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CHAPTER FIVE

The Birth Experience

Today it is the rule that a man should be present for the birth of his baby. Severe pressure is put on the man who is reluctant—by both women and other men. Such is the power of the new orthodoxy. A generation ago it was rare for a man to witness a birth, and even if he wanted to, permission was rarely given by the hospital authorities. Now in some places over 90% of men are there when their babies are born.[1]

Such a major change has many underlying causes, some more open and obvious than others. Basically we can isolate three main pressures: from women, from the medical profession, and from men themselves. If we take a closer look at the British figures, an interesting thing emerges. Anne Woolett and her co-workers asked women of all ages whether they had wanted their husbands to be present at birth. Those who had given birth in the 1940s and 1950s did not want fathers present, and they were not. In the 1960s 43% of women said that they would have like their husbands to be present, but only 19% were. By the 1970s 82% of women wanted the father to be there for the birth, and 71% of them now were. It is possible to interpret these figures as suggesting that men have ‘followed’ women into the delivery room, accompanying them simply because their womenfolk have desired it. Certainly the evidence suggests that women are more keen than either men or the hospital system.

It must be remembered that during this period we have also seen the removal of birth from the home into the hospital. This may well have had a large impact on the changing patterns of birth attendance. When birth was at home, in familiar surroundings, the family would be nearby, even if not actually present. The mother felt much more in control of the situation since it was her territory. In hospital things are different. The mother is isolated from family, friends and neighbourhood. The environment is strange, the rules are not made by her, and she is under the control of others whom she may not know and may never have met before. In such circumstances it is not surprising that a woman should want a familiar face for moral support. The question is, why the father?

Traditionally, it is women who have provided companionship for women in labour. Some societies do allot this role to men, but the general rule is that a labour companion should be female. This used to be the case in the West also. As late as the 1959 more women who delivered at home in Nottingham had a female labour companion (15%) than the father (13%). This female companion would usually be the woman’s mother, but a sister, female friend or even mother-in-law might also be considered suitable. Today it is rare for a woman to have a female labour companion.

One reason for this change may be found in our changing family and social patterns. Increasingly, people move away from the place where they were brought up and set up homes in new areas. As a result, the old extended family ties have weakened, and new family patterns have grown up. In the traditional family the husband and wife have separate networks of friends and acquaintances. He will have mates from work, or his male relations, or people he meets down at the club or bar, or fellow members of a sports club or other interest group. She will have her nearby neighbours, female family members—especially her mother and married sisters, other women she meets at work or in the shopping precinct, or at bingo or bridge.

The notion of ‘network’ is worth looking at more closely. Suppose that I know Fred, Bill, Joe, Susan and Sarah but none of them know each other. The only thing they have in common is that I know each of them. Since they don’t know each other they are certainly not a group, but they aren’t just a random collection of people either—they are part of my network. Now in practice at least some of the people in my network of friends, work mates, family and so on are bound to know each other. The more ties there are between members of my network, the more ‘closely knit’ the network is.

The anthropologist Elizabeth Bott (1971) has suggested that a couple with closely knit networks will be likely to have separate, traditional roles in marriage. They will tend to turn to their networks for help and support rather than to each other. Couples with loosely knit networks are much more likely to do things together and to turn to each other for comfort and support.

The trend, since the last War, has been towards the second kind of family structure. As people become more mobile in search of jobs and new opportunities their traditional close knit networks break down. In their place there will be a much more loosely knit network, with a few friends from work, one or two neighbours, perhaps some people from the sport’s club and a few family members. Few of these people will know each other. In view of this it is hardly surprising that women should be asking their husbands to accompany them in labour. Who else could they turn to? It isn’t just that other women are not available as labour companions, but also that the idea that husband and wife should “share” as many experiences as possible has grown up.

The medical establishment was at first hostile to the notion of allowing any labour companion into hospital. It was felt that they might endanger the birth process, and especially that they might introduce infection into the labour room (medical objections to changes in practice are often couched in terms of sterility and infection). But gradually attitudes changed. Some male doctors started being present at the birth of their own babies. Both they and their wives found it a positive experience and there seemed to be no adverse side effects on mother or baby. So gradually they started to allow and then to encourage men into the labour room.

In the United States the man who exemplifies this trend is Dr Robert Bradley.

