Men At Birth – Should Men Be In The Birth Room?
When I set out to compile the book, Men At Birth, I spoke with many men and received many letters and birth stories from men. For the large majority, birth was seen as an empowering and significant event in their lives. But not for all men. Consider the following quotes from men who attended the birth of their child.
“I was nervous, anxious and at times shaking with worry. I couldn't bear the noises Susan was making. I knew that I had to reassure her but who was reassuring me? The midwives popped in and out and the obstetrician wasn't available. All I could think about were my feelings.” — Jason at the birth of Kyle
“Oh it was easy. I mostly sat in the corner and watched the TV, which the hospital had provided, with the headphones on. Janet seemed not to care much whether I was present or not. The midwives cared for her and when early on in the labour I had offered drinks and energy foods to her in the ad breaks she just said “No!” and told me to go back to the TV. She seemed a bit petulant – it was probably the pain." — Andrew at the birth of Josh
“We had done heaps of planning – well Cheryl had done the reading and planning and she told me about how she wanted it to go. She gave me a birth plan to read, but I didn't have time as I work long hours. But that was okay because we had employed a private obstetrician and so I knew that it was going to be fine. I made it to the birth in time as it ended up being a caesarean, so there was some delay in getting the operating theatre ready. I had been interstate at a sales conference, but made it. Cheryl was unhappy about the caesarean, but at least she didn't have all that pain with the drug relief. The blood made me feel a bit woozy… The baby was healthy and that's all that matters.” — Duncan at the birth of Lesa
“I didn't know what Jane wanted me to do. I tried massaging her back but she said I did it wrongly. Eventually I got tired of getting it wrong so I fired up my laptop and played computer games in the corner, so to be honest I didn't experience much of it. I do remember the midwife interrupting me when I had nearly finished a level to tell me that the head was crowning and I might want to come and help. The baby was born while I was still finishing the level, but I got up anyway and cut the cord. Jane seemed tired but happy. So I guess I didn't really pay much attention but I didn't get in the way either. Oh and I got a new high score!” — Peter at the birth of Sarah
“I was terrified. Utterly terrified. I wanted the drugs. I didn't want to be there but Dawn was insistent. She wanted my support. Her Mum was much better at the support stuff than I was. I think it was much better when men paced the corridor and waited for the cigar. Had I done much reading? No, I'd left that stuff to Dawn. She was having the baby not me.” — Martin at the birth of Caitlin
“Where I come from it's womens business. Men don't attend and therefore I didn't know what to expect. I felt pretty helpless. The birth classes at the hospital hadn't prepared me properly for what I was going to witness. But I think I performed well. I didn't feel sick. Anxious, yes but not really sick. But I left the room when things got really intense. Anh did really well and she thought I was good too and gave her good help at the start. Then the midwives did their work and I wasn't needed, so they suggested that I wasn't needed and so I went outside. That was good.” – Thanh at the birth of Mai
“I hadn't been there I don't know what would have happened. I basically ordered the midwife to get the epidural. She was faffing around with positions and stuff and Leanne was in pain. I mean I couldn't bear the pain. It was really getting to me. But the epidural fixed it fine and then it was okay. I left when the obstetrician had to use forceps. Lucky that I had arranged the epidural or I reckon Leanne would have been out to it.” — Tim at the birth of Jayden
“Geez. I was stuffed. Yeah, Cath was tired but so was I. I had to keep holding her and my arms got tired and my legs got tired and I got a cramp in my foot. Every time I moved she shouted at me to hold still. Eventually when a midwife came in to check everything was all right with Cath, I did a runner to get a drink and take a leak. I popped out to the car and had a snooze in the front seat for an hour and then I dawdled my way back. But I got there in time to see the head emerging and I got to cut the cord. I don't think Cath missed me much.” — Ian at the birth of Simon
Honest Appraisals of Childbirth
All these men provided an honest appraisal of how they experienced their birth of their child. I have used their comments with permission (but changed their names) and I can say that most of them would not consider that their performance was lacking. Those men who felt anxious and worried would have preferred to feel otherwise, but in general, the rest felt that their behaviour was acceptable and the ‘best they could do' under the circumstances.
