ORIGINAL RESEARCH

Father's participation in planned home birth: a meningful act for woman

Jane Baptista Quitete^I; Jéssika Andrade de Melo Braga Monteiro^II

^I Obstetric Nurse. PhD in Nursing. Nursing Professor, Universidade Federal Fluminense, Rio das Ostras Campus. Rio de Janeiro, Brasil. E-mail: janebq@oi.com.br
^II Obstetric Nurse. Rio de Janeiro, Brasil. E-mail: jessikaamelo@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2018.18682

ABSTRACT

Objective: to discuss the father's participation in labour and childbirth from the women's perspective. Method: qualitative research, using semi-structured interviews with eight women who had a planned home birth attended by obstetric nurses in the State of Rio de Janeiro. The project was approved by Research Ethics Committee. The statements were analyzed using content analysis. Results: data analysis revealed a thematic category named: giving meaning to the father's presence, in which it is possible to understand the importance of father's support for women. Thus, natural birth becomes easier; women feel safer. Conclusion: the participation of the father during labor and childbirth was taken as fundamental for women.

Descriptors: Paternity, home birth, humanized delivery, obstetric nursing.

INTRODUCTION

The planned home birth came to rescue delivery in its most natural form by assuming that childbirth is a physiological process. It also came to rescue women's autonomy, as they have been curtailed with the institutionalization of childbirth. In home birth, women can give birth in a place where they feel safe, which in case of normal risk pregnancies, can be their own home^1,2.

With the institutionalization of childbirth in the 1940s, women were no longer accompanied by family members at home during labor and delivery, and were alone in this event, since the hospital institution was not planned to have a companion in that process^2,3.

Planned home birth was rescued in the 1990s as a struggle movement of women against the medicalization of childbirth with the support of the World Health Organization (WHO) and organized sectors of society. It culminated in public policies that favored the performance of obstetric nurses in the care of planned home births in urban centers¹. Obstetric nurses consider childbirth as a natural, female, physiological, and intimate event ⁴. The goal of obstetric nurses in the home birth is to rescue delivery in its most natural form, since the home environment favors the physiological evolution of childbirth so that women can experience this moment in a pleasurable way¹.

The father's presence as a companion during childbirth is the subject of several studies that reveal its importance, advantages and benefits, but in obstetric practice, men are seen with prejudice³. Even with the Law of the Companion (Law 11.108/ 2005), which guarantees parturients the right to choose a companion during all labor, delivery and immediate postpartum within the scope of the Unified Health System⁵, many professionals still do not realize the importance of the father's presence for the woman and the baby².

The aim of this study is to discuss the father's participation during labor and delivery from the perspective of the woman, that is, to understand how women feel about having the father as a participant in the process of home birth. The object of this study is the father's participation in planned home birth in order to portray how is it for the woman to have the father as companion in labor and delivery.

LITERATURE REVIEW

Assistance at birth is still very centralized in the woman and the baby, and puts men in the background. The involvement of fathers brings a mix of feelings not only to men, but especially to women, who feel more secure and prepared for this special moment, in addition to encouraging husband/wife and father/child bonding. Participation of the father provides emotional support, helps women better withstand the pain and strain of childbirth, and the presence of someone of their trust on their side makes them feel more satisfied, confident and happy³.

The reintegration of fathers in the delivery room happened from 1970 with the objective of recovering the effectiveness and valorization of women and family references, since these values were lost in the passage from home delivery to hospital delivery^3,4.

With the medicalization of labor, non-physicians were excluded from the follow up of labor, which left a gap. The relationship between professionals and companions is uneven in the hierarchical model of health care. Companions are seen with a certain prejudice by health professionals, who claim a lack of physical structure to accommodate them (environment, surgical clothing, overcrowding in maternity wards), and the companion's unpreparedness to attend the delivery³. For these reasons, men's desire to share the birth of their child is not always realized.

The participation of men in maternity hospitals is a relatively recent event, which began in the 1980s in private maternity hospitals. In public maternity units, the father's participation in labor began to be allowed and encouraged from the 1990s, particularly in those that seek care provision in line with the philosophy of humanized childbirth⁶.

METHODOLOGY

This is a descriptive qualitative field study in which was considered the subjectivity of the research object – father's participation in the planned home birth from women's perspective.

The procedure for data collection occurred through the snowball sampling method. It allows the definition of a sample through indications made by people who share or know others with common characteristics of interest of the study⁷. The starting point for the selection of participants was through obstetric nurses who indicated women they had followed up in the State of Rio de Janeiro. The first interviewees indicated others and so on, until the repetition of data occurred. Data collection was closed after the eighth interview.

Inclusion criteria were the following: to have had at least one of their children by natural birth at home (planned home birth), delivery assisted by obstetrical nurses in the State of Rio de Janeiro, voluntary participation in the study, presence of the father as a companion during labor and delivery, age over 18 years old.

For data collection, was conducted a semi-structured interview addressing questions about the gestation and childbirth with use of the following guiding question: Was the father involved in the birth process? If so, how did you feel having the father at your side during this whole process?