Internationally known as the ‘Father of Fathers’, I was the first doctor ever to advocate the continual presence of the father in labor and birth, back in 1947. I chuckle over several Johnny-come lately methods with their claims that this began with them. (p 31).

Bradley was a newly-qualified MD when his wife suggested that he read Grantly Dick-Read’s Childbirth Without Fear. His interest in natural childbirth was aroused and he started to teach and use it with his patients—who at that time were all unmarried mothers. It worked well, but his colleagues were sceptical. It wouldn’t work for married women, they said, they would be much more difficult because they had their husbands to put on a show of martyrdom for! So Bradley tried ‘the world’s second most impossible obstetrical patients—married pregnant nurses.’ (The world’s most impossible obstetric patients are, according to Bradley, married pregnant female doctors).

Despite the fact that their training tends to make them less compliant than ordinary patients, and their knowledge tends to make them worry about all the things which could go wrong Bradley’s methods were hugely successful. He remained throughout each labour, “coaching” the woman and telling her what she ought to do to have a natural birth. According to Bradley, it was only when one newly delivered mother had thanked him most profusely, kissing him roundly in gratitude for his ministrations that the scales dropped from his eyes.

Seeing the anxious husband waiting outside a revelation occurred. It struck me like a sledge hammer. What on earth was this lovely young woman kissing me for? Why was I the object of her gratitude as a labor coach while her young lover sat uselessly in the waiting room, fearful and anxious over his sweetheart’s safety...? So husbands were enrolled as labour coaches, and the movement into the delivery room began. (pp 17-18)

Things went slowly at first. Bradley himself makes a distinction between “delivery” which is the ‘knock-’em-out, drag-’em-out’ approach and “birth” which is a natural event with no medication. It is apparently not appropriate for men to be present at delivery, but perfectly acceptable for them to be present at birth. Most obstetricians did not accept natural childbirth as either possible or desirable and continued to exclude men from the delivery. Even Bradley only allowed them in on his own terms.

Husbands have no business being with their wives unless: (1) the wife has been trained how to perform in labor and has physically prepared her birth-giving muscles; (2) the husband has been prepared so that he understands how, why, and what his wife is doing, enabling him to coach, guide, and encourage her in her ennobling work. (pp 20-21)

Notice that the man is present as a “husband” not a father. He has a job to do: to manage and guide his wife’s labour—as a Robert Bradley substitute, perhaps. There is still no suggestion that a man should be present simply as a father in his own right. But gradually the climate of medical opinion loosened up.

During the 1970s a succession of studies claimed that the presence of men in the delivery room could have three major benefits. Firstly, Bradley’s claims were supported—the father is able to provide support and assistance to the mother; he is, in other words, able to coach her through her labour. Furthermore, the husband seemed to be more effective in this role than medical staff. Secondly, the presence of the father seemed to help the mother to relax more. This in turn both eased and speeded up the delivery. Mothers reported less pain and needed less medication when their partners were present. Thirdly, the presence of the father appeared to enhance the mother’s appreciation of the birth experience. Fathers, it would seem, are good for mothers. And of course, fathers may be useful as unpaid auxiliaries if there is a staff shortage—caused perhaps by an unexpectedly high number of deliveries at one time.

By the end of the seventies both mothers and medics were keen to have men present at birth. But what about men themselves want? What are their responses to this concerted pressure? Once more I find it convenient to divide men’s attitudes towards attending delivery into four categories. It is tempting to compare these with the four kinds of father—as indeed Brian Jackson does in his book. But the comparison is not a simple one, and should be approached with caution.

The first response to consider is that of the man who does not want to be there. This is becoming ever less common—or at least it is becoming less common to hear a man say that he doesn’t want to be there. Our ‘uncommitted father’, of course, will not want to be present. It’s “women’s business”—nothing to do with him. Yet even he is less likely than before to express his sentiments too loudly. For if he does he’s in danger of being branded as an old fashioned male chauvinist; a patriarchal dodo. He will be castigated by men and women alike, while his partner will be pitied and talked about behind her back. The new liberal orthodoxy demands that, whatever they feel, men must no longer talk of “women’s business”—everything must be shared.

