By our regular contributor, Walker Karraa, MFA, MA, CD(DONA)

A recent (2012) study published in the Archives of Disease in Childhood: Fetal

Neonatal Edition contributes to the growing awareness that partners are negatively impacted by traumatic childbirth. The first study of its kind, 'Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery' (Harvey & Pattison, 2012) is a retrospective analysis of semi-structured interviews with 20 fathers who had witnessed the resuscitation of their baby immediately following delivery. While small in number, this study sheds invaluable light on the experience of fathers in the presence of trauma in childbirth.

Semi-structured, private interviews were audio-taped with consent, and the transcripts were analyzed for thematic content using the NVIVO-7 software in sequence. Analysis generated four themes (1) 'preparation'; (2) 'knowing what happened'; (3) 'his response'; and (4) 'impact on him' (Harvey & Pattison, 2012, p. F2).

Theme One: 'Preparation'

While over half of the fathers (n =12) had been given information prenatally regarding potential causes and instances for neonatal admission for their baby, none of the fathers had been given information about newborn resuscitation. Fathers did not realize before birth that their baby might require this level of support at delivery, and most were only told by health care professionals (HCP) immediately before the birth that their baby would require resuscitation, if at all. Information was often vague, not forthcoming, or overheard and second-hand.

'No, we always glanced passed that bit. We thought, we won't need that, we won't need that either'

Theme Two: 'Knowing What Happened'

The majority of fathers were unaware of the type of resuscitation given at time of interview, were unaware at the time, and had not been subsequently told. Contributing factors to the theme of not knowing what happened were his position in the room, and not having asked HCP directly what was happening during or after the event. Most fathers did not view the resuscitation due to obstructed view, or being focused on partner. When fathers attempted to stand up to see the baby, they were told to sit down. Those who did posed questions went unanswered, and still other fathers only learned about what was happening through cross-conversation among staff. Does this sound familiar to anyone?

'It was only about a week or so after that we actually found out that they had to bag him.'

Theme Three: 'His Response'

Themes of conflict between partner and baby emerged from the father's experience. All fathers expressed doubt regarding their focus of concern, their partner or their baby. Many fathers reported that they thought either or both would die. In the interviews themselves, recalling the event caused fathers to become visibly upset. One father stopped the interview process momentarily during this line of inquiry.

Continued distress occurred for fathers regarding the conflict of whether to stay with partner or go to their baby being resuscitated. Most reported wanting to go to their baby, but felt they should stay with partner for reassurance. In some cases, staff contributed to this conflict by telling fathers to stay put. A variety of coping strategies were employed by fathers to endure the event-but most commonly emotional-controlling strategies were used, where they avoided looking at the baby, tried not to think about what was happening, leaving the room, or self-reassurance that there would be a positive outcome.

'So all the time I was just thinking in my mind, you know, to try and not think about what's happening if you know what I mean?'

Theme Five: 'Impact on Him'

• There was general lack of memory of the event. While none reported regretting being there, all fathers reported feelings associated with the birth in terms such as: worried, distressed, petrified, scared, panic-stricken.
• None of the fathers reported feeling supported from HCP's during resuscitation
• The majority of fathers who wanted to discuss their experience with someone after did not do so.
• None of the fathers were given an opportunity to discuss the event with HCP's afterward
• Some reported symptoms of post-traumatic stress such as flashbacks, nightmares, agitation and hyper vigilance.

'It was heart-shaking. I was just like holding my missus like that (puts his arms out). It was emotional, so I was a bit, I did like have tears come to my eyes.'

'To be honest I haven't spoken to anyone about it. This is my first conversation.'

'I've had nightmares about it. I would go back to sleep and would sort of wake up jumping.'

Conclusion and Discussion

The authors concluded: 'There is a growing awareness that meeting the needs of fathers facilitates their involvement in the lives of their children. Supporting fathers before, during and after newborn resuscitation could be a step towards achieving this.' (Harvey & Pattison, 2012, p. F5).

Hopefully this study will generate increased awareness the largely overlooked partners' experience of traumatic events in childbirth.

Harvey, M., & Pattison H. (2012). Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery. Archives of Disease in Childhood: Fetal Neonatal Edition Arch Dis Child Fetal Neonatal Ed (2012). doi:10.1136/archdischild-F2 of F5 2011-301482.

Walker Karraa is a doctoral student at the Institute of Transpersonal Psychology. She is a birth doula, maternal mental health advocate, and researcher. She currently writes for the Lamaze research blog, Science and Sensibility. She presents at conferences, trainings, and organizational retreats pertaining to perinatal psychology, postpartum mood disorders, childbirth education, and labor support.
Walker is currently the President of Penny Simkin's new organization, PATTCh, a not for profit dedicated to the prevention and treatment of traumatic childbirth.

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