Duncan Fisher

My last post was about the FAMILIES who protested for better maternity services in London at the weekend. I took lots of photos, particularly of the men. This is the headline in The Independent. A different picture entirely.

My family once arranged a family photo and the photographer asked me to hand the baby to Clare “because it does not look right” with me holding the baby.

Does it matter that editors and photographers change the reality and tell a lie? So what if men who care for children are airbrushed out of the picture “because it does not look right”? Is not the important thing that they are doing it?

I think it does matter. Because a false picture underpins inadequate policies and services. There are striking statistics from the former Equal Opportunities Commission about how much more caring of children is shared these days. But people don’t believe these statistics - “they don’t look right”. And so policies and institutions remain unchanged. This affects the vulnerable families much more than the well-resourced, because it is the vulnerable who need services more.

It also matters in families. When one parent, the mother, finds that her role as a parent is persistently elevated and impossibly idealised, whilst the other sees that his role is persistently unrepresented, it has an impact on family dynamics. Take a debate about parenting methods between a mother and father - in most couples both parents will feel the mother is more entitled to assert an opinion than the father.

The new debate about families is all about relationships. This is good because a relationship implies more than one person; the word itself changes the picture. But to understand relationships, we still need to understand how differently messages are conveyed to mothers and fathers and how much this affects how they see themselves and each other and how they negotiate with each other.

Personal family, Fatherhood, gender equality, media, motherhood, parental relationships, parenting

At the weekend I went to the demonstration in London against the destruction by King’s College Hospital of the Albany Midwives, a beacon of family and community based midwifery. I even spoke at the demo from the top of a double decker bus in front of the Department of Health - the listeners were certainly a lot more responsive than at any of the many meetings I have been to inside the Department!

The demo showed once again that maternity is a family issue. I took my camera and had some fun.

Parenting together Add new tag, birth, family, maternity, media

Two journalists this week have noted that fathers are out of the family picture.  E Jane Dickson writes in The Independent about teenage pregnancy and Libby Purves writes in The Times about the role of the real father in the death of Khyra Ishaq. As far as I can recall, this is the first time that columnists have made this point.

E Jane Dickson says that leaving fathers out of the picture is misogyny – only mothers are being held responsible. Her recipe for dealing with fathers is the stick: “tracking absent fathers”, “securing their engagement”, “compulsory community service programmes where a proportion of the wage is deducted”, “required attendance at parenting courses to make them think twice about casual fatherhood”.

Libby Purves demands that natural fathers live up to their responsibilities for seeing their child is safe, whatever barriers are placed before them by the system, by the mothers of their children and by the mother’s boyfriends or by stepfathers.  Otherwise they must be considered “dishonest weaklings” and should instead “get a vasectomy or stay home with a pile of porn mags and a rubber doll”.

It is good that the problem of holding only mothers responsible for children is being debated. It is sad that neither of these journalists have looked into some of the programmes that have for many years been bringing about the changes they advocate. I recently shared a platform with young fathers from the St Michael’s Fellowship Programme in London – these young men have turned around their lives, some after periods in prison, actively supporting their children, the mother of their children and mentoring other young fathers. They have recently made a video about domestic violence and are getting these messages in front of more young people than anyone else has ever done. The foundation of these programmes is respect for the young men and the challenges they face and the celebration of achievement - in short, the opposite of the approach advocated by E Jane Dickson and Libby Purves.

Fatherhood domestic violence, Fatherhood

I was talking to a divorced single father the other day.  I know all the theory about the difficulties that single parents face (I lack the direct experience, being neither divorced nor separated) but being faced by the reality of a single case sometimes has more power than the theory.  And I was really taken aback at the extremity of his difficulty.

This father looks after his son almost exactly 50% of the time - 3 nights and four days a week. He is wise enough to know that he must obey to the letter every agreement that has ever been made with the mother of his children.  His case is a text-book study of good working arrangements emerging from an acrimonious divorce.

