Few fathers-to-be prefer caesarean section for the birth of their baby

The Impact of Prepartum Depression and Birth Experience on Postpartum Mother-Infant Bonding: A Longitudinal Path Analysis

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 dreaded delight: A longitudinal qualitative interview study of paternal childbirth fear during the transition to fatherhood

INTRODUCTION

Childbirth is a life-changing event where fathers desire being involved. As fathers take a more active role, fear of childbirth can arise. The aim of this study was to explore fathers' experiences of childbirth fear during pregnancy and after the birth of their baby.

METHODS

This was a qualitative longitudinal prospective study that included 14 interviews with seven fathers, one during the prenatal period, and one follow-up interview after childbirth. Data were analyzed using thematic analysis according to Braun and Clark.

RESULTS

The main theme 'Being vulnerable during the transition to fatherhood' was based on the perception of childbirth as risky with threats toward the woman's and baby's health, not being able to give and receive enough support, unable to handle the unknown process of birth, and not being a good father. Helpful strategies for coping with fear were to talk about fear, to learn more about childbirth and techniques on how to handle fear, and to avoid dealing with fear. Fathers' fear of childbirth changed after the birth of their baby. Their thoughts of another childbirth did not evoke the same strong feelings of fear. Issues important for the reduction of childbirth fear were: receiving professional support, actively taking part in the childbirth process, and the partner having an uncomplicated birth.

CONCLUSIONS

Fathers with childbirth fear regarded childbirth as risky, but they expressed helpful coping strategies. After the birth of their baby, they became less fearful. Quality of fear-reducing support to expectant fathers may influence how they cope with their transition into fatherhood.

The Paternal Experience of Fear of Childbirth: An Integrative Review

BACKGROUND

It is estimated that approximately 13% of expectant fathers experience a pathological and debilitating fear of childbirth.

OBJECTIVE

The aim of this integrative review was to examine and synthesise the current body of research relating to paternal experience of fear of childbirth.

METHODS

A systematic literature search of five databases-CINAHL, Cochrane Library, MEDLINE, PsycArticles and PsycInfo-identified seventeen papers. Methodological quality of studies was assessed using the Crowe Critical Appraisal Tool.

RESULTS

Thematic data analysis identified three themes: the focus of fathers' childbirth-related fears, the impact of fear of childbirth on health and wellbeing, and fear of childbirth as a private burden.

DISCUSSION

Fear of childbirth is a significant and distressing experience for expectant fathers who may benefit from an opportunity to express their childbirth-related fears in an environment where they feel validated and supported. Antenatal education is recommended to enhance fathers' childbirth-related self-efficacy to reduce fear of childbirth.

CONCLUSIONS

Fear of childbirth may negatively impact the lives of men and consequently their families. Further investigation into methods and models for identifying and supporting men at risk of or experiencing fear of childbirth is required to improve outcomes for this population of men.

Why are first time expectant fathers afraid of birth? : A qualitative study

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.

[Factors Influencing the Paternal Experience of Birth in the Labour Ward: A Qualitative Study]

INTRODUCTION

Today the majority of fathers-to-be are present at the birth of their children in the labour ward. Their presence at the birth is a significant event in their lives. The aim of this study is to identify factors influencing the paternal birth experience in the labour ward.

MATERIAL AND METHODS

The experiences of 12 first-time fathers during pregnancy and birth and their perception of birth in the labour ward were gathered through problem-centred interviews. The transcribed and anonymised interviews were analysed by means of content analysis according to Mayring.

RESULTS

All fathers retrospectively assessed the experience of the birth of their child positively. A large number of potential factors influencing the paternal birth experience were identified, both biographical factors and factors during pregnancy and birth. In particular, the medical staff, especially the midwife, proved to be of importance.

CONCLUSION

Medical professionals should pay more attention to the paternal birth experience. The focus for further research could lie on concepts to promote a positive birth experience for fathers.

Interventions to reduce unnecessary caesarean sections in healthy women and babies

Optimising the use of caesarean section (CS) is of global concern. Underuse leads to maternal and perinatal mortality and morbidity. Conversely, overuse of CS has not shown benefits and can create harm. Worldwide, the frequency of CS continues to increase, and interventions to reduce unnecessary CSs have shown little success. Identifying the underlying factors for the continuing increase in CS use could improve the efficacy of interventions. In this Series paper, we describe the factors for CS use that are associated with women, families, health professionals, and health-care organisations and systems, and we examine behavioural, psychosocial, health system, and financial factors. We also outline the type and effects of interventions to reduce CS use that have been investigated. Clinical interventions, such as external cephalic version for breech delivery at term, vaginal breech delivery in appropriately selected women, and vaginal birth after CS, could reduce the frequency of CS use. Approaches such as labour companionship and midwife-led care have been associated with higher proportions of physiological births, safer outcomes, and lower health-care costs relative to control groups without these interventions, and with positive maternal experiences, in high-income countries. Such approaches need to be assessed in middle-income and low-income countries. Educational interventions for women should be complemented with meaningful dialogue with health professionals and effective emotional support for women and families. Investing in the training of health professionals, eliminating financial incentives for CS use, and reducing fear of litigation is fundamental. Safe, private, welcoming, and adequately resourced facilities are needed. At the country level, effective medical leadership is essential to ensure CS is used only when indicated. We conclude that interventions to reduce overuse must be multicomponent and locally tailored, addressing women's and health professionals' concerns, as well as health system and financial factors.