The only person who could respectably share the uncommitted father’s viewpoint—though not his views—is a radical feminist. She is able to talk of “women’s business” and sees no harm at all in excluding men from large areas of her life. For such a woman any increase in men’s interest is suspect as another attempt to increase male control over women and—especially in this case—over women’s sexuality. Some men have also been convinced by feminist arguments and think hard before intruding on any “female” areas of life.

But in truth a man does not have to be either callously uncaring or a radical feminist to wish to stay away from the delivery room. I received this letter some time ago in response to an article I wrote about the pressures on men to be “good” fathers:

We are expecting our first baby in a month’s time and throughout my pregnancy my husband has given me all the support, both emotional and practical, that he can. He will not, however, be present at the birth because he has a tendency to become distressed and feel faint if he sees me in pain, bleeding, or being subjected to an injection. It is precisely because of this sensitivity towards me that he will absent himself at a time when he cannot help me and may indeed be a hindrance to the hospital staff and cause me worry at a time when I have to concentrate on the job in hand.

It may be rare for a man to faint in the delivery room, but it does happen occasionally. If you know that you are at risk, then your concern for your partner should not be interpreted as lack of concern. Fear of fainting is not the only reason for staying away. A man may simply not wish to see his wife in what he (and she) may feel is a vulnerable and humiliating situation. He may feel that this a private matter, one which can be shared but not witnessed. Just because a function is natural does not mean that it has to be shared. Excreting is as natural a function as giving birth, but most couples don’t feel any need to watch each other doing it. It isn’t only men who may feel this way. A woman may also feel that this kind of intimacy is out of place in their relationship. This seems to be a perfectly reasonable point of view and it should be respected. It is wrong for a couple to be pressured into performing together in the delivery room just because some people think that there should be no barriers to the sharing of experience between a couple. It seems to me that this is likely to do more harm than good to their relationship and their introduction to parenthood.

Most men today, whatever their private scruples, have decided to be present during labour, and probably during delivery as well. They say that they ought to be present, in order to “help”. Or as a childbirth educator puts it, On the day of the labour and birth the father will be an integral part of the birth team, acting as liaison between the mother and the staff, and being the main support person and coach. (Sundin 1985). It isn’t always so obvious just what this means in practice. In the old movies, when births were still at home, the anxious father paces endlessly at the bottom of the stairs, his only useful function being to find copious supplies of clean towels and boiling water. Herbert Brant, Professor of Clinical Obstetrics and Gynaecology at University College, London suggests that this was simply a diversionary activity since he cannot believe that such vast quantities of water were really necessary. The indefatigable Robert Bradley has a different explanation.

According to Bradley, there was a useful purpose for all the towels and water. They were used to make hot salt compresses which were applied to the labouring woman’s vagina and perineum. These compresses are alternated with applications of olive oil and manual massage of the vaginal opening to enlarge it. The effect is that the skin loses its normal elasticity and the birth is made easier. Unfortunately, the tissues never regain their original shape or size. The alternative to this treatment is episiotomy, which Bradley enthusiastically espouses. Episiotomy is a small cut made in the perineum, the skin between vagina and anus, which makes delivery easier. It is a controversial operation, almost routine in America but rare in some other countries. Its opponents say that it is seldom necessary, and is only performed because the delivering obstetrician or midwife is too eager to ‘get the baby out’ instead of waiting a little longer and aiding the natural rhythms of the body.

But if the obstetrician’s cut has taken over from the father’s kettles of boiling water, just what is the attendant father to do now? What does “coaching” involve? For Bradley it starts well before birth and includes such vital activities as squatting, relaxation, and pelvic rocks. It is not the husband who has to perform these antics, but it is his job to ensure that his wife does them. ‘It doesn’t matter how late it is or how tired she may claim to be; don’t let her in bed with you until she does her pelvic rocking!’ At the birth itself the husband’s role is even more demanding.