His income is uncertain from month to month – he runs his own business.  He has to pay £200 child-support to the mother of his child each month.  He knows that if he cannot pay that, she will immediately challenge the sharing arrangements and the child will not be delivered at the agreed time, and that will lead quite possibly to extended loss of any contact.  A few months ago, one of his business invoices was paid late and the £200 was paid two days late; the mother had already threatened to refer the matter to her solicitor.

He has a mortgage on a flat that has a room for the child, and that too must be paid each month.

So, one hic-cup in his business and

• the child’s relationship with him is put at severe risk

• his occupancy of a house that enables him to care for the child is also put at severe risk

• he has no access to any kind of benefits to help him through the crisis because, as far as the state is concerned, he is not a parent at all

I know what it is like not to know where one’s income is coming from the next month – it is a constant worry with the costs of caring for children.   But the consequences for me of even an extended period of no income are as nothing compared to the consequences for this single father.

The other single parent in this scenario has quite a different experience.  She lives in a much larger house (she is now wealthier than he).  If she loses her job, she gets additional benefits to care for the child and to secure her accommodation.  And she gets £200 guaranteed income every month along with Child Benefit.  Everything about her parenting role is supported.

In the UK, we argue that most children are not cared for 50/50 and that the “parent with care” is likely to be more needy and more likely to spend money they receive on the child.  This is incontrovertible.  But is it acceptable to place a minority of children in a highly vulnerable situation – as is the child in the case I here describe – for the benefit of other children?  In other areas of separated family policy, much emphasis is placed on the idea that “every case is different” – why in this area is every family not treated as different but as within a certain limited range?

I was telling this story to a clinical psychologist who works in the community with adults with mental health difficulties.  She reported that she sees fathers in this situation all the time: they live in constant fear of losing the connection with their child.  They get no support or recognition for their role as parent and they are powerless.  One foot wrong (and vulnerable adults are not always sure-footed), and the axe comes down on the relationship with their child.  Meanwhile the other parent plays by a different set of rules, able to indulge in a very high degree of rule breaking before there is any challenge.

We never hear anything from these parents because keeping silent is a crucial part of their strategy to sustain their child’s relationship with them.  They know they must face the situation without support; they develop quiet resilience instead.  Many, however, fail, and there is no safety net.

Australia has a system that addresses all this, so no rocket science is needed.  The state recognises that when parents split, two single parents are created – the UK system of regarding separation as a reduction of two parents to one parent is difficult to understand.  Child support is fully flexed down to no payments at all from one parent to the other, depending on relative incomes and extent of sharing – in short, it recognises that every family is different and does not undermine those families less near the average than others.

All three main political parties are working on family policy just now and are seeking ways of improving things. Finding a way of making the tax, benefits and child support system robust without sacrificing the good of some children for the good of the majority would be one valuable part of reform.

Parenting together child poverty, Fatherhood, parental relationships, parenting, separation

One of the first things I noticed when going out with our new puppy, Lottie, is how people respond to her just like they do to a baby.  But with one big difference – boys and men respond just as much as girls and women.  I was quite taken aback by a teenage boy describing Lottie as “adorable” in front of his peers.  Only girls and women respond in public to human babies in this way.

I had occasion to reflect on this further during last week’s Horizon on BBC2, which was about the human-dog relationship.  I learned that dogs, unlike any other animal, look at and read our faces (like babies do), and that we have bred dogs to select for characteristics that we find childlike or “cute”.  Dogs trigger in us the same hormonal changes that babies do, for example, a cuddle with a dog stimulates oxytocin in both human and dog.  The idea is that we have bred dogs as pets in response to our instinct to nurture.

