Page last updated at 11:59 GMT, Wednesday, 25 November 2009

Should dads be in the delivery room?

By Clare Murphy
Health reporter, BBC News

Dad and baby
Would it have been better if he wasn't there?

It was once imparted to the father over the phone, yet now it's men themselves who often tell their exhausted partner the sex of the child she has just delivered. But could men be more of a hindrance than a help in the delivery room?

French obstetrician Michel Odent says yes, and even blames fathers for an increasing rate of births by Caesarean section.

At a debate hosted this week by the Royal College of Midwives, Mr Odent will argue against what he dubs "the masculinisation of the birth environment".

The presence of an anxious male partner in the labour room makes the woman tense and slows her production of the hormone oxytocin, which aids the process of labour, so the French doctor contends.

This, he says, makes her much more likely to end up on the operating table having an emergency Caesarean section.

"Having been involved for more than 50 years in childbirths in homes and hospitals in France, England and Africa, the best environment I know for an easy birth is when there is nobody around the woman in labour apart from a silent, low-profile and experienced midwife," he says.

"Oxytocin is the love drug which helps the woman give birth and bond with her baby. But it is also a shy hormone and it does not come out when she is surrounded by people and technology. This is what we need to start understanding."

He will be debated by Duncan Fisher, a leading advocate for fathers, who, while pressing for more preparation for fathers, argues they are there because women want them to be - "and we should trust mothers' instincts".

Here we come

Certainly men's appearance on the labour ward does co-incide with a rising number of caesarean births - although ironically their arrival was in part a backlash against doctor-led, highly-medicalised care in favour of a more woman-centred approach.

In the 1960s only about a quarter of men in the UK attended the birth of an infant, today it is well over 90%.

There are many reasons why the number of emergency Caesarean sections has risen ...none of which have anything to do with the presence of dads
Patrick O'Brien
Consultant obstetrician

It is seen as an important rite of passage for any involved father, as well as a marker of social progress - the less developed a country, the more likely childbirth is to be seen as a woman's business best conducted behind closed doors.

"But I think the other issue is the lack of one-to-one care of women by midwives," says Winnie Rushby of Doula UK, an organisation which provides birthing support from experienced, but non-medically trained women. "Fathers have been called on to provide that help.

"Some of them are very attuned to the emotional and psychological needs of their partner. But if they are shocked by bodily fluids and very agitated by the pain they see her in, this could play on her mind and stop her psychologically entering the place she needs to be to deliver the baby - the birthing 'zone', if you like.

"We've gone from men not being there to virtually all men being there. We need to find a new medium, where there is no shame in discussing whether the father should be there or not. Women need to start asking if they really do want him there - and if so, is he prepared for what will go on."

Staying home

In fact, the greatest advocate of putting men in the mix was US doctor Robert Bradley, who in 1962 published Father's Presence in Delivery Rooms. This was a review of 4,000 cases when husbands were present.

Some partners will not feel comfortable themselves in providing physical and emotional support during labour
Elizabeth Duff
National Childbirth Trust

He concluded, quite contrary to Dr Odent, that the husband's presence as a so-called "birth coach" actually helped the woman to relax. "With husbands coaching, we have more than 90% totally unmedicated births. No other approach comes near to that figure," he wrote.

Iran only recently allowed fathers into the delivery room after the health ministry in Tehran asked doctors to reduce the number of Caesarean births.

At 70% it has been among the highest in the world, and has been explained largely by women's fear of childbirth. Bringing in the men, it was hoped, would provide women with the reassurance they needed to deliver their baby without surgery.

Whether some men do in fact aid or irk in the delivery room is likely to remain a staple - and unresolved - debate, as any clinical trial would be almost impossible to conduct.

"But what we do know is that there are many reasons why the number of emergency caesarean sections has risen - including obesity, older mothers, and fear of litigation - none of which have anything to do with the presence of dads," says Patrick O'Brien, a consultant from the Royal College of Obstetricians and Gynaecologists.

"Having a baby together is an intense, life-changing experience that most couples want to experience together. The father can be an immensely reassuring presence for the mother.

"And as for the suggestion that men won't cope with the so-called gore - well, most of his role can be carried out at the head-end, talking, mopping her brow, offering sips of water. Of course a man shouldn't feel forced to be there, but I have yet to meet one who said after the birth of his baby - 'I wish I'd stayed at home'."



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