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You cope by breaking down in private: Fathers and PTSD following childbirth
Abstract
Literature on birth trauma has focused on women's experiences and the evidence of post-traumatic stress disorder (PTSD) following childbirth. For some fathers witnessing a traumatic birth involving their partner and/or baby, symptoms of post-traumatic stress disorder may also be apparent. In this New Zealand study descriptive phenomenology was used to explore the phenomenon of post-traumatic stress following childbirth as twenty-one fathers narrated their experiences of witnessing a traumatic birth. Four themes encapsulated their experiences: It's not a spectator sport; It's about being included; it's sexual scarring; it's toughing it out. These results demonstrate that some men are left with a negative emotional experience that has serious consequences for their relationships and families. Midwives should be aware that many men have ambiguous expectations about being at the birth. If fathers are witness to a traumatic birth, as they perceive it, they need resolution.
... Maternal depression, excessive infant crying, and maladjustment to parenthood also impact the mental health of fathers in the post-partum period [13][14][15]. The feelings of helplessness, fear and abandonment may precipitate anxiety, post-traumatic stress disorder (PTSD) and 'sexual scarring' [16][17][18]. Exposure to stressful circumstances such as a traumatic event in pregnancy and childbirth may also contribute to depression, acute stress disorder and PTSD in fathers [6,16,[19][20][21]. Fathers of babies born preterm (< 30 weeks gestation) have significantly higher depression scores when compared to fathers whose babies are born at term [22]. ...
... Additionally, 16% of liveborn babies require some form of active resuscitation immediately after birth [28]. Fathers witnessing these life-threatening situations may be left with long-standing post-traumatic stress symptoms (PTSS) [5,17,29,30]. This trauma may culminate in guilt, self-blame, fear and shame, as well as perceived stigma [31][32][33]. ...
... There are no provisions for dedicated personnel to support the fathers in these challenging and unpredictable circumstances, even in the developed world. Such traumatic exposures may intensify their anxiety and distress [7,12,56] These traumatic experiences may also result in long term PTSS and PTSD, as previously reported in the literature [5,6,12,17,30,60] Participants in our study discussed ways in which a traumatic pregnancy and childbirth experience had given rise to feelings of guilt, anxiety, depression, possible PTSS and suicidal ideation, consistent with other studies in the literature [5,6,17,30]. Currently, fathers are not routinely screened for physical or mental health conditions or other pre-existing vulnerabilities [61]. ...
Background
This study aims to explore the emotional and behavioural responses and coping strategies of fathers or expectant fathers who faced a significant traumatic event during a partner's pregnancy, labour, or the postpartum period.
Methods
This prospective qualitative study of 24 fathers was conducted at a public teaching hospital in Brisbane, Australia. ‘Traumatic pregnancy’ was defined as a pregnancy complicated by life-threatening or severe risk to the mother and the fetus, termination of pregnancy, intrauterine fetal death or stillbirth. Semi-structured interviews of participants were conducted 3-4 months after the traumatic event. An initial qualitative analysis with automatic coding was performed using Leximancer and later followed by a six-phase manual thematic analysis.
Results
A pregnancy-related traumatic event had significant mental and physical impacts on fathers. Participants' reactions and coping strategies were varied and influenced by their background history, pre-existing vulnerabilities, and the gap between expectation and reality. Most fathers described a fluctuating state between their needs 'not being met' and 'being met'. These needs were conceptualised using Maslow’s hierarchy and Calman’s gap theory to construct a composite thematic model to depict the universal requirements of men facing a traumatic pregnancy or childbirth.
Conclusions
A greater understanding of the needs of men and gaps in their care is urgently needed. A targeted effort is required to make maternity services father-inclusive. This approach may assist in preventing long term consequences on fathers, partners, and their children.
... Birth trauma experiences do not affect only mothers but they also affect the relationship of mothers with their partners. Negative childbirth experiences have important short-and long-term consequences on the couples relationships and on the parent-child interactions [23,24]. Indeed, the state of well-being following childbirth both in mothers and their partners is critical for the child's development [25]. ...
... Our results showed a positive correlation between depression and PTSD-FC symptoms for mothers. Several studies showed a high comorbidity between postnatal depression and PTSD following childbirth [23,54] In this light, Söderquist et al. [17] suggested that depression and PTSD might share the common vulnerabilities and risk factors. In addition, several studies showed that the depression is a significant predictor for post-partum PTSD symptoms [55]. ...
... Several studies showed that higher symptoms of depression and anxiety caused a poorer parent-baby interaction [51,59]. Likewise, according to previous scientific literature, the symptoms of PTSD and depression associated with lower quality of parent-baby bond [23,51]. ...
Background
Childbirth experience could be complicated and even traumatic. This study explored the possible risk factors for post-traumatic stress disorder following childbirth (PTSD-FC) in mothers and partners.
Methods
Through a cross-sectional online survey biographical, medical, psychological, obstetrical and trauma history data were collected. The PTSD-FC, postnatal depression, social support, and perceived mother-infant bond in 916 mothers and 64 partners were measured through self-reported psychometric assessments.
Results
Our findings highlight the possible impact of several risk factors such as emergency childbirth, past traumatic experiences and distressing events during childbirth on PTSD-FC. The difficulties in mother-infant bond and the postpartum depression were highly associated with the total score of PTSD-FC symptoms for mothers. While for partners, post-partum depression was highly associated with the total score of PTSD-FC.
Conclusions
Our study demonstrated significant links between psychological, traumatic and birth-related risk factors as well as the perceived social support and the possible PTSD following childbirth in mothers and partners. Given that, a specific attention to PTSD-FC and psychological distress following childbirth should be given to mothers and their partners following childbirth.
... Five studies were based on women; two in the UK (Allen, 1998;Ayers, Eagle & Waring, 2006); one in the US (Kendall-Tackett, 2014); one in Iran (Taghizadeh, Irajpour, & Arbabi, 2013); and one across Australia, New Zealand, and UK (Beck, 2004). One study was based on couples in the UK (Nicholls & Ayes, 2007) and the final study was of men in New Zealand (White, 2007). ...
... Three studies included participants on the basis of self-identified PTSS (Kendall-Tackett, 2014;White, 2007) or disclosure of an earlier diagnosis (Beck, 2004). Remaining studies used a variety of PTSD measures; the PTSD Diagnosis Scale (PDS) (Ayers, Eagle, & Waring, 2006;Nicholls & Ayers, 2007), the revised Impact of Event Scale (Allen, 1998), and assessment using the DSM-IV criteria however it is unclear if this was done by interview or questionnaire (Taghizadeh et al., 2013). ...
... At times when as a couple you want to be kind of closer, and then that closeness seems to have something stopping it, there's a barrier to being closer that shouldn't be there (male). (Nicholls & Ayers, 2007, p 500) It is important to highlight that there were examples when relationships were strained to the limit (Beck, 2004) leading to relationship breakdown (Ayers et al., 2006;White, 2007). ...
Objective: This review aimed to identify the impact of childbirth-related post-traumatic stress disorder (PTSD) or symptoms (PTSS) on a couple’s relationship.
Background: Childbirth can be psychologically traumatic and can lead to PTSD. There is emerging evidence that experiencing a traumatic birth can affect the quality of the couple’s relationship. This is an important issue because poor-quality relationships can impact on the well-being of partners, their parenting and the welfare of the infant.
Methods: A systematic search was conducted of Amed, CENTRAL, Cinahl, Embase, Maternity and Infant Care, Medline, MITCognet, POPLINE, PsycARTICLES, PsycBITE, PsycINFO, Pubmed and Science Direct. Additionally, grey literature, citation and reference searches were conducted. Papers were eligible for inclusion if they reported qualitative data about parents who had experienced childbirth and measures of PTSD or PTSS and the relationship were taken. Analysis was conducted using meta-ethnography.
Results: Seven studies were included in the meta-synthesis. Results showed that childbirth-related PTSD or PTSS can have a perceived impact on the couple’s relationship and five themes were identified: negative emotions; lack of understanding and support; loss of intimacy; strain on the relationship; and strengthened relationships. A model of proposed interaction between these themes is presented.
Conclusions: The impact of childbirth-related PTSD or PTSS on the couple’s relationships is complex. As the quality of the couple relationship is important to family well-being, it is important that healthcare professionals are aware of the impact of experiencing psychologically traumatic childbirth as impetus for prevention and support.
... The supporter's role includes many types of activities, such as: being the woman's advocate, providing calm reassurance by gentle touch or talk, holding her hand, being an advocate, calming her down and being present (Johansson, Fenwick, & Premberg, 2015). However, many birth supporters, fathers in particular, state that they feel unprepared for their labour support role which diminishes their experience and limits their contribution; even leaving some fathers vulnerable to post-natal depression, anxiety or post-traumatic stress disorder upon witnessing traumatic births (White, 2007). If, and how, the physical design of institutional birth settings impact the supporter role has previously received minimal research attention. ...
... Trauma can arise in part due to feeling a lack of control and to concern for the wellbeing of their partner and baby (Persson, Fridlund, Kvist, & Dykes, 2012;Steen, Downe, Bamford, & Edozien, 2012). In addition, phenomenological interviews and narrative research suggests that the presence of fathers who feel emotionally unsupported, anxious or stressed during childbirth may negatively contribute to the childbirth experience (Longworth & Kingdon, 2011;White, 2007). In interviewing Australian fathers about their role in childbirth, Vernon (2006) revealed many negative accounts of experiences by fathers who felt stressed and were potentially unsupported themselves. ...
... A randomised controlled trial, of 412 women's views of factors that contributed to positive birth outcomes, highlighted the crucial importance of calm, supportive and continuously present supporters as a central factor to foster a fulfilling experience (Lavender, Walkinshaw, & Walton, 1999). At the same time, three different phenomenological studies of supporters found that supporters often feel overwhelmed and struggle to find their role, feel anxious and are more vulnerable after a distressing birth experience (Longworth & Kingdon, 2011;Sengane, 2009;White, 2007). In the first study 11 first-time fathers struggled to find their roles, due to feeling overwhelmed (Longworth & Kingdon, 2011). ...
