A meta-ethnographic synthesis of fathers׳ experiences of complicated births that are potentially traumatic. (January 2016) - Elmir, Rakime
Abstract: Introduction: birth is a natural and for many, life enhancing phenomenon. In rare circumstances however birth can be accompanied with complications that may place the mother and infant at risk of severe trauma or death. Witnessing birth complications or obstetric emergencies can be distressing and potentially traumatic for the father. Aim: the aim of this paper is to report on the findings of a meta-ethnographic synthesis of father's experiences of complicated births that are potentially traumatic. Methods: databases searched included CINAHL, Scopus, PubMed and PsycINFO with Full Text. The search was conducted in February and March 2013 and revised in February 2015 for any new papers, and the search was limited to papers published in English, full text and peer-reviewed journals published between January 2000 to December 2013. Inclusion criteria: studies were included if they focused on fathers/men׳s experiences of witnessing a birth with complications including a caesarean section or an adverse obstetric event. Studies included needed to use qualitative or mixed methods research designs with a substantial qualitative component. Analytic strategy: a meta-ethnographic approach was used using methods of reciprocal translation guided by the work ofNoblit and Hare (1988) on meta-ethnographic techniques. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool. Findings: eight qualitative studies with a total of 100 participants were included in the final sample. The men ranged in age from 19 to 50 years.Synthesis: Four major themes were identified: 'the unfolding crisis', 'stripped of my role: powerless and helpless', 'craving information' and 'scarring the relationship'. Participants described the fear and anxiety they felt as well as having a sense of worthlessness and inadequacy. Men did not receive sufficient information about the unfolding events and subsequently this birth experience impacted on some men׳s interactions and relationships with their partners. Conclusions: witnessing a complicated or unexpected adverse birth experience can be distressing for men and some may report symptoms of birth trauma. Being informed by and receiving support from midwives and other health professionals appears to help mitigate the negative impact of birth complications. Effective support may help address men׳s confusion about their role, however genuinely including men as recipients of care or service in pregnancy, labour and birth raises important questions about whether the father is also a recipient of maternity care and if the transition to fatherhood is itself becoming a medical event? Highlights: Many commonalities were identified across the studies despite participants having experienced different types and degrees of birth complications. Fathers had not expected complications to occur; they were unprepared for an unexpected event and were confused about their role during labour and birth. Fathers were distressed that they were not able to advocate for and or protect their partners from these events. Fathers wanted to be fully informed and to participate in decision-making yet most acknowledged that these decisions were out of their control. Some men experienced ongoing distress following a complicated birth, some regularly reliving the event/s. There is little informal or formal support available for men who may wish to talk about their experiences.