The Horizon programme described this, but something very odd suddenly happened.  Having presented oxytocin as a hormone that increases in mothers - with no mention of men, in whom oxytocin also rises when handling a baby - suddenly all the dog-owners presented on camera were women.  Male dog owners simply disappeared the moment there was a comparison between our nurture of babies and our nurture of dogs.  This resulted in a short but bizarre episode of stereotyping the love of dogs as a female activity, completely in contrast to the normal narrative about dog-loving, which, if anything, goes the other way – “one man and his dog”.

That led me back to the teenage boy who described Lottie as adorable.  It seems that boys and men are socialised to suppress any public demonstration of their nurturing instincts in relation to human babies. We know from experimentation that women and men respond similarly to babies - when they are wired up to measure physiological reactions - but that their subsequent external reaction is entirely different, defined by restrictive social norms.  Lottie liberated the teenage boy by allowing him to express his natural nurturing instinct in a way that is socially normative.  Perhaps all men who have dogs are liberated in this way.

I never thought I would gain a new insight into gender from a dog!  But at least it gave me an excuse to put a picture of Lottie in a blog post!

Gender gender equality

On Monday I am on Woman’s Hour discussing the issue of fathers losing their jobs and being pitched into full-time care of children.  I will comment on their experiences.  So what should I say?

It seems to me there are two key factors.  First there is the burden of social expectation - which is very hard not to internalise.  Men should work, women should look after children.  So when a father loses a job and the mother is earning most of the money, there is often a mother who feels guilty at not caring enough, and a father who feels inadequate at not earning enough.  This is bonkers - with earning and caring  both essential to a family and with both mothers and fathers equally capable of doing both (on average, at least) it should not matter; but we have boxes in our heads which make us squirm when it is one way round but not the other.

Another factor is the largely unacknowledged burden of earning money for a family.  There is a widespread narrative about the burdens of looking after children and the home, but the pressure of earning enough money for a family is huge - ever since we lived in caves, mobilising all the resources needed to bring up children has been the hardest challenge for human men and women.  So when a father (or mother) has been inhabiting the role of main earner, suddenly being cast out of that role, by unemployment, illness or disability, is bound to be traumatic.  Of course one is going to feel a failure.  What happens to the family now?

But let’s look at the positive.  If you are kicked out of a box, you discover things outside that you did not know were there.  When I suddenly found myself caring for a baby on certain days of the week all by myself, it was a transformative experience.  And let me be honest, we would not have chosen this way of doing things had we had a choice, such was our ignorance of anything outside the box until we were ejected from it.  The kind of intimacy you get in sole care of a child is normally the privilege of mothers only and I certainly had never heard anyone talk about it like that.

Work is fluid these days and mothers and fathers are equally qualified to do it.  Similarly, both mothers and fathers have evolved to be good at caring for children.  Both parents will move in and out of employment, unpredictably.  The best we can do to create a resilient family is ensure we are flexible - competent and confident to take up any role when the time comes to do so.  At every point in the process, there will be factors that distress us and factors that delight us, so perhaps it is better not to stay too long in any one pattern.

Parenting together family, motherhood, parenting, work

Antenatal education is in trouble.  The latest review of the evidence by the Department of Health is discouraging – put simply, there is little evidence that antenatal education works very well.  This may be because it has always been given a low priority by the NHS – half-hearted evaluations of half-hearted attempts are not going to result in anything inspiring.

We also know that many parents find what is on offer from antenatal education in the NHS to be wide off the mark.  Some maternity services, particularly where midwives are involved high up in the management, have pioneered better antenatal education, but they battle against a system that prioritises only management of medical risk.  That some mothers and fathers find antenatal education valuable is clear from the success of NCT in selling a service to a proportion of parents.  But the interest of parents in things like money and relationships are not going to feature high on the list of medical risks.  Furthermore, the feminisation of the transition to parenthood that comes about from marking birth as a medical event for a “woman” (the NHS never uses the word “mother” or “mother-to-be”), rather than the extension of a family, also means that the perspective of fathers in the transition to parenthood is typically very poorly represented.

I think it is time to start thinking from scratch.  Here is a small contribution.

