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Husband-father’s perceptions of labour and delivery Leonard, Linda Gaye 1975

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HUSBAND-FATHER'S PERCEPTIONS OF LABOUR AND DELIVERY by -LINDA GAYE LEONARD -B.S.N., University of B r i t i s h Columbia, 1966 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF •THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE- IN NURSING i n the School of Nursing We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1975 In presenting t h i s t h e s i s in p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r agree that permission for extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r e p r e s e n t a t i v e s . It i s understood that copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n permission. Department of The U n i v e r s i t y of B r i t i s h Columbia Vancouver 8, Canada Date i i Husband-Father*s Perceptions of  Labour and Delivery This study was concerned with the husband-father*s perceptions of labour and deli v e r y , how he perceived h i s ro l e during t h i s period, and his perceptions of the nursing care provided to h i s wife and himself. Sample s e l e c t i o n was by random sampling and included twenty husbands. A l l were Caucasian, Canadian or B r i t i s h born, between the ages of twenty-two and fo r t y years of age, and a l l had attended prenatal classes. Eighteen fathers attended the d e l i v e r y . Seventeen were fathers f o r the f i r s t time and three were fathers f o r the second time; Data were obtained v i a one hour-long interview with the husband during the f i r s t three days postpartum. An interview schedule was used and contained r a t i n g scales, f i x e d - a l t e r n a t i v e and open-end questions. The data were subsequently analyzed by single variance analysis, nonparametric (Chi-square) t e s t s , and by content analysis of the open-end questions. Major findings were that labour and del i v e r y were seen as p o s i t i v e experiences, d e l i v e r y being the most p o s i t i v e ; that husband focus during labour was on his wife u n t i l l a t e second stage when i t s h i f t e d to the baby and to h i s own f e e l i n g s • Labour was s t r e s s -f u l f o r many, t h e i r wives* pain being a major contributor i i i to t h e i r uneasiness. The major function of the husband i n labour was c i t e d as providing moral support, encouragement, and the provision of bodily care to h i s wife. Most f e l t that they were e f f e c t i v e i n t h e i r r o l e but needed to confirm t h i s with t h e i r wives. Prenatal classes were viewed as having a p o s i t i v e influence oh husband attitudes toward labour and d e l i v e r y . The attitudes and responses of the nurses during labour and d e l i v e r y were noted as having a s i g n i f i c a n t e f f e c t on the husband•s confidence and r e l a x a t i o n . The major weakness of the nursing care was the inadequate assessment, explanation, and nurse contact time during the active phase and second stage of labour. The study r e s u l t s have implications f o r the prenatal preparation of,couples, f o r care of the parents during labour, delivery, and the early postpartum period. Recommendations f o r future study centered on the need f o r more information about husband-father response during labour and d e l i v e r y , early responses to the newborn, and information about the e f f e c t s of husband-father particfcpation i n c h i l d b i r t h on the husband-wife-child r e l a t i o n s h i p , (165 pages) iv TABLE OF CONTENTS LIST OF- TABLES . . i 1 . iV. • . • • • i'; • • •'• • • • • • vi ACKNOWLEDGEMENTS . . ft'iI?*1.. l ' ? $ • i i J. * • • v i i i Chapter I INTRODUCTION ~ 1 Background of the Study . . . . . . . . . • • . • . . • . • 1 Statement of the Problem • • • • • • • • • • • • • • • • • 8 Statement of the Purpose . . . . . . . . . . .<>. . . . . 8 Definit ions 9 Bel iefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 II REVIEW OF THE LITERATURE . . 1* Role Theory as a Framework • • • • • • • • • • • • • • • 1* Masculinity and Fatherhood • • • • • • • • • • • • • • • 16 Histor ica l Changes i n the Role of the Husband-Father during Labour and Delivery . . . . . . 19 The Husband-Father during Labour and Delivery 23 III RESEARCH DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . ° 37 Introduction W * . M. i f . i i . ttv;. i v . . 37 The''Setting . i . i f . M : . I : i f f i f 1 . i f . i f i ' i ' . . . i . 37 The Sample of S u b j e c t s . . i i i i . . i i i i . i i i i . . . 38 The Interview M e t h o d . . . . . . . . . . . •..<>.<>• . i . . *M thod. • . i ! i  • i i  •. . f i f • *9 Procedure for Collection of Data 51 Data Analysis , . i V . i i f t . . i ! i . . . . . . . . . . . . . . . 5* Limitations of the Study 58 IV FINDINGS AND DISCUSSION 59 Perceptions of Labour and D e l i v e r y . . . . . . . 59 Husband's Perception of Role • • . . . . . • • • • . • 93 Evaluation of Nursing Care • 113 V SUMMARY, MAJOR FINDINGS, IMPLICATIONS AND RECOMMENDATIONS 13^ Summary and Major Findings . . . . . . . . . . . . . . . . . 13^ Implications for Nursing Practice . . . . . . . . . . 137 Recommendations for Future Study lko SELECTED BIBLIOGRAPHY.•••«•• • • » • • • ' • • • • • • • • " • • • • • • • • M APPENDIX . . . . . . . . . . . . ; . . . . . . . • • • • • . . . . . . . • • • • 1*7 A. Consent Form • • • • • • • • • • . • • « . • • • • • • • * 1*7 B. F ina l Interview Schedule 1*9 C. Pretest Interview Schedule • • • • • • • • • • • • • • 157 v i LIST OF" TABLES 1 • Fathers 1 Demographic Data _ 40 2. Duration of Labour for Sample Wives , , , , , 43 3. Analgesia and Anaesthesia Given during Labour and Delivery ; .VI i^;U • t i : i i ' » * i • . . . • • i*• . • • • 44 4. Newborn Data at Birth . ; . 46 5. Husbands• Emotional Comfort When Inside a Hospital ' , , f,\ • ;v2s. >*•;•; . i . h ' i ••Vt.f*, U . *£• i . ; . . . 47 6. Interview Length and Time after Delivery . . . . . 