The interviews were recorded by digital media player equipment, heard and transcribed by the researcher. Interviews were conducted in the second half of 2014 and beginning of the first half of 2015. Data from the transcription of testimonies went through exhaustive reading, separation of events, naming of events, thematic grouping and naming of thematic categories, as recommended by the methodological reference of Bardin ⁸.

The anonymity of the eight interviewees was maintained. Their statements were identified by E1, E2, E3, and so on.

This study is a cut of the doctoral thesis titled Attributing meanings to obstetrical nurses: a social construction from users' point of view in the perspective of symbolic interactionism⁹. All recommendations of Resolution 466/2012 of the National Health Council were followed. The project was approved by the Research Ethics Committee of the Universidade Estadual do Rio de Janeiro.

RESULTS AND DISCUSSION

Data analysis revealed a thematic category named 'Signifying the presence of the father', which answered the object of this study.

Women's feelings about the father's involvement in childbirth are positive. They reported that fathers have helped in the course of labor, and they felt secure and supported with their presence during labor and delivery. The presence of the companion brings comfort, security and confidence ⁶, and characterizes as emotional support^2,10.

The parturient needs continuous support during childbirth. When such support is given by a family member, women have a more positive assessment of delivery, feel more satisfied and happier¹⁰. Father's participation in childbirth is perceived by women as very important, fundamental and essential for a natural childbirth process. This fact is confirmed by studies that affirm the presence of a companion during labor promotes the physical and psychic health of the parturient⁶.

When experiencing the process of birth, men enjoy an intense moment, full of meaning, feelings and reflections³. This favors the co-responsibility of men and women in the parturition process and childbirth, which in turn will give birth to a new man, a new father¹¹, thereby allowing the delineation of a new role he will play².

Women knew the father would be with them for whatever they needed. They knew they could count on his presence, that they could surrender to labor, because the father would be there to provide all the support needed.

The presence of the companion in the delivery room is considered a non-pharmacological method for the reduction of pain¹². Studies show that the father's presence contributes to less painful experiences and suffering sometimes experienced by women in the birth scene, and helps to avoid unnecessary procedures (Kristeller maneuver, repeated vaginal touch, episiotomy, oxytocin , among others), thereby reducing complications during the birth process^6,13,14. The companion's presence is also a strategy for humanization of labor and birth, because it asserts the rights of women, who are vulnerable during labor and delivery¹⁴.

In women's view, fathers gave birth together with them. According to testimonies, labor and delivery were experienced by the couple in a joint, intimate and familiar work. Home assisted births allow greater involvement of the father, promote greater control of the situation by the couple, and a sense of freedom and responsibility, which are reasons leading couples to choose assisted home birth¹⁵. In addition, for professionals working in home childbirth (obstetric nurses), the father/companion is not a stranger in the environment, but someone who positively favors the physiology of a childbirth and is focused on humanized care and respect for those involved².

Fathers have been increasingly active during prenatal care, labor and delivery, and allow themselves to be thrilled to be the first to hold their babies or to cut the umbilical cord^3,15. The main motivation for the father's involvement in childbirth is still his partner's protection and support by promoting physical and psychological well-being, and fostering early bonding with their child³.

Given the benefits of the companion's presence, health professionals should welcome and encourage it from prenatal care to delivery, continuing during puerperal period and breastfeeding, thus minimizing fears and yearnings with birth¹⁶, and by understanding that fathers' active participation in this whole process should begin as early as possible².

For men, there is an affirmation of fatherhood when experiencing the birth of their children. Their role as father is valued, and this is also a possibility of personal maturation, because it provides a reflection on the value of life and the conjugal relationship, and brings positive repercussions for the couple and for society^3,15,17.

Men who participate actively in the birth experience begin to have more respect for women. They become more involved in the care of their children, the planning of a future pregnancy, and in providing for the family¹⁵. The image of the domineering and insensitive man gives way to a new being capable of emotional involvement¹⁵.

CONCLUSION

The objective of this study was reached, because was identified the importance of father's participation in labor and delivery from the woman's perspective.

The father's participation favors the development of labor, reduces obstetric interventions, and reinforces feelings such as security, strength, and support for women. These feelings help women to surrender during labor and delivery, which favors their performance.

Even today, little is seen or discussed about the presence and participation of the father at the time of childbirth, since gestation and childbirth are still considered female events from which, consequently, the father has been excluded. In opposition to this reality, in planned home births, participation of the father is active and he is seen as a coparticipant together with the woman.

Limitations of this study were the scarcity of scientific productions on the theme and a sample that does not represent the universe of the phenomenon investigated, therefore, prevents the generalization of findings. However, the results of this study reflect a local reality and may support further research.

