The birth of a child: Confusion and powerlessness. A father’s role in labour, delivery and aftercare. Part 3

POST-PARTUM LIFE

The focus post-delivery was now on developing a bond with our baby and supporting the new parents in the practical side of caring for a new child.

The focus post discharge from hospital was how my wife was adapting to mother-hood and if I was being a supportive husband and father. This is fine and appropriate – however little emphasis is placed on the partner’s emotional reaction and adaption to the birth process and new-found fatherhood.

More than once I have had male friends and family with similarly traumatic birth experiences become a little “misty-eyed” in their brief recounts of the events, only to quickly change tack and subject to return to socially acceptable male behaviour.

The medical paradigm is interested in the reduction of child and mother mortality in the least complicated and efficient manner, and ensuring mother and child are able to be discharged from care in as best shape as possible.

Support services and in many ways society also has this focus – Odent’s (2010) call for the removal of fathers from the birthing process is to improve maternal and infant outcomes. Vernon (2006) and Winder’s (2006) push for a doula or support person is a movement to remove the stress that father’s bring to the delivery situation and and effort to improve maternal and infant outcomes.

Fathers will continue to be present and realistically require involvement and engagement (Chandler & Field, 1997), with research showing higher levels of post-partum satisfaction for both parents who have shared the experience of labour and birth (Chan & Paterson-Brown, 2002).

There is very little literature or real services in improving the father’s emotional outcomes, something that should be a concern to all – as doula or no doula, once returning to home, the father is more often than not the primary support person for mother and child (Wong, Perry, & Hockenberry, 2002; Chan & Paterson-Brown, 2002).

A father still dealing with negative emotions from the birth experience could have a negative influence on the initial settling process (Chandler & Field, 1997). Support is needed; before, during and after the birth of the child in a manner and delivery structure that is appropriate and accessible.

 

Thanks for reading

 

References

 

Australian Institute of Health and Wellfare. (2011). Nursing and midwifery labour force 2009. AIHW bulletin no. 90. Canberra: AIHW.

Chan, K. K., & Paterson-Brown, S. (2002). How do fathers feel after accompanying their partners in labour and delivery? Journal of Obstetrics and Gynaecology, 22(1), 11-15.

Chandler, S., & Field, P. A. (1997). Becoming a Father: First-Time Fathers’ Experience of Labor and Delivery. The Journal of Midwifery & Women’s Health, 42(1), 17-24.

Odent, M. (2010). THE MASCULINISATION OF THE BIRTH ENVIRONMENT. Retrieved September 20, 2011, from WombEcology: http://www.wombecology.com/masculinisation.html

Vernon, D. (2006). Men at Birth. Sydney: Finch Publishing.

Winder, K. (2006). Bellybelly.com.au. Retrieved September 20, 2011, from http://www.bellybelly.com.au/birth/ten-tips-on-being-a-great-birth-support-person

Wong, D., Perry, S., & Hockenberry, M. (2002). Maternal Child Nursing Care. St. Louis: Mosby.

 

 

 

 

 

 

 

 

The birth of a child: Confusion and powerlessness. A father’s role in labour, delivery and aftercare. Part 2

THE EXPERIENCE

My wife had a long labour. We had been enthusiastic labour parents, taking to the role and its expectations with duty and excitement. We walked the block in the early stages of labour, ate well, relaxed when possible and stayed home as long as seemingly possible.

I was told by a tired midwife over the phone to not come to the hospital until my wife’s contractions were less than 4 minutes apart, not to get too excited, but to call back if her water broke.

The clinical and apathetic mood of our conversation was mildly deflating, the midwife almost annoyed that I had rung. I understand night-duty and its pressure, its lethargy and its sleep deprivation – but I was having a baby! Well, my wife was anyway – some excitement or encouragement could have been in order!

We waited and waited. My wife’s water had broken while she’d gone for a nap and her contractions were under the 3 minute mark. Surely things were looking good. We headed up to the hospital in an eerie calm, driving slowly to not cause discomfort; excited but fully aware this was the start of the journey – not the end. While I was completely aware of how unrealistic Hollywood birth scenes really are, yet it still seemed anti-climactic driving in a calm and restrained manner through the quiet streets to the hospital.

Our arrival to hospital led to us being ushered in to a sterile examination room and the midwife “had a look” at how things were progressing. Anyone familiar with this area would know that midwives don’t look with their eyes. There was some confusion and deliberation before the first midwife made off for reinforcements to also “have a look”; leaving my wife sitting on an examination bench, with slightly less dignity and a lot more KY jelly than when we entered.

Eventually everyone was happy having “had a look” and we were ushered to the birthing suite to have some rest and prepare for the day ahead. Through this process I was pushed to the side and out of the way, my involvement seeming unnecessary.

Labour went as smoothly as possible until after the 30 hour mark, my wife’s dilation slowed and things became more complicated. A foetal heart rate monitor was connected and my wife was administered syntocinon intravenously. The midwives had been fantastic as they had made every effort to explain things to my wife about what was happening. As the effects of the synthetic-hormone began, the heart rate monitor began to display our baby’s heart rate dramatically slowing with each strong contraction, before rising back up to normal limits.

