Expectant fathers’ experience during labor with or without epidural analgesia

Supporting birth companions for women in labor, the views and experiences of birth companions, women and midwives: A mixed methods systematic review

BACKGROUND

Birth companions can have a positive effect on women's experiences in labor. However, companions can feel unprepared and need professional guidance to help them feel involved and provide effective support.

METHODS

A convergent segregated mixed-methods systematic review was conducted to explore women's, companions', and midwives' experiences of birth companion support and identify ways to improve the experience for women and companions. A thematic synthesis of qualitative data and a narrative summary of quantitative data were conducted followed by integration of the findings.

RESULTS

Companions who cope well in labor reported feeling involved, able to preserve women's internal focus and have a defined role, providing physical or emotional support. LBGTQ+ partners faced barriers to inclusion due to "forefronting" of their sexuality by staff and a lack of recognition in the language and processes used. The experience of birth companions can be enhanced by promoting their role as co-parent, guardian, and coach, provision of timely information and developing a trusting relationship with care providers. Only two papers reported midwives' views on birth companions in labor.

CONCLUSIONS

Women's and companions' satisfaction with birth is increased when companions can support the mother, feel supported themselves, and valued as a co-parent. The midwives' role in information provision and guidance can maximize birth companions' experience and ability to provide positive support. LBGTQ+ families need more support to feel included and recognized.

Fathers' subjective childbirth stress predicts depressive symptoms at six months postpartum

BACKGROUND

Childbirth is a seminal experience in parents' lives. However, little research has investigated the link between fathers' birth experiences and their postpartum mental health. We hypothesized that a more subjectively stressful birth will predict greater self-reported depressive symptoms in fathers at six months postpartum. We also investigated the association between mode of delivery and paternal subjective stress.

METHODS

Seventy-seven heterosexual fathers expecting their first child and cohabiting with their pregnant partners participated in the study. Depressive symptoms were assessed in pregnancy and again at six months postpartum. Subjective birth stress was measured within the first few days of the birth, and birth charts were collected to examine mode of delivery.

RESULTS

Fathers' ratings of subjective birth stress significantly predicted postpartum depressive symptoms at six months postpartum. Subjective birth stress ratings varied significantly for fathers whose partners delivered via emergency cesarean section compared to those whose partners gave birth via both medicated and the unmedicated vaginal delivery.

LIMITATIONS

The study was limited by its small community (non-clinical) sample, which was restricted to heterosexual, cohabitating couples. Additionally, births were mostly uncomplicated and only 14 mothers underwent emergency cesarean section.

CONCLUSION

These findings highlight that the days immediately following childbirth are a window of opportunity for early intervention in new fathers at risk for postpartum depression.

How Do Anxiety and Relationship Factors Influence the Application of Childbirth Education Strategies During Labor and Birth: A Bowen Family Systems Perspective

The effectiveness of childbirth education (CBE) has long been debated with studies showing contradictory outcomes for mothers and babies. Understanding how what is learned in CBE is translated into practice during labor and birth is an area that requires investigation as this may be a mediating factor in its effectiveness. Bowen family system theory's concept of differentiation of self, the ability to be guided by and to act from one's beliefs and values, is an organizing principle that may affect how relational factors affect the use and application of CBE at the time of birth. The ability to act with emotional maturity when faced with a stressor, such as childbirth, depends on an individual's capability to separate thoughts from the more reactive feeling process. Recognizing how one's level of differentiation interacts with the anxious responses of others may assist pregnant women and birth partners to make decisions more objectively about how they want to manage the birthing process. For the health professional, understanding the interplay of relationship variables, physiological stress, anxiety and individual reactivity may allow for the provision of more thoughtful evidence-based practice, which may increase objectivity, and aid communication and decision-making for women during birth. Bowen theory, as a comprehensive systems-based approach to understanding human functioning under stress, offers a novel approach to exploring the application of CBE during birth.

The partner's experiences of childbirth in countries with a highly developed clinical setting: a scoping review

Background

In Western countries, it is common practice for a woman to be supported by a trusted person during childbirth, usually the other parent. Numerous studies have shown that this has a positive effect both on the woman’s satisfaction with the birth process and on physical outcomes. However, there is little research on the birth experience of partners and their wellbeing. The aim of this review is to summarise the existing literature on partner experience, consider its quality and identify the underlying themes.