Health issues

Health is the legitimate concern and responsibility of the NHS.  We must move beyond trying to transact all health business in antenatal appointments for mothers-to-be (sorry, “women”).  Unlike antenatal education, the evidence base for well constructed health interventions that target the family is very strong – spectacular improvements can be easily achieved in over-early hospital admissions during labour, smoking cessation, breastfeeding and so on.  Preparing mothers and fathers for the birth falls in this territory.  We need to expand group work, community drop-ins and workplace supports, all routinely targeting both parents-to-be.  We need to reconfigure health visiting to be a family support that recognises that health is a family issue, not an individual one.  These are big changes - it shakes the very fundamentals of the NHS system, in particular the designation of only one parent as the ‘patient’.

All the other issues: a social enterprise approach?

But let’s not pretend that the NHS can deliver reliably on anything beyond health.  It never could and now we are in the middle of a massive financial squeeze.

Parents know what they need and want.  Those that cannot articulate it could with a little help.  Let them decide what they want and take into their own hands the task of getting it.  Rather like some parents make a choice to use NCT support.

Who can facilitate this?  It has to be someone with an interest.

The good news is that expectant and new mothers and fathers are indeed very interesting.  They are people at a transition point, with a new interest in employment, in the state of their community, in the future of the world.  For individuals in some disadvantaged groups – teenage parents, for example - motherhood or fatherhood can bring about a transformation in the way they relate to work and engagement in their communities.  This is a tremendous resource for every community.  Communities should organize to capture it.

So I propose, instead of antenatal education, regular local “New Family Markets” for expectant and new parents where they can purchase locally available supports and training, using vouchers given to each mother and to each father.  The market would need to be organized by a social entrepreneur embedded within their community.

Here is a random collection of stuff that could be for sale in a New Family Market:

• NVQ in child development (the ultimate way to understand your child as s/he grows up)
• Baby training sessions for all the family - reading babies’ cues, toy workshops, first aid (really they are parenting training sessions, but saying so is not a good marketing ploy!)
• Fitness sessions
• Sports coaching with children (be a professional by the time your child is ready for football, tennis, netball…..)
• Photography (ensure you get a superb record of your child’s growing up and end up with a qualification)
• Cooking for kids
• Careers advice for new mums and new dads and management of caring/earning balance
• DIY
• Specialist services for young mothers and fathers, parents who live apart, etc.
• An introduction to the local support services of Relate
• English as a Second Language
• Financial check-up
• Home insulation help

Prices for these things would vary, of course, because some will already be funded also from other sources; some services could even be free.  It matters not – what matters is that mothers and fathers are deciding for themselves what they want.  And having made their choices, they find themselves rubbing shoulders with other fathers and mothers with similar interests – and the mutual parent support networks come as a free bonus, even networks inclusive of fathers.

As these parents pursue their chosen paths, the social enterprise model will ensure they are continually supported to move to the next rung of the ladder, improving their parenting skills, their local support networks and their readiness for better employment, all in one process.

So instead of a penniless maternity service struggling with antenatal classes, the NHS service focuses on innovations in health promotion, and you mobilize the whole panoply of local labour and training networks around the transition to parenthood.

Parenting together, Social Entrepreneurship birth, family, maternity, work

This blog comes with a new challenge.  I have a very small puppy on my lap.  Animals now outnumber humans in this house!

I watched Mumsnet last week giving David Cameron a hard time.  It was all over the news.  I suddenly saw something I had not seen so clearly before.  Mothers, through their massive national networking on Mumsnet and Netmums, have become powerful.  So powerful they are a force that the political parties are truly engaging with as they enter a general election.  It is magnificent to behold - what a turnaround in 100 years!

And then it was clear to me: fathers, in contrast, are weak.

