrome or excessive pains. The fear was based on practices observed in some 'primitive societies' where men exhibit all the signs of labour, screaming in agony and crying for comforts, sometimes wearing their wives clothing and hiding straw dolls beneath their garments to produce at the same time as their real baby is born. But given that such culturally-specific practices are designed to confuse evil spirits, it seems surprising that they were considered likely to spontaneously emerge in Catholic Ireland!
The person credited with being the first to make it acceptable and desirable that fathers be present at birth, thirty years ago, is the French doctor Michael Odent, who also popularised the use of water immersion as a method. After overseeing more than 15,000 births in his 48-year career as an obstetrician, Odent has made a u-turn more dramatic than the about face made by childcare expert Dr Spock, who has completely revised his theories on discipline.
The French childbirth guru now appears to be having a man present at the birth is one of the worst things a mum-to-be can do, says Farren. He blames men, who worry about their partners' pain, for the rise in epidurals and caesareans and, as a result, women are missing out on the natural birth experience. He also says men are too much inclined to celebrate the birth too soon and distract the woman before the placenta is safely delivered.
"Men feel happier knowing that their wives are getting as much medical attention as possible; what their wives need is some peace and the freedom to shout and scream without being made to feel self-conscious. Women are better off being accompanied by another woman who is already a mother herself," he says.
The Frenchman says that in his experience women are happier giving birth when their partner isn't present. "The labour may be going slowly and suddenly, for whatever reason, the man has to leave the room for few minutes. In his absence the woman starts to scream and to shout and, when he returns, the baby has been born. I know of many instances where women have said to me that the birth was wonderful except that their husband was not there. It is as though women have two languages. They are convinced that they cannot give birth without the baby's father, but on the day of the birth, their body language says something different."
A good thing?
Generally, it is felt within Irish midwifery circles that Odent is right in linking the presence of men in the delivery room to the very high rate of epidurals used in maternity hospitals, says Farren, who is also a professional development officer with the National Council for Nursing and Midwifery.
"Because of epidurals, men are not having to be as supportive as they would otherwise have to be," says Farren. "But if a woman is effectively paralysed from the waist down that means that instruments are more likely to be used in delivery and whenever you make an intervention with instruments there is an increased risk. I have mixed feelings about whether men should or should not be there."
While there is no change likely in current fashion soon, Fanagan says: "I often wonder what it will be like in 20 years time - it might go back again to the way it was."
While couples say that fathers being present at childbirth has helped bring the two parents closer together, Eithne Kelleher, a relationship counsellor with the marriage support agency Accord says she has never once heard a woman list as a grievance against a husband that he was not present at a birth.
"When marriages run into difficulty it is about much more fundamental issues – house work and child care," she says. "How men and women support each other in the home long after a child is born is what matters.
"That said, the culture has changed when it comes to childbirth. It is now quite difficult for men to say 'I don't feel up to it' or for a woman to say 'I would rather have my mother with me'. But the important thing is for the couple to negotiate what is right and works for them."
Indeed, there is no real reason why, once the father is allowed in, that a woman shouldn’t be allowed to have her sister or her mother there too. "In the Middle East, you could have the country in with you," says Farren, who worked as a midwife in Abu Dhabi. She says that in Arab countries it is traditional for many relatives of a mother to be present at a birth, but that in recent years, like most of the Western world, the custom has been changed to also have husbands present.
Certainly, if a man is going to be present at childbirth, he should also attend some antenatal classes, so that at the very least he will know what is going on as labour progressives. "I always ask the men if they want to be at the classes," says Fanagan. "And they nearly all say 'yes' and are enthusiastic. There will be some who will say ‘I was told to come', but I think they want to be at the birth but find the idea a bit daunting.
"I tell the women – don't be too hard on your man, after all men and women are different. Women are designed to have babies, men aren't. Men aren't used to seeing blood, women have been having periods since they were 12. But afterwards, if you talk to any man they will say being at the birth of their child is probably the best day of their lives."
However, Farren says she believes that men often don't fully understand a mother's needs in the days and weeks following childbirth. “The men sometimes don’t have a clue what is going on immediately afterwards and all the emotional issues that click in," she says. "This is one area where there might be a bit more education."
Fanagan agrees that it is when mother and child come home that men can make the greatest contribution to new parenthood. She says: "Fathers can be most helpful, I tell the women, they can shop and cook and clean for you. If you're a new mum, it's lovely to have a man around to help you while you just rest and feed and eat. I tell them to say to their men 'I am sitting here feeding your baby, would you go and get me something nice from the kitchen'. New mothers need partners to be nice to them."