[Background] It is accepted that the physical environment of healthcare influences the perceptions and experiences of patients and staff. Research has explored how birth unit design influences the experiences of women and midwives during childbirth. However, although there is evidence that cooperative supporters are beneficial to labouring women, and that women desire such support, little attention has been paid to the impact of physical design on the experiences of a woman's chosen childbirth supporter. This thesis describes how the physical environment influences the behaviour, experiences and role navigation of birth supporters. [Aim] To gain an understanding of how physical birth environment design accommodates women’s supporters and facilitates their support roles. [Study Design] This childbirth supporter study presented in this thesis, is a research substudy of a larger Birth Unit Design (BUD) research project. Ethics approval was obtained for the BUD video-ethnographic study where six consenting women and their 11 supporters were filmed during labour at two different Australian hospitals (February/March 2012). The ‘childbirth supporter study’ (CSS) presented here is a single-case study design that was selected from the larger cohort of participants from the BUD study. One woman, her four supporters and three midwives provided the foundation for the ‘childbirth supporter study’ described in this thesis. Video footage and video-cued interviews with all participants and observational field notes provided data for analysis. Three-phase analysis cycle for both text and video included: descriptive, interpretive and selective coding (using an approach informed by Saldaña, 2013). Phase one, the descriptive coding cycle, consisted of identifying what would be filmed, viewing the video, reading the transcription text and interview field notes and becoming familiar with the data. Phase two, the interpretive/pattern coding cycle, consisted of condensing the data so that themes could begin to be identified, such as by selecting exemplar still images from the video footage. The third phase, the selective/codeweaving stage, consisted of data reconstruction and synthesis, to facilitate interpretation of the evidence into thematic findings. The ‘AEIOU’ framework (an analysis approach informed by Wasson, 2000) was utilised for the video data during the third phase of analysis. An extended, reflective cross-validation inquiry of the thematic findings, using the Birth Unit Design Spatial Evaluation Tool (BUDSET) as both criterion and building block, provided translation of the findings into practice. [Findings] The physical environments of typical birth units do not appropriately meet the needs of supporters, who may feel unsure of their role, behaviour or positioning, thus limiting the potential benefits of their support role. Key themes are: ‘Unbelonging Paradox’, ‘Role Navigation’ and ‘Supporting the Supporter’. Findings are supported by illustrative video footage stills and verbatim quotes. Viewing supporters as both individuals and part of a team dyad is the basis for the design recommendations. Examples of some of the recommendations are: spaces for both privacy and togetherness; informational support zones; transition space; positive distracters; easy access food, drink and toilet facilities; and the ability to personalise and adjust the space to increase the perception of agency. [Implications and Relevance to Practice] Knowing how the design of birth units can best accommodate the needs of women’s supporters may facilitate optimal birth experiences for women and increase opportunities for safe, satisfying birth. Designers and healthcare managers may benefit from understanding the birth environment’s influence on supporter’s behaviours.
... The involvement of men in the pregnancy experience and in birth has resulted in shared experiences for couples and can be considered an important transition ritual that is almost mandatory for new fathers. (Draper, 2002;White, 2007;Hildingsson et al., 2014). Many studies however, report men's dissatisfaction with the birth experience (Rubertsson et al., 2005) and this dissatisfaction and or distress is frequently linked with descriptions of complicated or adverse birth experiences (Lindberg and Engstrom, 2013;Hinton et al., 2014). ...
... This included determining if the aims of each study were clearly articulated, if the methodological approach was congruent with the overall design and appropriate methods for data collection were selected, recruitment strategy was evident, and the data collection and analysis processes were explained, ethical considerations and rigour adhered to, and the findings presented in a concise and coherent way, and level of depth and comprehension demonstrated through the interpretation of the findings. The majority of studies reviewed reported on the methodological framework, for example descriptive phenomenology (White, 2007), and most made mention of ethical considerations. Two papers were removed as they did not meet the methodological criteria. ...
... The theme 'the unfolding crisis' relates to both the unexpected nature of the birth complication or adverse event and the complex emotions described by the men just prior to, during and immediately following the birth. Some of the birth complications or emergencies that the men witnessed included near miss events (White, 2007); severe postpartum haemorrhage (Snowdon et al., 2012), neonatal resuscitation (Harvey and Pattison, 2012), emergency caesarean section (Nicholls and Ayers, 2007;Yokote, 2007;Johansson et al., 2013), instrumental birth (Hinton et al., 2014) and complicated birth (Lindberg and Engstrom, 2013). Men described the 'unexpectedness' of birth complications, using words such as 'panic' and 'shock' and in some instances, they feared for the life of their partner and or their baby: ...
Introduction:
birth is a natural and for many, life enhancing phenomenon. In rare circumstances however birth can be accompanied with complications that may place the mother and infant at risk of severe trauma or death. Witnessing birth complications or obstetric emergencies can be distressing and potentially traumatic for the father.
Aim:
the aim of this paper is to report on the findings of a meta-ethnographic synthesis of father's experiences of complicated births that are potentially traumatic.
Methods:
databases searched included CINAHL, Scopus, PubMed and PsycINFO with Full Text. The search was conducted in February and March 2013 and revised in February 2015 for any new papers, and the search was limited to papers published in English, full text and peer-reviewed journals published between January 2000 to December 2013.
Inclusion criteria:
studies were included if they focused on fathers/men׳s experiences of witnessing a birth with complications including a caesarean section or an adverse obstetric event. Studies included needed to use qualitative or mixed methods research designs with a substantial qualitative component. ANALYTIC STRATEGY: a meta-ethnographic approach was used using methods of reciprocal translation guided by the work of Noblit and Hare (1988) on meta-ethnographic techniques. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool.
Findings:
eight qualitative studies with a total of 100 participants were included in the final sample. The men ranged in age from 19 to 50 years.
Synthesis:
Four major themes were identified: 'the unfolding crisis', 'stripped of my role: powerless and helpless', 'craving information' and 'scarring the relationship'. Participants described the fear and anxiety they felt as well as having a sense of worthlessness and inadequacy. Men did not receive sufficient information about the unfolding events and subsequently this birth experience impacted on some men׳s interactions and relationships with their partners.
Conclusions:
witnessing a complicated or unexpected adverse birth experience can be distressing for men and some may report symptoms of birth trauma. Being informed by and receiving support from midwives and other health professionals appears to help mitigate the negative impact of birth complications. Effective support may help address men׳s confusion about their role, however genuinely including men as recipients of care or service in pregnancy, labour and birth raises important questions about whether the father is also a recipient of maternity care and if the transition to fatherhood is itself becoming a medical event?
... Although overall the majority had a positive experience of childbirth, there has been research about fathers and posttraumatic stress disorder (PTSD) after attending childbirth (Bradley et al. 2008;White 2007). White (2007) found that, for some fathers, childbirth was so distressing that their marital relationships suffered and they became sexually scarred. ...
... Although overall the majority had a positive experience of childbirth, there has been research about fathers and posttraumatic stress disorder (PTSD) after attending childbirth (Bradley et al. 2008;White 2007). White (2007) found that, for some fathers, childbirth was so distressing that their marital relationships suffered and they became sexually scarred. On the contrary, Bradley et al. (2008) found that none of their respondents had PTSD and that the distress faced was probably related to anxiety about their partners' health and the new roles and responsibilities of becoming a father. ...
... This inclusion gave fathers an increased sense of control over the situation, resulting in a more positive experience (Premberg et al. 2011). In contrast, asking women in pain to make decisions during childbirth while neglecting the fathers made fathers feel excluded and angry (White 2007). ...
Background
While fathers are increasingly expected to participate during their partners' pregnancies and childbirth and many studies have reported their experiences during these periods, no review studies have examined fathers' experiences and needs during pregnancy and childbirth together.AimTo provide an overview of evidence on fathers' experiences and needs during their partners' pregnancies and childbirth to identify any gaps in the existing literature and practice.Methods
An integrative literature review was performed to analyse and synthesize fathers' experiences and/or needs during pregnancy and/or childbirth based on articles published in CINAHL, PubMed, Scopus, PsycINFO and Web of Science databases between the years 2002 and 2012. Only articles found in the National University of Singapore's online library collection were retrieved.ResultsAltogether, 25 studies (six quantitative and 19 qualitative studies) that reported fathers' experiences during pregnancy (n = 8), childbirth (n = 13) or during both periods (n = 4) were reviewed. Fathers experienced mixed feelings both during pregnancy and childbirth. They required support from their partners and healthcare professionals and wanted to be informed, involved and respected. However, more studies are needed to explore this phenomenon in different cultural contexts or care models.Conclusion
This review provides evidence for healthcare professionals to pay more attention to fathers when delivering perinatal care. Sociocultural-sensitive interventions should be developed to facilitate a smoother transition to fatherhood.Implications for nursing and health policyFather-specific information should be given to prepare fathers for pregnancy and childbirth. Healthcare professionals and policymakers should take fathers' feelings and concerns into consideration and provide family-centred care to the couple during the antenatal and intrapartum periods.
... Fathers may display a classical grief response with public grief suppression to conform to the societal expectations of masculinity [6,19]. There is concern that exposure to traumatic circumstances in pregnancy and childbirth may contribute to post-traumatic stress symptoms (PTSS) in fathers [6,17,[20][21][22]. ...
... Paternal stress reactions have not been studied extensively. Fathers witnessing life-threatening maternal or neonatal events may be left with long-standing PTSS [6,9,17,[20][21][22]24]. Parental PTSS are associated with exposure to hospital environments (e.g. ...
Background
This study aims to explore the prevalence of symptoms of depression and traumatic stress in fathers in the setting of poor fetal, neonatal, and maternal outcomes.
Methods
A prospective mixed-methods study was conducted at an outer metropolitan public teaching hospital in Brisbane, Australia, with quantitative results presented here. Subjects included 28 fathers whose male partners had experienced pregnancy or childbirth complicated by a significant congenital abnormality or aneuploidy, termination of pregnancy, fetal death in-utero, stillbirth, admission to the neonatal intensive care unit or special care nursery or significant maternal morbidity, such as a postpartum haemorrhage or an emergency postpartum hysterectomy. These experiences were classified into two groups: anticipatory (time to prepare) and sudden (no warning). The fathers were screened using the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R) to assess subjective distress at 2-3 weeks (timepoint 1) and 3-4 months (timepoint 2) after the event.
Results
Data for both the EPDS and IES-R scales was available for 26 fathers (92.9%) at timepoint 1 and for 15 fathers (53.6%) at timepoint 2. High overall EPDS scores (≥10) were noted in 16/27 (59.3%) fathers at timepoint 1 and 6/15 fathers (40.0%) at timepoint 2. High overall IES-R scores ≥33 were noted in 12/26 (46.2%) fathers at timepoint 1 and 4/15 fathers (26.7%) at timepoint 2. A higher percentage of fathers who experienced anticipatory events had EPDS and IES-R score above these cut-offs at timepoint 1 (8/13 or 61.5%) compared to those experiencing sudden events (8/14 or 57.1%), however, percentages were similar between groups at time point 2 (2/7 or 28.6%% and 4/8 or 50.0%, respectively). More fathers who experienced anticipatory events had IES-R scores ≥33 at timepoint 1 (7/13 or 53.8%) compared to those experiencing sudden events (5/14 or 38.0%).
Conclusion
Our study indicates high rates of distress in fathers exposed to poor fetal, neonatal, and maternal outcomes, which can persist for months after the event. Increased support for fathers in this setting may be required to prevent poor mental health. Further research on the long-term effects of these adverse events is warranted.
... It was determined in this study that expectant fathers were afraid of complications. These results are similar to those of previous studies [2][3][4][5]18,19]. In this study, it was also determined that expectant fathers were afraid of damage to their partner's reproductive organs and of their partners experiencing incontinence in the future. ...
... In the previous studies made, it was also determined that men were afraid of wrong applications during childbirth, of insufficient medical treatment and of the health personnel behaving negatively [3,4]. Health personnel not providing enough support before childbirth and during childbirth, shouting and showing a disrespectful behavior increases the stress of men associated with childbirth [19]. Whereas, the fears for childbirth are decreased in fathers who are supported during pregnancy and the process of childbirth [5,20]. ...
Objective
To determine the fears associated with childbirth among first time expectant fathers and the reasons for these fears.