When I compiled the book I received many perspectives on birth from men " some showed considerable understanding of birth and how to provide effective support to their partner. Others showed that some men didn't understand the preparation needed before the birth to overcome their own anxieties and to learn to be an effective support person. Still others showed that they simply didn't ‘get it', they didn't see the point of being there or if there, didn't know how to behave.
I believe there are significant benefits for a couple when the man is involved in the birth of his child. The majority of men find the experience overwhelmingly positive. Men have described it to me in various terms, but the words ‘ecstatic', ‘emotional', ‘wonderful', ‘fabulous', ‘heart-rending', ‘beautiful', ‘amazing' and ‘extraordinary' are often used.
Stephan Schmidt said:
“I'll never forget Kate sitting in the bath with Raphael in her arms feeding him for the first time. Her face spoke of so much. What a beautiful expression she had in her face – happiness, relief, pride and joy. I was, and still am, so proud of Kate for what she did to enrich our relationship with such a wonderful gift – our son.” (p211)
Attending the birth not only strengthens the bond between the father and the baby but also between the father and the mother.
David Wilkinson commented:
“I lay there and couldn't take my eyes off our new baby. He was so perfect, so tiny, so beautiful. My eyes met Anne's and again I felt deep love for this woman who worked so hard to bring our boy into the world…” (p30)
For a man to see what his partner goes through to bring their child into the world is an awe-inspiring thing. And such feelings of awe and pride are so helpful in the postnatal period as both parents adjust to the arrival of their baby and the forging of new relationships between them. When such love is expressed between partners, the baby gets the best emotional start possible in its new world.
There is some interesting research that shows how important good birth support really is. Thomas Dellmann, in a paper entitled The Best Moment of my Life: a literature review of Fathers' experience of childbirth highlights research showing that when a labouring woman was supported by a doula during labour, she had less need for chemical pain relief, there was a reduction in the likelihood of caesarean section, a reduction the use of forceps, a reduction in the length of labour and the baby had a higher Apgar score.
Interestingly, the paper also notes that it cannot be automatically assumed that the presence of the male partner leads to similarly improved birth outcomes. Indeed, Professor Michel Odent, one of the ‘fathers of natural childbirth' explains that when men are anxious, their adrenaline levels can be ‘contagious' and this in itself can reduce the effectiveness of his partner's contractions. Thus anxious men are not able to provide the same support as doulas. The research cited by Dellman also showed that compared to doulas, partners touched the labouring woman less often and spent less time being ‘close' to the woman. This is a strange result given that it is the man and the woman who are lovers, and not the woman and the doula!
How can this result be explained? Dellman suggests that fathers may be too emotionally involved and therefore sharing a woman's anxiety rather than allaying it. Furthermore, the doulas had experienced childbirth themselves and therefore were more knowledgeable and … exerted a more calming influence than the woman's male partner did. An anxious or fearful man is not going to be touching, massaging or whispering sweet nothings into his partner's ear, he's more likely to be thinking about his own emotional reactions.
So what can be done so that your bloke does provide you with the support you are hoping for?
From the experiences men have related to me in Men at Birth and from other sources, I have developed the following checklist to help you and your partner decide if he is likely to be able and willing to provide the support you need. Ask your partner to read it and discuss it with you before you decide if he should be there at the birth. It is also worthwhile discussing the quotes from men at the beginning of this article with him. Use them to work out where any differences may lie in how you view effective support. The investment you make now in understanding each other will not only be well worthwhile at the birth but also when you become parents.
Seven Steps For Men Who Wish To Be Good Birth Supporters And Partners
Treat these seven steps as a checklist. If you can answer each question, positively and optimistically, then you are likely to be a wonderful support to your partner. Each step will require you to do some work – either reading or watching a video or attending a class and discussing the step with your partner.
1. Do I Have A Good Understanding Of My Partner's Hopes And Expectations From This Birth?
Birth is a highly emotional event for women and despite some people's claims that we should focus on the outcome and not the process, the process of giving birth is extremely important. When women experience appropriate and sensitive care and support during birth (and after) postnatal depression and other problems can be minimised. Work through a birth plan with your partner. Whilst it is unlikely your birth will go exactly as planned, the planning process helps you both identify issues that are important to you. You might wish to ask your midwife for a sample birth plan or read the BellyBelly article on birth plans HERE, which includes a downloadable birth plan.
