The Elephant in the Room

It's common for expectant dads to attend the birth of their baby. Numbers have steadily increased over the last 5 decades to the point where it’s (almost) a foregone conclusion. So what is their role in the birth suite and why aren’t we talking about it?

One of the reasons we don’t discuss men at birth is that it's “womens business”. Which is both true and false. With expectant fathers at 95% of births these days the modern version of this ancient feminine ritual has become men’s business too. Most are placed in a primary support role for which they have no training – which delivers the second reason mum’s the word.

They’re such a mixed bag when it comes to effective support. They can be a great help or risky hindrance. In some cases they may be the difference between a normal physiological birth and an emergency caesarean.

The quality and effectiveness of support expectant fathers provide exists on a spectrum – from excellent to dangerous. Some can help accelerate labour and reduce reported pain levels. Others drag their dread into the room and influence the progress of labour, making medical intervention more likely. The emotional landscape of the dad is as unpredictable as childbirth itself ranging from calm, confident and supportive to fearful, anxious and awkward. Perhaps if we begin to educate dads about birth they'll be more able to support themselves and their families through this challenging time?

Its important to realise that, as a collective, they haven’t had much time to adjust to the new paradigm - dads weren’t always expected to be there!

My mother gave birth to me in Belvidere hospital - Glasgow, Scotland. When mum felt the first onset of labour she caught a bus across the city, accompanied by my late father. He stayed only long enough to ensure that someone else was taking responsibility for her.

In those days labouring women were placed in one ward – aptly named the labour ward. Side by side they laboured until birth was imminent whence they were taken to a private room for delivery. Postpartum newborns were immediately transferred to the ‘viewing room’ where visitors could coochy coo behind glass, at specified times of the day. After visiting hours mothers nursed together and dads were excluded.

During labour, and as I was taking my first breaths, my father was wetting my head on the other side of the city. I was brought into the world under the occasional watchful eye of a matronly midwife ‘doing her rounds’ while my father was groggily drinking his.

Culture dictated he be celebrated by the men in his life with single malt whiskey. My personal image is one of wee drams, hearty laughs with heartier backslaps in the midst of thick cigar smoke. The year was 1968 when men were men and Scotch was Scottish.

Fast forward to today and if you go to the pub during the birth of your child then you’ll be lambasted from pillar to post, hung drawn and quartered by all and sundry. Not only by your own family but her family and, these days, by the men in your life – your mates.

What progress! In the span of half a century expectant dads have migrated from the pub, to the hospital waiting room, to the bedside to “catch the baby” and cut the cord… Essentially, they have graduated from ‘getting steamin’ doon the boozer’ to ‘deer in the headlights’.

They are now ‘in the room’, however, many are grossly underprepared for the experience. While they may occupy space in the birth suite many are not really able to engage in the process in any effective way. Some men are so clueless about childbirth that experts debate whether they’d be better back in the pub.

Renowned natural birth advocate Rhea Dempsey refers to dads as the weakest link when it comes to medical interventions. When the labouring women faces a “crisis of confidence” (in her ability to continue with natural physiological birth), the first one to blink is often the male partner. He is defenceless to her impassioned pleas for pain relief and must come to her rescue by agreeing to change their pre agreed birth goal ie; no drugs. Dempsey points out that he does this to ease the pain of his beloved but also to dispel his own discomfort.

While I agree that some cannot cope with the enormity of the task I believe others are willing and able to make a difference. As any seasoned midwife or doula would attest, some blokes have just got it. They seamlessly drop into tune with the ebbs and flows of labour and follow her lead as she deepens her necessary trance. They know when she needs encouragement and when to be silent. They intuit her wishes and co create a contraction ritual to help her through her peaks. For these couples it’s a growth opportunity. A time to bear witness to the raw feminine power of creation and forge a fierce family bond. This is what is possible at one end of the ‘dads at birth spectrum’. Unfortunately these blokes are a rarity, especially if it’s their first time.

The other end of the spectrum is rife with fear, intervention and trauma. These birth partners are really better off in the waiting room its safer for mother, baby and dad. The dreaded expectation that they must fulfil the primary support role weighs too heavily on them.