Methods

Both a systematic literature search in three databases and a manual search were conducted, for qualitative, quantitative, and mixed-methods studies from Western countries examining the experiences of partners present at a birth.

Results

A total of 35 studies were included. Only one study included same-sex partners (the other studies addressed fathers’ experiences only) and only one validated questionnaire examining partners’ birth experiences was identified. Four major themes were found to influence partners’ birth experiences: (1) intense feelings, (2) role of support, (3) staff support, and (4) becoming a father.

Conclusions

Partners may feel very vulnerable and stressed in this unfamiliar situation. They need emotional and informal support from staff, want to be actively involved, and play an important role for the birthing woman. To promote good attachment for parents, systematic exploration of the needs of partners is essential for a positive birth experience. Because of the diversity of family constellations, all partners should be included in further studies, especially same-sex partners.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05014-1.

Epidural analgesia information sessions provided by anesthetic nurses: impact on satisfaction and anxiety of parturient women a prospective sequential study

BACKGROUND

Information on epidural analgesia delivered to parturient women is frequently incomplete, making it difficult for expectant mothers to make an appropriate choice for their delivery. We assessed the impact of a multimodal information session on epidural analgesia delegated to anesthetic nurses on new-mothers' satisfaction.

METHODS

We performed a prospective sequential study including parturient women who gave birth with epidural analgesia. During the first period, information on epidural analgesia was delivered by anesthetists during the scheduled anesthesia consultation, according to French standard-of-care. Then, a dedicated information session about epidural analgesia provided by anesthetic nurses was implemented. The primary endpoint was the satisfaction of women with the quality of information received. Main secondary endpoints were knowledge of women about epidural analgesia, anxiety before epidural catheter placement, and satisfaction with delivery.

RESULTS

259 and 298 women were included during the first and second periods respectively, among whom 178 and 188 were analyzed. Information on epidural analgesia delivered by anesthetic nurses was associated with improvement of new-mothers' satisfaction with information received (9 (8-10) vs. 10 (9-10) - p < 0.001). Moreover, information delivered by anesthetic nurses was associated with decreased anxiety before epidural catheter placement (4 (1-8) vs. 3 (1-6) - p = 0.006) and increased satisfaction with delivery (8 (7-10) vs. 9 (8-10) - p = 0.01). Women's knowledge on epidural analgesia was durably increased when information was delivered by anesthetic nurses compared to conventional information by anesthetists. After adjustment, the only variable associated with both new mothers' satisfaction with information and delivery was the information session taught by anesthetic nurses.

CONCLUSIONS

Information sessions on epidural analgesia delivered by anesthetic nurses was associated with improved satisfaction of women with their delivery. Such information sessions may be used in maternity wards to improve new-mothers' childbirth experience.

Analgesic effects of sterile water injection in the management of low back pain during labor: A systematic review and meta-analysis

BACKGROUND

Sterile water injections (SWIs) as a non-pharmacologic and cost-effective method have been adopted to relieve low back labor pain (LBLP).

OBJECTIVE

To compare the efficacy of intradermal and subdermal SWIs in the treatment of LBLP.

SEARCH STRATEGY

Three databases (PubMed, Cochrane Library, and ScienceDirect) were searched to find relevant articles using two terms, "labor" and "sterile water".

SELECTION CRITERIA

Studies reporting women with LBLP treated by intradermal or subdermal SWIs in the low back area were included.

DATA COLLECTION AND ANALYSIS

Mean differences with 95% confidence interval (CI) and relative risk with 95% CI were used to estimate VAS score and cesarean section rate, respectively.

MAIN RESULTS

Except for 10 min, the patients in the intradermal or subdermal SWI group experienced considerable pain reduction compared with the control group for 30-45, 60, and 90 min. Directly comparing intradermal and subdermal SWI groups, the subdermal injection group had significantly better pain relief than the intradermal injection group only at 10 min after treatment.

CONCLUSIONS

Both intradermal and subdermal SWIs could reduce LBLP at 30-90 min. The subdermal SWI had significantly better LBLP relief than the intradermal injection only at 10 min after treatment.