Study Design
A descriptive, phenomenological approach was used. The sampling was composed of 16 men who were first time expectant fathers, who were at least primary school graduates, who were 18 years of age or older, whose partner was in her final trimester week of pregnancy, who did not have any psychiatric problems and who stated that they had a fear of childbirth.
Results
The data were collected under the two main themes of fears about childbirth and the reasons for the fears. It was found that the expectant fathers had fears associated with the complications that could develop during childbirth and with the health personnel.
Conclusions
There were various fears associated with childbirth among expectant fathers. The reasons for the fears were mostly the negative stories heard. Health personnel have important duties in defining and decreasing the fears of expectant fathers associated with childbirth. It should not be forgotten that expectant fathers are also a part of childbirth in antenatal education.
... 16 The estimates rate of postpartum depression is between 10 to 20% of women who give birth each year. 17 Rates may be even higher for minority women and those who experience a pregnancy complication. 18 Postpartum depression has a significant impact on the parenting couple and the partner's ability to identify the warning signs of depression and to provide support during this stressful period is critical to the future health of the family. ...
... There is the potential for post-traumatic stress for both the father and the mother after a difficult birth and the couple's sexual relationship can be adversely affected by the fathers attendance and witnessing of the. 10 Among fathers reporting psychological and sexual scarring after observing childbirth many were likely vulnerable prior to watching the birth. 16,17 It is reasonable to explore the emotional vulnerabilities of the couple's intimate relationship during the prenatal period so that counseling and intervention strategies can be implemented if sexual intimacy becomes a concern postpartum. 17 ...
... Fathers in our study described the need to hide or control their emotions and fear from their partner. However, the number one rated fear for fathers in many studies across countries has been described as the fear of a partner possibly dying during a normal childbirth ( Eriksson et al., 2006;Hanson et al., 2009;Vehviläinen-Julkunen and Liukkonen, 1998;White, 2007 ). Some fathers fear the loss of both their wife and their unborn child. ...
... Some fathers fear the loss of both their wife and their unborn child. They reported coping the best they could without revealing their fears to their partner ( White, 2007 ), similar to the findings of this study. ...
Background:
Fathers’
experience
of
childbirth
has
been
described
as
both
distressing
and
wonderful,
but
little
has
been
described
in
the
literature
about
fathers´reactions
when
their
partners
get
life
threatening
diagnoses
such
as
peripartum
cardiomyopathy
(PPCM)
during
the
peripartum
period.
Aim:
To
learn
more
about
fathers’
reactions
over
their
partner’s
diagnosis
of
peripartum
cardiomyopathy.
Methods:
Fourteen
fathers,
whose
partner
was
diagnosed
with
PPCM
before
or
after
giving
birth,
were
interviewed.
Data
were
analysed
using
inductive
content
analysis
technique.
Results:
The
first
reaction
in
fathers
was
shock
when
they
heard
their
partner
had
PPCM,
which
was
sud
den,
terrible
and
overwhelming
news.
Their
reactions
to
trauma
are
described
in
the
main
category
:
The
appalling
diagnosis
gave
a
new
perspective
on
life
with
emotional
sub-categories:
overwhelmed
by
fear,
dis
tressing
uncertainty
in
the
situation
and
for
the
future,
feeling
helpless
but
have
to
be
strong,
disappointment
and
frustration,
and
relief
and
acceptance.
Although
terrified,
fathers
expressed
gratitude
towards
health
care
professionals
for
the
diagnosis
that
made
it
possible
to
initiate
adequate
treatment
.
Conclusion:
Exploring
father’s
reactions
will
help
peripartum
and
cardiology
healthcare
professionals
to
understand
that
emotional
support
for
fathers
is
equally
important
as
the
support
required
for
moth
ers
during
the
peripartum
period.
Specifically
they
will
help
professionals
to
focus
on
future
effort
s
in
understanding
and
meeting
the
supportive
care
needs
of
fathers
when
their
partner
suffers
from
a
life
threatening
diagnosis
like
PPCM.
©
... White [17] attempted to explore men's experience of PTSD after childbirth through the narratives of fathers who had witnessed a traumatic birth, finding that men felt alienated through being "a spectator", rather than having a role in the birth, and excluded by the actions of staff. Men reported feeling very distressed during the birth but tried to keep this hidden. ...
... This seems to have established how they would cope with the experience afterwards, leading to the avoidance strategies adopted. White's study [17] demonstrated that men tried to avoid showing their distress after the birth; what this study adds is that some men do not view what they have been through as something that should cause distress. They seem to invalidate their own experiences, which subsequently impacts on whether or not they access support. ...
Background
Given the limited research into men’s experiences of being present at childbirth this study explored the experiences of fathers who found childbirth traumatic. The aim of the research was to investigate how men coped with these experiences; the impact on their lives; and their views on what may have helped to reduce distress. Methods
Participants were recruited via websites relating to birth trauma and parenthood. A consent and screening questionnaire was used to ensure that participants met the inclusion criteria of: being resident in the UK; being 16 years or older; having been present at the birth and answering yes to the question “At some point during the childbirth I experienced feelings of intense fear, helplessness or horror”. Semi-structured telephone interviews were completed with 11 fathers who reported finding childbirth traumatic. Participants also completed the Impact of Event Scale as a measure of trauma symptoms. Template Analysis was used to analyse the interview data. ResultsChildbirth was experienced as “a rollercoaster of emotion” because of the speed and unexpectedness of events. Men described fears of death, mirroring their partner’s distress; trying ‘to keep it together’ and helplessly watching a catastrophe unfold. Fathers felt themselves abandoned by staff with a lack of information. Men were subsequently distressed and preoccupied with the birth events but tended to feel that their responses were unjustified and tried to cope through avoidance. Men described the need for support but reluctance to receive it. Conclusions
Fathers may experience extreme distress as a result of childbirth which is exacerbated by aspects of current maternity care. Maternity services need to be aware of the potential impacts of fathers’ attendance at childbirth and attend to fathers’, as well as mothers’, emotional responses.
... Advantages include: family bonding (Klaus and Kennell, 1976; Tomlinson et al, 1991; Righard and Alade, 1990), greater closeness to infant and partner (Cronenwett and Newmark 1974, Greenberg and Morris 1974) and improved attitudes towards parenting (Henwood and Proctor, 2003; Sluckin et al, 1983). Disadvantages include: possible development of psychosexual problems (an under explored area) (Jackson, 1997); negative feelings towards mother and baby (Jackson, 1997; McVeigh et al, 2002); and PTSD (White, 2007). The content of childbirth related fears and anxiety are reasonably well explored in women but little is known about men (Saisto et al, 2001; Sjogren, 1998). ...
... Research supports the existence of Post Traumatic Stress Disorder (PTSD) in some women following childbirth (Ayers and Pickering, 2001 ), with reported prevalence ranging between 1.5% and 6% (Beck, 2004). For some fathers witnessing a traumatic birth, symptoms of PTSD are also apparent (White, 2007). ...
The aim was to develop a scale—the Birth Participation Scale (BPS)—which midwives can use to measure fathers' attitudes and needs in relation to birth participation. The objectives were to use the BPS to: detect whether fathers genuinely want to be present at the birth; identify localized perceptions and fears fathers may have about birth participation; and ascertain whether being present at the birth was a rewarding experience. A quantitative survey was carried out with data collected from York District Hospital Maternity Unit (UK). The participants were a stratified sample of first-time (n= 42) and second-time fathers (n= 36). Measurements and findings: the BPS was issued at two observation points: prior to birth participation and post birth participation. Difference in scores between conditions assessed the fathers' attitudes towards birth participation in a positive or negative direction. Scores post birth showed a small shift in attitude in a positive direction for first-time (p= 0.01) and second-time fathers (p= 0.02) with only 4% finding birth partnering more difficult than they had anticipated. Key conclusions are that midwives are facilitating the majority of fathers towards a positive birth experience. Implications for practice are that the BPS may prove useful for: identifying whether fathers genuinely want to be present at the birth; ascertaining fathers' personal concerns in relation to birth participation; and tailoring birth preparation to meet fathers individualized needs.
... Only five included studies considered mental ill health presentations beyond depression, and none examined mental health beyond the first year postpartum. A body of research is emerging in the field of paternal postpartum PTSD (Bradley et al., 2008;White, 2007). Moreover, alcohol and substance use are important indicators of mental health risk in the early family environment (Benoit and Magnus, 2017;Lee et al., 2009). ...
Background:
Unintended pregnancies are linked to adverse parental mental health, yet little attention has been given to this relationship in fathers specifically. We aimed to meta-analyse associations between unintended pregnancies and mental health problems in fathers with children aged ≤36 months.
Methods:
We conducted keyword searches of Medline, CINAHL, Academic Search Complete, PsycInfo and Embase to February 2, 2022, and hand searched included reference lists.
Results:
Of 2826 records identified, 23 studies (N = 8085 fathers), reporting 29 effects, were eligible for meta-analysis. Included studies assessed depression, anxiety, stress, parenting stress, post-traumatic stress disorder (PTSD), alcohol misuse and psychological distress. Pooled estimates, from random effects meta-analyses, for all mental health outcomes (k = 29; OR = 2.28) and depression only (k = 19; OR = 2.36), showed that the odds of reporting mental health difficulties were >2-fold higher in men reporting unintended births compared with those reporting intended births. However, there was no evidence of association with anxiety (k = 2) or stress (k = 2). Overall, mental health problems were greater in low-income countries. No differences were found across parity, timepoint of mental health assessment, or instruments used to measure mental health symptoms.
Limitations:
Analyses were limited by the use of retrospective assessment of pregnancy intention, and heterogeneity of measures used. Further, assessment of fathers' mental health was restricted to the first year postpartum. This review was limited to English language studies.
Conclusions:
Unintended pregnancies present an identifiable risk for postpartum mental health problems in fathers.
... They were hesitant, explaining the need to process their experience, which could be perceived as trauma. Fathers who have experienced a traumatic birth need professional support to cope with the trauma [30], but the support offered, in the healthcare setting, is primarily directed to the birthing woman [19]. This is also reported by partners to women with other severe complications during pregnancy. ...
Background:
Pre-eclampsia affects 3-5% of all pregnant women and is among the leading causes of maternal morbidity and mortality as well as iatrogenic preterm birth worldwide. Little is known about the experience of partners of women whose pregnancy is complicated by pre-eclampsia.
Aim:
To describe partners' experience of having a spouse whose pregnancy was complicated by pre-eclampsia.
Methods:
A qualitative study with in-depth interviews. Eight partners of women whose pregnancy was complicated by pre-eclampsia were interviewed and data were analysed using content analysis.
Findings:
Partners found themselves in an unfamiliar and unexpected situation. They experienced an information gap in which they tried to make sense of the situation by interpreting subtle signs. The situation left them feeling emotionally stretched, feeling like an outsider while trying to provide support for their extended family. The partners experienced a split focus after the baby was born, prioritising the baby while worrying about their spouse. Post-partum, they expressed needing time to process and heal after childbirth. A need for professional support was highlighted and concerns about a future pregnancy were voiced.
Conclusion:
Having a spouse who is diagnosed with pre-eclampsia is challenging and overwhelming. Our findings imply a need to develop a model of care for women with pre-eclampsia that includes their partner, i.e., the other parent.
