Engaging Fathers – Keeping Dad in Mind

Recently I attended a meeting with our local CCG to review our parent infant mental health pathway and looking at means of improving outcomes for families in our area. The discussion around the table very quickly identified the importance of engaging and including dads during the perinatal period.

Historically pregnancy has primarily focused on the needs of the woman and unborn baby. Dads have been sub-consciously sidelined and considered more as an interested onlooker than an expectant father with the same anxieties and needs as a soon to be mother. There are colleagues I work with now who still remember the days when it was unheard of for the father of the baby to even be in the room for the birth.

Fortunately times have changed in as much as there is an expectation that dad will be present for the birth to “offer support” to his partner but who offers support to him?

Male post natal depression and birth related PTSD is on the increase. Health professionals are very vocal about keeping women informed, making them feel supported and respected during the birth experience but what about dad? Men are often left feeling overwhelmed, scared and apprehensive watching their partner give birth, with the expectation of showing strength and control weighing very heavily on their minds, this can soon turn to abject terror and confusion if things don’t go to plan.

I was at a conference recently and heard a father describe how he felt when his wife needed an emergency Caesarean section. As she was wheeled through to the operating theatre he was told to ‘say goodbye to your wife’. He was left, alone, thinking he might never see his wife again before a member of staff appeared after a lengthy period of time to inform him that all was well.

Post natal de-briefing is offered to parents if requested following a traumatic birth but this is often focussed on an affected mother. How often is this service offered to a father who may be deeply affected by something he has witnessed during the birth which he is struggling to make sense of? Do we ever even ask dad about his experience?

Engaging fathers isn’t difficult. Appointment letters for example can be addressed to both parents. There will be occasions where this may not be appropriate but a discussion at the primary booking appointment can identify where this is not required. Sending a letter to both parents may seem like a small gesture but it says ‘we acknowledge you’re in this together, that this is happening to both of you and we consider you equally important’.

Welcome dads onto the postnatal ward after the birth. Why, when a couple have been through childbirth together and welcomed this precious baby into their lives, do we send dad home whilst encouraging mum to ‘bond’? Dads need to bond too and how wonderful to be given the opportunity for the parents to spend those first, irreplaceable few hours alone with this new life before going home to face the onslaught of visiting well-wishers. 

The importance of secure attachment with fathers is often underestimated. Disengaged and remote father-child interactions as early as the third month of life have been found to predict behaviour problems in children when they are older (Ramchandani et al., 2013). This attachment can also have a positive influence on the relationship between mother and baby, and is linked with lower stress and depression in mothers (Fisher et al., 2006).
The term ‘midwife’ means ‘with woman’ but I feel we have moved on from this. Our role has always been to support women through pregnancy, birth and the postnatal period but we should be ‘with family’, walking alongside both parents, supporting, nurturing and encouraging. 

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