52 7. Husband Response to How Well Labour Went , , , , , 61 8. Husband Response to How Well Delivery Went . . . i . i i , , 62 9. Husbands* Rating of Labour and Delivery 64 10. Husbands1 Focus on Persons during Labour . , , , „ , , , , , 73 11. Husbands• References About Wife during Labour 75 12. Fathers* Thoughts on F i r s t Seeing Their Babies 82 13. Uneasiness Experienced by Fathers during Labourr, , J % , . • , . . . • • • • , . . . . . . . , , , , , , 87 14. Uneasiness Experienced by Fathers during ' Deliyery _ _ • • . • _^'_ •ul<» ^:v^^ "^  ^ 90 15. Husband Response Regarding Who Suggested That He Attend Labour and Delivery 94 16. Husbands * Rating of Prenatal Classes 96 17. Husbands* Reasons for Attending Labour and Delivery V. i i'£i • i . . . . . . . . * . . 99 18. Husbands• Perceived Role during Labour . . J * ; ' , . 4 ; . 101 19. Fathers * Response to His Right to Attend Delivery ; , , f * ; , , i v f . . h ' S i • . • ' • • • i'i&.,..::i©4 20. Fathers* Reasons for Wanting To Be Present during the Birth of an Unhealthy;:Infant - , . . . . . . , , , 106 21. Amount Husbands* Helped Wives during Labour and Delivery , , i> ;£,. i ; , ' , i ' . i . • • . . i v . V i . . • ; • • 107 If, v i i 22, Fathers' Rating of Care during Labour - and Delivery . . . . . . . . . . . . . . . . . . . . . . . . 11* 23, Evaluation of How Well Husband Was Kept Aware of His Wife's Progress 115 Zk, Father's Evaluation of Helpful and Non-Helpful Aspects of Nursing Care . . . . . . . . . . . 117 v i i i Acknowledgements v This study exists because of the time given by twenty-three husband-fathers. The writer wishes to thank them for their willingness to share their thoughts and feelings about labour and del ivery. Gratitude i s expressed to the hospital i n which this study took place and i n part icular to Bemadet Ratsoy and Li la Morrow. Support, constructive cr i t ic ism and much encouragment were supplied by two members of the nursing facultyi Helen E l fe r t and Helen Olsen. A "thank you" i s rea l ly inadequate. Linda Gaye Leonard CHAPTER I INTRODUCTION Background of the Study There i s a growing trend to view the childbearing experience within the framework of the family. Nursing of families and family-centered care are concepts f a m i l i a r to v i r t u a l l y a l l nurses, e s p e c i a l l y those who work with expectant or new parents. Within the past decade, involvement of husbands i n the childbearing experience has s t e a d i l y increased. Prio r to t h i s time, the major focus had been on the expectant mother and the r e s u l t i n g mother-child r e l a t i o n -ship. L i t t l e attention had been paid by behavioral s c i e n t i s t s and health team members to the needs of the husband-father. Several reasons f o r h i s lack of involve-ment i n and exclusion by others during the childbearing experience have been offered, English states that fatherhood, unlike motherhood, i s not a c l e a r l y defined r o l e , with the exception of the provider r o l e , * Colman and Colman note that society does not validate the 2 experiences of fathers-to-be as important. They further c i t e a lack of acceptance of male i n t e r e s t i n the e s s e n t i a l feminine secret, childbirth.-' Josselyn emphasizes 1 2 that men tend to avoid those experiences which require a display of tenderness. She states that tenderness and related emotions have been l a b e l l e d as feminine and, therefore, when displayed by males as a t y p i c a l of "men". These attitudes and values are changing and these changes have meant that pregnancy and c h i l d b i r t h are evolving i n t o more of a shared family experience. I t i s believed by many that these changes w i l l enhance family unity ^through improved r e l a t i o n s h i p s ! more s p e c i f i c a l l y , those of the husband-wife, father-mother-child,^"^ Interest i n the family and the relat i o n s h i p s within the unit has been renewed, p a r t l y because of the s o c i a l upheavals i n the l a s t two decades. The one stable i n s i t i t u t i o n i n our society has been the family. Keane states t h a t i the family i n whatever form i t takes, continues to be the major influence for good or i l l i n the l i v e s of a l l human beings. 8 Duvail shares t h i s view and sees the family as the nurturing center f o r human development* the primary Q agent f o r physical and mental h e a l t h . 7 These functions have p a r t i c u l a r relevance f o r Canadians as there are approximately 3,2 m i l l i o n f a m i l i e s i n Canada with children l i v i n g at home.*0 Hymovich and Barnard believe that the trend to focus on the family unit i s a r e a l i s t i c and reasonable one f o r nursing. I t emphasizes the di g n i t y and the personality of the family as well as the dig n i t y and 3 11 personality of the indiv idual , Keane comes out strongly i n favour of nursing's commitment to the family and statesi i t deserves at th is time, perhaps more than ever before, the fu l les t possible understand-ing and support i n carrying out i t s m i s s i o n , 1 2 In order to improve the nursing care to families during the childbearing stage, more complete answers are needed to some very fundamental questions. Nurses need a base of knowledge i n order to plan nursing interventions that are theory based, rather than r i t u a l based. For without this base, i t becomes Impossible to predict with any degree of accuracy, the kind;.1, of support family members require and i n part icular , that needed by the husband-father. Unanswered questions pertaining to the husband-father are numerous. Some examples which have relevance for nursing arei What i s the father'a perception of labour and delivery? What factors influence the father 's a b i l i t y to take on the fathering r o l e . Are these the same as those of his wife? What i s the psychological sequence i n taking on the role of father? Is the taking on of the maternal role dependent on the stage of paternal role development and vice versa? Before nursing can provide qual i ty care to the family members and the family uni t , more complete answers to the above questions are needed. Whether or not the husband-father chooses to be present for the labour and del ivery, he i s s t i l l affected by the chi ldbir th experience. As prospective parents, i t i s l i ke ly that they have tr ied to imagine the for th-coming labour and del ivery, revealed some of their anxieties and worries to one another, and