If they cannot manage to suppress or hide their fear they carry it with them like a brimming backpack full of risk to be unpacked over the course of labour. These are the moments they haven’t been waiting for. If there is fear to be found labour will find it. Fear and childbirth don’t mix – fear tenses us and engages our flight response. A tense muscled mama does not an easy birth make. Even if his state does not produce an adrenal response she may be distracted by his discomfort. If the experience is too confronting for her partner her attention may be on him when it should be directed to the task at hand.

For men with significant fear or anxiety about childbirth it might be best to consider their attendance carefully. A healthy birth culture includes the recognition that some fathers just shouldn’t be there.

Oft quoted legend Michel Odent has lamented the presence of men at birth for many years. Odent is synonymous with Pithiviers a French birth centre where thousands of babies were born in the absence of pain relief and a single figure caesarean rate. He is credited with introducing widespread water birthing and is one of the most progressive contributors to the field of childbirth evolution, philosophy and practice.

Odent has said men may be responsible for increasing medical intervention rates, however, close scrutiny of Odent's work also reveals “ When the mother-to-be is alone with the baby’s father and he seems to really share the emotions, leaving our world at the same time as his partner then it is possible the birth will not be too long away or too difficult.” (Birth and Breastfeeding 2003).

It is understandable that in the 5 decades since the first invitations were extended many men are still not entirely “in the room”. There has been very little concerted coordinated effort to provide information or guidance on what to expect and how to manage the challenging emotions that arise. The feminine insight of the ages remains mysterious. Its no wonder our birth culture is in crisis. The tribe of birth-wise women is now replaced by one man doing the best he possibly can.

And for their trouble, research shows that they are still ignored, dismissed, patronised, sent home after birth, left hungry, treated like they’re not welcome and sometimes disrespected in the hospital setting because they’re neither staff, patient or visitor – they hover in what respected men at birth expert, Professor Mary Steen describes as an interstitial and undefined space.

“I’m just lucky I live 20 minutes away from the hospital” says Luke a new dad I spoke to recently “any further and I might not have made it”. After being awake for 35 hours, providing physical and emotional support for his partner, Luke was asked to leave at 6.30am. His partner had haemorrhaged and as he watched the medical team weave their magic he held their newborn and worried about the survival of his beloved partner. When the medical emergency was over he was told to go. “The drive home was pretty sketchy, when I got home I balled my eyes out”.

It is my view that the time has come to recognise that expectant fathers are able to help (more than is currently recognised) and that they too have needs in the childbirth context. It's their birth story too. The time has come to provide them with a deeper understanding of what to expect, how to help and how to maturely manage the emotions that arise for them.

For at least 20 years researchers have unanimously called for interventions to assist men in their transition to fatherhood. Most recently the literature is leaning towards declaring the attendance of men at birth a medical event. These conclusions recognise that men are facing the risk of psychological harm just by witnessing the birth of their child.

In 2015 the World Health Organisation declared involving men in maternity care a priority. This recommendation recognises the role men can play to facilitate and support improved self-care of the woman, improve home care practices for the woman and newborn, and improve the use of skilled care during pregnancy, childbirth and the postnatal period for women and newborns.

Times have certainly changed. Research shows that fathers spend triple the time with their children than when I was a boy. According to mum, even though my dad wasn't at my birth he was still ahead of his time. He was a great father who was loving and tender, funny and playful. He changed lots of nappies and even took me for walks in the buggy (pram) long before "Man With a Pram" was a thing.

I founded Birthing Dads to dispel the myth that men have no functional role in childbirth. Just as doulas can provide meaningful support so too can fathers - if given the tools. If we want families to thrive I believe it starts with giving men a solid foundation to navigate the perinatal period with confidence.

Grantly Dick-Read the founder of antenatal education said “The totally unprepared man has no place at the birth of his child”. He said this nearly 80 years ago!

Modern fathers, for the most part, are ready to be involved, present and helpful during the perinatal period. It's time to start the conversation about the elephant in the room and wake the sleeping giant of perinatal care – expectant fathers.

Steven Kennedy, Birthing Dads Founder.