I don’t buy into the popular belief in the uselessness of individual men in the home, a flourishing topic of debate in both national and local networks of mothers, and something that some men proclaim as a virtue (and the media give them a megaphone each time they do).  If you take account of the burden of being a main earner in uncertain employment, and the numerous cultural and economic pressures on both mothers and fathers to live in different domains, I think what comes out is the strength of many fathers who step up despite the pressures and the lack of social support.  (What comes through also is the strength of the mothers who share their territory with them.)  I think a lot of the finger pointing arises because the system puts heavy burdens on mothers in the domestic domain and they are often angry and unhappy.  Pointing the finger at fathers is easy because there is a readily available narrative to explain things - men grunt and hunt like cavemen (why do we always think so little of cavemen?), they cannot multi-task, they lack the ‘maternal instinct’, and so on.

No, what I am talking about is an overwhelming collective weakness.  In the public debate about parenting and about family and children services, particularly relating to young children, fathers are extraordinarily invisible.

Fathers just don’t talk to each other; usually the only person whom a father confides in is the mother of his children.   Whilst the social networks for mothers are bursting at the seams, every attempt at a social network for fathers has resulted in an embarrassing absence of any reaction at all.  Men gathering together in order to talk about parenting is regarded as downright weird.  (Men are in fact just as adept at talking to each other when the opportunity is socially normative - e.g. workplace discussions about parenting - but there are almost no such opportunities.)

Men’s public silence as fathers is reinforced by women who manage the media debate about parenting and equality issues.  I loved the debate recently about the young men in universities setting up men’s groups.  Jenni Murray’s article in The Daily Mail was a tour de force.  But see what happened: some men made a stand, and the female editors of the women’s pages of the newspapers commissioned women to write about these men.  Why not actually talk to the men and let them have their say?

I am a man who has stepped up to the mark in public on these issues.  In theory this is what women have been waiting for and indeed, some women have embraced this initiative.  But that is not the dominant response, sad to say.  Men who do step up to this mark also meet hostility.  Some years ago a Minister (a woman) used to go round privately describing me as a “wolf in sheep’s clothing” - a man asserting himself in this domain and professing to be in favour of gender equality just must have a hidden, self-centred agenda.  More common, though, is condescension - women who realise that men stepping up is what is needed in theory, but who are unwilling really to share the family/equality agenda with them.

Does it matter if men are silent and let women lead on these issues?  I think yes.

• Improvements in public services for families and children need fathers to join the lobby.  Yes, mothers are now powerful, but in many cases not powerful enough.  Take continued investment in adequate maternity services.  I was saddened when the Royal College of Midwives recently only asked mothers about their opinion of maternity services - if they had asked fathers too, they would have marshaled more strength.

• The division of mothers and fathers into different roles by cultural, social and economic factors makes many parents miserable.  Only 20% of couples say their relationship gets better after a baby.  Two thirds say it gets worse.  Couples with babies are much more likely to split up than those without.  The key reason is division of roles.  In an EHRC survey this year, 34% of mothers and 23% of fathers said the mother should be in charge of caring.  But 86% of mothers and 69% of fathers say the mother is actually in charge.  That is a very big gap between aspiration and reality.

• Fathers say they want to be more available to their children than their fathers were to them.  They are.  But not enough - too many children still say they feel their father is too distant.

• When fathers separate from the mother of their children, they often become disconnected from their only channel of access to the world of their children - the mother.  This is a situation of absolute misery and fear.  Not surprisingly, in this position of extreme weakness with such enormous cost, men do join together, just like women have done since the beginning of the last century.

• A serious myth has emerged and is informing a series of policies - that things can be fixed for women without the involvement of men.  Most spectacular was the extension of maternity leave to a year with only two weeks for fathers - this immediately reversed progress in tackling the pay gap, as women were made an even more risky employment prospect compared to men.  Similarly, we have among the lowest breastfeeding rates in Europe, and the evidence shows that fathers are the main influence on mothers; but our breastfeeding strategies don’t want to go there.  An articulate fathers’ lobby working closely with women would result in more balanced approaches with better outcomes for everyone, including for women.