... In light of the well-documented consequences of maternal CB-PTSD on family outcomes (e.g., see Cook et al., 2018), it is likely that partner CB-PTSD can also influence parental and child outcomes (Horsch & Stuijfzand, 2019). Paternal CB-PTSD symptoms seem to influence the couple relationship and make a subsequent pregnancy less probable (Garthus-Niegel et al., 2018;White, 2007), while evidence on its impact on the relationship with the infant is inconsistent (Hinton et al., 2014;Stuijfzand et al., 2020). Early detection of CP-PTSD in partners appears fundamental to prevent probable consecutive consequences. ...
Objective:
There is no evidence on the latent structure of symptoms of childbirth-related posttraumatic stress disorder (CB-PTSD) in fathers and to date, no validated French instrument exists to measure CB-PTSD in partners, although the City Birth Trauma Scale (partner version) (City BiTS (P)) was developed to measure such CB-PTSD symptoms. This study aimed to validate the French version of the City BiTS-P (City BiTS-F (P)) in partners attending childbirth and to examine its factor structure, reliability, and validity.
Method:
French-speaking fathers of 1-to-12-month-olds participated in this online cross-sectional survey (n = 280). They completed the City BiTS-F (P), the PTSD Checklist, the Edinburgh Postnatal Depression Scale, and the anxiety subscale of the Hospital Anxiety and Depression Scale, as well as sociodemographic and medical items.
Results:
The four-factor model did not fit well the data, contrary to the two-factor model with birth-related symptoms (BRS) and general symptoms (GS). However, the bifactor model with a general factor and the BRS and GS provided the best fit to the data. High reliability (α = .88-.89), and good convergent and divergent validity were found. Fathers with a history of traumatic childbirth reported higher total and subscale scores.
Discussion:
Our findings provide evidence for the use of the City BiTS-F (P) as a reliable and validated tool to assess CB-PTSD symptoms in French-speaking partners. The use of the total score in addition to the BRS and GS subscale scores is warranted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... Many mothers used the term 'we' to describe what they experienced, and in some instances, spoke on behalf of their partner to describe their shared experience. Existing literature around birth trauma suggests that when partners are interviewed alone, they identify that their experience is not justified, or that it is not 'their story to tell' [25,26] as such, our approach adds a novel perspective to the current birth trauma literature by understanding the systemic couples experience together. ...
Globally, a large proportion of birthing mothers, and a to a lesser extent their partners, experience birth trauma each year, and yet access to adequate post-natal trauma support is rarely available. Untreated birth trauma has been shown to negatively impact the family in terms of the parents’ relationship with one another, and long-term negative consequences for the child. Despite a drive towards integrating mental health support into maternity services and a call to provide mental health support for couples rather than solely the birthing mother, there is little research exploring what birthing couples find helpful in recovery from birth trauma. The current research interviewed six couples using an Interpretative Phenomenological Approach in order to explore their understanding of what supported their recovery from birth trauma. Four themes were identified: ‘We need validation’, ‘Feeling paper thin’, ‘This is a system failure’ and ‘Birth trauma is always going to be a part of you’. The data describes an understanding of parents’ feelings of vulnerability and loss of trust in services to provide support following birth trauma. Further, parents’ need for validation and repositioning of control away from healthcare professionals when considering the availability and knowledge of the support options available is discussed. Clinical implications for supporting parents following birth trauma are explored, including an identified need for trauma informed care communication training for all healthcare professionals involved in maternity care, and the requirement for sources of therapeutic support external from the parent dyad in order to maintain the couples’ interpersonal relationship.
... Partners play a crucial role during pregnancy and in the postpartum period as depression scores of mothers and their partners correlate significantly and are predicted by perceived parenting stress (116). While there is research examining the impact of pregnancy and childbirth on the mental health of partners (7,72,79,96,114), there are few studies addressing the effects of birth complications on partners (117). Future studies should thus aim at including mothers and fathers in such studies. ...
Introduction
Negative effects of impaired postpartum mother-infant-bonding on mental health of mothers, their newborn children and subsequent child development are well documented. Previous research demonstrated an association between a negative birth experience and postpartum mental health affecting postpartum mother-infant bonding. This study investigates the extent to which prepartum depression and birth experience influence the postpartum mental health of mothers and their bonding toward their newborns, and whether these influences differ according to parity and self-reported prior mental health problems.
Method
Three hundred and fifty-four women (18-43 years; M = 30.13, SD = 5.10) filled in the Edinburgh Postnatal Depression Scale (EPDS), the Maternal-Fetal Attachment Scale (MFAS), Salmon's Item List (SIL) assessing the birth experience, and the Postpartum Bonding Questionnaire (PBQ) at pre- and postpartum; they were also asked about birth complications and parity status.
Results
Primipara reported significantly more birth complications ( p = 0.048), with path analysis confirming this result ( p < 0.001). Birth complications were associated with a more negative rating of the overall birth experience ( p < 0.001). Mothers with self-reported prior mental health problems had higher prepartum depression scores ( p < 0.001) but did not differ in other variables from mothers without prior self-reported mental health problems. Differences in depression scores between mothers with self-reported prior mental health problems and those without vanished at postpartum assessment ( p > 0.05). Path-analysis highlighted the key role of postpartum depression, which was the only significant predictor of postpartum impairment in maternal-child bonding ( p < 0.001). Birth experience and prepartum depression scores exerted an indirect effect on postpartum maternal-child bonding, mediated by postpartum depression.
Discussion
The present study demonstrates the relevance of prepartum mental health of expectant mothers, especially of those who self-report prior mental health problems. The results support that reducing mental health problems of pregnant mothers might contribute to a more positive birth experience and potentially reduce postpartum depressive symptoms. As postpartum depression is associated with impaired parent-child bonding, such targeted interventions could promote child development. Group differences between primiparous and multiparous mothers suggest that the birth experience may be an influential factor for postpartum mental health.
... A review of paternal perinatal mental health estimates that approximately 10% of men experience postnatal depression during the perinatal period, moderately positively correlating with maternal depression (Paulson & Bazemore, 2010). Qualitative research with fathers suggest that men prioritise their partners' needs and question the legitimacy of their own perinatal mental health struggles; this leads to a reluctance to seek support and perceived exclusion from support services (Darwin et al., 2017;White, 2007). The emergence of research into paternal mental health has highlighted the need for a paradigm shift to focus on perinatal mental health from a family-perspective (Wong et al., 2016). ...
... Fathers are also vulnerable to post-traumatic stress disorder (PTSD) particularly after traumatic births [57], irrespective of whether their partners or practitioners perceived them to be traumatic. Birth-related PTSD can have long term consequences including resentment of the infant, poor quality emotional relationships, and diminished sexual relationships with their female partners [58]. Fathers who have had preterm infants that required a significant stay in intensive care have also shown signs of post-traumatic stress symptoms [59] which could be related to the fear of losing their partner and/or their infant. ...
Fathers in the UK are becoming more involved in the care of their infants and children. A constructivist grounded theory approach was adopted to explore men’s transition to fatherhood. This paper reports on one of the sub-categories derived from the data. First-time fathers with a child under two were recruited predominantly via social media. Audio-recorded semi-structured interviews were undertaken with an opening question asking men to tell their story of becoming a father. Interviews were transcribed and analysed using constructivist grounded theory methods. This paper reports one core aspect of the research findings which has particular relevance for healthcare professionals. The men in this study were highly appreciative of the care their partner and baby received but consistently reported a lack of father-specific support throughout their journey to fatherhood. This ranged from generally poor communication with healthcare professionals to being ignored and side-lined in maternity settings where they continued to be treated as visitors before, during and after the birth of their baby. Despite similar findings being reported over the last 30 to 40 years and policy directives emphasising the importance of working with fathers, change within healthcare services remains slow. Currently, fathers’ needs are not being adequately met by perinatal services.
... On the other hand, qualitative phenomenological research has been found to be particularly suited to describing these types of experiences. For example, there are a variety of studies on women's and parenting experiences: feelings and fears during obstetric emergencies (Mapp & Hudson, 2005), women's expectations and experiences of childbirth (Gibbins & Thomson, 2001), pain during childbirth (Lundgren & Dahlberg, 1998), and the experience of fathers breaking down from PTSD following the birth of their child (White, 2007). ...
I show some problems with recent discussions within qualitative research that centre around the “authenticity” of phenomenological research methods. I argue that attempts to restrict the scope of the term “phenomenology” via reference to the phenomenological philosophy of Husserl are misguided, because the meaning of the term “phenomenology” is only broadly restricted by etymology. My argument has two prongs: first, via a discussion of Husserl, I show that the canonical phenomenological tradition gives rise to many traits of contemporary qualitative phenomenological theory that are purportedly insufficiently genuine (such as characterisations of phenomenology as “what-its-likeness” and presuppositionless description). Second, I argue that it is not adherence to the theories and methods of prior practitioners such as Husserl that justifies the moniker “phenomenology” anyway. Thus, I show that the extent to which qualitative researchers ought to engage with the theory of philosophical phenomenology or adhere to a particular edict of Husserlian methodology ought to be determined by the fit between subject matter and methodology and conclude that qualitative research methods still qualify as phenomenological if they develop their own set of theoretical terms, traditions, and methods instead of importing them from philosophical phenomenology.
... A review of paternal perinatal mental health estimates that approximately 10% of men experience postnatal depression during the perinatal period, moderately positively correlating with maternal depression (Paulson and Bazemore 2010). Qualitative research with fathers suggest that men prioritise their partners' needs and question the legitimacy of their own perinatal mental health struggles; this leads to a reluctance to seek support and perceived exclusion from support services (Darwin et al. 2017;White 2007). The emergence of research into paternal mental health has highlighted the need for a paradigm shift to focus on perinatal mental health from a family-perspective (Wong et al. 2016). ...
One in five women in the UK develop mental health problems during pregnancy or in the first year after childbirth. 'Birth trauma' is a common birth-related mental health issue which stems from perceiving childbirth as a traumatic experience; the term 'birth trauma' also encompasses living with and experiencing the accompanying symptoms of trauma after childbirth. A mini focus group study was conducted with two experienced perinatal counsellors to discuss their experiences working with parents struggling with birth trauma. Analysis of the focus group revealed five key themes: the complexity of birth trauma; the power of communication; changes in culture; falling through the gaps and coping with trauma. The themes identified reflect previous academic research on parent and clinician experiences of birth trauma as well as national reports aimed at improving maternity care for parents.
... It is unclear, therefore, whether there might be adverse consequences associated with participation. Whilst it is encouraging that studies of PTSD have found that disclosure can be cathartic for participants (White, 2007), further investigation is needed to determine whether this is also the case in moral injury as research. ...
The need for research to advance scientific understanding must be balanced with ensuring the rights and wellbeing of participants are safeguarded, with some research topics posing more ethical quandaries for researchers than others. Moral injury is one such topic. Exposure to potentially morally injurious experiences can lead to significant distress, including post-traumatic stress disorder (PTSD), depression, and selfinjury. In this article, we discuss how the rapid expansion of research in the field of moral injury could threaten the wellbeing, dignity and integrity of participants. We also examine key guidance for carrying out ethically responsible research with participants’ rights to self-determination, confidentiality, non-maleficence and beneficence discussed in relation to the study of moral injury. We describe how investigations of moral injury are likely to pose several challenges for researchers including managing disclosures of potentially illegal acts, the risk of harm that repeated questioning about guilt and shame may pose to participant wellbeing in longitudinal studies, as well as the possible negative impact of exposure to vicarious trauma on researchers themselves. Finally, we offer several practical recommendations that researchers, research ethics committees and other regulatory bodies can take to protect participant rights, maximise the potential benefits of research outputs and ensure the field continues to expand in an ethically responsible way.