Patients are often connected to various forms of technology and devices that monitor and assess homeostasis to varying degrees, often alarming and beeping due to changes in blood pressure or heart rate, alterations in oxygen saturation or occasionally a dropped lead or sudden movement.

The alarms often create anxiety and confusion in patients and visitors, worried that a Hollywood-style resuscitation attempt would ensue following an alarm. I often tell people – “don’t start worrying until I look worried”. Our midwife was doing her best to look unworried – but a little experience could see that she was concerned. That and the notes she was writing all over the print-out; outlining that she was still awaiting the doctor’s review, despite having paged him earlier.

To the layman, the midwife jotting notes on the printouts may not raise any alarms, but this had me concerned. In a day and age when documentation is paramount in ensuring professional protection, I know you only start documenting things that carefully as they happen in times when things start going wrong.

Nothing was mentioned of the dipping numbers on the monitor. My wife was focused on her contractions and I was attempting to remain focused on helping her through them; all the while knowing my baby’s heart rate was dipping below acceptable levels and nothing was being said about it.

Our obstetrician finally arrived. He was an affable and seemingly well-read fellow open to our wants and needs; including our intentions to have as natural a birth as possible, attempting to avoid a caesarean section if able, and with minimal drug therapy. He offered his suggestions and explanations of what was happening in clear and understandable language.

There was little medical (or obstetric) jargon as he explained that mother and baby were now quite “tired” and that the baby was having some difficulties maintaining its heart rate and was in some distress. He offered us a plan of attack that would seem him attempt to deliver the baby without surgical intervention. His calmness was strongly juxtaposed by the goings on around us midwives milling around in preparation as we all tried to ignore the heart rate monitor, beeps dipping in the background.

The delivery of his information in such a casual and straightforward manner was comforting for me. It was personal, sensitive and reasonable – panic is not an emotion you wish to see on anyone’s face in times like these and his ability to diffuse our increasing anxiety was welcome.

What followed was a delivery that was later described by our obstetrician as “agricultural”. My wife had been in more pain than I had seen any patient before in my professional duties and the analgesia that had been administered to her had been administered incorrectly. I was torn as I noticed what had happened; as to what my boundaries and roles were. An average father-to-be wouldn’t have noticed that there was a problem, but I’d seen the drug not fully clear the intravenous line.

Professionals were at work in a highly stressful environment and my primary concern was supporting my wife. This role dilemma continued to place me in a difficult situation after our son was born; he was blue and unresponsive, the umbilical cord having been around his neck. Part of me was panicked to hear the familiar sounds of an infant resuscitation effort being performed just near me. Part of me wanted to be involved, or even to see him. To be honest, in the rush of baby being delivered; I had not seen he was a boy – I’d just seen this blue, contorted baby being pulled as swiftly as possible from my wife’s body, covered in amniotic fluid, vernix and blood and handed to the awaiting Paediatrician.

The fears of any complications due to asphyxiation, a failed resuscitation or other complications were very real in my mind. There was no ceremonial cutting of the cord, quick gentle cuddle or time to rejoice; our son needed medical attention and my wife was still in pain. I was helpless and unable to influence any of these situations – something I am very much not used to and it was not welcome.

The confusion on what to do and where to be is intense, all the while midwives, nurses and doctors are attending to the needs of my wife and baby, helping them as best they can. Communication at this time was understandably minimal. The paediatrician and nursing staff were working on our baby, the obstetrician and midwives focussed on my wife’s pain and birthing of the placenta.

Time went by and the severity of the situation subsided; we got our cuddles, then our son was whisked away for observation and we were left to it. What was my role now? I had a wife to help, still connected to an intravenous line that had eventually delivered the pain relief after the birth of the baby, failing to take away any labour pain, but now successfully making her drowsy and giddy – on top of the usual post-partum issues.

My newly born son lay under a heating lamp, connected to monitors; still mildly cyanotic, alone and asleep. Our families were interstate, as our wish – but were desperate for news after such a long labour. The doctors and midwives had moved on to the next problem, next birth and the next duty. I was left somewhere in the middle – emotionally and physically drained, still confused on what went wrong towards the end of the labour, and still confused as what my role now was, still uncertain on how I fit into the plan of care or delivery of services.

I was capable of caring for my wife as any husband is and also capable of caring for sick or injured patients requiring assistance with mobility and showering – which my wife now was. However, was this MY role? I knew better than most that hospitals run on people knowing and understanding the roles within the organisation and fulfilling them – but where did I fit in? The past few hours had been so chaotic that I was unsure what to take on as my role and what to leave for the staff.

I still had adrenaline pumping from the excitement, but also from fear. My wife had been in incredible amounts of pain and I had been unable to help her. The medical model of care had failed her in the very important task of pain management, which aside from being incredible unpleasant has also been shown to directly affect the birthing process (Wong, Perry, & Hockenberry, 2002).

