Include Fathers in Labor Management Plans.

A recent study of fourteen first-time fathers has provided information relevant to anyone providing labor support. Comparisons were made between the fathers' prenatal expectations and their perceptions after birth.

A first-time father was defined as a "biologic father who has lived with the expectant mother during the pregnancy. Although the father might have experienced a first trimester abortion, he had not experienced a live birth with either his current or any other partner."

During pre-labor interviews the fathers believed they were confident in their abilities to support their wives during labor and birth. They also viewed the pregnancy and upcoming labor and birth as a "team" experience. Confidence in both the staff and their wives' ability to manage were also common themes among the men.

In the early stage of labor the fathers remained calm about the labor, but excited about the moment finally arriving. Based on what they had learned prenatally about progress, the men viewed this early stage as normal. They also felt confident in the effectiveness of the comfort measures they had learned in prenatal classes. As labor progressed they learned that it required more work than they anticipated. For example, some of the men supported their wives in a squatting position for long periods of time and others provided back rubs and massages. They were amazed at how tiresome this became. Some were also discouraged because many of the coping techniques they learned did not work.

The study indicates that the length or progress of labor was the single most important factor in determining the degree of support the men provided. One of the fathers described the prolonged second stage as a period of "intense stress, fatigue, fear, and hopelessness."

As labor progressed all the men experienced increased fears. They did, however, realize when they needed to stay in control and keep those feelings from their wives in order to fully support them. This is in direct contrast to the prenatal emotions when the men shared their concerns and fears openly. When staff did not answer questions fully, come when called, or announced plans for unanticipated interventions, all men felt more fear and, as a result, could not concentrate fully on their wives.

One of the most prevalent themes that arose was that the fathers felt a lack of inclusion during labor. They received little or no direction from the staff and thought their presence was tolerated rather than viewed as an important and necessary part of the birth. The men knew they needed guidance, but many were too uncomfortable to ask.

After the birth the most common emotion felt by the men was that of relief. Despite any problems they may have had with the staff (ranging from arguments about following birth plans to unnecessary interventions), the men described all positive emotions.

In general, the fathers were satisfied with the care their wives received during labor. Their primary concerns were that procedures were not adequately explained and lack of encouragement from the staff in supporting their wives. It is unfortunate that the fathers were not asked what role they wanted to play, that they were still viewed as simply another person in the room and not part of a couple experiencing labor.

Researchers conclude that it is critical that care givers recognize the couple as partners; consider both individuals when developing a care plan; and give fathers praise and encouragement in their role as support person. Prenatally, doctors, midwives, educators, and labor assistants can help fathers prepare by discussing the range of experiences they might encounter during labor and birth. While the men were educated on the amount of work their wives would experience, it was clear that the men did not realize the amount of work required from them. Fathers also need more information about ways they can assist their wives throughout pregnancy and labor. Additionally, care givers need to be aware of the fathers' needs during labor and should encourage them to rest or eat when appropriate.

--Journal of Nurse-Midwifery, Vol. 42, No. 1, January/February 1997

Editor's note: Labor support persons and childbirth educators should review their forms and materials to include clearly defined roles and expectations for partners and other support people. Although this study focused on fathers, it is always important to consider the mother's partner's needs during pregnancy and birth.