Justus Hofmeyr, professor of obstetrics and gynaecology at Witwatersrand University in South Africa, has found that having a female supporter at childbirth can have lasting psychological benefits for mothers, but that when male partners attempt to give such support the opposite may happen.
For most of history, men have been excluded from childbirth. Even when male obstetricians took charge, other men, such as the father, were kept well away. So if both tradition and new research suggest that childbirth is basically a secretive, female event, why has the presence of the father been considered such a very good thing in recent times?
Dr Michel Odent, the French doctor who became famous for his 'underwater births' and who now supervises home births in the UK, has recently researched this subject for his latest book, The Nature of Birth and Breastfeeding. He says: 'Two things were responsible for fathers being present at the birth - the trend towards births taking place in hospital, and the growing isolation of the nuclear family. As families became smaller, often the only person the mother was familiar with was her husband or partner. Other relatives may have lived hundreds of miles away.
'As the traditional midwife became part of the medical team, a remote person in a white coat, many women felt a strong need for a family member to be there to provide a link with home. Also, as births became ever more technological throughout the Sixties and Seventies, it was felt that men had a place. They could help to work or monitor the machinery.'
But now, he says, there are moves to bring back genuine options in childbirth, to have more home births, and special birth centres, 'rather than the clinical setting of a large hospital'. What happened, says Dr Odent, is that an idea which seemed humane at the time became an orthodoxy so that no man felt he could refuse to watch his child's birth. 'I'm not saying that fathers should never be present at the birth,' Dr Odent adds, 'but they can be more trouble than they're worth. For instance, they often try to be logical, to explain and reassure - and end up making the woman feel worse. If men keep a low profile and just sit in a corner, their presence can be reassuring, but often they want to take charge and tell the woman what to do.
'Essentially, I believe that women, like other mammals, would rather have privacy and not be observed when giving birth. One reason, I believe, why marriages commonly break up soon after childbirth is that all the mystery has gone, there is no sexual attraction any more.'
Dr Odent feels the best way forward is to continue to offer as much choice in childbirth as possible, and not for anything to harden into unalterable orthodoxy. At the moment, few fathers dare to say they'd rather not be there at the birth, even though 25 years ago most men would have run a mile rather than watch their own child be born.
The National Childbirth Trust was one of the organisations responsible for persuading hospitals to allow fathers to watch childbirth. Their view, once considered very radical and even hippyish, is now the prevailing orthodoxy. Sue Bruton, an NCT teacher for 16 years, says: 'We wouldn't want to undervalue the support that male partners can give. A lot of hospitals nowadays allow two people in, to give the partner a rest. This is a good way forward, as it means men don't feel they have to be there every second.'
Tony Parsons, consultant obstetrician at the Hospital of St Cross, Rugby, believes that 'the presence of male partners at the birth is now here to stay'. But he acknowledges that 'a lot of studies have shown that having a female companion during labour is extremely helpful, while there is not much evidence to show that a male companion is equally helpful.
'This issue has hardened into orthodoxy, and it has become difficult for male partners not to be there. But nobody should ever feel under pressure to attend - we do need to keep options open, and remain flexible.'
I WANTED A WOMAN TO BE MY HELPER
Amandla Smith, 30, gave birth at home to her third child, Themba, after four hours of labour, on 4 August 1992. She chose to have a woman as her main birth helper while her husband, Ire, kept a low profile and looked after the children
DURING my third pregnancy, my husband and I tried to practise the things that had helped me in my other labours. I wanted him to look into my eyes while I was breathing and say 'Soft . . . loose . . . open mouth', which means 'soft . . . loose . . . open vagina', which had really got me to relax in my other births. But he couldn't do it properly and I was going 'No, not that way, no, you're breathing too hard'. So I think he was quite relieved when I said I preferred a woman to be my main birth helper again.
In my first labour, Ire had been my primary birth partner with Jessica, the instructor from my NCT ante-natal class, assisting. I had asked her to be there because I was afraid that the NHS midwives would pressure me into taking drugs and wanted someone knowledgeable who shared our views on natural birth. When I got pregnant again and thought back on my first labour, I realised that Jessica had a number of special qualities to offer, so I asked her to be at my next birth.
But towards the end of my third pregnancy, Jessica's father died and she said she couldn't come. I wanted a partner who had birth support skill and who was objective, so that ruled out close friends. I had been going to yoga and had developed a rapport with a woman called Elke who was the organiser for a home-birth support group. She'd massaged me and we'd done breathing together and she agreed to be my helper.