... Globally, antenatal education has focused on women; and recently male involvement in maternal health services including antenatal education has been advocated [6][7][8][9][10]. This argument is supported by the rationale that men are likely to participate in maternal and child health issues and fulfill their supportive roles as husbands and partners if they are knowledgeable about pregnancy, childbirth and early parenting. ...
Background
Despite advocating for male involvement in antenatal education, there is unmet need for antenatal education information for expectant couples. The objective of this study was to gain a deeper understanding of the education content for couples during antenatal education sessions in Malawi. This is needed for the development of a tailor-made curriculum for couple antenatal education in the country, later to be tested for acceptability, feasibility and effectiveness.
Methods
An exploratory cross sectional descriptive study using a qualitative approach was conducted in semi-urban areas of Blantyre District in Malawi from February to August 2016. We conducted four focus group discussions (FGDs) among men and women independently. We also conducted one focus group discussion with nurses/ midwives, 13 key informant interviews whose participants were drawn from both health-related and non-health related institutions; 10 in-depth interviews with couples and 10 separate in-depth interviews with men who had attended antenatal clinics before with their spouses. All the interviews were audiotaped, transcribed verbatim and translated from Chichewa, the local language, into English. We managed data with NVivo 10.0 and used the thematic content approach as a guide for analysis.
Results
We identified one overarching theme: couple antenatal education information needs. The theme had three subthemes which were identified based on the three domains of the maternity cycle which are pregnancy, labour and delivery and postpartum period. Preferred topics were; description of pregnancy, care of pregnant women, role of men during perinatal period, family life birth preparedness and complication readiness plan, coitus during pregnancy and after delivery, childbirth and baby care.
Conclusion
Antenatal education is a potential platform to disseminate information and discuss with male partners the childbearing period and early parenting. Hence, if both men and women were to participate in antenatal education, their information needs should be prioritized. Men and women had similar choices of topics to be taught during couple antenatal education, with some minor variations.
Electronic supplementary material
The online version of this article (10.1186/s12884-018-2137-y) contains supplementary material, which is available to authorized users.
... When fathers view childbirth as negative or traumatic, there is a risk of developing postpartum mental health problems ( Poote and McKenzie-McHarg, 2015;Skari et al., 2002 ), which might also lead to impairment of his partner ( Iles et al., 2011;White, 2007 ) and impairment of the newborn child ( Poote and McKenzie-McHarg, 2015 ). Therefore, similar to previous research ( Singley and Edwards, 2015 ), the current study argues that since fathers can also suffer from maternity-related poor psychological ill-health, the care chain should also provide them with social support. ...
Background: Fathers’ attendance during pregnancy and childbirth has increased in recent decades. During childbirth, complications may occur that may put the woman and/or child in danger. To experience such situations may be traumatic for the father, as well as may increase his risk of childbirth-related mental illness during the postpartum period.
Aim: The aim of this literature review was to describe expectant fathers’ experiences of complications during childbirth.
Method: We undertook a systematic literature review and meta-ethnography, where 10 articles were included. The search was conducted using the databases PubMed, CINAHL, PsychInfo and Medline with keywords and Boolean terms regarding fathers and birth complications.
Results: All included articles except one were qualitative. Eight articles were from high-income coun- tries, while two were from a low-income country. The synthesis generated three overall themes Medical professional-father communication, An Emotional Journey and The Physical Environment with associated categories.
Conclusion: When unpredictable birth complications arise, fathers may need additional social support. Child health professionals should reconsider how they support fathers, especially during complicated births, as a lack of support may lead to poor psychological mental health, feelings of exclusion and negative birth experiences. Greater effort s should be made to change medical professionals’ attitudes and behaviors toward fathers so that they can better support their partner and have a more positive birth experience.
... Sin embargo, existe muy poca literatura actual que demuestre beneficios directos sobre el padre derivado de su experiencia personal como "actor". Lo existente, apunta a experiencias difíciles y adversas para los varones (8,9). Asimismo, lo que se reporta desde la perspectiva de los profesionales de salud, revela escasa consideración y valoración del rol que puede asumir el padre durante el nacimiento (10,11). ...
Objetivo:
recoger la información y comprender el significado atribuido a la presencia activa del padre durante el proceso de nacimiento desde la perspectiva de los padres y las madres.
Método:
a través de una metodología de naturaleza cualitativa, fueron analizados 85 testimonios escritos y tres entrevistas abiertas de parejas que vivieron la experiencia del nacimiento en la modalidad MASIP, en un área del sistema público de Santiago. Se utilizó análisis temático, a través de codificación abierta para caracterizar la participación de los padres en el nacimiento.
Resultados:
los tres grandes temas que emergieron de los relatos dan cuenta de la forma que tienen los padres de vivir el proceso: rol co-participativo con la mujer; rol al servicio de la mujer; y el rol personal paterno.
Conclusiones:
Los escenarios de asistencia integral del nacimiento deben considerar estrategias de promoción de inclusión y participación activa de los padres en beneficio de una experiencia saludable y positiva.
... However, the effect was removed once existing depressive symptoms were controlled for (Greenhalgh et al., 2000). Similar findings with relation to pre-existing vulnerabilities were evident in men who reported psychological and sexual scarring after watching their partner give birth (White, 2007). ...
... Women seek to have one or more supporters, with evidence indicating that cooperative supporters are beneficial to laboring women (Bruggemann, Parpinelli, Osis, Cecatti, & Carvalhinho Neto, 2007), especially with continuous presence (Hodnett, Gates, Hofmeyr, & Sakala, 2013). However, supporters, especially fathers, tend to be confused about their role and experience increased feelings of vulnerability (Dellmann, 2004;Johansson, Fenwick, & Premberg, 2015) and stress during (Bartels, 1999), and sometimes after labor (White, 2007). ...
... Studies of male partners show high levels of comorbidity within couples and men's PTSD FC responses may affect the mental health of their partner . Men also report PTSD FC responses (Stramrood et al., 2013;White, 2007), but evidence of the scope of these is mixed (Bradley, Slade, & Leviston, 2008). Similarly, the impact of PTSD FC on the parent-baby relationship is not clear cut. ...
... Additionally, men and women can hear information in different ways or have different preferences for information delivery or content (Buist et al. 2003). Separate antenatal classes aimed at fathers have been viewed as beneficial (White 2007). Involving and supporting fathers in breastfeeding by health professional is also part of the broader and international policy trend of 'involved fatherhood', which seeks to involve fathers in all aspects of their baby's/child's health and well-being. ...
Increasing breastfeeding rates is a strategic priority in the UK and understanding the factors that promote and encourage breastfeeding is critical to achieving this. It is established that women who have strong social support from their partner are more likely to initiate and continue breastfeeding. However, little research has explored the fathers' role in breastfeeding support and more importantly, the information and guidance he may need. In the current study, 117 men whose partner had given birth in the previous 2 years and initiated breastfeeding at birth completed an open-ended questionnaire exploring their experiences of breastfeeding, the information and support they received and their ideas for future breastfeeding education and promotion aimed at fathers and families. Overall, the findings showed that fathers were encouraging of breastfeeding and wanted to be able to support their partner. However, they often felt left out of the breastfeeding relationships and helpless to support their partner at this time. Many reported being excluded from antenatal breastfeeding education or being considered unimportant in post-natal support. Men wanted more information about breastfeeding to be directed towards them alongside ideas about how they could practically support their partner. The importance of support mechanisms for themselves during this time was also raised. The results highlight the need for health professionals to direct support and information towards fathers as well as the mother–infant dyad and to recognise their importance in promoting and enabling breastfeeding.
Background:
Ongoing distress following a traumatic birth experience, commonly known as birth trauma, can lead to post-traumatic stress symptoms. Experiencing birth trauma can affect personal well-being and impact the couple relationship.
Objective:
The present study aimed to explore the lived experience of the impact of birth trauma on the couple relationship and related support requirements.
Methods:
A purposive sample of men and women in the UK who had experienced birth as traumatic were recruited and interviewed remotely in 2021. Data were analysed using framework analysis in NVivo 12.
Results:
The sample (N=18) contained 9 women who were first time parents and 9 men; 5 of which were first time parents and 4 who had two children. Twelve themes are reported related to the impact of birth trauma on the couple relationship. Findings suggest the impact of birth trauma on the couple relationship can be negative and distressing, or for some lead to a strengthened relationship. Fourteen themes are reported related to associated birth trauma support. Negative aspects of support were reported in themes: unavailability of help from friends and family; unhelpful birth debriefing services; no personal awareness of birth trauma; absence of trauma validation from health care professionals; lack of awareness of the emotional needs of men; and barriers to accessing psychological services. Potential improvements to support included: supporting parents to understand the traumatic events; birth trauma informed antenatal preparation; improving access to specialist psychological services; and compassionate parent centred maternity services.
Conclusions:
The impact of birth trauma on the couple relationship appears complex with both positive and negative affects reported. Current support for the impact of birth trauma on the couple relationship has perceived inadequacies for which improvements are proposed.
Doğum, kadının hayatında güçlü psikolojik etkilere sahip önemli bir olay olarak kabul edilmekte ve doğum süreci her kadın ve ailesi tarafından içinde bulundukları kültürel özellikler doğrultusunda farklı deneyimlenmektedir. Bu süreçte özellikle ailenin iyilik halinin korunması için travmatik doğumla ilgili faktörlerin belirlenmesi ve sonuçlarının çözümlenmesi son derece önemlidir. Doğum anne için travmatik olabildiği gibi, anne veya bebeğin tehlikede olduğunu algıladığında baba için de potansiyel olarak travmatik yaşanabilmektedir. Ancak doğumda daha çok annenin yaşadığı deneyimlere odaklanılırken babanın ruh sağlığı göz ardı edilebilmektedir. Bu bağlamda yapılan derleme çalışmasının amacı, travmatik doğumla ilgili babaların deneyimlerini araştıran çalışmaları inceleyerek babaların doğumu travmatik olarak algılama nedenleri ve travmatik doğuma yaklaşımlarını ortaya koymaktır. Ayrıca doğumun babalar için nasıl daha az travmatik olabileceği ile ilgili uygulamaları sağlık profesyonellerinin rolleri çerçevesinde tartışmaktır.
The transition to fatherhood has been described as a physical, emotional, psychological and spiritual journey. Nevertheless, it has been acknowledged that fatherhood is a somewhat neglected concept within society, with its importance often being overlooked. The involvement of fathers in the parenthood journey has long-term social and economic benefits not only for themselves and their families but also for society at large. Despite this, men have reported feeling as though society does not attribute the same importance to new fatherhood as it does to motherhood, even though many men become fathers. Research has highlighted how new fatherhood presents itself with many contradictions as most men struggle with the idea of their expanding roles and their changed lifeworlds. Indeed, many men have described new fatherhood as being a difficult experience, one that requires endurance and patience. Many men have also reported feeling excluded within maternity settings by the professionals they encounter. This has implications for men’s mental health and well-being and for midwifery practice. Nevertheless, the midwife has been identified as a key supportive figure who can help men traverse the transition to fatherhood.