• The absence of a strong fathers’ lobby gives an easy ride to those men who shirk domestic responsibilities and those women who control the domestic domain and exclude men from it.

The trouble with all of this is that the idea of women being strong and men being weak goes right against the doctrine of gender equality that is predicated on the opposite.  Men are terrified of appearing weak and women do not like weak men: opting for silent isolation in the garden shed is a good protection for men.  When weak men organise themselves in protest, they are reviled - they are seen as powerful individuals wanting to reimpose patriarchy.

Nor can we handle the idea of the complexities of role - that one can be powerful and weak at the same time.  A rich man can be bankrupt when it comes to the relationship he has with his children.  A man who is violent in the home is usually simultaneously disempowered.  We panic when these ideas are put forward because we think it means excusing the abuse.

So, along with Jenni Murray, I celebrated when I heard the news of young men in universities talking to each other.  (See Mancollective at Oxford University.)  Is this a tip of an iceberg of men admitting their vulnerabilities to each other?  And we see them being embraced by young women who are outraged at shortcomings in our efforts to address equality, particularly how we have divided parental leave (see Jennie Agg in the Guardian).

Can we dare to hope that this social networking generation will cast aside our hang-ups about male weakness?   Will this generation have the strength to withstand the pressures that parenthood puts on mothers and fathers to live different lives?  Will we finally get a generation of children who don’t complain about the lack of intimacy with their fathers?

I am now off to find the men starting these groups to talk to them.

Fatherhood Fatherhood, gender equality

I’m back - book written!

Yesterday, at the invitation of the Royal College of Midwives, I debated with the famous French obstetrician, Michel Odent, “should men be at the birth of babies?”  The debate was discussed in the national papers, on the BBC TV news (twice), on radio stations (four times on Radio 5 Live), in the Australian media and yesterday in Time magazine in USA.  Two men debating childbirth in front of 400 midwives.  One man long enough in his profession to have delivered the other!

Here is my speech - you won’t find anything about what I actually said in the media (a point for later discussion!)

I said:

The best thing ever written on fathers at the birth was written in 1959 in a book Childbirth without Fear by Grantly Dick-Read, one of the most influential thinkers in this field last century.  This debate today in 2009 represents our failure to get this issue right for 50 years.

In the 1950s, birth had only recently been taken out of the home.  For the previous 200,000 years of human history, mothers were surrounded by loved-ones during childbirth; knowledge about childbirth was embedded within extended families.

Now, suddenly, birth was taken out of the home.  Yes, the maternal mortality rate dropped 60 times, but at a price.

Maternity units in those days were pretty gruesome.  One of the earliest campaigners for better maternity services was Dr Norman Morris, a Professor of Obstetrics in London.  In 1960 in The Lancet he described antenatal clinics as “drab and colourless…with an atmosphere of coldness, unfriendliness and severity more in keeping with the spirit of an income-tax office”.

He describes how women in labour were undressed, shaved, given an enema - and in some places castor-oil - then left alone on a large ward with other abandoned women in different stages of labour, without kindness or sympathy.

He quotes a young mother: “My mental condition was indescribable!  I thought all this might injure my baby and they could not be bothered to offer one word of comfort or explanation.  From 7am till noon, I did not see a soul.  I could not bear my husband near me for a long time after the baby’s birth.”

Most mothers lived then, as they live now, in small family units, with only their partners immediately at hand.

Following the instinct to have someone who loves them at the birth, it was absolutely inevitable that many mothers would want to take the fathers with them.

And still to this day, fathers are there by invitation, as is any other birth partner.  It is the mother’s right to choose.  And it is our duty to trust the mother’s instinct.

Michel Odent says that mothers are acting according to dogma: the choice to have fathers at the birth is not real, because women do not know what the full consequences of each choice are.  He is certainly right about the lack of information, but my proposition is that mothers are acting according to instinct in what is, in human historical terms, a highly unusual situation - the coincidence of institutionalised birth and the division of families into small units.

