Transcript Involving Fathers in Maternity Care:

Involving Fathers in
Maternity Care: Best Practice
Dr Mary Steen, LTHT NHS Trust,
Prof Soo Downe & Katrina Rigby, (UCLan)
Duncan Fisher, Adrienne Burgess,
Jeremy Davies (Fatherhood Institute)
Introduction:
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Women-centred maternity care is now widely
accepted.
NHS data (2005) 98% of fathers attend birth,
48% attend A/N classes, 85% at least one
A/N consultation with a MW, and at least one
ultrasound scan.
Acknowledgement - need to support fathers
to support their partner during pregnancy,
birth and after birth
Many midwives try hard to involve fathers
with limited guidance and resources
What Fathers think of Midwives?
 Singh
& Newburn (2003)
assessed what men think of
midwives and reported most
have positive opinions and
highlighted the need for holistic
care for mothers & fathers
Structured Review
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Aim: To identify published evidence relating
to involving fathers in maternity care and
develop best practice guidelines
Structured review used, Cochrane Library,
CINAHL, MEDLINE, EMBASE, Mother & Infant
Care & PsychInfo databases.
Different permutations ‘fathers’ OR, ‘dad’
OR, ‘dads’ OR, ‘partners’, OR ‘fatherhood’
AND ‘maternity care’, OR ‘pregnancy’ OR,
‘antenatal care’ OR, ‘antenatal education’ OR
‘parenting education’ OR, ‘childbirth’, OR
‘birth’ in the title, keywords or abstracts
were the terms used.
Search period -Jan 1998 to Mar 2008.
Structured Review
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Search Strategy- a total of 831 Hits
Full article reviewed if related to fathers &
maternity care.
Exclusions: > 6 wks P/N Care, teenage, BME,
disabled, step fathers & birth partners.
Removal of exclusions, duplications & a hand
search of potential papers from reference lists,
total 77 papers reviewed 24 opinion-based
53 research, 33 quantitative, 20 qualitative
Critiquing these papers, CASP tools, Narrative
synthesis of qualitative literature
Identified studies focused on:
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The role of the
expectant father
Fathers attitudes
towards & experiences
of pregnancy
Experiences of
antenatal education
Massage in pregnancy
and labour
Smoking issues
Changes in health for
first-time fathers
Transition & experience
of fatherhood
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How fathers perceive
midwives
Experiences around the
time of labour & birth
Partner support in labour
and maternal outcomes
Breastfeeding
Experiences in P/N period
Anxiety & depression
following birth and in the
postnatal period.
Involving fathers in pregnancy
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Pregnancy associated - high levels of stress &
anxiety for men (Condon et al, 2004;Johnson and
Baker,2004; Rosich-Medina & Shetty, 2007)
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Men became the channel of communication
with professionals, shielding their partner, eg.
phoning for test results. (Locock & Alexander 2006)
Early involvement with fathers in pregnancy –
major impact on the future relationship
between father and child (Henwood & Proctor, 2003;
Santos Perez et al, 1998).
Involving fathers in pregnancy
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Most men rely on second hand information
passed on by their partners (Locock &
Alexander, 2006).
Expectant fathers need access to a
professional to answer questions during
pregnancy (Finnbogadottir & Svalenius, 2003)
Men’s attendance at scans now appears to be
a widely accepted part of pregnancy
Draper (2002) identified importance of
ultrasound for helping men to visualise the
baby & realise their transition to fatherhood.
Involving fathers in A/N Education
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Diamer (1998) - a correlation with
A/N education specially designed for
fathers to > the likelihood of their
support with housework, more likely
to ‘reason’ with their partners,
better relationships
Hallgren et al, (1999) education
found to be effective in preparing
fathers to take active roles at the
birth.
Involving Fathers in Birth
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(Wockel et al,2007)Well-Prepared fathers Positive effect & > positive birth experience
& fears of seeing their partners in pain were
less.
“how much a man trusts other carers and
how much he trusts the woman’s body to be
able to give birth will have an influence on
his understanding and fear within the
situation” (Downe, 2004)
Involving Fathers
in Birth
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Chang et al, (2002) massage
psychosocial support for women
Latifses et al, (2005) teaching
massage or relaxation techniques
- effective way to > marital
satisfaction & decrease P/N
depressive symptoms
Involving Fathers in Birth
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Erlandsson et al,
(2007) showed
skin-to-skin
contact with the
father after
caesarean
section babies
were more likely
to stop crying,
became calmer,
Involving Fathers after birth
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Abramowitz et al, (2001) - first report
describing (OCD) in fathers
White (2007) PTS, fathers - negative emotional
experiences with serious consequences for
family relationships
Maternal PND strong predictor of paternal PND
and at > risk if unemployed & relationship
problems (Bria et al, 2008)
Madsen & Juhk (2007) Better methods for
identifying men with PND need to be developed
Involving Fathers after birth
Public Health Targets:
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Wolfberg et al, (2004) Fathers influential
advocates for BF
Play a important role in BF support (Piscane et
al, 2005)
Blackburn et al, (2005) examined parents
smoking patterns & infants exposure - Both
parents make substantial contributions
A survey sponsored by NCT highlighted - men
want classes to provide more information on
P/N issues (Singh & Newburn, 2000).