Globally, a large proportion of birthing mothers, and a to a lesser extent their partners, experience birth trauma each year, and yet access to adequate post-natal trauma support is rarely available. Untreated birth trauma has been shown to negatively impact the family in terms of the parents’ relationship with one another, and long-term negative consequences for the child. Despite a drive towards integrating mental health support into maternity services and a call to provide mental health support for couples rather than solely the birthing mother, there is little research exploring what birthing couples find helpful in recovery from birth trauma. The current research interviewed six couples using an Interpretative Phenomenological Approach in order to explore their understanding of what supported their recovery from birth trauma. Four themes were identified: ‘We need validation’, ‘Feeling paper thin’, ‘This is a system failure’ and ‘Birth trauma is always going to be a part of you’. The data describes an understanding of parents’ feelings of vulnerability and loss of trust in services to provide support following birth trauma. Further, parents’ need for validation and repositioning of control away from healthcare professionals when considering the availability and knowledge of the support options available is discussed. Clinical implications for supporting parents following birth trauma are explored, including an identified need for trauma informed care communication training for all healthcare professionals involved in maternity care, and the requirement for sources of therapeutic support external from the parent dyad in order to maintain the couples’ interpersonal relationship.
How fathers cope with stress may be critical to their mental health during the perinatal period. Using a sequential explanatory design for systematic review and meta-analysis, we aimed to identify associations and causal relations between higher- and lower-order avoidant and approach coping strategies and paternal psychopathology. We searched five electronic databases and grey literature, and used random-effects models to calculate pooled effects from 11 quantitative studies. Meta-analytic results were integrated with findings from 18 qualitative studies. Fathers' avoidant coping was positively associated with global psychopathology and depression. Approach-oriented coping, particularly problem-solving, was associated with positive affect but not psychopathology. Qualitative findings indicate distressed fathers employ avoidant coping strategies such as suppression, distraction, and social withdrawal. Approach-oriented coping strategies such as problem-solving and cognitive reappraisals appeared to be constructive components of men's coping repertoires supporting adaptation to fatherhood. Different coping strategies and approaches may reflect enactment of constrictive, moderate, or reinterpreted masculine norms. Study designs did not allow conclusions about causal relations between coping and psychopathology. Screening for, and targeting of, high avoidant coping among expectant and new fathers may help detect men at risk of or experiencing mental health difficulties and inform clinical response to psychopathology. Research examining whether different patterns of avoidant and approach coping are associated with psychopathology over time could inform interventions to support men's mental health and adaptation to fatherhood.
Research suggests that some fathers and birth partners can experience post-traumatic stress disorder (PTSD) after witnessing a traumatic birth. Birth-related PTSD may impact on many aspects of fathers’ and birth partners’ life, including relationship breakdown, self-blame and reducing plans for future children. Despite the potential impact on birth partners’ lives there is currently no measure of birth-related PTSD validated for use with birth partners. The current study therefore adapted the City Birth Trauma Scale for use with birth partners. The City Birth Trauma Scale (Partner version) is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (G), and exclusion criteria or other causes (H). A sample of 301 fathers/birth partners was recruited online and completed measures of birth-related PTSD, bonding, and demographic details. Results showed the City Birth Trauma Scale (Partner version) had good reliability (α = 0.94) and psychometric and construct validity. The fathers/birth partners version has the same two-factor structure as the original scale: (1) general symptoms and (2) birth-related symptoms, which accounted for 51% of the variance. PTSD symptoms were associated with preterm birth and maternal and infant complications. Overall, the City Birth Trauma Scale (Partner version) provides a promising measure of PTSD following childbirth that can be used in research and clinical practice.
Centred on their concept ‘repertoires of illegitimacy’, this chapter outlines Hodkinson and Das’ framework for understanding fathers’ difficulties coming to terms with perinatal mental illness and the ways digital engagement might offer possibilities to help address what they’re going through. Drawing on theories of masculinity and understandings of the experience of having a baby, the authors outline how the biographical disruptions that can accompany new fathers’ journeys can combine with their being positioned as marginal, yet stoic supporters, leading to difficulties recognising their mental health struggles as legitimate. The chapter draws on work on mediated intimacies, communicative agency, self-disclosure and digital dis/engagement to outline how different forms of online engagement may provide opportunities for fleeting, yet significant expression of agency.
In this chapter, Hodkinson and Das outline the mental health difficulties experienced by fathers in their study, the circumstances that contributed to them and the barriers fathers faced in coming to terms with and seeking support for their struggles. At the centre of the chapter’s findings are the ways in which fathers’ lack of preparation for having a baby and their positioning as peripheral yet stoic supporters of their partners had made it difficult for them to understand their feelings as legitimate or deserving support. The chapter demonstrates with evidence how these internal repertoires of illegitimacy led to spirals of guilt and made it particularly challenging for the fathers to communicate about and seek support for their difficulties.
Birth satisfaction impacts on a man’s adjustment to his new role as father. Fathers have been found to have needs similar to those of mothers during pregnancy and childbirth. Research suggests that these needs may not be being met for first-time fathers. In a quantitative survey, fathers’ birth satisfaction was similar to mothers. This study then used a phenomenological form of thematic analysis to gain an insight into the birth experiences of 155 first-time New Zealand fathers. Core themes included safety of mother and baby, understanding support role, mother in control and managing pain and care and communication after birth. Fathers commented on what impacted on their childbirth experiences and in so doing outlined their needs for a positive experience. Fathers experienced a high level of satisfaction along with a need to be involved and included.
Previous research on pregnancy and birth from the perspective of men has found that men approach them from the perspective of hegemonic masculinity, though many find that hospital birth is a time of potential ‘failure’ at masculinity. In this qualitative study of eleven men who had children born at home, I find that, like their hospital-birth counterparts, they find roles in their partners’ pregnancies and early labors that are congruent with hegemonic masculinity. In ways that converge and diverge with the experience of hospital-birth fathers, they find their masculinity disrupted as the birth approaches, becoming nurturers and servers rather than technicians and protectors. These acts shift them from the masculinity of a young man to that of a father. This is consonant with Connell's theory that masculinity is not singular, but shifts situationally and across the life course, and Butler's theory that gender is constructed through acts. This article is protected by copyright. All rights reserved
Objective:
the objective behind the current study was to explore the experiences and perceptions of fathers after childbirth trauma, an area of minimal research. This is part two of a two-part series conducted in 2014 researching the mental health of fathers after experiencing a perceived traumatic childbirth.
Design:
qualitative methodology using semi-structured interviews and reporting of qualitative questions administered in part one's online survey (Inglis, 2014).
Setting:
interviews conducted face-to-face at an Australian University or on Skype.
Participants:
sixty-nine responded to the online qualitative questions and of these seven were interviewed.
Measurements:
thematic analysis of verbal and written qualitative responses.
Findings:
thematic analysis of qualitative survey data and interviews found a global theme 'standing on the sideline' which encompassed two major themes of witnessing trauma: unknown territory, and the aftermath: dealing with it, and respective subthemes.
Key conclusions:
according to the perceptions and experiences of the fathers, there was a significant lack of communication between birthing teams and fathers, and fathers experienced a sense of marginalisation before, during, and after the traumatic childbirth. The findings of this study suggest that these factors contributed to the perception of trauma in the current sample. Whilst many fathers reported the negative impact of the traumatic birth on themselves and their relationships, some reported post-traumatic growth from the experience and others identified friends and family as a valuable source of support.
Implications for practice:
improved communication between midwifery staff and fathers before, during and after childbirth may reduce the rates of paternal postpartum mental health difficulties and experiences of trauma.
The intimate and sexual dimension of future and new parenting couples' relationship is the most affected and the most vulnerable during the transition to parenthood. The purpose of this scoping review is to present the portrait of perinatal sexuality through 123 empirical articles published in the last 15 years. This second article in a series of two is about sexuality during labor and birth, during the postpartum, and in relation to breastfeeding. A total of 29 sexual variables were analyzed. Sexuality during the intrapartal and postnatal periods is very diversified. Some recurring items, however, can be identified: a period of non-sexuality in the first postnatal months, followed by a gradual return of sexuality from 3 to 6 months postpartum and continuing until 12 months or more. Sexuality during the intrapartum is considered taboo and couples' experiences can be at opposite ends: some couples' experiences are sensual and erotic during childbirth, while others experience birth trauma with a negative sexual impact postnatally. Sexuality during breastfeeding is also taboo with a negative impact on women's sexuality. In all of these circumstances, women's and men's sexuality are affected and a multitude of simultaneous physiological and psychological factors affect their experiences. Fluctuations in the intimate and sexual dimensions of the conjugal relationship are considered as a natural phenomenon but temporary. Sexoperinatal interventions should be part of holistic perinatal health care in order to help couples maintain a positive intimate and sexual relationship.
Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Objective: To explore inhibiting and facilitating design factors influencing childbirth supporters’ experiences.
Background: Birthing women benefit from the continuous, cooperative presence of supporters. However, little research has investigated how birth room design facilitates or inhibits supporters’ role navigation.
Methods: We conducted an exploratory video ethnographic single case study of childbirth supporters’ experiences, within an Australian hospital birth environment. Video, field notes, and video-cued reflexive interviews with the woman, her midwives, and supporters were thematically analyzed using ethnographic/symbolic interactionist perspectives to frame supporters’ understandings.
Results: Findings suggest supporters’ experiences are complex, made more complicated by sparse understanding or accommodation of their needs in the built environment. Supporters’ presence and roles are not facilitated by the physical space; they experience “an unbelonging paradox” of being needed, yet uncertain and “in the way” during “tenuous nest-building” activities.
Conclusions: Suggested design guidelines to facilitate supporters’ well-being and their roles in designed hospital birth spaces are provided.
Postpartum depression has become a more recognized mental illness over the past decade as a result of education and increased awareness. Traumatic childbirth, however, is still often overlooked, resulting in a scarcity of information for health professionals. This is in spite of up to 34% of new mothers reporting experiencing a traumatic childbirth and prevalence rates rising for high risk mothers, such as those who experience stillbirth or who had very low birth weight infants.