'As long as they are safe--birth mode does not matter' Swedish fathers' experiences of decision-making around caesarean section

BACKGROUND

Decision-making in childbirth involves considerations about both the mother and her unborn baby's wellbeing. For men the safety of both is paramount.

AIM

To explore and describe Swedish fathers' beliefs and attitudes around the decision for a caesarean section.

METHODS

Qualitative descriptive study. Twenty one Swedish men whose partners had experienced elective or emergency caesarean participated in a telephone interview. Thematic data analysis was used.

FINDINGS

The theme, 'Childbirth is Risky', included "Caesarean birth has lots of advantages" and "Birth mode does not matter". In the context of having experienced a caesarean section male partners considered birth mode to be irrelevant. The majority considered caesarean to be a quick and efficient way of giving birth which equated to being safer. Most men could articulate some risks associated with caesarean but these were mainly minimised. The second theme, 'Simply a matter of trust: Birth mode is not my decision', reflected men's belief that they had little to contribute to the decisions made around birth mode. The decision for a caesarean section was considered to lie with the medical practitioner.

CONCLUSION

Mode of birth was regarded as unimportant. The recommendation for a caesarean section was readily accepted and appreciated, and shifted responsibility for birth to the medical practitioner. Involving men in the decision-making process by means of giving them information was valued. Men's limited knowledge about the risks of a caesarean may contribute to birth mode decisions. Professionals need to provide balanced and correct information within the context of individual circumstances.

Change of childbirth preference after delivery among nulliparous Chinese women and their partners

AIM

The aim of the present study was to assess the effect of childbirth preference among nulliparous Chinese women and their partners on actual mode of delivery, and to assess women's change in preference from vaginal delivery to cesarean and the factors associated with this change.

METHODS

A cohort study was conducted from July to October 2011 in the First Hospital of Tsinghua University, Beijing. Nulliparous women at the gestational age of 36-40 weeks and their partners were included. Their childbirth preference was recorded twice: once in pregnancy and again 2 or 3 days post-partum.

RESULTS

Women preferring cesarean during pregnancy had a 3.9-fold higher chance of undergoing a cesarean than those preferring vaginal delivery (P = 0.004), while the partner's preference had no effect (P = 0.35). Preference for cesarean in the post-partum period increased significantly compared to that during pregnancy both among women, whose preference increased from 10.1% to 28.0%, and among their partners, whose preference increased from 7.8% to 16.7% (P < 0.001 for both). The rate of change in women's preference from vaginal delivery to cesarean was 26.0%. Women having high couple's monthly income, who were feeling depressed, whose partner preferred cesarean during pregnancy or who delivered by cesarean were more likely to experience this change due to fear of labor pain and perineal cutting and a greater perceived safety of cesarean.

CONCLUSION

Women's cesarean preference during pregnancy was associated with actual cesarean delivery. Inadequate quality of care in labor and delivery and overestimation of cesarean safety underlie post-partum women's increased preference for cesarean.

Women's experiences of induction of labour--findings from a Swedish regional study

BACKGROUND

 Induction of labour is common in modern obstetrics but its impact on women's birth experiences is inconclusive.

AIM

 The aim of the present study was to explore the prevalence of induction in a Swedish region and reasons for labour induction. A second aim was to compare the experience of spontaneous labour and birth for women to the experience of induction of labour. A third aim was to explore the difference in labour in relation to the length of pregnancy.

METHODS

 A one-year cohort of 936 women was included in a longitudinal Swedish survey in which data were collected by questionnaires, two months after birth. The main outcome was a set of data recording women's birth experiences.

RESULTS

Labour induction was performed in 17% of births and mostly performed for medical reasons. Women who were induced used more epidurals (OR 2.3; 95% CI 1.4-3.8) for pain relief and used bath/shower less frequently for pain relief (OR 0.3; 95% CI 0.2-0.5). Labour induction was associated with a less positive birth experience (OR 1.5; 95% CI 1.0-2.3), and women who were induced were more likely to totally agree that they were frightened that the baby would be damaged during birth (OR 2.1; 95% CI 1.2-3.9), but the assessment of feelings during birth differed with regard to length of pregnancy.

CONCLUSION

 Labour induction affects women's experiences of birth and is related to length of pregnancy.

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.