2. Do I Know About The Physiology Of Birth?
Knowing the basic facts about birth – what happens during first stage, transition, second stage and third stage – will give you a road map for the birth. Whilst any road will have twists and turns that may not be on the map, in general you will be able to say to yourself, “Ah, she told me to go away and that she can't do it anymore. She must be at transition, so the baby will be here soon” and you will know where you are. Any good pregnancy book will give you this information. See BellyBelly's recommended birth books.
Attend antenatal classes with your partner. Consider going to a private ante-natal class run by a qualified Child Birth Educator. While most hospitals run antenatal classes, they tend to be aimed at dealing with large groups of parents-to-be rather than providing information tailored to the needs of the individual participants. Some of them seem to be designed for the needs of the hospital staff. I remember being told by one Child Birth Educator that she had been asked to skip the warnings she gave about the side-effects of pharmacological pain relief as it took up too much of the doctor's time dealing with the parent's concerns. Check out the National Association of Childbirth Educator's website (http://www.nace.org.au) for where your nearest classes are. Contact the appropriate State Branch.
As well as getting very helpful information from the classes, you will meet other couples and other men and quite often the contacts you make at these classes will help you in the early months of parenting.
3. Do I Know About How I Shall Emotionally React To The Birth?
This one is tricky. Of course you wont know how you will react because you have never attended a birth before. But you need to know this, so you can be prepared for most eventualities. So ask your mates how they felt. Now this is also tricky. Men don't like to talk about birth. Don't stop when your best mate says, “Oh it was fine. A bit bloody and Mary made a bit of a racket” because that is NOT enough information. Push him for more detail. Ask your Dad about attending your birth. Ask your brother-in-law. They'll all think you are a bit odd or a bit obsessive, but forearmed is forewarned. This is perhaps the most important homework you can do. And if this is all a bit difficult, buy, beg, borrow, or steal a copy of Men at Birth. And then read it!
4. How Brave Am I?
Having done points 1, 2 and 3 above, you are now in an ideal position to sit quietly on the back deck with a cold beer and reflect on your inner strengths. You know what your partner wants – she wants a water birth with no chemical pain relief. You know about the physiology of birth and understand that water birth is for the vast majority of healthy women a valid choice that reduces the need for pain relief. You have spoken with (or read about) other men who have attended water births with no chemical pain relief. So how will you react?
It's okay to know you will be anxious. It's also okay for you to even admit to being a bit scared and perhaps even frightened. But are you brave enough to accept that you are scared and frightened but can still provide the support your partner needs? Ambrose Redmoon, an American writer, once said that, "Courage is not the absence of fear, but rather the judgement that something else is more important than fear." That ‘something else', is supporting your partner.
Fear is a major enemy of effective labour. The hormone, adrenaline, which is so useful for running away from ravening beasts in the forest is counterproductive at during labour. Adrenaline shuts down the birth process and counteracts the women's hormones that are trying to open her body to let the baby out. If your partner is fearful the birth will be more difficult. If you are fearful, your fear will be transmitted to your partner. If you feel fear, you must be brave and hide it.
A horror writer, Howard Lovecraft, once said that the biggest fear humans have, is the fear of the unknown. Make sure that birth is not an unknown for you. Re-read step 3.
One option that should be discussed between you and your partner is the option of you leaving the birth room if you are unable to contain your anxiety. If at some stage you feel you are focusing more on you, rather than her, it might be best if you leave; even briefly. During the birth of one of my sons, I felt quite dizzy and couldn't focus on what I was supposed to be doing. It may have been because I had been sitting in a most uncomfortable position with my feet and legs in body-temperature water for what seemed to me like months, or it may have been my ‘hospital anxiety' kicking in. Whatever the reason, I had previously discussed this with my partner and our midwife beforehand and I left the room. I sat down on the cool tiles, took some deep breaths and ten minutes later I returned as an effective support to my partner.
5. How Wise Am I?
This is another toughie! I bet you never imagined that preparing for the birth of your baby would be so difficult, especially as you've spent your hard earned dollars on buying the best obstetrician! I can do nothing better than quote Steve Biddulph in his introduction to Men at Birth:
“Most medical professionals are great, but some are dreadful. You can strike a midwife, nurse, or doctor who is incompetent, inexperienced, arrogant, unfeeling, or just not coping for reasons of their own, and you have to be able to say, ‘This isn't right, get someone else, do it differently.‘ Just because you are getting medical help doesn't mean you leave your brains at the door. You have to know what you want and stick up for it. Your partner needs you to help do this.” (pii)
Are you ready to stand up for your partner and know when something isn't right? If you have done your homework and completed stages 1, 2 and 3 and understood what you have read then you will be fine. Combine your wisdom with your bravery and you will support your partner beautifully on this front. Medical staff are there to help your partner, but that doesn't mean leaving your brains at the door.