So what does Grantly Dick-Read say?

First, he saw that what fathers think and do matters.  He writes (and remember, he is writing in the 1950s when everyone having a baby was married - supposedly!):

“The importance of the husband’s attitude towards, and understanding of childbirth, cannot be exaggerated.  His words and actions, and even the atmosphere in the house that he may create in silence, have a profound effect upon his wife. Her health and happiness during pregnancy, and certainly her approach to labour, will be influenced for better or for worse by harmony or discord that she feels in her husband’s mind.”

I have spent the last 10 years looking at the influence of fathers on maternal and baby health.  I organised a major review of evidence when I was at the Fatherhood Institute; and Chester University is about to publish another.  And, all the evidence shows that the relationship between the mother and father, and the father’s beliefs and actions and the mother’s perceptions of the fathers’ beliefs all have a profound impact on every aspect of the health of the mother and baby:
* on breastfeeding
* on smoking
* on mental health
* on the mother’s bonding with her baby
* on the mother’s birth experience

So, what about fathers at the birth?  Grantly Dick-Read answered the question 50 years ago better than ever I could.  He wrote:

“The question that has now occupied so much attention in so many hospital and maternity organisations - ’should the husband be present?’ - depends entirely upon the husband.”

The top priority, says Dick-Read, is for the father not to be ignorant.  He writes: “The totally unprepared man has no place at the birth of his child…. If he has not occupied himself to be interested and to have an understanding of childbirth at least equivalent to his wife, he should remain absent until such time as the obstetrician requests him to greet his wife and their newborn child.”  These were the days when the obstetrician was definitely in charge!

A father who is knowledgeable, who offers practical help with, for example, breathing and massaging - of these, Dick-Read says: “These men cannot be superseded in the value of their service by the most patient nurse or obstetrician.”

Dick-Read says the surest way to bring peace and confidence is information.  The role of the health professional is, “with kindly-stern authority, to urge that the husband learns with his wife, the phenomena and common sense of this natural human function.”

Dick-Read points out that it is not just the ignorance of fathers that can be a problem.  He writes: “Mothers, husbands and friends must be recognised as agencies for the production of fear in the minds of the vast majority of young married women…. We recognise that very few daughters learn much that is likely to be helpful from their mothers.  The days of large families have passed.”

When it comes to the culture of fear around birth, we are all in this together and we can only get out of it together.

Since 1959, researchers have confirmed everything that Dick-Read has said:
* Women who have a close support person tend to have a more positive birth experience, and that is often the father
* When birth partners, including fathers, know a lot about pain control, women have shorter labours and are less likely to have epidurals
* Practical support is more effective than purely emotional support
* A partner’s fear at the birth increases post-operative pain

So Dick-Read divides men into three categories:
* Men who have learned about the birth and can be helpful and confident.  These men should attend the birth.
* But some men try to learn and just cannot overcome their fears.  They should not be present:  “We sympathise with them” says Dick-Read, “but for their wives’ sake, we keep them downstairs.”
* Men who have not shown interest and are not prepared.  They should not be allowed in.

The days when we had the authority to direct parents so definitively have long gone!  Obstetricians no longer rule the roost like they did.  So the onus is even more on engaging with both the parents and helping them come to the right decision for them, so that labour is shortened and made more positive by the father’s positive contribution - or by his absence.

Michel has also claimed that attending the birth is a major cause of depression in fathers post-natally; and that the impact on the couple’s sex life is commonly negative.  No evidence has been found for a correlation between a ruined sex life and fathers’ presence at the birth; and a study in 2000 by Greenhalgh and others found that any correlation between negative birth experience and fathers’ depression in the postnatal period disappeared once pre-existing depressive symptoms were controlled for.

As I am sure you are told repeatedly in your training: “correlation does not imply causation!”  Men are present at the birth - yes.  Postnatal depression in new fathers is a real problem - yes.  But the evidence does not demonstrate that one causes the other.