REFERENCES

1. Lessa HF, Tyrrell MAR, Alves VH, Rodrigues DP. informação para a opção pelo parto domiciliar planejado: um direito de escolha das mulheres. Texto & contexto enferm. [Online]. 2014 July [citado em 18 jan 2018]; 23(3):665-72. Disponível em: http://www.scielo.br/pdf/tce/v23n3/pt_0104-0707-tce-23-03-00665.pdf

2.Carvalho IS, Carvalho CFS, Enders BC, Brito RS. A participação do homem durante o nascimento do filho: vídeos do Youtube.Rev. enferm. UERJ. 2017 [citado em jan 2018]; 25(e11474):1-6. Disponível em: DOI: http://dx.doi.org/10.12957/reuerj.2017.11474

3.Jardim DMB,Penna CMM. Pai-acompanhante e sua compreensão sobre o processo de nascimento do filho. REME rev. min. enferm. [Internet]. 2012 [citado em 20 mar 2017]; 16(3):373-81. Disponível em: DOI: http://www.dx.doi.org/S1415-27622012000300009

4.Koettker JG. O parto domiciliar planejado assistido por enfermeiras [dissertação de pós-graduação]. Florianópolis(SC): Universidade Federal de Santa Catarina; 2010. [citado em 18 jan 2018 ]. Disponível em: http://repositorio.ufsc.br/hanvghdle/123456789/93958

5.Ministério da Saúde (Br). Lei nº 11.108, de 07 de abril de 2005. Altera a Lei nº 8.080, de 19 de setembro de 1990, para garantir às parturientes o direito à presença de acompanhante durante o trabalho de parto, parto e pós-parto imediato, no âmbito do Sistema Único de Saúde.Brasília (DF):Senado Federal; 2005.

6.Motta CCL, Crepaldi MA. O pai no parto e o apoio emocional: a perspectiva da parturiente. Paidéia. [Online]. 2005 [citado em 18 jan 2018]; 15(30):105-18. Disponível em: DOI= http://www.dx.doi.org/10.1590/S0103863X2005000100012&pi=S0103-863X2005000100012&pdf_path=paideia/v15n30/12.pdf&lang=pt

7.Goodman LA. Snowball sampling. Ann. Math. Statist. [Online] 1961 [cited 2018 Jan 18]; 32(1): 148-70. Available from: DOI: 10.1214/aoms/1177705148. https://projecteuclid.org/euclid.aoms/1177705148

8.Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2011.

9.Quitete JB. Atribuindo significados às enfermeiras obstétricas: uma construção social sob a ótica das usuárias na perspectiva do interacionismo simbólico [tese de doutorado]. Rio de Janeiro: Universidade Estadual do Rio de Janeiro; 2015.

10.Dodou HD, Rodrigues DP, Guerreiro EM, Guedes MVC, Lago PN, Mesquita NS. La contribucióndelacompañante para lahumanizacióndel parto y nacimiento: percepciones de mujeresdespuésdel parto.Esc. Anna Nery Rev. Enferm. [Online] 2014 [citado em 10 ene 2018]; 18(2):262-9. Disponible en: http://dx.doi.org/10.5935/1414-8145.20140038

11.Melo RM, Brito RS. The perception of men/companions with regard to their presence at the birth of a child. Rev. enferm. UFPE on line. 2011 [cited 2018 June 10]; 5(10):2585-9. Available from: http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/view/2085/pdf_741

12.Oliveira ASS, Rodrigues DP, Guedes MVC, Felipe GF, Galiza FT, Monteiro LC. O acompanhante no momento do trabalho de parto e parto: percepções de puérperas. Cogitare enferm. Rev. [Online] 2011 [citado em 12 jan 2018]; 16 (2): 247-53. Disponível em: https://revistas.ufpr.br/cogitare/article/viewFile/20201/14211

13.Perdomini FRI, Bonilha ALL. A participação do pai como acompanhante da mulher no parto. Texto & contexto enferm. 2011 [citado em 12 jan 2018]; 20(3):445-52. Disponível em: http://www.scielo.br/pdf/tce/v20n3/04.pdf

14.Vargens OMC, Nunes S, Silva CM, Progianti JM. Procedimentos invasivos no cuidado à parturiente sob a perspectiva de gênero. Rev. enferm. UERJ. 2016 [citado em 12 jan 2018]; 24(6):e15066. Disponível em: DOI: http://dx.doi.org/10.12957/reuerj.2016.15066

15.Cardoso BM da C. O papel do pai no trabalho de parto [dissertação de mestrado]. Porto(Pt): Escola Superior de Enfermagem do Porto; 2017.

16. Matos MG, Magalhães AS, Carneiro TF, Machado RN. Construindo o vínculo pai-bebê: a experiência dos pais.Psico-USF. [Online] 2017 [citado em 10 jan 2018]; 22(.2):.261-71. Disponível em: http://dx.doi.org/10.1590/1413-82712017220206

17.Antunes JT, Pereira LB, Vieira MA, Lima CA. Presença paterna na sala de parto: expectativas, sentimentos e significados durante o nascimento. Rev. enferm. UFSM. 2014 [citado em 14 jan 2018]; 4(3):536-45. Disponível em: http://dx.doi.org/10.5902/2179769212515