tr ied to predict what kind of an impact a new family member w i l l have on the family unit as well as on their own ro les . In Canada, approximately 99,5 percent of babies are born i n h o s p i t a l s , E a c h year, nurses i n Canada have contact with approximately 370 thousand expectant Ik and new parents. It i s unknown how many husbands accompany their wives through labour but i t would seem that the majority are present for a l l or at least a portion of i t i An ever increasing number of husbands seem to attend the delivery of their in fants . Estimates of husband-attendance at delivery run from ten to ninety percent, depending on the hospital f a c i l i t y and the sample of parents;*5-19 Prenatal classes have attempted to lessen the anxieties of parents by educating them about the psychophysiological changes occurring during pregnancy and the succeeding stages. The classes have attracted increasing numbers of expectant fathers i n recent years. In one study, i t was reported that sixty-two percent 20 of the husbands accompanied their wives. Of the tota l population of expectant parents, the percentage of husbands attending the classes i s unknown. In part , the classes are designed to assist the husband i n playing an active role i n the upcoming labour 5 by teaching him how to coach and supervise his wife. One group claims that an important modification has been 21 made i n the area of goal setting for parents. Previously, success or fa i lure of the labour and delivery was based on the need for medication or obstetr ical intervention^ Now, i t i s believed that the couple who set their own r e a l i s t i c goals for the experience are more l i ke ly to perceive the outcome as successful, i . e . , a happy and f u l f i l l i n g experience, , An outcome of husband-coached labour has been that nursing must re-examine i t s goals and role with the labouring couple. The amount of direct care that the nurse once gave to the mother may be reduced, depending on the couple and the labour. However, the amount of support that the nurse must give has not been 22 24 altered, only the form that i t takes. Some authors notes that the concept of supporting a patient through a;family member has been a d i f f i c u l t adjustment for nursing; For now, the husband i s not at the periphery of the experience. He i s the one that his wife depends on and the one to whom she often saysi "I couldn't have made i t without your," Relating the proceeding i n a more personal vein, the wri ter 's interest i n the husband-father during labour and delivery stems from two inter-related commitments. One i s the bel ie f that nursing can and 6 must help support the family unit by preventing untoward d i f f i c u l t i e s i n the assumption of new ro les . The second stems from the observation that nurses are being asked to support a human being, the father, during the emotionally-charged situation of labour and del ivery, Weidenbach's def in i t ion of an indiv idual 's need seems appropriate for those caring for the expectant and new parentst "anything the individual requires to maintain or sustain himself i n his si tuat ion." 2 - * She suggests that help i s any measure or action that enables the individual to overcome whatever interferes with his a b i l i t y to function capably i n re lat ion to his s i tua t ion; 2 ^ Both of these def ini t ions are applicable to the woman i n labour and to her partner, her husbandi Support to the family members achieves two interdependent objectives; Not only i s the father's self-concept strengthened but also his a b i l i t y to support another human being, his wife, i s heightened. Having observed and worked with numerous husbands during the chi ldbir th experience, the writer has noted that some fathers become act ively involved i n most a l l aspects of their wives* care while others lend what might be described as a more passive type of support. Yet, whether or not they have been formally prepared for labour and delivery, i n the course of i t a father may demonstrate any combination of anxiety, suffering, awe, joy, bewilderment, tenderness, anger, fatigue, and exhilarat ion. This became apparent during a recent exploratory study of parents 1 reactions to a family-centered maternity programi 2^ The writer observed the spontaneity with which husband-fathers discussed their perceptions of labour and delivery, and their role during this period; Some husbands were i n i t i a l l y reluctant to admit speci f ic feel ings, especially those which are not t ied into the soc ia l ly prescribed masculine r o l e . However, once their trust was gained, they seemed very eager to share their "uncomfortableM moments of labour and del ivery; The writer noted s imi lar i t ies between the maternal ; phenomenon of "taking i n " described by Rubin and the 28 paternal responses during this period. Just as newly-delivered women need to review and understand what has happened, so i t appeared did the husbands. The author believes that i t behooves nursing to discover the wealth of information that husband-fathers hold, and once discovered, to use i t i n a systematic way to improve the support offered to th is family member and the family. 8 Statement of the Problem The questions asked i n t h i s study about the husband-father's involvement i n c h i l d b i r t h werei What were the husband-father's perception of labour and delivery? . What were h i s thoughts and feelings about labour and delivery? What were the husband-father's perceptions of his ro l e during labour and delivery? , What were some aspects of the decision-making process related to h i s p a r t i c i p a t i o n during labour and delivery? , What were h i s thoughts and feelings about his rol e during labour and delivery? What were the husband-father's perceptions of the care received by his wife and himself during labour and delivery? . What was seen as helpful? . What was seen as non-helpful? Statement of the Purpose The purpose of t h i s study was to learn about the husband-father's perceptions of labour and delivery, hi s perceived r o l e during t h i s period, and h i s perceptions of the care received by h i s wife and himself. 