Charles and Emma Darwin: Under the 'influence' of chloroform anaesthesia

A number of Charles Darwin's biographies record the administration of chloroform by Darwin to his wife Emma, during her labour and delivery of her eighth child, Leonard. This occurred on 15 January 1850, a little over two years after James Young Simpson in Edinburgh described the analgesic action of inhaled chloroform. An online search of more than 9000 items of Darwin's correspondence at Cambridge University and other sources revealed that he was an active proponent and user of chloroform in midwifery, for euthanising animals he studied, as well as in botanical studies of carnivorous plants. He also discovered that the concurrent inhalation of chloroform, during its administration to his wife, alleviated his distressing anxiety which he suffered when present at her earlier confinements.

Development of the Labor Pain Relief Attitude Questionnaire for pregnant women (LPRAQ-p)

BACKGROUND

Receiving epidural analgesia during labor can possibly have negative consequences for mother and child. Yet, the use of epidural analgesia rapidly increased in the Netherlands over the last decade. Since antenatal plans for labor pain relief have been related to epidural analgesia use during labor, the aim of the current study was to develop a Labor Pain Relief Attitude Questionnaire for pregnant women (LPRAQ-p).

METHODS

Three focus group interviews were conducted with pregnant women, new mothers and caregivers and 13 candidate items were derived. Psychometric properties were tested with explorative factor analysis in sample I (N = 429) and a subsequent confirmatory factor analysis in a different sample II (N = 432).

RESULTS

The explorative factor analysis suggested a two-factor seven-item solution: a 'women's perception' and 'social environment' subscale. The confirmatory factor analysis confirmed an excellent six-item model fit with appropriate internal consistency. Higher scores on the six-item LPRAQ-p indicate greater willingness for request of pain relief medication during labor. Two-tailed t-tests showed that women with elevated levels of depression and pregnancy-specific distress symptoms, nulliparous women and multiparous women with complications during a previous delivery had greater willingness for request of pain relief medication during labor. Linear regression showed that the most important association with higher scores on the LPRAQ-p were high pregnancy-specific distress symptoms.

CONCLUSIONS

This study showed the LPRAQ-p to be a valid instrument to evaluate attitude towards labor pain relief in pregnant women. High scores on this questionnaire are associated with high levels of pregnancy-specific distress symptoms.

Anesthesiologists' Preferences regarding Visitor Presence during Placement of Neuraxial Labor Analgesia

INTRODUCTION

Neuraxial labor analgesia has become an integral part of modern obstetric anesthetic practice. Presence of a familiar person during its placement may be beneficial to the patient. A survey was sent to anesthesiologists practicing obstetric anesthesia in the USA to determine their views.

METHODS

The survey queried the following: existence of a written policy; would they allow a visitor; visitor's view, sitting or standing; reasons to allow or not allow a visitor; and influence by other staff on the decision. The responses were analyzed using multiple chi-square analyses.

RESULTS

Most practitioners supported allowing a visitor during placement. Reduction of patient anxiety and fulfillment of patient request were the major reasons for allowing a visitor. Sitting position and no view of the workspace were preferred. Visitor interference and safety were cited as the major reasons for precluding a visitor. Nonanesthesia providers rarely influenced the decision. Epidural analgesia was the preferred technique. Essentially no bias was found in the responses; there was statistical uniformity regardless of procedures done per week, years in practice, professional certification, geographic region (rural, urban, or suburban), or academic, private, or government responders.

CONCLUSION

The practice of visitor presence during the placement of neuraxial labor analgesia is gaining acceptance.

Modern Neuraxial Anesthesia for Labor and Delivery

The availability of safe, effective analgesia during labor has become an expectation for women in most of the developed world over the past two or three decades. More than 60% of women in the United States now receive some kind of neuraxial procedure during labor. This article is a brief review of the advantages and techniques of neuraxial labor analgesia along with the recent advances and controversies in the field of labor analgesia. For the most part, we have aimed the discussion at the non-anesthesiologist to give other practitioners a sense of the state of the art and science of labor analgesia in the second decade of the 21st century.

Treatment-Associated Anxiety among Pregnant Women and their Partners: What is the Influence of Sex, Parity, Age and Education?

BACKGROUND

Anxiety during pregnancy can influence outcomes negatively. The aim of this study was to assess the fears of expectant parents in the setting of antenatal and obstetric care according to their sex, age, parity and education.

METHODS

259 pregnant women and 183 partners, who had presented for antenatal investigation, routine antenatal care or for delivery in the UKSH women's hospital, Lübeck campus, completed a self-assessment questionnaire of fears and the German version of the STAI (Laux et al.). ANOVA and t-tests were used for significance testing.