I was three weeks late and wondering when I'd go into labour. I got into the birth pool Ire had set up in the kitchen, but I felt really weird and I said, 'There's something wrong', and Ire said, 'You know what's wrong, you're in labour, you've got exactly the face you get when you go into labour.'
We were both so excited, but Ire was distracted by the kids and I was holding back, waiting to get into it with somebody who was totally there for me. At one point, I got angry because I couldn't have his full attention and I was shouting, 'When I need to rely on you, you always fuck up, and don't you dare deny it]' And he was being understanding and saying 'Don't worry, things will be fine'.
Then Elke came and Ire took the kids to the neighbours and soon afterwards two NHS midwives arrived. Elke wanted to massage me but I said, 'No, I want you to sit and make eye contact while I walk up and down'. She was fine about that, but the older midwife couldn't accept it. She had one of these phallic massage things with two wooden balls on either side that you roll up and down and she followed me across the room trying to roll this phallic thing on my back. Eventually I karate-chopped it out of the way and said, 'Look, I don't want that]'.
At one point I burst into tears. I got big cuddles from Elke and Ire, but the midwife said, 'No need to cry now' and Elke went 'Soft . . . loose' and we just ignored the midwife while Ire distracted her by offering her tea in the other room.
Then it was just me and Elke in the room and the contractions got really strong. I started walking up and down and every few paces I'd stop and hold my fist above my head and go 'Heeeeeeyyy' and bring my hand down slowly. Elke was doing it with me and it made a beautiful sound. Then Ire came back and he was the missing ingredient I needed to start pushing.
I got into the birth pool and Elke and I were giggling, a sort of blissful, naughty giggle you only have with sisters or female friends and it was like, here I am having fun in the middle of my labour. Then my waters burst and it was a lovely feeling as it merged with the waters of the pool. I felt the baby's head and its fullness in my fanny was an amazing feeling.
The health professionals were getting worked up, but Elke and I focused in on each other and blotted them out and everything was calm. The head came out and then the body and that's such a beautiful moment, when the baby's there and it's all over.
Afterwards, when all the health professionals had left and Ire was fetching the kids, it was just me, the baby and Elke and we'd done it and she was giving me feedback about what a powerful experience it had been to see me cope in the way I had. Then the kids came home with Ire and sang 'Happy Birthday' to their new brother, and Elke left and we all got into bed with the baby.
HOSPITALS CAN BE LONELY PLACES, AND WENDY NEEDED A FRIEND
Shane Wall, 25, is a first-time father whose wife, Wendy, gave birth to Heather Lee on 16 June in London, after 48 hours of on-and-off labour
I tend to be squeamish, and although I was a bit worried, there was never any doubting whether I'd be at the birth. On the Saturday night - her due date - Wendy got leg cramps, which we dismissed as a false start. All through the weekend she had light contractions, but on Monday morning they started for real. I tried to ease the pain, but no amount of massage seemed to help, and by the end of the day she was only two centimetres dilated and I felt helpless and mentally drained. The midwife took us to hospital and Wendy was given a shot of pethidine and hooked up to a monitor. The baby's heartbeat was dropping alarmingly with every contraction, but Wendy couldn't see the monitor and I felt I had to protect her and not show my fear.
Then the midwife started talking about induction and a doctor came to administer an epidural and to test whether the baby was in distress. He stuck a tube about two inches in diameter up Wendy's vagina and shone a light up to see the baby's head. Then he stuck what appeared to be a needle through the tube into the baby's head. He tried to draw blood six times. Wendy was distraught, but the doctor never reassured her. I asked him to be gentle, he took it as an insult, and after that he ignored me.
I had never seen Wendy having an internal before and now, suddenly, I was in a situation where my wife's vagina was the focal point for everyone in the room. There was no time to be self-conscious and I had to come to terms with it very quickly.
In the meantime, Wendy had jumped to seven centimetres, so they decided not to induce. She had no pain because of the epidural and we were able to sit back and relax. I'd had four hours' sleep in two days and I realised how exhausted I was. We did silly things, such as play dominoes, and when everyone left the room we turned up the music and took photographs of ourselves like two naughty kids.
At around 1pm I took a walk. I felt guilty even suggesting it, but Wendy said she didn't mind at all. So I ran to friends who lived over the road from the hospital and they made me a hot cup of sugary tea. After 10 minutes the telephone went and it was the midwife to say that if I didn't come right then, I'd miss the birth. I sprinted back to find that Wendy had decided to push. You could see the baby's head, and as it was coming out it looked like chunks were missing. I thought: 'No, no, it's just typical of my luck,' but I never said anything.