9 Definit ions For purposes of this study, the following definit ions were employed! Husband, husband-father. father. The labouring woman's legal husband. Wife, wife-mother, mother. The wife of the husband. Perception. A process whereby man selects, organizes, and interprets sensory data available to him. Labour. The series of medically defined phases and stages characterized by cervical di latat ion and descent of the presenting part. Delivery. The period of labour which usually occurs within the delivery suite , as opposed to the labour sui te , and ends with the delivery of the baby and products of conception. Role. An organized set of behaviors that belongs to an ident i f iable posi t ion. 7 Perceived r o l e . How a person thinks he behaved. Support, care, help. Any measure or action on the part of those caring for the labouring woman and her husband and which enables the individuals to overcome whatever* interferes with their ab i l i t y to function capably i n re lat ion to their s i tuat ion. - ' 1 10 Beliefs The following bel iefs represent a part icular stance i n re lat ion to this studyi , The family i s a unity of interacting individualst changes occurring within and outside the unit affect the functioning of the whole or i t s parts. • During pregnancy, profound emotional, physiological and socia l changes occurj changes which have relevance for the roles of husband, wife, father, and mother. , Labour i s a psychophysiological c r i s i s experience for the expectant woman, her husband, and the baby, . Every husband and wife enter labour with a set of role expectations. , For the husband, the role assumed and emotions evoked during labour and delivery may or may not be congruent with his perception of the role expectations for man, husband, and father. • The perceptions of experiences during and the outcomes of the labour and delivery experience may have a posit ive or negative influence on the husband-wife, father-mother-child re la t ion-ship. , Family-centered care enhances the sol idar i ty of the family unit as well as the role sat isfact ion of individual family members. 11 FOOTNOTES 1 0 . Spurgeon Engl ish, "The Psychological Role of the Father i n the Family," i n Marriage and Family i n the  Modern World, ed. Ruth S. Cavan (New Yorkt Thomas Y. Crbwell, I960), p. 515. Arthur Colman and Libby Colman, Pregnancyi The Psychological Experience. (New York! Herder & Herder, 197D, P. 100. 3 I b i d . , p. 135. . Irene M. Josselyn, "Cultural Forces, Motherliness.., and Fatherl iness," American Journal of Orthopsychiatry 26 (Apri l 1956) i 26o\ ^Gerald Caplan, An Approach to Community Mental  Health. (New Yorkt Grune and Stratton, 1961), p. 217. ^Edith B. Wonnell, "The Education of the Expectant Father for Chi ldbi r th ," Nursing C l in ics of North America 6 (No. * , December 1970)i 597. 'Lucie Jessnert Edith Weigertrand James L. Foy, "The Development of Parental Attitudes During Pregnancy," i n Parenthood! I ts Psychology and Psychopathology. ed, E . James Anthony and Therese Benedek, (Boston! L i t t l e Brown, 1970), pp. 230-239. Vera Keane, "Is the Focus on the Family?," i n ANA C l i n i c a l Conferences. (New Yorkt Appleton-Century Crofts, 1970), p. 32*. ^Evelyn M. Duvall . Family Development, 4th ed. (PKiladelphiai Lippincott, 1971), p. * K. Ishwaran, ed. The Canadian Family. (Toronto# Holt, Rinehart & Winston, 1971), p. 28. I i Debra P. Hymovich and Martha U, Barnard, ed . , Family Health Care (New Yorki McGraw H i l l , 1973), p. xv. 12 Keane, "Focus on the Family," p. 324. 12 *^Stat ist ies Canada, Canada Yearbook. 1972 (Ottawat 1972), p. 250. l i K _ b i d . , p. 250. *^Charles Aldridge, " In i t ia l Experiences with Pathers i n the Delivery Room," Michigan Medicine 69 (No, 11, June 1970)« 489. ^Malcolm S. Al lan, "Husband-fAttended Del iver ies ," Obstetrics and Gynecology 27 (No. 1, January 1966)1 146. f C a r l Goetsch, "Fathers i n the Delivery Room — •helpful and supportive?,," Hospital Topics 44 (No. 1, January 1966)1 105. 18 John Mi l le r , " 'Return the Joy of Home Delivery' with Fathers i n theDDelivery Room," Hospital Topics 44 (No. 1, January 1966)1 108. 1^Robert Rutherford, "Fathers i n the Delivery Room — Long Experience Molds One Viewpoint," Hospital Topics 44 (No. 1, January 1966)» 97. 20 Lara Khairat and Guy Costanzo, Preparation for Parenthood, A Project to Evaluate the Effectiveness of an Educational Program for Expectant Parents, Metropolitan Health Service of Greater Vancouver, May 1974t p. 1. (Mimeographed) 21 Jeannette L. Sasmori Constance R. Castor1 and Patr ic ia Hassid, "The Childbirth Team during Labour," American Journal of Nursing 73 (No. 3» March 1973)» 444. 22 Jeanette D. Hines, "Father — the Forgotten Man," Nursing Forum 10 (No. 2, 197D» 194. 2-Vonnell, "Education of the Father," p. 324. o h ^Sasmor, "The Childbirth Team," p. 446. 2^Ernestine Wiedenbach, "The Helping Art of Nursing," i n Nursing Fundamentals, ed. Mary E . Meyers, (Dubuque, Ipwat Wm. C. Brown, 1967)» 20. 2 6 I b i d . , p. 20. 2^Helen E l fe r t and Linda Leonard, "An Evaluation of St . Paul's Hospital Family-Centered Maternity Programj An Exploratory Study," University of B . C . , School of Nursing, September 1974. (Mimeographed) 13 2 8 Reva Rubin, "Puerperal Change," Nursing Outlook 9 (No. 12, December 196l)t 75*. 2^Theodore R, Sarbin and Vernon L. A l len , "Role Theory," i n The Handbook of Social Psychology. Vo l . I ed. Gardner Lindzey and E l l i o t Aronson, 2d ed. (Reading, Massi Addison-Wesly, 1968), p. 5*5. 3°Mildred A. Disbrow, "Changing Roles and Se l f -Concepts of People," i n Maternity Nursing Today, ed. Joy P. Clausen et a l . (New Yorki McGraw H i l l , 1973). P. 6. ^Weidenbach, « T h e Helping Ar t , " p. 2 0 . CHAPTER II REVIEW GF THE LITERATURE In order to demonstrate the inter-relat ionship between the husband's perception of labour and del ivery, his role during the period, and his perception of the care provided to his wife and himself, a framework was selected. Sarbin and Al len 's theory of role enactment and expectation was chosen.