Health care services must favour fatherhood too
by Svend Aage Madsen, Ph.D. (Head of project)
January 17th 2007
last updated January 17th 2007
State-of-the-Art Knowledge on Men as Fathers - a Health-Service Perspective
1. Developments in Men’s Participation in Health Services Surrounding the Birth of their Child
It is difficult to find comparable figures in order to examine men’s participation in prenatal services across Europe.
A Danish study shows that most fathers in Denmark participate in prenatal visits at their general practitioner, a large number participate in prenatal courses, practically all attend the ultrasound scan, and the vast majority are present during midwife-consultations. 80% participate in prenatal preparation courses and prophylactic consultations. 54% do not consider themselves invited. 40% do not feel they are being directly addressed during consultations.
Most fathers state that it is beneficial for them to attend these consultations. The fathers are also satisfied with the performance of midwives and maternity-ward nurses after delivery. Between 80 and 90 % of fathers stated that the contribution of the staff during delivery and the ensuing maternity care was satisfactory.
The fathers do not, however, feel that any of the offerings from the health authorities explicitly involves their role or their presence and most of them do not feel directly invited or addressed during consultations. This points to a discrepancy between the attitudes of the health authorities and those of families as to the role and importance of fathers during pregnancy and delivery. The authorities barely mention fathers in their general directives. Likewise, there are still many hospitals where routines prohibit fathers from staying overnight with mother and baby at the hospital after delivery. This goes against the wishes of fathers. Such policies indirectly ignore the involvement of fathers while supporting the view of their presence as being of little consequence.
Although there are no precise numbers reflecting developments when it comes to paternal participation at delivery, a revolution has taken place during the last 30 to 40 years.
In Sweden the father is present in about 95% of cases, whereas the numbers for e.g. England and Australia in the 1980's were believed to lie between 60-80%.
Comprehensive research in Denmark shows that 95 % of Danish fathers attend the delivery of their child, with 98 % of these stating that they are attending for their own sake. Up to 70 % wish to stay overnight with mother and child in the hospital, while the remaining 30 % have other children they must take care of at this time.
It is reasonable to claim that this constitutes a change in human culture surrounding the birth of children, and that the general emergence of these changes have redefined the birth of a child as a family matter.
2. Father-related Health Service Guidelines and Instructions
Health-service guidelines are formulated procedures aimed at guiding decisions and criteria in specific areas of healthcare. They include summarized consensus statements, addressing practical issues, and defining central questions in relation to clinical practice. Furthermore they integrate identified decision points and respective courses of action with practitioners’ clinical judgment and -experience.
The actual guidelines themselves reflect the state-of-the-art in health services and are a tool with which to guide service-developments. At this point hardly any guidelines have been developed concerning men’s participation in activities surrounding the birth of their child.
Hence we need to develop guidelines regarding:
• Men’s participation in prenatal consultations and courses
• Men’s presence at delivery
• Men’s stay in hospital for the first days after the birth
Such guidelines should - among other things - contain directions for:
a. explicitly inviting fathers to participate in prenatal activities
b. addressing men and putting fatherhood on the agenda during consultations and antenatal courses
c. suggesting activities for men during the course of labour and delivery
d. supporting early contact between father and infant
e. making room for the father to stay with mother and baby
f. including the father in home-based postnatal care and -services