RESULTS

Pregnant women had higher levels of trait anxiety and state anxiety than their partners. Level of education had a significant, inverse effect on trait anxiety. Age had no influence. Fears for the child's health ranked highest among pregnancy-specific fears. Expectant fathers had the same level of anxiety for the birth irrespective of parity; for women fear of the birth decreased with increasing parity. Anxiety only increased significantly for expectant fathers from the 20th week of gestation onwards.

CONCLUSIONS

Pregnant women and their partners have different levels of anxiety dependant on their age, education, parity and the stage of pregnancy. These findings could contribute towards improving support of couples during pregnancy. The fears of expectant fathers require particular attention.

Perceptions of labour pain management of Dutch primary care midwives: a focus group study

BACKGROUND

Labour pain is a major concern for women, their partners and maternity health care professionals. However, little is known about Dutch midwives' perceptions of working with women experiencing labour pain. The aim of this study was to explore midwives' perceptions of supporting women in dealing with pain during labour.

METHODS

We conducted a qualitative focus group study with four focus groups, including a total of 23 midwives from 23 midwifery practices across the country. Purposive sampling was used to select the practices. The constant comparison method of Glaser and Straus (1967, ren. 1995) was used to gain an understanding of midwives' perceptions regarding labour pain management.

RESULTS

We found two main themes. The first theme concerned the midwives' experienced professional role conflict, which was reflected in their approach of labour pain management along a spectrum from "working with pain" to a "pain relief" approach. The second theme identified situational factors, including time constraints; discontinuity of care; role of the partner; and various cultural influences, that altered the context in which care was provided and how midwives saw their professional role.

CONCLUSION

Midwives felt challenged by the need to balance their professional attitude towards normal birth and labour pain, which favours working with pain, with the shift in society towards a wider acceptance of pharmacological pain management during labour. This shift compelled them to redefine their professional identity.

A meta-synthesis of fathers' experiences of their partner's labour and the birth of their baby

OBJECTIVE

to develop greater understanding of how expectant fathers experience their partner's labour and the subsequent birth of their baby.

DESIGN

a qualitative meta-synthesis. Data were search for in CINAHL, PubMed, Psych Info and SCOPUS.

SETTING

eight studies conducted in England, Malawi, Nepal and Sweden were included.

PARTICIPANTS

120 fathers with experiences of their partner having a spontaneous vaginal, assisted or surgical birth.

MEASUREMENTS AND FINDINGS

1st order themes were identified and subsequently grouped into seven 2nd order themes. Finally through a process of exploring patterns and connections seven 3rd order themes were developed which produced new insights into the men's experiences of labour and birth. This meta-synthesis revealed that most men wanted to be actively involved in their partner's labour, present at the birth and respected for what they could contribute. Men recognised that birth was a unique event that may be potentially challenging requiring a level of preparation. There were also men who felt pressured to attend. During the actual experience of labour men commonly expressed overwhelming feelings and inadequacy in their ability to support their partner. They particularly struggled with the 'pain' of labour. Midwives were subsequently identified as best placed to make a significant difference to how men perceived their experiences of labour and what they described as the life changing event of birth.

KEY CONCLUSIONS

the expectant fathers' birth experiences were multidimensional. Many were committed to being involved during labour and birth but often felt vulnerable. Being prepared and receiving support were essential elements of positive experience as well as contributing to their ability to adequately support the labouring woman.

IMPLICATIONS FOR PRACTICE

men's ability to actively prepare for, and be supported through, the labour and birth process influences their perceptions of the childbirth event as well as their sense of connection to their partner. Couples should be given opportunities to explore expectations and how these may influence their own construction of their role during the birth process. While the role of expectant fathers in labour and birth should be facilitated and supported arguably their wish not to participate should be afforded the same respect.

Fathers' experience of childbirth when non-progressive labour occurs and augmentation is established. A qualitative study

OBJECTIVE

Augmentation with oxytocin during labour has increased in Western obstetrics over the last few decades. The aim of this study was to describe how fathers experienced childbirth when non-progressive labour occurred and augmentation was established.

METHOD

A qualitative descriptive design. Ten fathers were interviewed 4-15 weeks post partum. The interviews were semi-structured and were analyzed using Braun and Clarke's thematic analysis.

