Where is the F in MCH? The Role of Fathers in Pregnancy and Birth (Blair, 10/14/2020)

Many thanks to Dr. Jason Blair, chief resident and father of three (one recently arrived), who gave a thought-provoking Grand Rounds presentation this week on the Role of Fathers in Pregnancy, Birth, and Infancy. 

Dr. Blair made a compelling argument for a link between high neonatal mortality rates in the US and our inclusion (or lack thereof) of fathers in the pregnancy and birthing process. We know that 50% of births in the US are to mothers on Medicaid; these mothers and babies have worse outcomes than women with private insurance (higher mortality, lower birth weight, higher preemie rates and less breastfeeding) and are also statistically more likely to be unwed and get less support at the time of birth and at home.

Dr. Blair also highlighted the effects of paternal participation on maternal breastfeeding rates, peripartum depression rates, and the general health and well being of families. And what about father in the role of continuous birth attendant (aka doula), which we know has strong evidence in reducing surgical birth, length of labor, and birth complications?

The US literature on the topic of fathers in birth is (perhaps not unsurprisingly) sparse, Dr. Blair cautioned, with much of the literature on the role of fathers in birth coming from Europe, where maternity and paternity leaves as well as other policy tends to be more robust.

Here are some highlights and some of my own suggestions in italics below each category.

Navigating fatherhood starts in the prenatal period

• What it means to be a good father extends beyond financial responsibilities to include a hands on role with baby and providing emotional support to their partner. This new role begins long before a baby is born.
• In a study from Iran and Afghanistan, when fathers were engaged in prenatal care, had a positive association between quality of a mother's participation in prenatal care and gestational age at birth, as well as maternal satisfaction.
• In a study from England, greater paternal engagement with associated with earlier access to care, increased number of antenatal checks, attending birthing and parenting classes, and breastfeeding Mothers were also more likely to report feeling very well or quite well at post partum visit
• Many fathers want to be more involved but often feel ignored by healthcare providers and unclear what their role should be. Do you actively engage dads in prenatal visits, birth, and post partum?

While, in theory, we welcome fathers into exam and labor rooms rooms, we all could do a better job of actively including them in the prenatal visits and helping them understand how they can help their partner and new baby.

• Engage father as a crucial member of the process (beyond making sure he received a Flu shot and Tdap, consider including how is his mental and physical health? how may he prepare for the birth of his child?
• Help clarify roles, outline potential tasks dad could participate in in the antepartum and post partum period (e.g. birth classes, sharing night feedings, supporting breastfeeding, etc.)

Paternal health and well-being can have a negative impact on mothers and children.

• A male partner's biological characteristics, work, and non work exposures, and substance abuse have adverse impacts on pregnancy outcomes (e.g. low birth weight, neural tube defects, PTL)
• Intimate partner violence against pregnant women leads to poor birth outcomes
• High prevalence of perinatal depression and anxiety (5-20%) in men is associated with increased struggles for the entire family.
• Verify if father has access to primary care. If he doesn't, offer it to him.

Fathers may understand their negative experiences in the ante and postpartum period as "stress" rather than as depression

• Pregnancy and a new infant can put tremendous strain on fathers in addition to relationships/couples
• Consider inquiring specifically about a father's or family's stress level rather than of depression (or mental health)
• Children with depressed fathers in the peripartum period higher risk of childhood behavior problems 
• Consider screening fathers for perinatal anxiety and depression when you are screening mothers

Fathers taking paternity leave is strongly associated with improved maternal well being at 3 months post partum

• Well, that's not a surprise now, is it?
• California has decent paternity leave; Do you inform you fathers of their rights? Do you encourage them to use it? Do you help them advocate with their employer to take the leave?

Benefit of fathers in support role for mothers

•  Many fathers recognize that the center of focus SHOULD be mother and baby; however helping fathers show up help mothers and babies in birth and beyond
• Labor attendants reduce maternal anxiety and catecholamine levels, minimizing dysfunctional uterine activity and leading to improved birth outcomes 
• A child's father (and a woman's partner) is uniquely able to provide ideal support throughout the pregnancy, during labor and beyond
• Help fathers be the best labor support they can be: this can be by using a professional doula OR by having him participate in reading/classes that help him learn how to support a woman in labor