One of the big myths about fathers attending childbirth is that the trauma might put them off sex for life. Confusingly, while there is research indicating that witnessing childbirth can affect sexual relations detrimentally, there is also plenty of research indicating otherwise.
While witnessing a childbirth can take away some of the mystique, Fanagan says the main reason sexual relations are muted following child birth is that mothers are usually to exhausted and sore for hi-jinx. "I don't think there is any truth in the myth," she says.
AnnMarie Smith, national president of Cuidiú, the Irish Childbirth Trust, says that the period of recovery following childbirth before sexual relations begin will vary from couple to couple.
"There are plenty of anecdotal stories about women going back for their six week check-ups to find they are pregnant," she says. "But I've never seen any statistics about the resumption of sexual activity."
One way men can ensure that their sexual relations remain healthy in the long-term says Kelleher is to be as involved as possible in childcare and house work. She cites research into unhappy marriages by sociologiest Ciaran McKeown which found that "Housework and child care, despite their very practical nature, are symbolic arenas through which the quality of a marital relationship finds expression. In other words, housework and child care are forms of love labour, as they act as a barometer of satisfaction in the relationship between men and women".
Often its the case that women do most of the housework, but Kelleher says that is not likely to become an issue providing the man shows appreciation for the work that his partner does.
And perhaps that is one of the reasons why Irish women want fathers to be present at childbirth. They want their men to appreciate their labours. And yes, we do.
Case Study -- Kevin Gildea and Tracy Rennie
Comedian Kevin Gildea was a star turn at the delivery of his daughter last October, but the forty-year-old funny man says that he wouldn’t have missed the birth for all the world.
"I really wanted to be there at the delivery big time," says Gildea "I really didn't want to miss birth of my child. It was brilliant. My advice to any father who has any doubts about being present is that it is such an amazing experience that you want to be there."
Tracy and Kevin attended their two antenatal classes together and are both amazed that some people attend many more classes than that. But they were additionally prepared for childbirth because they took part in the community midwife scheme.
Nevertheless, Kevin says that actually sitting down in the antenatal class and thinking of the questions he needed to ask actually made him realise fully for the first time that his new baby's arrival was imminent. “The classes make you think "Oh my God! I am really going to have a baby," says Kevin. "But they also help answer any of your concerns and they provide you with encouragement."
Because Tracy didn't but on enough weight during the last weeks of her pregnancy, it was decided that she would have birth as part of the normal Holles Street programme, nevertheless contact with the Community Midwife Scheme continued and Tracy is extremely keen to promote the scheme because of how positive the couple found the experience thanks to the help of the community midwives. Tracy says: "During labour, the midwives were really in the background, but encouraging Kevin to go through the birth with me."
While many dads nod off briefly if a labour is particularly off, Kevin did not fall asleep during Rosa’s long birth process which started at 9am when Tracy was induced and finished at 6.13am the next day when Rosa was born. "At about 1am, the nurse gave Tracy some Petadine and she told me that Tracy would be relaxing now for a short bit and why don’t I grab a quick nap," says Kevin. "The nurse had just handed me a pillow when the contractions started and labour began."
After Rosa was born, she was found to have had too high a level of acidity in her blood and she was taken to intensive care. Tracy says this was when she really was glad Kevin was with her for comfort and reassurance.
"First thing after Rosa was born, the midwife said to me ‘Can you press that red button?’ - they really aren’t words you want to hear,” says Kevin. “It was 6am in the morning and I couldn’t see a red button anywhere, I was struggling with a mass of cables and stuff behind the bed. Eventually, I found the button and pressed it and these people rushed in and took Rosa away. It was a bit frightening, but she was soon back to us before again before she had to be taken away again.
“I suppose we missed out on the transformation from when Rosa came out looking like something from a bad B movie to being presented back to us all scrubbed and looking lovely in her clothes.”
Now that the family are all home together, six months after Rosa’s birth, Tracy is delighted to report that Kevin is fully involved in childcare, regularly babysitting in the mornings while she goes out and changing his share of mucky nappies.
“My own father was great at playing with us,” says Tracy. “But he wasn’t at the childbirth and he didn’t change nappies – it wasn’t done then.”
Does she have any regrets about having her husband at childbirth? None at all, she says: “I think its brought us closer together as a couple and I think it helped Kevin to see me in a new light.”