RESULTS

The analysis revealed three themes and four sub-themes. The themes were: (1) A rational approach to own role, (2) Labour and birth as uncontrollable processes and (3) Relief about the decision of augmentation. The fathers had a rational approach and felt powerless when the process of labour was uncontrollable. They felt they were not able to help their partners in pain when non-progressive labour occurred. They experienced relief when augmentation was established because of the subsequent progression of labour, and because it was then easier to find a role as a helper.

CONCLUSION

This study demonstrates that fathers feel relieved when augumentation is established. In addition, the study underlines that fathers, in order to regain control after experiencing the non-progressive labour, need directions from the midwives to carry out appropriate and usefull tasks.

Fathers' engagement in pregnancy and childbirth: evidence from a national survey

Background

Early involvement of fathers with their children has increased in recent times and this is associated with improved cognitive and socio-emotional development of children. Research in the area of father’s engagement with pregnancy and childbirth has mainly focused on white middle-class men and has been mostly qualitative in design. Thus, the aim of this study was to understand who was engaged during pregnancy and childbirth, in what way, and how paternal engagement may influence a woman’s uptake of services, her perceptions of care, and maternal outcomes.

Methods

This study involved secondary analysis of data on 4616 women collected in a 2010 national maternity survey of England asking about their experiences of maternity care, health and well-being up to three months after childbirth, and their partners’ engagement in pregnancy, labour and postnatally. Data were analysed using descriptive statistics, chi-square, binary logistic regression and generalised linear modelling.

Results

Over 80% of fathers were ‘pleased or ‘overjoyed’ in response to their partner’s pregnancy, over half were present for the pregnancy test, for one or more antenatal checks, and almost all were present for ultrasound examinations and for labour. Three-quarters of fathers took paternity leave and, during the postnatal period, most fathers helped with infant care. Paternal engagement was highest in partners of primiparous white women, those living in less deprived areas, and in those whose pregnancy was planned. Greater paternal engagement was positively associated with first contact with health professionals before 12 weeks gestation, having a dating scan, number of antenatal checks, offer and attendance at antenatal classes, and breastfeeding. Paternity leave was also strongly associated with maternal well-being at three months postpartum.

Conclusions

This study demonstrates the considerable sociodemographic variation in partner support and engagement. It is important that health professionals recognise that women in some sociodemographic groups may be less supported by their partner and more reliant on staff and that this may have implications for how women access care.

[Labor pain worries future fathers more than the mothers]

OBJECTIVE

To evaluate the concerns of the future father about labor pain and another 9 items which could be important to the well-being of the mother during delivery. To investigate any possible differences in opinion between the future father and mother.

PATIENTS AND METHODS

An anonymous and voluntary questionnaire was offered to the father and the pregnant patient during the last month of pregnancy. They had to answer the questionnaire separately, scoring 10 items in a 0-10 point ordinal scale, according to their concerns and the importance for the good development of the delivery (0= not concerned about/insignificant to 10=concerned about/great importance). The items included were: 1) esthetic aftermath, 2) embarassment, 3) continous information, 4) walking during labor, 5) drinking during labor, 6) companionship, 7) labor pain, 8) keeping composure, 9) kindness, 10) room comfortability. Data on age, education, parity and nationality were recorded.

RESULTS

A total of 147 questionnaires were completed, 99 by mothers, and 48 by fathers. Pain was the most important concern for the future fathers scoring a mean (SD) of 8.15 (2), while continuous information 7.71 (2.5), kindness 7.9 (2.1), and companionship 8.21 (2.3) were more important than pain for mothers. A statistically significant difference was found between fathers and mothers regarding labor pain (P=.001), walking during labor (P=.003), and drinking during labor (P=.009).

CONCLUSIONS

The result of our study suggests that increasing the presence of the father during the delivery process, and taking care of the emotional aspects and the quality of the information given could be very important for the perception of satisfaction.

Partner's presence during initiation of epidural labor analgesia does not decrease maternal stress: a prospective randomized controlled trial

BACKGROUND

Epidural analgesia reduces pain and anxiety during childbirth. In this randomized controlled trial, we sought to determine whether partner presence during the initiation of epidural analgesia reduces stress of both the mother and her partner and their perception of maternal pain.

