Wednesday, July 22, 2009

Out Damn Father!

A friend sent me a link (thanks!) to this article from a UK obstetrician, asking for my thoughts. I gave a few flippant responses, and a couple of more thoughtful ones, but it keeps bugging me, so I thought I'd pull it apart in some more depth.

You may have seen it, it was a London-based obstetrician expounding his belief that fathers should not be present at the birth of their babies.

The first quote is this:
For many years, I haven't been able to speak openly about my views that the presence of a father in a delivery room is not only unnecessary but also hinders labour.
Anyone who starts out with such a sweeping generalisation has me on side from the get-go. I was not disappointed:

But, having been involved in childbirth for 50 years and having been in charge of 15,000 births, I feel it's time to state what I - and many midwives and obstetricians - privately consider the obvious: that there's little good to come, for either sex, from having a man at the birth of a child
I love a man who is "in charge", especially of someone else's labour and delivery. I also note that the "obvious" need for a ban on men at births exempts his good self.

He then goes into some physiological discussion:
First, a labouring woman needs to be protected against any stimulation of the thinking part of her brain, the neocortex, for labour to proceed with any ease. ... Yet, motivated by a desire to "share the experience'', the man asks questions and offers words of reassurance and advice. In doing so, he denies his partner the quiet mind she needs.
I'm in support of his first statement. There is no doubt that your brain is working in a really different way, especially at the pointy end of labour. But there is a whole lot of labour when that is just not true, and some chit chat is most helpful. Of course, your average obstetrician never sees that bit, so it is obviously an irrelevant part of labour.

It seems to me that even if it were true that all men "asked questions and offered words of reassurance", it hardly means they need to be banished. From my own experience, if Crash was doing those things, it had no impact on my neocortex - it was out to lunch and only came back for important things like the sound of a gas bottle running out. However, I am not the sum total of the global birthing experience, so it is completely plausible that this does cause problems for some women. So perhaps we could like, tell the fathers that talking to a labouring woman who has checked her neocortex at the door is counter-productive? They are keen to have it all over and done with just like everyone else. In fact, I reckon many would give a great sigh of relief that they didn't have to think of supportive things to say any more.

The second reason is that the father's release of the stress hormone adrenalin as he watches his partner labour causes her anxiety and prevents her relaxing.

It has been proven that it is physically impossible to be in a state of relaxation if there's an individual standing next to you who is tense and full of adrenalin.

With a man present, a woman cannot be as relaxed as she needs to be during labour. Hence, the process becomes more difficult.

I have been with many women as they struggled to give birth, with their partner at their side. Yet, the moment he leaves the room, the baby arrives.

OK, more plausible science mixed with sweeping generalisations. I'd like to see some actual data (rather than Super Obstetrician's assertion) that even a majority of fathers are "tense and full of adrenaline".

After birth, too, a woman needs a few moments with her baby, particularly between the time of birth and when she delivers the placenta.

In order to deliver the placenta easily, her levels of oxytocin - the hormone of love - need to peak.

This happens if she has a moment in which she can forget everything, save for her baby, and if she has time in which she can look into the baby's eyes, make contact with its skin and take in its smell, without distractions.

Often, when a baby is born, men cannot help but say something or try to touch the baby.

Their interference at this key moment is, more often than not, the main cause for a difficult delivery of the placenta, too.

WTF? "The hormone of love"? I don't doubt the need for women to be with their babies just after delivery, but I have very serious doubts that it is most often the fathers who interfere with that. It seems far more likely that it is medical staff. Actually, strike that, I do doubt the need for women to be their babies, I don't doubt their right to be with them.

After my first was born, I certainly forgot everything. Pretty much the baby included. I wasn't in any way overwhelmed with emotion for him. I was overwhelmed with a feeling of emptiness - in a good way. When he was born I thought he was dead. It was only looking at the slightly bored, business-as-usual manner of the midwife and obstetrician that convinced me he was ok. I don't remember any particularly strong emotion with that observation. I was a little scared, but it wasn't overwhelming. He did need to be taken to the nursery after I had a cuddle, because the suction wasn't working in the birth centre. I was going to say that I was glad that his father was there to go with him, but to tell the truth, I don't remember feeling that. What I remember was how good the cheese sandwich tasted and the utterly awesome feeling of swallowing without immediate heartburn. It was all about me. And the placenta found its way out, I only vaguely remember that too.

Again, I am not definitive, but if I had a completely different experience, I'm guessing I am also not unique. Not to mention the fact that I don't recall Crash interfering with my cuddling or feeding any of our children, it simply isn't true that all men do this. If someone pointed out to those who do that it is really uncool for reasons X, Y & Z (before the delivery), I'm sure even fewer would.
There are two other important questions I would like to see answered scientifically.
Fair call, I can't argue with such a request.

The first is: are we sure that all men can easily cope with the strong emotional reaction they have when they participate in the birth?

Over the years, I've seen something akin to post-natal depression in men present at birth.

In its mild form, men take to their bed in the week following the birth, complaining of everything from stomach ache or migraine to a 24-hour bug.

It's well known by those who study depression that, rather than admit a low mood, men often offer up a symptom as a reason why they've taken to their bed.