* viWithtthese boundaries established, three major areas of the l i terature related to husband-father were reviewed. The l i terature pertaining to masculinity and fatherhood was br ie f ly examined and that relat ing to the h is tor ica l changes i n husband-father involvement i n labour and delivery was reviewed. F ina l ly , the few studies concerned with the husband-father during pregnancy, labour and delivery were examined. Role Theory as the Framework Sarbin and Al len 's concept of role enactment and role expectation was chosen because of the emphasis on the complementary nature of the husband-wife-health team member relationship during labour and del ivery. Role i s defined as "an organized set of behaviors that 2 belong to an ident i f iable posi t ion." These behaviors are activated when the posit ion i s activated. 14 15 Role enactment does not occur i n iso la t ion! i t takes place i n re lat ion to other persons. The individual must know the expectations of a l l the complementary roles — the role set, as defined by Merton — before one can say that he has learned the r o l e . 3 Role expectations include the r ights , p r i v i l i g e s , duties, and obligations of any occupant of a socia l posit ion i n relat ion to persons occupying the complementary positions i n the socia l structure. Not only i s there a quantitative component to role expectation, there i s also a qualitat ive component. I t i s expected that'when one enacts a ro le , the appropriate amount of commitment and involvement i s demonstrated. Persons enacting a role may be viewed as facing a task; the task i s to f u l f i l l to the best of their a b i l i t y , the expectations of that ro le . Role enactment c a l l s for the possession of cognitive and motoric s k i l l s , the development of which i s enhanced by the coaching and prompting of others. The role of the coach i s to provide socia l reinforcement i n the form of praise or cr i t ic ism^ to the learner and, at the same time, provide feedback which can be usediito improve role performance.^ The behavior of others, i . e . , the audience, i s the basis for one's own further behavior.^ S k i l l i n taking on the role of the other i n the form of empathizing with the other, f ac i l i t a tes socia l interaction? While the role enactor observes and evaluates his own behavior, he becomes more vulnerable when this enactment occurs i n a highly v is ib le place. I t i s l i ke ly that too much v i s i b i l i t y 16 of enactment could place the performer under heavy stress. Self-congruence, or how well one's t r a i t s , values, or bel iefs concur with those of the role to be enacted, o influences performance, 7 I f one's concept of se l f i s congruent with the requirements of the ro le , i t may result i n attachment, involvement, or pleasure i n enacting that r o l e , * 0 Masculinity and Fatherhood Changes i n the social and economic structure of North American society have been responsible for the redef ini t ion of masculinity and fatherhood. Today, there i s a narrowing of the differences i n cul tural ly approved behavior of males and females,** In spite of this narrowing, one i s s t i l l able to ident i fy signif icant aspects of male socia l izat ion and the result ing behaviors. The male's basic orientation i s 12 instrumental, as opposed to expressive for the female. The discipl ined pursuit of goals encourages resistance to any emotional involvement as an end i n i t s e l f , , In ef fect , affective restraint along with a desire for achievement are fostered i n the instrumental orientation, J Males are expected to combine expressive and instrumental Ik qual i t ies i n the varying ro les . The role of the husband ca l l s for a greater emphasis on the expressive qual i t ies and the role of the father demands an equal 1*? emphasis on the two types of qua l i t i es , J Fulcomer believes that males are conditioned not to express their feel ings, especially feelings about 17 personal matters, as for example, pregnancy. He statesi The need (cultural) for the husband to pretend he knows i t a l l and can cope with i t a l l keeps him from le t t ing others, including his wife, know that he, too*/-needs reassurance and some helpful information. Josselyn writest Tenderness, gentleness, a capacity to empathize with others, a capacity to respond emotionally . . . i s not the prerogative of women alonei i t i s a human character ist ic . ' These qual i t ies are a natural part of the ro_e of husband and father but are often considered to be repressed 19 1 ft femininity. The male i s often fearful of being feminine and the corol lary, of not being fu l l y masculine.' To be a man, he must deny his dependency on others and 20 part icular ly upon women. Changes i n the posit ion of the father within the family are noted by Engl ish. Where oncie the father was 21 i n the central posi t ion, he i s now at the periphery. The significance of his role has been minimized and has prompted the contemporary question of "are fathers 22 rea l ly necessary?" Now, the role i s seen as manifest-ing i t s e l f i n a more co-operative, affectionate and socia l ly integrated pattern within the family u n i t , 2 ^ Further theoretical discussionssof fatherhood and fatherliness have been undertaken by Benedek, Engel, 24-27 Josselyn, and Jessner et a l , ' Fatherhood and motherhood are seen as complimentary processes which evolve within the cul tural ly established family structure i n order to safeguard the physical and emotional 18 28 development of the c h i l d . Fatherhood i s not only the means for further evolution of the parent's personality but i t i s also a biologic fu l f i l lment . 7 Preparation for fatherhood i s seen as taking place throughout the man's l i f e and by some, as evolving during pregnancy, delivery and the postpartum p e r i o d . 3 0 ' 3 1 Becoming a father i s a stereotyped role and i s assigned to the father by othersi namely his wife, his parents, in-laws and p e e r s , 3 2 The results of caricatures characterizing his non-role has resulted i n the acceptance by many fathers that there i s l i t t l e about pregnancy to interest and involve them, except perhaps, the economic burdens. 3 3 ' 3 ' * ' The existence of fatherl iness, as compared to motherliness, has not been enthusiastical ly supported by theorists, Fatherliness i s seen as a binding together and amalgamation of the meanings of the chi ld to the father, into an emotional unit . 