PurposeThe presence of husbands at childbirth has been widely accepted in Japan. However, the negative effects of attending childbirth on husbands can include mental health disorders such as symptoms of PTSD, anxiety, and depression. The purpose of this study was to explore husbands' experiences and feelings with attending their partners' childbirths and to describe the transformation process of their feelings before, during, and after childbirth.Methods
Semi-structured interviews were conducted by a male interviewer. Fourteen Japanese men who had attended their wives' childbirths at two maternal hospitals within the past three months were recruited. Ten agreed to be interviewed and participated in the study from October 2011 to January 2012. Data were collected using an ethnographic approach called the Rapid Assessment Process. Interviews were approximately 90-120 minutes long and were conducted in person at a time and location convenient for participants. Two researchers independently analyzed the qualitative data using content analysis to identify categories and sub-categories of husbands' experiences and feelings before, during, and after attending childbirth.ResultsSeven of ten participants were attending childbirth for the first time. All participants attended the vaginal delivery from the first stage until the end of labor. Five categories consisting of 12 sub-categories emerged as descriptions of the husbands' experiences and feelings: "Wanted to support my wife," "Concerns about unknown world," "Overcame a problem with my wife," "Noticed the differences between men and women," and "Grew up." Two factors—"Responses of the medical staff" and "Appreciation from my wife"—affected the experiences and feelings of the husbands regarding attending childbirth. Furthermore, their feelings shifted as time passed. Specifically, "Wanted to support my wife" was apparent in husbands' feelings and actions during their wives' pregnancy. Categories that were salient during labor were "Concerns about unknown world," "Overcame the problem faced with my wife," and "Noticed the differences between men and women." Finally, "Grew up" was a common theme during the postpartum period. It was demonstrated that experiences and feelings were different between men who had and those who had not attended childbirth previously. Data from four subcategories, including "A feeling of powerlessness" and "Discover a new world," were not extracted from participants who had already attended childbirth.Conclusion
Husbands' feelings regarding attending childbirth were transformed before, during, and after childbirth. The present findings might help caregivers to better understand husbands' feelings and anxieties, which could facilitate husband involvement in childbirth. Health care providers should incorporate this process in working with husbands involved in childbirth to help husbands as well as childbearing women have a satisfactory childbirth experience.
Midwives have been criticised for neglecting the expectations and needs of fathers. They either ignore the fathers or pressure them into becoming more involved than they would choose, if allowed to provide support to the mothers during labour. Whilst midwives are providing woman-centred care, it is important that they remember to involve the fathers in decision-making and to acknowledge their role, expectations and needs, because the birth of a child is one of the most important events in a person's lifetime. This study focused on fathers' expectations of the care provided to mothers by the midwives during labour. A qualitative, explorative, descriptive and contextual study design was utilised. In-depth qualitative interviews were conducted with fathers about the care provided to their partners or wives by midwives. Data were then analysed with an open descriptive method of coding that is appropriate for qualitative research. The results of the interviews were subsequently positioned within a holistic health-promotive nursing theory that encompassed body, mind and spirit. The results revealed that fathers saw the provision of comfort and support as the two main aspects for mothers in labour that they expected from midwives. The findings were that midwives should improve their communication skills with the mothers, as well as with the fathers if they are available. Fathers expected midwives to encourage them to accompany the mother during labour and to facilitate bonding between father, mother and baby. The results of this study should assist midwives to provide holistic quality care to mothers and fathers during labour.
From the 1950s the Parents' Centre, a new consumer group in New Zealand, included amongst its goals the right for men to accompany
their wives into maternity hospitals at childbirth. This campaign was eventually successful; fathers' presence at childbirth
became the norm and hospital spaces changed significantly to accommodate these new demands. This article explores the reasons
for that social change, including ideas in the 1950s about the psychological benefits to the family of men's attendance, and
the influence of the women's and consumer movements of the 1970s. It then examines attitudes to the changes among health professionals
as well as men and women themselves, and explores whether, once men's attendance had become the norm, the reality met expectations.
A systematic review of the literature was undertaken to explore fathers' opinions and views on antenatal education and its effectiveness in preparing them for their role as birth partners and for parenthood. The findings are categorised under four key themes: outnumbered, excluded, anxious and uncertain, and preparedness. While research suggests that most fathers want to support their partners and be involved in the pregnancy, labour and birth of their baby, they are less likely to attend antenatal classes than women. While fathers who attend antenatal education classes value them, their experiences are not always as positive or helpful in preparing them for their role as birth partners or in parenthood. It was highlighted that men are more likely to feel unprepared when complications at birth arise. A common finding was that men would welcome the opportunity to focus on their individual needs.
Objective: This paper aimed to report the current status of research in the field of post-traumatic stress disorder following childbirth (PTSD FC), and to update the findings of an earlier 2008 paper. Background: A group of international researchers, clinicians and service users met in 2006 to establish the state of clinical and academic knowledge relating to PTSD FC. A paper identified four key areas of research knowledge at that time. Methods: Fourteen clinicians and researchers met in Oxford, UK to update the previously published paper relating to PTSD FC. The first part of the meeting focused on updating the four key areas identified previously, and the second part on discussing new and emerging areas of research within the field. Results: A number of advances have been made in research within the area of PTSD FC. Prevalence is well established within mothers, several intervention studies have been published, and there is growing interest in new areas: staff and pathways; prevention and early intervention; impact on families and children; special populations; and post-traumatic growth. Conclusion: Despite progress, significant gaps remain within the PTSD FC knowledge base. Further research continues to be needed across all areas identified in 2006, and five areas were identified which can be seen as ‘new and emerging’. All of these new areas require further extensive research. Relatively little is still known about PTSD FC.
This article details the use of Phenomenology as a research method which is to fully describe a person's lived experience of an event or experience. It stresses that only those that have experienced phenomena can communicate them to the outside world. It therefore provides an understanding of an experience from those who have lived it. The two schools of phenomenology which are described are utilized in both midwifery and nursing research. These are Husserlian and Heideggerian (Hermeneutics) phenomenology. The main focus in this article, however, is on the Husserlian approach, its background, data collection, data analysis methods and its application to midwifery research.
There has been discussion about the possible occurrence of post-traumatic stress disorder (PTSD) in mothers after difficult childbirth.
Four cases with a symptom profile suggestive of PTSD commencing within 48 hours of childbirth are presented.
The PTSD was in each case associated with the delivery. In each case, there was an associated depressive illness. All four had persistent disorders, and two had difficulties with mother/infant attachment.
As confirmed by other reports, the prevalence of PTSD associated with childbirth is a matter of concern.
Recent research suggests that a proportion of women may develop posttraumatic stress disorder after birth. Research has not yet addressed the possibility that postpartum symptoms could be a continuation of the disorder in pregnancy. This study aimed to test the idea that some women develop posttraumatic stress disorder as a result of childbirth, and to provide an estimate of the incidence using a prospective design, which controls for the disorder in pregnancy. Method: This prospective study assessed 289 women at three time points: 36 weeks gestation and 6 weeks and 6 months postpartum. The prevalence of posttraumatic stress disorder was assessed by questionnaire at each time point, and the incidence was examined after removing women who had severe symptoms of posttraumatic stress disorder or clinical depression in pregnancy.
After removing women at the first time point, 2.8 percent of women fulfilled criteria for the disorder at 6 weeks postpartum and this decreased to 1.5 percent at 6 months postpartum.
The results suggest that at least 1.5 percent of women may develop chronic posttraumatic stress disorder as a result of childbirth. It is important to increase awareness about the disorder and to give health professionals access to simple screening tools. Intervention is possible at several levels, but further research is needed to guide this intervention.
Approximately 1 in 200 UK pregnancies ends in stillbirth. Although serious psychological effects of stillbirth on mothers are well established, much less is known about the impact of such loss on fathers.
To assess the psychological morbidity of fathers in the pregnancy and post-partum year subsequent to a stillbirth, to test within-couple effects and to identify risk factors.
This was a community-based cohort study of 38 pregnant couples whose previous pregnancy had ended in stillbirth, and 38 pair-matched controls. Psychological assessments took place antenatally and at 6 weeks, 6 months and 1 year postnatally.
Fathers in the index group experienced significant levels of anxiety and post-traumatic stress disorder antenatally, but all of their symptoms remitted postnatally (after the birth of a live baby). Fathers' symptom levels were lower than those of mothers at all time points. In contrast to mothers, fathers experienced greater anxiety when a subsequent pregnancy (following stillbirth) was delayed.
The vulnerability of fathers to psychological distress during the pregnancy after a stillbirth needs to be recognised.
It is now common practice, in the United Kingdom, that the father is present at the birth of his child. In fact this is only a relatively recent phenomenon, which has happened over the last thirty years; the father's presence is now so normal as to be expected (Blackshaw, 2003), which must put pressure on those men who would otherwise choose not to attend (Chan and Paterson-Brown, 2002). However, the fathers’ role in the labour room has never really been defined, and while some men find it enlightening and exciting it has been mooted that others may find it distressing and distasteful.
Childbirth can be a primary trigger for post-traumatic stress disorder or retraumatize survivors of previous stress. This article aims to increase midwives' understanding of this disorder, particularly in relation to the perinatal period, so that they can respond appropriately when caring for these women.
500 women volunteers took part in a study about the psychological stress associated with obstetric and gynaecological procedures. The sample was recruited by advertisements in local and national newspapers and in women's magazines and newsletters. Women completed a preliminary questionnaire on their experiences of obstetric and gynaecological procedures, their biographical data, and their feelings associated with the procedures both at the time and now. Out of the 500 subjects, over 100 women gave an history of an obstetric and for gynaecological procedure which was ‘very distressing’ or ‘terrifying’, which was ‘out of the ordinary’ and which occurred ‘more than one month previously’. These women were sent follow-up PTSD-I questionnaires and 30 of them fulfilled the DSM-111-R criteria for a diagnosis of post-traumatic stress disorder (PTSD). Significant differences between the 30 women with PTSD, and 30 respondents who rated their experiences from ‘very good’ to ‘slightly distressing’, were found on a range of findings, including feelings of powerlessness during the procedures, lack of information given to the patient, the experience of physical pain, a perceived unsympathetic attitude on the part of the examiner, and a lack of clearly-understood consent by the patient for the procedure. The results are discussed in relation to the literature on women's emotional reactions to the childbirth process and also to sexual violence and other causes of PTSD. The present findings suggest a cause of PTSD not previously described and challenge current medical working practices in the area of obstetrics and gynaecology.
The prevalence of having a posttraumatic stress disorder (PTSD) profile after childbirth and women's cognitive appraisal of the childbirth were studied cross sectionally in an unselected sample of all women who had given birth over a 1-year period in Linköping, Sweden. The PTSD profile was assessed by means of Traumatic Event Scale (TES), which is based on diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994). The women's cognitive appraisal of the childbirth was measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Twenty-eight women (1.7%) of 1640 met criteria for a PTSD profile related to the recent delivery. A PTSD profile was related to a history of having received psychiatric/psychological counseling, a negative cognitive appraisal of the past delivery, nulliparity, and rating the contact with delivery staff in negative terms.
To describe how fathers who are present during childbirth experience the event, what they feel during childbirth and how they understand the meaning of childbirth.
Survey using questionnaire.
Maternity unit in Finland.
A non-random sample of fathers (n = 137) who were present at the birth of their baby at one university hospital in Finland. The response rate was 81% (n = 107).
Young fathers and those expecting their first baby reported feeling uncomfortable during delivery more frequently than others. Almost all said that they had plenty of good experiences, younger fathers more so than older fathers. The fathers expressed their confidence in the staff and described the environment at the hospital as pleasant. They said their presence at delivery was important for their growth into fatherhood. The best experience was the moment that the baby entered the world. The hardest things were the pain experienced by their partner and being unable to help. Most of the fathers were very pleased with current midwifery practices followed in childbirth, however, it was felt that more attention ought to be paid to pain relief and to supporting and providing guidance to the father during delivery.