For instance the Australian author quoted earlier lists a dozen things the father will be responsible for, including staying with the mother at all times, reminding her to empty her bladder at regular intervals, showing pride in her, keeping a written log of the labour, and ensuring good rapport with the birth team with tact, good humour and respect. But perhaps the most important of the father’s responsibilities, and the one that most clearly summarises his role, is ‘Providing appropriate physical and emotional support, being sensitive to her changing needs throughout the varying phases of labour.’ This is reinforced with a further list of 21 specific suggestions to do with relaxation, breathing, massage and encouragement. Finally the father is reminded that, during delivery itself, ‘Your partner will no doubt have an earthy and instinctive involvement in this fantastic phase of labour. Don’t be embarrassed, allow her to be herself and birth the baby in her own way.’ (Sundin 1984)

The father who goes to the birth because he wants to help thus finds that there are two rather conflicting sets of expectations forced upon him. He must in some way ‘coach’, control or be in charge of the labour and he must also be clear that he is to be quite subordinate to the needs and dictates of his partner. Despite this most men seem reasonably satisfied with their role. Herbert Brant reports a survey done at the West London Hospital in the UK in which 730 men were asked how they thought they had contributed to their partner’s labour.

Helped to sustain morale                               615

Provided physical comfort                            147

Helped with breathing                                   112

Furthered husband/wife relationship            56

Wife appreciated sharing experience              23

Helped pass instructions                                 11

Eased pain                                                       10

The role of labour companion is a hard one for a father to play. Ideally it requires selflessness and detachment—hardly the easiest qualities to cultivate while your partner is in distress and your baby is being born. For many men there is an ambivalence about this side of the experience. They go to help, but in the end they aren’t too clear just how much that help was worth. For instance, in the same hospital survey about a third of the men identified some aspect of the labour which they found upsetting.

Wife’s pain                                                      116

Helplessness                                                      25

Attitude of staff and lack of attention              24

Blood and placenta                                           18

Forceps                                                                9

Emergence of head                                             9

I felt really awful about it, totally helpless you know because there was nothing you could do. We went through all the exercises and things like that, but then it got to the point where even that wasn’t helping, she just couldn’t use it. It was just that the pain just totally took over everything and that was really hard for me to take as well. (Andy)

I don’t want to diminish the pain of labour or try to insinuate that it’s really the men who suffer, but it is important to recognise that labour is often difficult for men too. Men are used to doing; many of us find it hard to accept an intolerable situation. So our partner’s pain becomes our guilt. It was through my doing that she became pregnant (no matter that we both wanted it), and now she is suffering and I am powerless to do anything about it. The problem of doing is one which crops up a lot in the context of fatherhood. In the labour room there is little to do—especially if you feel that the paternalistic approach of Bradley and his followers is demeaning to women. A labour companion should support, not direct. It is the woman who is giving birth; it is she who is experiencing the agony and ecstasy. The labour companions role is to give help and support; which often involves little more than simply being there.

I have often heard couples talking about their birth experiences. ‘I couldn’t have managed without him.’ she says, ‘He made all the difference.’ ‘But I didn’t do anything’ he protests. And in truth there is little you can do. A bit of massage, cooling her down with a damp sponge when appropriate, and helping her to remember how to do her breathing. I was a complete failure at the latter—and it felt just like failure. I’ve never been good at exams; I always thought I’d revised properly and knew the subject but when I got the paper in front of me I realised that I didn’t really know it at all. It was the same in labour. I thought I knew all about the different kinds of breathing recommended by the antenatal teacher, but when it came to the crunch I forgot the lot! So I wasn’t much help there. The only thing which came to my aid and stopped the whole experience being a failure on that front was the wonderful monitoring machine.

Like most men, I find machines reasonably accessible. So the fetal monitor, showing the baby’s heart beat and the build up of contractions provided almost endless fascination. More to the point, it was possible to see the start of a contraction building up before Shirley was able to feel it. This meant that I could warn her of the impending pain, and thus she was able to cope with it a bit better. It seemed like a positive contribution to the proceedings and it is one which many other men have also discovered.

Unfortunately there is a lot of unnecessary monitoring and it can have some serious adverse consequences for mother and baby. Fetal monitoring usually restricts mobility, preventing the mother from moving around during the first stage of labour. Since this helps the progress of labour and makes it less painful, anything which prevents it is to be discouraged. It is therefore a pity that the fetal monitor should be so attractive to men who feel the need to justify their existence in the delivery room. So long as men are told that their primary reason for being there is to “help” they will have to try to find ways of “helping”, even if those ways are counterproductive.