3 -* Tender love i s ident i f ied as the cohesive force i n fa ther l iness . 3 ^ It i s a desirable goal i n this culture for a man to be an endocrinological father while successfully repressing or hiding his fa ther l iness . 3 ? Fatherliness i s believed to stem from two sourcesi the relationship with the mother and that with the f a t h e r . 3 ® C l i n i c a l knowledge about expectant fatherhood i s scarce. Much of what has been learned about the husband and his status prior to labour and delivery has been gained from interviews with pregnant women or from husbands undergoing psychiatric support. Fatherhood i s seen as 19 a signif icant precipitant of mental i l l n e s s by Wainwright.-^ Liebenberg studied sixty expectant primiparae and, kn during the project, interviewed the husbands. She found personality disturbances, exaggerated dependency and acting out i n these normal fathers. She encourages understanding the husband's involvement i n pregnancy and chi ldbir th as i t points toward preventive intervention with fathers. Gaplan also stresses that support for the husband-father during pregnancy i s important, not only for his own benefit , but also for the future father-chi ld ki relat ionship. H is tor ica l Changes i n the Role of the Husband-Father During Labour and Delivery The husband-father of the nineteenth century commanded respect from a l l members of the familyi ko k<5 authority was lodged i n the male head, • r Pregnancy f e l l under the influence of Victorian codes of behavior, i t was hidden and not openly discussed. Pregnancy was not deemed a suitable interest for the male and was, therefore, not a shared emotional experience as one knows of i t today. Delivery of the infant took place i n the family home, and for this reason, the experience was kk family-centered; Prior to the 1930's, hospital delivery was reserved for the poor or for those women who experienced obstetr ical complications, J As care i n hospitals began to improve, i t was realized that home delivery 46 carried a high mortality rate for both mother and infant . 20 The development of medical techniques and the application of sc ien t i f i c principles meant that hospitals were to become the scene of labour and del ivery. With thei: shi f t i n the delivery s i te came surgical delivery techniques, loneliness of the expectant woman and iso la t ion from her family and friends;*7-*9 Fathers were le f t with no role i n c h i l d b i r t h . ^ 0 . .. Women gradually moved away from drugs as,a means of re l iev ing the pain of labour and delivery to a new concept of preparing themselves to cope with labour. Natural chi ldbir th and psychoprophylaxis meant active part icipation of the woman with support needed from a companion when her ab i l i t y to cope was threatened. Husbands f i r s t appeared i n the labour and delivery areas because women objected to being l e f t alone and unsupported during this experience.-** As a result of shared labour, both husband and wife real ized that this experience had implications for their own husband-wife relationship as well as for their relationship with their ch i ld . - * 2 Concern was soon being expressed by interested medical practit ioners regarding the role of the husband during labour. Publications directed at the expectant father were written i n an effort to help him understand the psychophysiology of pregnancy, labour, and delivery.->3t5* Suggestions were made on how the father might be supportive to his wife during these periods. By 1964, a heated controversy was brewing over 21 whether or not husbands should be present i n the d e l i v e r y room. A s i g n i f i c a n t number of couples were asking f o r h i s admission. A preponderance of medical and some nursing opinions were revealed with the opponents focusing on the following b e l i e f s . Permitting husbands i n t o the delivery room would increase the i n f e c t i o n rate, lawsuits against the physician would increase, and the father would l i k e l y d i v e r t attention away from the mother and i n f a n t by f a i n t i n g , asking too many questions, or contaminating the equipment.55-57 Concern about the husband-wife r e l a t i o n s h i p was expressed, such as one partner l e t t i n g the other down, or women f i n d i n g i t d i s t a s t e f u l to have the husband present.5 8 ~ 6 ° Some f e l t that h i s presence might increase the e f f e c t of the problems that he was already experiencing as an expectant father, and some believed than an i n -experienced husband witnessing the b i r t h would contribute l i t t l e to h i s wife*s emotional support or to family s o l i d a r i t y . 6 1 " 6 3 Obvious discomfort on the part of the physician and nurse was apparent when some admitted to f e e l i n g uncomfortable with a father "looking over one's shoulder," or when t r y i n g to teach students i n the presence of the husband. 6^J: 6:^?A$titudes concerning c h i l d b i r t h and sexuality wene viewed with the b e l i e f that c h i l d b i r t h i s womens' work and that the delivery room i s no place f o r sightseeing, sentimentality, and sex g r a t i f i c a t i o n . 6 ' " 6 ^ 22 Those supporting the husband's presence saw the benefit as family-centered care, with the delivery seen as a peak experience that unites father-mother-infant psychologically.? 0""'' ' 2 Some stressed that i t i s a supportive and valuable interpersonal experience for both husband and wife and that the husband i s the only person with whom a wife can f i t t i n g l y share t h i s . Other benefits included the bel ief that the trust of the apprehensive woman i n labour i s more l i ke ly to be gained i f the husband i s there to support her, with the result being a woman requiring less analgesia, and the fostering of dependency of the wife on the husband 8 ii—ft t\ rather than on the physician or nurse. ; The status of the husband was seen by some to be elevated to a part icipating team member as he serves as coach, companion, and provider of physical care to his wife.