In summary,
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There is cumulative evidence that
demonstrates that when men are
involved during pregnancy, birth
and the early postnatal period this
can significantly affect the health
and well-being of women and their
babies.
Policy Guidance
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There is a move towards engaging better
with fathers. Reference to this has been
made in several policy documents
The NSF (DH, 2004) supports a cultural
shift in all service provision to include
fathers in all aspects of a child’s wellbeing.
It also specifies the importance of staff
being trained to support fathers, and
possess skills for engaging with fathers
as well as mothers.
Policies relating to Maternity Services
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Maternity Matters (DH 2007)
‘High Quality maternity care… involves
access to a wide range of services that
work in partnership to help equip mothers
and fathers with the skills they require to
become confident and caring parents.’
Aiming High for Children: Supporting
Families (HM Treasury/DfES 2007)
‘…A focus on midwives and health visitors
and their role in supporting both
parents…’
Policies relating to Maternity Services
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NICE (2006) Clinical Guideline:
Routine Postnatal Care of Women and
their babies
‘Postnatal care in the community should
provide mothers and their partners or
companions with information…’
(DH & DCFS 2007) Teenage Parents
Next Steps: Guidance for Local
Authorities and Primary Care.
‘Working with young fathers is to be a
priority in teenage pregnancy.’
Ch. 5: Inclusive Services
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5.6 Involvement of prospective and new
fathers in a child's life is extremely
important for maximising the life-long wellbeing and outcomes of the child (regardless
of whether the father is resident or not).
Pregnancy and birth are the first major
opportunities to engage fathers in the
appropriate care and upbringing of their
children.
Ref: DH (March, 2007) NSF for Children Young
People and Maternity Services Standard 11:
Maternity Services
Engage-Me & EPiC
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Perinatal Health Research
Collaboration:
University of Manchester.
Several projects:
Some aim to promote, engagement of fathers
in care of their partners during pregnancy,
childbirth, after birth
Produce resources - maternity units to facilitate
active involvement of partners in maternity
care,
In particular BME fathers, shortlisted for a RFPB
Best Practice Guidelines
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Midwives well placed to engage with
fathers
Fisher (2007) confirmed “no other
health or family service other than
maternity achieves remotely this
level of connection with men in their
role as carers of children”
Summary of Guidelines:
Antenatal:
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Respect women’s choices at all times
Midwives need to explore, reflect on their
attitudes, beliefs, practice re: involving fathers
in care
Midwives make fathers feel welcome &
involved
Some flexibility for easier access to A/N care
Fathers like mothers, are open to professional
information and advice at this time
Document health advice, guidance given to
both
Summary of Guidelines:
Antenatal:
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Greet him by his name - document his name in
hand-held notes
Encourage attendance & include them more in
parenting education
Offer fathers opportunities to discuss their
thoughts & feelings about changes they are
facing
Be sensitive to the needs, concerns of both
expectant parents - < anxiety & stress
Create opportunities for fathers to ask questions
Summary of Guidelines:
Childbirth:
 Respect, be aware of religious, cultural
beliefs associated with birth
 Fathers need to be well informed about the
benefits of providing companionship &
support
 Need to prepare fathers for an active role
 Encourage fathers to use massage &
relaxation techniques
Summary of Guidelines:
Childbirth:
 Discuss & inform fathers of any
complications
 Fathers should be main care
provider during mother-baby
separation
 Encourage skin-to-skin contact to
promote bonding & development of
pre-feeding behaviour
Summary of Guidelines:
Following birth:
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Support them to support their partner &
infant.
Raise awareness - risk of fathers suffering
PND & assess health - well-being of both
Provide, promote health education regarding
breastfeeding benefits & issues
If the mother decides not to B/F ensure both
have skills to safely prepare formula feeds
Father’s smoking receives less research or
health promotion than that of mothers. Need
to address this deficit
Summary of Guidelines:
Following birth:
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Make opportunities to
explore & discuss both mother’s, father’s
experience of birth, early
parenting
Provide information,
support, guidance and
reassurance at regular
intervals
Develop clear referral P/N
pathways for both if PTS or
PND suspected and
identified
Conclusions:
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Most women want their partners to become
involved in all areas of maternity care.
Many men want to be involved in their
partner’s pregnancy, birth and fully
participate in baby care
Vast amount of evidence of benefits when
fathers are involved in their partners
pregnancy, birth and following birth
Need to undertake further research, focussing
on involving disadvantaged fathers
Need to standardise good practice guidelines
for Maternity Services throughout the UK
The Fatherhood Institute
The vision of the Institute is to give all
children a strong and positive
relationship with their fathers, support
co-operative parenting, provide greater
support for mothers as carers and
earners, supports the role of men in
caring for children (Fatherhood Institute,
2008).
Being a Family