METHODS

Healthy, nulliparous women who were accompanied by their partners and requested neuraxial analgesia were enrolled into the study. The study took place in the Labor and Delivery Unit of a large tertiary hospital in Israel. Upon request for epidural analgesia, both partners were assessed for baseline anxiety (numerical rating scale, 0 to 10), systolic blood pressure, heart rate, estimated contraction pain of parturient (verbal rating scale for pain, 0 to 10), and salivary amylase. After measurements, couples were randomized into 1 of 2 groups: "partner in" and "partner out." Immediately after epidural catheter insertion, anxiety, arterial blood pressure, heart rate, and salivary amylase were measured again in both partners. Both partners were asked to complete the State Anxiety Inventory questionnaire measuring current anxiety. The parturient was asked to rate the pain of epidural catheter insertion. The primary outcome measurement was parturient and partner anxiety as assessed by the numerical rating scale.

RESULTS

Eighty-four couples were randomized (partner in 41, partner out 42, protocol violation 1). At baseline there was no difference in self-reported anxiety of parturients between the partner-in and partner-out groups (median interquartile range 7.5 [6.0 to 9.0] versus 7.0 [3.5 to 8.5]; P = 0.26, difference in medians = -1.0; 95% confidence interval [CI] of difference -2.0 to 1.0). After epidural catheter insertion, parturients in the partner-in group had a higher level of anxiety than those in the partner-out group (8.0 [7.0 to 10.0] versus 7.0 [5.0 to 9.0]; P = 0.03, difference in medians -1.0; 95% CI of difference -2.0 to 0.0). Pain scores during epidural catheter placement were higher in partner-in than in partner-out groups (7.0 [4.0 to 8.0] versus 4.0 [3.0 to 6.0]; P = 0.004, difference in medians = -2.0; 95% CI of difference -3.0 to -1.0).

CONCLUSION

Partner presence during epidural catheter insertion for labor analgesia did not decrease anxiety levels. To the contrary, anxiety and pain of epidural catheter placement were greater if the partner remained in the room.

Pain relief in labor: a survey of awareness, attitude, and practice of health care providers in Zaria, Nigeria

Background:

The purpose of this study was to assess the attitudes of maternal health care providers to pain relief during labor in Zaria, Nigeria.

Methods:

This was a multicenter, collaborative, cross-sectional pilot study of provider perspectives concerning pain relief during labor. A structured, self-administered, questionnaire was completed by 95 consenting maternal health care providers at three high-volume facilities in Zaria, an ancient northern Nigerian city. Descriptive statistics was performed on the data.

Results:

Most respondents (94.8%) agreed that pain relief is needed during labor. Only 2.1% of respondents were undecided about the provision of pain relief during labor and 3.2% were of the opinion that pain relief was not necessary during labor. Most respondents (93.7%) had attended a woman in labor in the 4 weeks preceding the survey. Of these, 56.8% had counseled a parturient in labor. Most of the counseling (42.1%) took place during labor. Less than half of the respondents (48.4%) had administered pain relief in labor in the preceding 4 weeks and systemic opioids was the most commonly form of pain relief. Among the respondents who did not offer pain relief agents in labor, the majority (54.5%) had no reason for not offering it. Unavailability of methods, inability to afford the cost of pain relief, lack of knowledge and skills, as well as lack of essential equipment to provide the procedure were also given by respondents as reasons for not offering pain relief.

Conclusion:

Even though maternal health care providers in this environment have a positive attitude to pain relief in labor, most women go through labor without the benefit of analgesia. There exists a gap between provider attitudes to pain relief in labor and practice of the same, with many providers having no genuine reason(s) for not offering pain relief to their clients during labor. Providers need to align their practice to their attitudes, and need to be helped to do this through training as well as enhancing their ability to think critically about their practice.

Fathers' birth experience in relation to midwifery care

The aim was to identify the proportion of fathers having a positive experience of a normal birth and to explore factors related to midwifery care that were associated with a positive experience.

BACKGROUND

Research has mainly focused on the father's supportive role during childbirth rather than his personal experiences of birth.

METHODS

595 new fathers living in a northern part of Sweden, whose partner had a normal birth, were included in the study. Data was collected by questionnaires. Odds Ratios with 95% confidence interval and logistic regression analysis were used.