^""^ 0 He could also learn that interest and 9'ti involvement i n delivery i s d igni f ied , not demeaning. He was seen by this group as an a l l y of the nurse, as less of a legal r i s k , and as someone who does not affect the infect ion r a t e . ^ 2 " ' ^ In the event of the birth of an abnormal infant , i t was the bel ie f that parents do better to share grief immediately and meaning-f u l l y , just as they had anticipated sharing joy. '97 Out of this discussion of viewpoints came the establishment of c r i t e r i a for the husband's admission -;98£'' into the delivery room. • ~ 23 There was concern expressed regarding the husband's motives for watching the del ivery. Many saw the acceptable role as that of supporter to his wife; One author believed that i t was necessary to assess the husband's attitude and to ensure that i t was a real desire to share and provide support i n his wife's experience. ' The motive of "curiosity" seemed to be an unacceptable ™ 100,101 one. There was the bel ief expressed that control over who enters the delivery room i s s t i l l necessary and that the husband's presence i s a pr iv i lege, not a r ight to be 1 0 2 10*3 demanded; » J A nurse asked i f the health team had the right to deny the father the privi lege of watching the bir th of his c h i l d ; 1 0 1 ' ' The Husband-Father during  Labour and Delivery To support Wonnell's theory of why husbands returned to the chi ldbir th scene, i . e ; , at the request of their wives, a short review of the studies i l l u s t r a t i n g a woman's need for support i s presented; Lesser and Keane interviewed newly-delivered women i n h o s p i t a l ; 1 0 5 They learned that two of the f ive needs of the women i n labour were to be sustained by another human being and to have attendants accept their personal attitude toward and behavior during labour. The need for the sustaining human was the most important and the ful f i l lment ©f other needs was dependent on how well the need for another human was met. 24 The stresses of the childbearing year were studied by Larsen when she interviewed 130 mothers using an open-end q u e s t i o n n a i r e , S h e discovered that the dominant stress ofMabour and delivery was the unmet need for support, interest , and the presence of husband, nurse, and doctor, Allen demonstrated the decreased need of women i n labour for analgesics as well as the changes i n the type of contraction when a supportive person was present with the 107 labouring woman, A study of 208 couples, which focusedeon the husband 1 OR and his wife, was made by Jordan. The study was directed at comparing the reactions to two types of maternity care and was extended from the ninth month of pregnancy to eight weeks postpartum. She contrasted att i tudes, feelings and experiences of parents exposed to,family-centered care with those who experienced a more t radi t ional type of maternity care. More fathers of the former group wanted to see the bir th of their baby, fe l t that i t was a t h r i l l to see the bir th and had feelings 10'9 that the baby was theirs at the time of del ivery. More of the family-centered care group believed that a deeper husband-wife relationship had occurred during the experience of labour and the husbands believed that they had known how to help their wives during labour. None of the fathers i n the t radi t ional care group had attended prenatal c lasses. Anxiety was experienced by many husbands of both groups when asked to leave their 25 wives during the labour and delivery for examinations, in ject ions, and the a r r iva l of the p h y s i c i a n , 1 1 0 Many husbands believed that their presence during labour had helped rel ieve their spouses 1 anxiety. One of the strongest findings from both the t radi t ional and family-centered care group was the husband's desire to be alone,with his 111' wife immediately after the del ivery, Jordan's anecdotal comments revealed a mixture of husbands from both "care" groups who found the nursing staff to be considerate, tolerant, and supportive, to those who found them to be cold , non-communicative, 1 1 2 and unhelpful, -Cronenwett and Newmark studied the effects of formal chi ldbir th education and father attendance at the bir th on the father's response to the chi ldbir th 1 1 0 experience, r They£administered£a^se;£f^ Likert-type questionnaire to 152 fathers following the del ivery. Before the father le f t the hospita l , he was asked to turn i n the completed form. The researchers concluded that there was a positive relationship between attendance (at prenatal classes and childbirth) and the positive response to ch i ldb i r th . There was no measureable difference i n the paternal-child relationship and the attendance or non-attendance at del ivery. Those who attended prenatal classes and the bir th demonstrated a more posit ive husband-wife relationship than those without one or both of these experiences. The husbands who attended prenatal classes and the bir th tended to 26 view themselves more posit ively than those husbands who did not attend either the bir th or classes. Of interest was theiresearchers' discovery that regardless of preparation, the fathers who attended delivery perceived chi ldbir th as a more posit ive experience than the non-attenders at the b i r th . Both Jordan's and Cronenwett's results may have to be viewed and interpreted careful ly as neither study accounted for the differences i n the father's motives for or for not attending prenatal preparation and c h i l d -b i r t h . Are there signif icant personality or mariital differences between those persons who choose to attend prenatal classes cori the bir th of their children and those who do not attend? I f this i s found to be so, then one must be guarded, especially at this point, i n concluding that prenatal classes or attendance at the bir th accounts for the differences i n post-delivery att i tudes, Kopp and Schindler, i n an unpublished study, interviewed seventeen fathers on the second day post-partum regarding theffathers'; feel ings and experiences 11 'U during labour and del ivery. The researchers developed an interview schedule u t i l i z i n g open-end questions and rating scales; The sample was chosen randomly, cul tural variables were not control led. None of the fathers attended the del ivery. They asked the fathers to rate their feelings according to adjectives 1 27 provided for each of