Whilst most men still see their role as that of helper, a change is gradually coming about. Fewer men are now willing or able to act simply as a labour companion. She is becoming a mother, but you are becoming a father. It is not a process which many men can view dispassionately. You become deeply involved, and this increases both your own concern for your partner and also your sense of disquiet at your lack of control. On my original four-point scale of fatherhood, the man who goes to ‘help’ is nowadays the ‘traditional’ father—thus have the times changed! The ‘committed’ father is the one who is present at the birth because he wants to celebrate his own transition to parenthood as well as help and support his partner. This shows as clearly as possible how artificial such distinctions are, because an increasing number of men are falling between these two categories.

There are some who go simply to help, and nothing more; there are some men who say quite openly that they are there to mark the start of fatherhood—but the vast majority don’t fall neatly into either category. Indeed, there are now conflicting influences. Hospitals and women are still, by and large, keen on having men as labour companions. Any other involvement is secondary and may be viewed with either pleasure (most women) or displeasure (most hospitals). But increasingly, men are telling each other that the emotional experience is what counts. One recent book for fathers tells us that,

During your partner’s labour you’ll probably feel a wide range of emotions. You’ll feel terrified, ecstatic, exhausted; but you won’t be bored, even if you decide that you don’t want to be present. (Bradman 1985)

But many men are bored—especially during a long first stage when there seems to be little progress.

It was a nice experience, that I wouldn’t have missed, but if I hadn’t been there with a camera in my hand taking photographs of the baby coming out and that, I would have felt as though I was just a bystander—anybody could have been there other than me. (Ian)

There is sometimes a suggestion—usually left unvoiced—that a man who doesn’t react emotionally to the birth is not going to be very concerned with his children. Interestingly, two of the men I know who were least impressed by the birth experience are both looking after their children full time while their wives work. They both experience the normal frustrations and aggravations of full-time parenthood, but neither could be described as uninvolved or unconcerned—quite the reverse.

But they are in the minority, both in their full-time care and their reactions to birth. Most men do find the experience of birth quite overwhelming, and almost impossible to describe. There is something both touching and amusing in hearing a new father tell others of his birth. When he gets to the delivery itself, he will almost always use broken phrases and commonplace clichés:

It’s a fantastic experience and...and they are so aware when they come out. They look at you like, like,... well as though you’re the first thing they’ve ever seen and...it’s a fantastic feeling...yeah...it’s worth it for that... (Andy)

But the clichés don’t matter. We all know what he means, and everyone smiles and nods benignly remembering the moment for themselves.

Everyone is totally unprepared for the experience and no-one can really describe it properly for you, just because it is so personal. Sheila Kitzinger has described giving birth as a psychosexual experience for a woman, but as far as I know no-one has pointed out that it is possible to say the same for a man. Yet I think that one reason why the moment so overwhelms and surprises us is that it is so much like an orgasm. Not in an obviously physical sense, but more in the release of tension. Yet there was never an orgasm like this. For a start, the build up takes so long. You prepare for nine months until the time arrives. And then you start, gently at first, but with ever increasing intensity as time goes on; two hours, five hours, ten hours, fifteen hours, maybe even more. Not even the supermen of the Kama Sutra can match this. Perhaps this is why men feel so let down, bitter even, if they are thrown out of the delivery room before the birth is complete. It is the frustration and sense of incompleteness which may accompany coitus interruptus.

And this is not mere fanciful imagery. We often forget just how physical a birth can be. What is your job as labour companion? It is to massage, cuddle, console, caress, and stroke your partner. In public. For hour after hour. And she, hardly dressed at all. That her involvement is direct and physical no-one can doubt. His may not be so direct, but it need be no less physical. Some couples—particularly if they have not been prepared to be so intimate in such a public way—may find it hard to perform. They may even be so embarrassed that he doesn’t attend at all. But most of us manage to shut out the spectators—they seem to fade into the background as absorption in the matter at hand gets more intense.