RESULTS

The majority of fathers (82%) reported a positive birth experience. The strongest factors associated with a positive birth experience were midwife support (OR 4.0; 95 CI 2.0-8.1), the midwife's ongoing presence in the delivery room (OR 2.0; 1.1-3.9), and information about the progress of labour (OR 3.1; 1.6-5.8).

CONCLUSION

Most fathers had a positive birth experience. Midwifery support, the midwife's presence and sufficient information about the progress of labour are important aspects in a father's positive birth experience. The role of the midwife during birth is important to the father, and his individual needs should be considered in order to enhance a positive birth experience.

'She can choose, as long as I'm happy with it': a qualitative study of expectant fathers' views of birth place

OBJECTIVES

A programme of research was undertaken to explore which factors contributed to decisions regarding birth place. As part of this programme, the views of male partners of pregnant women were examined to gain understanding of their contribution to the decision making process, with regard to different birth settings.

STUDY DESIGN

A qualitative interpretive approach was utilised to explore, in-depth, the views of 19 expectant fathers, in the North West of England. Semi-structured interviews were conducted, audio recorded and transcribed, following consent. Data were analysed using a thematic approach.

FINDINGS

Four main themes were identified; Silent decisions, Powers of persuasion, Trust in a medical environment and Personal vulnerability.

CONCLUSIONS

Choice regarding place of birth is multi-dimensional. Expectant fathers are likely to contribute to their partner's decision making; their motivation can relate to their own beliefs and personal vulnerability as well the need to protect the women. The overwhelming trust in the medical environment dominates partner's views regarding birth place. The lack of discussion regarding birth place, between partners and with health professionals, reinforces the notion that hospital birth is safest, thus strengthening the normalization of birth in this environment. Midwives need to engage with expectant fathers to ensure that their contributions to decisions around birth place are fully informed.

Differences in preferences for obstetric care between nulliparae and their partners in the Netherlands: a discrete-choice experiment

BACKGROUND

In the Netherlands, in low-risk pregnancies, the views of pregnant women and their partners on characteristics of obstetric care services are leading for the selection of place of birth. The aim of this study was to investigate whether there are differences between the decision-making process of pregnant women and their partners with regard to these attributes of obstetric care.

METHODS

This study was a prospective cohort study with low-risk nulliparae and their partners. A questionnaire, based on the method of discrete-choice experiment, was used to gather the data.

RESULTS

Possibility of influencing decision-making was, both for pregnant women (n = 321) and their partners (n = 212), the most important characteristic of the obstetric care. For women, a home-like birth setting was an important characteristic, while the partners found the possibility on pain-relief treatment during birth important.

CONCLUSIONS

The results of this study suggest that women and their partners have clearly defined preferences for obstetric care. There are also some essential differences between the preferences of these two groups. The findings are important where policy issues related to aspects of maternity care service delivery are being considered.

Fathers' Feelings and Experience Related to their Wife/Partner's Delivery in Northern Greece

OBJECTIVES

The study aims at exploring the feelings and the experience of fathers about their wife/partner's delivery.

BACKGROUND

During the last decades birth attendance by fathers is a common phenomenon across many countries. Fathers' birth attendance may evoke both positive and negative feelings.

METHODOLOGY

The study was conducted in a city of Northern Greece. The sample consisted of 417 fathers whose wife/partner had given birth during the previous one week to one year. Data were collected using the Kuopio Instrument for Fathers (KIF).

RESULTS

Father's feelings about their wife or partner were very positive as nearly all (82.1%) of the participants were proud to become fathers and agree that they felt love and were grateful to their wife/partner. However, half of the fathers felt anxious and nervous. 40.7% quite agree that the staff was very professional, that they trusted the staff (45%) and that they were grateful to the staff (38.8%). There is correlation between the "feelings related to the wife/partner" and education (r=0.156, p=0.0047), "being afraid during the preparatory visit at the obstetric hospital" (r=-0.238, p=0.009), and "anxiety during the preparatory visit" (r=0.295 p=0.005). The subscale "feelings related to the environment and staff" correlates with "usefulness of preparatory visit" (r=-0.223, p=0.004) and the subscale of "experiences related to delivery" correlates with "usefulness of preparatory visit" (r=-0.357, p=0.001).

CONCLUSIONS

Our results support the findings of previous studies, which indicated that birth attendance by fathers has evoked positive feelings about their wife/partner, the delivery, the staff and the hospital environment.