6. How Fit Am I?
You've heard the traumatic stories of births that go for days (or is it weeks?). Either way, these are exaggerations. Most true labour, where the woman ‘gasps' at the contractions, lasts for between two and twelve hours. But if you score a long labour, are you fit enough to be hanging in at the end to greet your baby with a smile on your face? You might be really busy during your partner's labour " massaging, fetching water, keeping face cloths cold, fetching hot compresses, talking to midwives, holding hands, supporting your partner's squats, feeding your partner, dealing with her emotions, being empathetic, being a coach, shutting up…
Your partner has to run the marathon of labour and so the least you can do is to be fit enough to be there to hold her in both arms and give her a victory hug.
If you don't think you are fit, get out there and do something during the pregnancy. You're going to need all the fitness you have after the birth, so you might as well be fit for the birth too!
7. How Well Do I Know The Birth Team?
While this is the last on the checklist, it is one of the most important items. There is significant evidence showing that a woman who knows her birth team very well, will have the easiest labour and best outcomes. There is nothing amazing about this. Birth is as much a head thing as a body thing and thus if the woman knows and trusts her midwife or obstetrician, then the outcome will be far better. When I mean ‘know', I mean she has met her midwife or doctor for some hours over many weeks before the birth. Her antenatal care has been provided by the same person and not by a fragmented collection of health professionals. There are a few birth centres and a few hospitals in Australia that offer this kind of care (often called ‘continuity of care') but it is so popular that you need to book as early as possible to be accepted.
If you, as well as your partner have had an opportunity to meet on multiple times with the same midwife, then you will feel much calmer and prepared for the birth than if you are provided with fragmented care. Your partner will trust her midwife and thus be far more able to get into the ‘head space' she needs to birth her baby.
Take the opportunity that knowing your own midwife or doctor provides, by asking her about what your role should be at the birth. If she dismisses your role along the lines of “It's okay, we'll do all the work, you can just relax,” consider getting yourself another care giver, for clearly she is not treating this birth as a wonderful bonding event for you and your partner and respecting your role as an important support person.
If you are unable to book into a service providing continuity of care, consider instead employing a doula or an independent midwife to provide additional support. See the BellyBelly Doula Directory HERE.
If you have employed a private obstetrician, on the grounds that you ‘get to know' him or her, be aware that the obstetrician is most unlikely to attend the labour and in nearly all cases arrive only after transition and sometimes not at all. If this is the case you may wish to take a doula with you, to provide continuous support.
So there you have it – seven steps to preparing to give your partner ideal support during the birth of your child. After nine months of carrying your baby and then having to give birth, we blokes get it easy, don't we?
The Myth of ‘Being There'
Until the mid 1970's it was rare for men to attend the birth of their child. Men were asked to remain outside the room and pace the corridors waiting. We now live in a much more enlightened age where it is recognised that men who are well prepared, provide excellent support for their partners by attending. And as a bonus, the attendance of the father usually speeds up the bonding process and also leads to great admiration for the woman for the work she has done.
But that said, there is no rule saying the man has to be in attendance no matter what. Poorly prepared men may not provide any support at all. Poorly prepared and anxious men may actually make the birth more difficult. One of the best gifts a man could give his pregnant partner is to make an honest assessment of his preparedness for the birth and his willingness to be an active partner. If, after reading the Seven Steps he honestly feels he doesn't stack up, and he doesn't wish to then the correct response is not to be there.
An absent partner doesn't mean he doesn't need to be engaged or useful. He can be getting the house ready, cooking meals and freezing them for later and generally preparing for no longer being a couple, but a family.
A Final Word To Men
I have discussed with many men that it is our generation that is forging a new relationship with birth. Few of us had our fathers attend our birth. Certainly our Granddads did not attend our father's birth. We are the leaders for our children. If we get it right then future generations will thank us.