Communications throughout the labour process had been fantastically clear and appropriate – but now there was no communication or support – the initial problem of a baby needing to be born had been effectively and efficiently dealt with. Our new requirements for support and explanations did not fall into the priorities of medical staff at this time.

The birth of a child: Confusion and powerlessness. A father’s role in labour, delivery and aftercare. Part 1

This is an ethnography assignment from my Master of Public Health. Its not perfect, not re-edited and clumsily chopped in three. References are listed on the final post.

INTRODUCTION

My wife lay exhausted on the crumpled sheets of the hospital bed; slightly dazed and confused by the late acting synthetic opioid analgesia she had been administered, still wearing the clothes she had laboured for thirty-six hours in; stained with amniotic fluid and sweat.

My new-born son, still unnamed, also exhausted; lay sleeping in the Special Care Nursery of the hospital, watched and monitored, having been admitted for observation due to being “flat” upon delivery.

I was the spare piece of the birthing puzzle- the husband, partner or friend that is along for the ride, but ultimately surplus to demand once things were in motion.

Now that the baby was born, I was torn. What was my role now?

My wife was still connected to intravenous lines that had long since served their purpose and my son was in another room being closely monitored having been born not breathing and requiring resuscitation.

I had waiting family to contact to share the wonderful news of the expected arrival of my newborn child.

I had a wife to assist following the most physically intense activity I’d ever witnessed.

I had a new creature in my life that I did not know, or yet love in a traditional sense – but had an overwhelming primeval impulse to protect and watch over.

Most of all, I had my own feelings, emotions and needs – but they had been largely ignored for the past few days and I had a feeling that was not about to change.

FATHER’S ROLE

The role of the father in the birth of their child is complicated and often unclear. A quick examination through the 1700 page textbook, Maternal Child Nursing Care (Wong, Perry, & Hockenberry, 2002)) found one dot point summary on the support needs of the father in labour.

Advice to practitioners included informing the soon-to-be-father of expected sights and smells and that needing to leave the room is fine; reinforcing that his presence in labour is helpful; offering him blankets to sleep on the chair and reminding him to eat (Wong, Perry, & Hockenberry, 2002). While this is arguably important information in practical terms; the almost condescending nature of the advice and occasionally the treatment of fathers in childbirth do little to acknowledge the father’s feelings and reactions to the machinations of labour.

A number of sources debate the value of having the father or partner in the delivery suite due to their lack of understanding of the process, high anxiety levels and lack of proper support to their partner (Vernon, 2006, Odent, 2010 and Winder, 2010). Winder (2010), a birth attendant and creator of BellyBelly .com.au; a high traffic Australian conception and birth website; challenges fathers in their motivation for attending the birth and their role in ensuring that their partner’s birth is all it should be. Vernon (2006), talks of men’s inability to allow things to “happen” in their role as “fixers” and creatures of action and often end up requiring comfort from their partners, increasing anxiety. Odent (2010), speaks of the increased neocortex stimulation and increased adrenaline associated with an attendant father-to-be.

All of these authors advocate for the use of a doula, or birth attendant; with the preferred outcomes being to ease the strain on the male as birthing partner through to removing the father from the role entirely.

While an unprepared, reluctant or anxious partner can be a hindrance to the birthing process (Vernon, 2006); should the emphasis be placed more on ensuring understanding than third-party involvement? Should all fathers be seen as a hindrance and potential negative influence on a successful birth? Chandler and Field (1997), argue that the benefits of an active, educated and engaged father in the support role is important to both parties. He also notes that fathers were not seen as part of a “labouring couple” and many felt tolerated rather than full partners in the birthing process (Chandler & Field, 1997).

Post-partum information and advice has a somewhat similar tone, with the onus being on the new father to ensure that he is providing the support and encouragement that his partner requires (Winder, 2006; Wong, Perry, & Hockenberry, 2002).

This is true, but there is little about the father’s own needs, insecurities and required support. The “father” in most of the literature and prenatal education appears to be the generalisation of the clueless bloke who purely wants to work, watch footy and have sex and hopes a baby won’t get in the way of all that.

Realistically, as the roles and expectations of women have changed dramatically over the past few generations – so has that of men.

MY BACKGROUND

Going into the labour experience was not going to be the same for me as it was for the general “bloke” described above. My background had given me some insight and education in to the birth process that had not been afforded on every man. It can be argued that knowledge is power. It can equally be argued that a little bit of knowledge is dangerous.

I am one of the 9.6% of male nurses in Australia (Australian Institute of Health and Wellfare, 2011) , and through training and employment opportunities I had worked with prematurely born babies and children, assisted in the birth of four babies and had experience of hospitals, pain and medical staff.

I had endeavoured throughout my wife’s pregnancy and labour not to advertise my profession as it can have two unwanted effects. The first being, occasionally other health professionals stop talking to you and your partner as patients or clients, but to me as a nurse, seemingly hoping I will later translate and explain the conversation to my wife.

Secondly, there can be some reluctance or even annoyance, often a pre-conceived idea that you will be a bit of a “know-it-all” or overstep boundaries. I wanted to be treated as a first-time expectant father, not an off-duty nurse.

to be continued