After such a build up, the release of the birth itself is almost unbearable. It seems to take for ever, yet is over in a flash. It isn’t a release at all, just a heightening of already overarching tension. Your senses are all working overtime. Every nuance of the moment comes straight through to you. The top of the head appears, then retracts. ‘I can see the head’ you say, clasping her hand desperately, hanging on to reality for all you’re worth. Then suddenly it’s out. Release begins, but immediately is stifled. The student stiffens. The midwife moves smoothly towards her. ‘Hold it there.’ she says. Now you see the cord, wrapped twice round the baby’s neck. Something is wrong. You thought it was impossible for you to get any more involved or anxious, but now you know differently. Before you have time to panic, the cord is cut. They relax. You start to relax. The rest of the baby—’A boy!’ you cry, anxious to be the first to say it—slips out so sensuously that you can almost feel it. Quickly they weigh him, check him, evaluate him. Is he alright? ‘Has he got everything? Has he got two…?’ And he has. He is passed, and they hand him back to you, and now you are three.

Now you can breathe again, now you can let go. And come down, down, down... Sobbing, gasping, laughing, high and low all at once. And together; it is not just you alone, but the two of you—no, the three of you. It took so long to come, this orgasm of parenthood, but now that it has arrived it seems that it ought to go on for ever. The outside world won’t let it of course. There are routines, procedures, examinations. They always intrude too soon, and then the moment is over. It stays with you though, and later on you too may try to explain it in your incoherent way. Just make sure you explain it to those who’ve already been through it—otherwise you’ll get some very funny looks!

Is this, then, the point of it all? Are we there just for that moment? Perhaps all of the coaching and companionship is just foreplay for the climax of new life. I think I’ve noticed a change even over the last couple of years. Men used to tell other men to be present at birth for their wives’ sake. Now, more often, they mention the wonderful experience. Of course, it’s not a question of one or the other, but it does represent a serious change in emphasis and it is a shift which many hospitals are finding difficult.

It is well known that hospitals are based on hierarchies of power with doctors at the top, nurses in the middle and patients at the bottom. In the delivery room, the father comes even lower still. As long as he is prepared to stay there, being a labour companion and generally knowing his place then there is a reasonable chance that his presence will be tolerated.

When, in 1973, I wanted to be present for the birth of our first child hospitals were still uncertain about the idea. I had to sign a form absolving the hospital of any responsibility and agreeing to do whatever they told me. I was made to leave the room whenever Shirley had to be examined and in the end I was excluded from the delivery because it was a Ventouse (vacuum extraction). The possibility that I might faint was raised by the staff more than once, and it was very clear that I was there simply as a spectator, someone who had no positive role to perform and who really had little business to be present.

Things have changed since then. But the committed father, the man who wants the birth of his child to be a special event for himself as well as his partner, still faces an uphill struggle before his needs and desires will be fully met. The more he asks for, the greater the resistance. I think that it is no co-incidence that the French childbirth guru Michel Odent was recently reported as saying he was no longer happy with fathers in the labour room. Subsequently Odent denied that he was against all fathers, but wrote, of his experience at his hospital at Pithiviers,

For instance, we have noticed on many occasions that the presence of the man can inhibit the woman and that labour only progressed well after the husband had left the room. On the other hand we had many examples where the man was a positive factor.

Notice the use of “many” in both examples, suggesting perhaps that there are as many inhibiting fathers as there are helpful ones.

Some women have also expressed concern. Beverley Beech, chairman of the British pressure group the Association for Improvements in the Maternity Services was reported in a women’s magazine as recounting a scare story of a Cambridge don who, she said, had organised his wife’s labour in the finest detail. Not surprisingly, his presence inhibited his poor wife to such an extent that she literally seized up and refused to give birth. It was as though her body was saying, ‘Sod your plans—I’m not going to give birth after all.’ Luckily the midwife realised what was happening and quietly suggested that the don left the room. As soon as the door was shut, the woman resumed her labour and the child was born almost immediately because the mother was obviously more relaxed. The same article goes on to tell of midwives throughout Britain who were coming across similar cases.

Yet in the end, if his demands are moderate and considerate the committed father will succeed. In a real sense fatherhood begins at birth. The experience of birth can be a powerful expression of the values of parenthood If a man tries to take an active and responsible part in the birth of his child, is he not more likely to do the same throughout the rest of his life? But if he is simply a subordinate, subservient both to the medical hierarchy and to his wife will he not be likely to continue his shadowy role, always taking second place?

Birth both expresses and confirms our hopes and goals for parenthood. To this extent it is possible to think of it as a ritual event, full of meaning and social significance The fact that fathers now participate with increasing vigour in the birth process is itself a powerful symbolic statement about the importance of establishing the ties of fatherhood. [Next]