The work of midwives should be planned so that fathers can feel secure and comfortable. Further studies are needed into the ability of midwives to support fathers in their fatherhood.
To discover the expectations and experiences of childbirth preparation and childbirth of Swedish men in order to contribute to a basis of reflections in the midwifery profession.
Three tape-recorded interviews were performed: before and after childbirth preparation, and between one and three weeks after the baby was born.
Swedish maternity care.
Eleven men who participated with their partners in antenatal classes.
The interviews were analysed in several steps and included co-assessments by co-workers. Finally, an interpretation based on the concept 'vital involvement' was undertaken. Indications of vital involvement as well as various levels of involvement or distance were found. The participation in childbirth was more demanding than expected for the eleven men. They felt unprepared for an unpredictable process, the experience of time and pain, the woman's action, and their own reactions. The men who were regarded by the authors as vitally involved seemed to manage overwhelming feelings of helplessness during childbirth, to support the women, and experience the meeting with the baby positively.
It seems important for midwives to meet men individually, design childbirth preparation from men's perspective, follow up interpretations of the content, discuss expectations with regard to the men's role, and assess their experiences during the birth process.
To identify the prevalence and potential predictors of post-traumatic stress type symptoms following labour.
A large sample, within-participants design with initial assessment and postal follow-up was utilized.
Two hundred and sixty-four women who had 'normal' births were assessed within 72 hours on potential predictive measures and at 6 weeks post-partum for levels of symptoms of intrusions, avoidance and hyperarousal on a questionnaire derived from DSM-IV (American Psychiatric Association, 1994) criteria. Symptoms of depression and anxiety were also assessed.
Three per cent showed questionnaire responses suggesting clinically significant levels on all three post-traumatic stress dimensions and a further 24% on at least one of these dimensions. Forward stepwise regression analysis yielded models for predicting outcome variables. Perceptions of low levels of support from partner and staff, patterns of blame and low perceived control in labour were found to be particularly related to experience of post-traumatic stress symptoms. Personal vulnerability factors such as previous mental health difficulties and trait anxiety were also related to such symptoms as well as being relevant predictors for anxiety and depression.
A proportion of women reports all three aspects of post-traumatic stress type symptoms following childbirth with many more reporting some components. A broader conceptualization of post-partum distress which takes account of the impact of labour is required. There may be opportunities for prevention through providing care in labour that enhances perceptions of control and support.
Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder in women as a result of their labor and birth experiences, and to identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Telephone interviews with 499 participants were conducted at 4 to 6 weeks postpartum to explore the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms.
One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder. Antenatal variables did not contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (beta = 0.351, p < 0.0001) and the perception of inadequate intrapartum care (beta = 0.319, p < 0.0001) during labor were consistently associated with the development of acute trauma symptoms.
Posttraumatic stress disorder after childbirth is a poorly recognized phenomenon. Women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. These findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the care provided to birthing women.
To investigate the functional status of new fathers.
A descriptive, correlational study.
A variety of postnatal services within one regional center in New South Wales, Australia.
One hundred twenty-eight men who had fathered a healthy infant born at or near term, both first-time fathers and men adding to their existing families, who could read and write English.
Fathers were surveyed at 6 weeks postpartum using the Inventory of Functional Status-Fathers.
Paternal age, number of children, and satisfaction with fatherhood were identified as correlates of functional status. An inverse relationship was noted between the number of children and satisfaction with fatherhood.
Although most fathers maintained their level of participation in household and family activities postpartum, few increased their involvement in response to the birth of their child. Practitioners should encourage expectant parents to actively negotiate the division of household labor and the sharing of infant and child care responsibilities before the birth of their newborn.
This study aims to investigate fathers' experiences of labour and delivery and compare their emotions from different types of delivery. One hundred and twenty-one couples were given questionnaires following the delivery of their babies after labour before discharge from the hospital where they were required to rate their feelings on a visual analogue scale. Generally, fathers were keen to accompany their partners during labour, with 81% giving a score of 9 or above. Most of them found the experience rewarding and enjoyable, but they found operative delivery more traumatic compared to normal vaginal delivery (P=0.003 for caesarean section and P=0.032 for instrumental delivery) and expressed increased anxiety at caesarean sections in labour (P=0.005). Women underestimated their partners' positive experiences during labour and found them more helpful than their partners had felt. Both partners felt their relationships with each other had improved following their shared experiences irrespective of mode of delivery.
The clinician manages trauma patients in the emergency room, operation theatre, intensive care unit and trauma ward with an endeavour to provide best possible treatment for physical injuries. At the same time, it is equally important to give adequate attention to behavioural and psychological aspects associated with the event. Knowledge of the predisposing factors and their management helps the clinician to prevent or manage these psychological problems. Various causes of psychological disturbances in trauma patients have been highlighted. These include pain, the sudden and unexpected nature of events and the procedures and interventions necessary to resuscitate and stabilise the patient. The ICU and trauma ward environment, sleep and sensory deprivation, impact of injury on CNS, medications and associated pre-morbid conditions are also significant factors. Specific problems that concern the traumatised patients are helplessness, humiliation, threat to body image and mental symptoms. The patients react to these stressors by various defence mechanisms like conservation withdrawal, denial, regression, anger, anxiety and depression. Some of them develop delirium or even more severe problems like acute stress disorder or post-traumatic stress disorder. Physical, pharmacological or psychological interventions can be performed to prevent or minimise these problems in trauma patients. These include adequate pain relief, prevention of sensory and sleep deprivation, providing familiar surroundings, careful explanations and reassurance to the patient, psychotherapy and pharmacological treatment whenever required.
The increased acceptance of the prevalence of trauma in human experience as well as its psychological consequences has led to revisions of diagnostic criteria for the disorder. The three purposes of this study were to examine the rates at which women experienced psychological trauma in childbirth, to explore possible causal factors, and to examine possible factors in the development of the disorder.
One hundred and three women from childbirth education classes in the Atlanta metropolitan area completed a survey in late pregnancy and a follow-up interview approximately 4 weeks after the birth.
The childbirth experience was reported as traumatic by 34 percent of participants. Two women (1.9%) developed all the symptoms needed to diagnose posttraumatic stress disorder, and 31 women (30.1%) were partially symptomatic. Regression analysis showed that antecedent factors (e.g., history of sexual trauma and social support) and event characteristics (e.g., pain in first stage of labor, feelings of powerlessness, expectations, medical intervention, and interaction with medical personnel) were significant predictors of perceptions of the childbirth as traumatic. The pain experienced during the birth, levels of social support, self-efficacy, internal locus of control, trait anxiety, and coping were significant predictors of the development of posttraumatic stress disorder symptoms after the birth.
These findings suggest several intervention points for health care practitioners, including careful prenatal screening of past trauma history, social support, and expectations about the birth; improved communication and pain management during the birth; and opportunities to discuss the birth postpartum.
It is now widely accepted that woman-centred maternity care is important. But surely planners and service providers should also examine the needs of expectant fathers? A postal survey of a randomly selected sample of 837 fathers-to-be throughout the UK found that midwives are not meeting all men's information and support needs. Although midwives were more highly rated than GPs and hospital doctors, men felt that midwives could still listen to them more, enable them to ask questions and explain things to help them better understand physical processes, clinical procedures, the baby's behaviour and their partner's needs. Most men wanted to be involved in their partner's pregnancy and care, but many felt left out by health professionals. Men play a pivotal role in supporting their partner during pregnancy and influence women's baby-feeding choices and esteem after giving birth. It is crucial that midwives see men not as an extra burden, but as individuals with needs of their own who are usually the main supporters of the women and babies at the centre of midwifery care.
The reported prevalence of posttraumatic stress disorder after childbirth ranges from 1.5% to 6%.
To describe the meaning of women's birth trauma experiences.
Descriptive phenomenology was the qualitative research design used to investigate mothers' experiences of traumatic births. Women were recruited through the Internet, primarily through Trauma and Birth Stress (TABS), a charitable trust located in New Zealand. The purposive sample consisted of 40 mothers: 23 in New Zealand, 8 in the United States, 6 in Australia, and 3 in the United Kingdom. Each woman was asked to describe the experience of her traumatic birth and to send it over the Internet to the researcher. Colaizzi's method was used to analyze the 40 mothers' stories.
Four themes emerged that described the essence of women's experiences of birth trauma: To care for me: Was that too much too ask? To communicate with me: Why was this neglected? To provide safe care: You betrayed my trust and I felt powerless, and The end justifies the means: At whose expense? At what price?
Birth trauma lies in the eye of the beholder. Mothers perceived that their traumatic births often were viewed as routine by clinicians.
To explore new/subsequent Australian fathers' perspectives on the experiences, processes, and life changes in the early weeks of fatherhood.
Interpretive study using in-depth interviews and grounded theory analysis techniques, based on a symbolic interactionist framework.
Participants were recruited from the postnatal wards of a major public hospital, early discharge program, and early childhood centers in southeast Queensland, Australia.
Eighteen first-time/subsequent fathers interviewed 6 to 12 weeks after the birth.
Although rewarding, fathers found new or expanding fatherhood to be a significant challenge and time of change. Major themes included making a commitment, taking responsibility, negotiating responsibilities, developing and maintaining relationships, maintaining family integrity, balancing activities, and perceiving the self as father. Work had a major impact on fathers' ability to participate with their family and newborn. To manage, fathers sought to balance the demands of work and home, deal with stressors, manage their time, develop routines, and reprioritize. Fathers developed a sense of themselves as fathers over time, building confidence and deriving satisfaction from their fathering role.
A range of competing factors affected fathers' ability to participate in the home with their newborn in the early weeks after birth.
To estimate the prevalence of post-traumatic stress disorder (PTSD) after childbirth in a group of postpartum Nigerian women and to examine any associated factors.
A cross-sectional survey.
Postnatal clinics and infant immunisation clinics of the five health centres in Ilesa Township, Nigeria.
A total of 876 women at 6 weeks postpartum.
The postpartum women were assessed for PTSD at 6 weeks. Other data collected were demographic characteristics, details of pregnancy and delivery and neonatal outcome. Additionally, the following measures were used: the MINI International Neuropsychiatric Interview to assess PTSD, the Index of Marital Satisfaction to measure the degree of problem a spouse encounters in the marital relationship, the Medical Outcome Study Social Support Survey to measure social support, the Life Events Scale to measure the life stress covering the preceding 12 months and the Labour Agentry Scale that measures the maternal experiences of control during childbirth.
Prevalence of PTSD in this population of postpartum Nigerian women, and how this prevalence related to other maternal and neonatal characteristics.
The prevalence of PTSD was 5.9%. The factors independently associated with PTSD after childbirth include hospital admission due to pregnancy complications (OR 11.86, 95% CI 6.36-22.10), instrumental delivery (OR 7.94, 95% CI 3.91-16.15), emergency caesarean section (OR 7.31, 95% CI 3.53-15.10), manual removal of placenta (OR 4.96, 95% CI 2.43-10.14) and poor maternal experience of control during childbirth (OR 5.05, 95% CI 2.69-9.48).
The prevalence of PTSD after childbirth in Nigerian women is slightly higher than those found in western culture. An effective model for the prediction of the development of PTSD after childbirth needs to be developed and evaluated, and interventions aimed at reducing the incidence of PTSD after childbirth need further research.