So why are we still stuck 50 years later discussing this issue?  For something to be stuck that long means there is an underlying problem that we have not perceived or addressed.

At the heart of the problem is that the NHS is structured to deal only with “patients” and “visitors”, not with a natural family event such as a birth.   Only mothers are registered with the health service.  The NHS only has a formal relationship with the mother.  The NHS will only talk to mothers - like the recently republished NHS Pregnancy Guide, which comes across as horribly patronising to fathers.

This approach simply cannot work for midwives, because you are eyeball to eyeball with fathers every day, however much the system pretends they are not there at all. The Royal College of Midwives once issued a statement that comes from the midwife’s particular exposure to reality on a day-to-day basis: the birth of a baby is also the birth of a family.

In honour of the 50th birthday of the final edition of Grantly Dick-Read’s Childbirth without Fear, Family Info is today launching a new edition of the Dad card with revised advice for fathers attending the birth, based exactly on what Grantly Dick-Read said.  Fathers should make sure they know what their role is.  And they should consider not being at the birth if they really don’t think they can play this role.  They should ask the midwife for information and advice on this.  The card will be distributed by midwives to 600,000 families a year, following Cathy Warwick’s call to all maternity services to distribute it.  The Dad card backs the RCM’s Normal Birth Campaign - because without the support of fathers that campaign cannot succeed.

Today the Conservatives are announcing, at this conference, their new maternity policy.   It includes the proposal that the standard care pathway should include at least one antenatal appointment where the father is specifically invited to attend and where the issue of his influence is discussed with both mum and dad - his influence on breastfeeding, mental health, smoking - and above all, his role at the birth.

This would be the first ever formal engagement of maternity services with the family of the mother.  It would require defining procedures, measuring performance and ensuring the necessary skills.  All for the first time.

This is directly in line with the Nursing & Midwifery Code of Conduct for Midwives, which states that midwives, as health professionals, must “work with others to protect and promote the health and wellbeing of those in your care, their families and carers”.  The Code states also that midwives must deliver “care based on the best available evidence or best practice”.

I want to end with a story.

I took my young daughter rock-climbing recently.  Before she set off up the rock face with me hanging onto the end of the rope, I received 15 minutes of instruction - how to hold the rope, how not to get it trapped, how to provide the right kind of support to my daughter on her way up and on her way down.  There is no way I would have put myself in this position without knowing what I was meant to do and feeling confident that I could do it.  I could really hurt her through my ignorance.  Birth is just the same - I need some instruction and without it, I am at risk of causing pain and misery.

My knowledge of rock-climbing up to that weekend away was absolutely zero - I had hardly done it before and I did not come from a family with lots of rock climbers.  Dick-Read wrote in 1959: “the ignorance of the average man about childbirth is incredible”.  And it is still the case today; just as most people have no idea about rock climbing. So, we fathers need the basic training so we do the right thing.

Thank you for choosing to be midwives.  It is the most wonderful job.  Remember Grantly Dick-Read’s words:

“Your concern is not only to see the child into the world but also to enable these two people to be united in the most wonderful, awe-inspiring experience that can possibly fall to the lot of wedded human beings.”

You will see more fathers than any other health professional or social worker or teacher.  But the NHS has not given you the tools you need to do the job you have to do.  I hope that can change - and in less than 50 years more!

Parenting together birth, Fatherhood, maternity, motherhood

As I have been preparing things to write about in these blogs, it has become evident that I am actually starting to write a book.  My journalist friends - particularly some of the Agony Aunts I am working with in the Kids in the Middle campaign - tell me I should resist the blogging for a while and focus on the book instead.  So that is what I am going to do.  Producing a blog a week is both fun and keeps me on my toes, so I look forward to returning to regular pieces in about a month’s time.  In the meantime, doubtless I will occasionally be provoked into outbursts by stories in the media!

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