Right. Where do we start? Oh, the poor menz can't cope with the stress of ... someone else's delivery. I'll come back to that, because I think there may be some merit to the question. However, the evidence? That men "take to their bed in the week following the birth"? To quote myself in my inital response to this (edited for typos) - Clearly it's the birth itself that causes men to have a moment or two in the week following - 'cos it sure as hell couldn't be the stress of the actual baby, or the ups and downs of the mum's emotions in that week, or dealing with elder siblings if there are any or anything else at all that I can think of.

The final question I would like answered is what, if a man is present at birth, will be the effect on the sexual attraction he feels towards his wife?

When men began standing at their partner's side in labour, I remember my mother's generation saying that the couple's intimate life would be ruined.

And, given that the key to eroticism is a degree of mystery, I'm left believing they had a point.

Really, honestly, I can't think of anything other than - what a dick. I mean seriously, if this is such an issue, we'd have a lot more only children. I think perhaps he should stop listening to his mother's generation and start listening to the one that has actually had fathers in the delivery room. Just a thought.

What annoys me the most about this ridiculous little piece, is that he raises some interesting issues and then distracts from them with spectacular fail.

We have reached a cultural opposite - it is virtually unthinkable for a father not to be present at a birth unless as a result of exceptional circumstances. Perhaps it is reasonable to ask the question whether this is always the best option. Some men may, in fact, be a hindrance to the process, especially if they really don't want to be there and genuinely can't cope. If his claims are backed up by evidence, then a "shut up and stay calm or leave" policy might be reasonable. There is validity to asking whether we should always condemn men for not being at a birth, and certainly for women in the habit of not putting their partners out in any way (still disturbingly common), it might go better for them if the father wasn't there. But all of this is mere speculation. It needs science to back it up and then a willingness for us to accept that our current practice might not always be best practice. Of course, it also requires a willingness for everyone to accept that best practice might differ from couple to couple. Then again, for once lesbian couples would have more rights than straight couples under this guy's regime.

I was a little surprised at how well Crash handled the deliveries. He's a guy with a bit of a knight in shining armour complex at the best of times, and I thought he would really struggle to handle seeing me in pain and not being able to do anything. I guess the ante-natal classes that warned him that this would be the case in a very specific way actually worked. But it is reasonable that some men may still not be able to cope. That the whole process could be too much for them. It is for some women. If that's true (again, I'm not prepared to take the word of Super Obstetrician), then everyone is probably better off is they aren't there, and they shouldn't be villified for it. Just like women who really don't cope with labour shouldn't be villified for choosing caesars.

I have read so many birth stories that are so different from mine, they are not even on a spectrum, they fill a whole scatter plot. The idea that there is a one-size-fits-all delivery is ridiculous. But since this post is based on one person's opinion, I'll finish with mine.

Despite the fact that I had a wonderful obstetrician who works in the birth centre and shares care with the midwives, I always felt that she was largely unnecessary at the birth itself. I went to her for the ante-natal care. The midwives gave me all the support and provided all the experience I needed. The father of my children, on the other hand, provided both figurative and literal support throughout the delivery - you know, from waters breaking to "ok, you can go now, I want to sleep". He literally held me up while I delivered two of them. I really couldn't have done it without him. Given the choice between father and obstetrician, I know who I'd choose.


  1. All I can think of to say to this is *boggles* What rubbish!

    I never really gave much thought as to whether Adam should or shouldn't be there for my births. I do remember half wanting my mum to be there as well for the first and mentioning that to her. She said something about being flattered but that it was a special time for me and Adam and she'd feel she was intruding. I dunno, maybe she was a bit less than keen - she'd been practically unconscious on pethidine for all 3 of her deliveries, not by choice. At any rate, Adam was great - he willingly offered his thumb to be almost wrenched off during contractions for all 3 kids and provided conversation about sci-fi and politics in the quiet bits. Except when he buggered off to do a conference call.

    I'm sure there are some people who do make things worse in delivery rooms but I too strongly suspect that those people are medical staff, not a mother's chosen birth support person.

    I suppose there could be something to be said for not assuming that a father is welcome by the mother in the delivery suite, just by virtue of him being the father, but that's hardly the same as saying all fathers are a problem.

    Apart from anything else it sounds to me very much like a desire to remove from the birthing process a person who is there as an advocate and support for the mother.

    Oh, ok, seems I did have a bit more than just "boggles" to say!

  2. Hear hear! When men start giving birth, they can start issuing opinions on birth, and that is when we will accept them as valid.

    Enjoyed your blog. Just thought I'd say.

  3. I'm really glad my partner was present for the birth of our son. He remembers more of it than I do, because I was all in the zone. He's the one who can tell me how long stuff took, what our son looked like when he was born (in the caul, I couldn't see and I was too knackered to move), and he helped me move around. He also held our baby first because I'd been carrying him for 39 weeks and 6 days and I thought it was his turn. I'd also been scared that they wouldn't bond and wanted to get them off on the right foot (they're fine, my fears were unfounded).

    I think it's fair to say that fathers shouldn't be assumed to be sufficient support for all women in labour. I think lots of women could do with a doula or midwife who can give one on one attention, or have their mother or other advocate there for them. I think it's hard for fathers (sometimes) to be partner/father/informed advocate all at once. I think there's a lot to be said for better ante-natal preparation for fathers so that they can be truly prepared and supportive during labour and the newborn phase, but I can't see any reason to ban a mother from choosing her own damn support crew!