Unfortunately, the situation I’ve just described is one that many midwives and doulas have encountered. While we strive to create a space where birth can unfold in a manner that engages and delights its participants, the reality isn’t always so pleasant. Nearly 70 years ago, Grantly Dick-Read wrote in Childbirth Without Fear that laboring women often experience a cycle of: Fear › Tension › Pain. This is a cycle with which many of us are familiar, and we’ve developed a myriad of ways to break the cycle since Dick-Read first published his seminal work in 1942. However, less attention has been focused on the emotional roller-coaster fathers experience throughout pregnancy and birth, and it’s this area that I’d like to explore in greater depth.
Although a man cannot feel the same pain as a laboring woman, I believe that many men experience a similar cycle of emotions in the birthing space to that which Dick-Read described, with a slightly different end product, namely: Fear › Tension › Panic. A man who is not confident in his partner’s birthing abilities, who is poorly informed, and/or who is poorly supported, becomes increasingly tense; and if this tension is not eased, then he spirals into an irreversible state of panic. This panic manifests differently in different men: some men become paralyzed by their fear (the familiar specter of the terrified dad sitting stock-still at the foot of the bed), while others spring into hyperactivity, bringing endless cups of water or becoming obsessively concerned with the temperature of the birth pool.The root of this panic is fear, and it’s a fear that often begins to grow long before the first contraction is felt. As such, we need to think about ways that we can address and minimize this fear in the days and months preceding birth. Men’s fears around birth (and our various ways of dealing or not dealing with them, as the case may be) were at the forefront of my mind when I was invited to observe a local antenatal class last weekend. This class took the form of a two-day intensive course and, as such, the instructor had the daunting task of preparing six couples for birth in less time than it takes for most people to complete a tax return. The couples arrived at the venue bright-eyed and keen to learn; after a few “getting-to-know-you” games, the men and women were dispatched into separate rooms, and the women were encouraged to draw pictures of their ideal birth space while the men were given a crash course in the stages of labor. After half an hour, the women were invited into the “men’s room,” where the men sat looking dazed amidst piles of anatomical charts and laminated birth photos.
The men were asked to tell the women what they’d learned, and several of them piped up eagerly with comments about optimal fetal positioning and the like. One man valiantly grappled with something called a “Dutch pelvis”—a contraption vaguely resembling a slotted box and a wooden spoon with a baby’s head on the end of it. Beads of sweat formed on the man’s forehead as he pushed the baby-shaped spoon through the various slats of the box (ostensibly to demonstrate fetal rotation and descent), and he finished with a halting explanation of the best presentation for a speedy birth. Job done, the fathers in the room sat back and breathed a sigh of relief, evidently pleased with themselves for absorbing crucial information, but still looking slightly panicked by the sheer enormity of the topic. The morning had included a brief exploration of parents’ fears, but in an attempt to demystify birth by examining its physiological stages, it seemed that some of the men in the group had worked themselves into a state of high tension and, yes, even panic. I was impressed by the facts and figures that these fathers-to-be had managed to absorb in such a short period of time, but I was also worried about how this cycle of fear, tension and panic might repeat itself when these men witnessed the imminent births of their children.
How can we, as birth workers, stop the vicious Fear › Tension › Panic cycle? While we may never be able to eliminate fathers’ concerns completely, I believe that a change in the way we structure and implement antenatal preparation can help men to feel calmer and more confident about birth. It is important for men to have at least a basic understanding of female anatomy and the stages of labor, but even more importantly, antenatal workshops must:
Confront the origins of men’s fears about childbirth. For example, each man might be asked to share the story of his own birth with the group, such as it was told to him, or to share a friend’s or colleague’s birth story that affected him in a particular way. This exercise could serve as a useful starting point from which to examine our preconceived notions about birth and could lead to a frank analysis of which notions are based on fact and which are fiction.
- Teach practical coping techniques. In the class I attended, many men were desperate to find out how they could lessen their partner’s pain during childbirth. In addition to teaching simple massage and relaxation techniques, a birth educator might do well to emphasize practical ways in which a man can create and “hold” a safe, private birth space for his partner. Many of the men I’ve worked with have been delighted to embrace this role as guardian of the birth space and have been keen to find out how an atmosphere of peaceful privacy can actually ease their partner’s perception of pain.
- Encourage open dialogue between parents. Ask women to be open about the role they expect their partner to play, but also encourage men to be honest about their capabilities. Although men have been welcomed back into the birth space in the last few decades, the expectations placed on them have grown almost unrealistically onerous: fathers often feel pressure to be an all-knowing birth partner, medical liaison, masseur, lover, protector and friend, while simultaneously being expected to “relax and enjoy” the birth experience. Antenatal preparation must incorporate an honest dialogue between parents, where expectations are expressed, but where limits are also respected. Crucially, we must also help parents to feel safe in acknowledging that, for men who cannot overcome negative emotions around birth, opting out of the birth space and paving the way for another supporter (such as a doula or friend) may actually be the most helpful thing they can do.
In conclusion, we as birth workers must begin to envision a new kind of birth preparation that aims specifically to combat the Fear › Tension › Panic cycle for men, as well as the more traditionally envisioned Fear › Tension › Pain cycle for women. A panicked man will never be able to provide adequate support for a woman in pain, and it is our responsibility to explore and address the root of that panic. Yes, there is a place for the Dutch pelvis and the anatomical chart, but first and foremost, there must also be a place for open, honest discussion of men’s attitudes towards birth and of their capabilities to “hold the space” in a way that is valuable for each birthing woman.