The midwife started pulling the head, but she couldn't get a grip and it looked really strange, like she was trying to get the top off a bottle. Then the baby shot out and there was blood everywhere and I did a subconscious visual check and I saw she was perfect and I said: 'She's beautiful,' and Wendy said: 'No she's not, she's blue and slimy.' But I knew she'd be blue and slimy and when I saw she was perfect - that to me was beautiful.
I think that my being at the birth was a positive experience for both of us. Wendy knows she can rely on me and that's made me feel more dependable and it's made us closer. Also, I feel I've been involved in my daughter's life right from the start. Wendy has implied that she couldn't imagine what it would have been like without me. Hospitals can be very cold, lonely and unpleasant places. I'm Wendy's friend, and that day she really needed a friend.
IT WAS THE WORST EXPERIENCE OF MY LIFE
Costa Kostis, 25, is a first-time father whose fiancee, Joanne, gave birth to Hollie after 16 hours of labour on 23 October, in London
BASICALLY, I didn't want to be there. I don't like blood and I don't like hospitals and I knew I'd be useless at supporting Jo during labour. All my male friends had attended their children's births and claimed it was the best thing that had happened to them. But I preferred Jo's mother to help while I paced the corridors, smoking away, like in the old days. In the end, I agreed to go because Jo insisted. Still, I hoped to stay in the background while Jo's mum did all the massage and breathing stuff.
Jo's waters broke late in the evening and I drove her to the hospital. The contractions were mild and she was coping fine. At around 5am the contractions got really bad. She has a low pain threshold and she was screaming and crying and in enormous pain. I started to panic and suggested an epidural. The anaesthetist came and tried to insert a tube into her back. She had to try four times and I was thinking: 'Jesus Christ, she doesn't know what she's doing.' Eventually she got it right, the epidural took and Jo's pain disappeared. She fell asleep and I thought: 'If it's all like this it'll be a doddle.' Then I sat back and fell asleep, too.
When I awoke, the anaesthetist was spraying Jo's body, going higher and higher and asking her where she could feel it. They had topped up the epidural but the anaesthetic had gone the wrong way and Jo was numb from the waist up. I was convinced she'd have a heart attack and I started to feel very scared. The anaesthetist and the midwife were frantic, saying things like: 'Oh my, I've only seen this once before.'
Then Jo's eyes started to close and I thought it had gone to her brain, too. She was having difficulty breathing and she was moaning: 'I'm gonna die, I'm gonna die.' I wanted to scream at the anaesthetist, to punch her, to kill her. But I didn't want to make things worse, so I just comforted Jo and tried to keep her conscious.
After about two hours the epidural started to wear off and her breathing eased. They wanted to top it up again and although Jo said no, she went ahead and it shot straight up again. By now I was convinced she was going to die and I burst into tears and charged out of the room to phone her family.
A doctor came and told us not to worry and said that the baby's heartbeat was fine. Jo was getting really strong contractions and by now her mum was there, too. I had expected to be in the background, but instead, there I was, helping her to breathe through every contraction, giving everything I had.
By midday Jo was fully dilated and the midwife got her to start pushing. Two doctors came in and one put a vacuum in Jo's vagina and fitted it to the baby's head. He started pulling but the vacuum came undone and he flew backwards and I was thinking: 'What's going on here? Are these doctors?' He tried again and tugged and . . . bang - he'd gone to the back of the room. It looked like something out of a Carry On film - there was blood everywhere, Jo was screaming and the doctors were having little arguments between themselves.
Then one of them took forceps and began to pull really strongly and I was thinking: 'Jesus, that's a baby's head you're pulling there]' Then the baby's head popped out, bloated and blue, and they offered it to Jo and she said: 'Give it to dad.'
And in front of me was this mashed up, elongated sausage head. No one had warned me it would look so terrible. I handed the baby straight back to the midwife and rushed out into the street for a cigarette. I was still in shock when I went to tell the family. The midwife kept reassuring me that our daughter was fine. It was hours before I was able to pick her up, yet when I did I felt an overwhelming love.
I can honestly say that attending the birth of my daughter was the worst experience of my life. I've told Jo that I'll never do it again. She hasn't said anything, though she'll probably make me - if there is a next time.
In one sense, I'd like to be there to help her - but if someone else could do it instead, that would be brilliant.
'The Nature of Birth and Breastfeeding' by Dr Michel Odent is published by the Greenwood group, 3 Henrietta Street, London WC2, price pounds 13.50.
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