three categories* happiness, fear, and depression. The fathers claimed to fee l happier during the time of delivery than during the labour, denied that they experienced strong feelings of fear such as panic, but commonly admitted feelings of uneasiness and worry. There were no signif icant findings on the depression scales. The father thought that trust i n his wife's doctor and confidence i n the nurses was a posit ive influence but seeing his wife uncomfortable was noted as a negative influence on how he viewed the chi ldbir th experience, Kopp and Schindler found that the father believed that i t was an important part of his function to be with his wife during labour. He saw his function as providing non-physical support such as hand holding, reassuring his wife etc . Those giving physical support to their wives were mostly fathers-to-be for the f i r s t time. Aspects of care deemed most helpful by the fathers were being with their wives, attention paid to both wife and husband, and progress reports from the nurse or doctor. After del ivery, seeing, and secondly, holding the baby were rated as very important. Hott investigated the relationship between psychoprophylaxis i n chi ldbir th and changes i n s e l f -concept of the participant husband and his concept of his w i fe . 1 ' 1 ^ she studied f i r s t time fathers, spec i f ica l ly forty-four men who attended psychoprophylactic training (PPM) and th i r ty - f ive men whose wives chose the 28 tradi t ional method of childbearing without husbands present (non-PPM). She hypothesized that men who participate i n PPM would show greater concordance among prenatal measures of se l f and wife, and would show a greater increase i n concordance postnatally among these concepts than men who did not part ic ipate. The Osgood Semantic Di f ferent ia l was used as a pretest i n the prenatal period and was again administered on the third postnatal day. Results indicated a rejection of the hypothesis. Implications for nursing were, among others, acceptance and understanding of anxieties and tensions associated with the father's new ro le , parents' freedom to decide for themselves whether or not they want to share the b i r th , and the nurse's role as a "signif icant other" i n helping the father cope with the responsibi l i ty of parenthood, Aldridge, i n a study of why expectant wives wanted their husbands i n the delivery room, asked each 116 of the marital partners whose idea i t was, Of the 122 fathers, 31 percent saw i t as their wives' idea, 25 percent as their own, k0 percent as both of their ideas, and 3 percent as the doctors. Answers to the same question given to the wives, resulted i n very different perceptions. The counterculture was studied by Bancroft when she participated i n a project to increase the level of 117 antepartum care to the members. She found that 29 the counterculture members sought their own solution to the lack of family-centered care for childbearing by having their babies outside of the hospi ta l . The need to incorporate the father, along with signif icant others, into the entire chi ldbir th experience outweighed the dangers of home delivery for both mother and c h i l d . For those who chose to have their babies i n hospi ta l , a health f a c i l i t y that permitted father-attendance during labour and delivery was essent ia l . These findings are supported by the experiences of Golman and Colman i n their 11.8 exposure to members of the counterculture, A review of,pertinent theoretical and research findings were presented i n an effort to provide a framework for the study that was undertaken by the writer. Role theory, theory related to the masculine, husband, and father roles were included. The h is tor ica l development of husband part icipation i n labour and delivery and the recent studies concerning his thoughts, feelings and behavioral changes were outl ined. FOOTNOTES Theodore R. Sarbin and Vernon L, A l len , "Role Theory," i n fhe Handbook of Social Psychology. Vo l . I ed. Gardner Lindzey and E l l i o t Aronson, 2d ed. (Reading, Mass.i Addison-Wesley, 1968), pp. 488-567. 2 I b id . P. 545. 3 Ib id , * P. 549. 4 * Ibid. * P. 497. 5 Ib id , » P. 548. 6 Ib id . » P. 516. 7 Ib id , * P. 497. 8 I b id , » P. 533. ?Ibid, t P. 524. 10 11, I b id . , p. 526. Vera Keane, "Is the Focus on the Family?" i n ANA C l i n i c a l Conferences. (New Yorki Appleton-Century Crofts, 1970), p. 323. 12 Leonard Benson, Fatherhoodi A Sociological  Perspective. (New York* Random House, 1968), p.217 1 3 I b i d . , p. 21. 14. 15 I6t I b id . , p. 28. I b id . , p. 28. David M. Fulcomer, "The Nuclear Family," i n Maternity Nursing Today, ed. Joy P. Clausen et a l . (New Yorki McGraw H i l l , 1973). p. 118. 1 7 I rene Josselyn, "Cultural Forces, Motherliness and Fatherl iness," American Journal of Orthopsychiatry 26 (Apri l 1956)« 267. 30 I 31 1 !l 1 8 I b i d . , p. 271. 7Benson, Fatherhood, p. 191. ; Josselyn, "Fatherliness," p. 268. 21 0.v.Spurgeon Engl ish, "The Psychological Role of Father i n the Family, " i n Marriage and Family i n the  Modern World, ed. Ruth S. Cavan (New Yorki Thomas Y. Crowe11, I960), p. 515. "Are Fathers Really Necessary?" The Medical Journal  of Austral ia 1 (No. 19. Saturday May 12, 1973)» 920. ^ E n g l i s h , "The Role of Father," p. 521. 2 4 There*se „Benedek, "Fatherhood and Providing," i n Parenthoodi I ts Psychology and Psychopathology. ed. E , James Anthony and Therese Benedek (Bostoni L i t t l e Brown, 1970), pp. I67-I83. 2^George L. Engel. Psychological Development i n  Health and Disease (Philadelphia! Saunders, 1962), pp. 189rl96. 2 6 J o s s e l y n , "Fatherliness," pp. 264-271. 2 ?Lucie Jessnerj Edith Weigertf and James L. Foy, "The Development of Parental Attitudes during Pregnancy," i n Parenthood! I ts Psychology and Psychopathology. ed. E ; James Anthony and Therese Benedek (Boston! L i t t l e Brown, 1970), pp. 209-244. Benedek, "Fatherhood," p. 167. 2 9 I b i d . , p. 171. 3 ° E n g e l , Psychological Development, p. 191. 3 *Jessner , "Development of Parental Att i tudes," p. 230. 3 2 I b i d . , p. 230. 3 3 Arthur Colman and Libby Colman, Pregnancy1 The Psychological Experience (New York! Herder,& Herder, 197D, P. 135. r^Edith B. Wonnell, "The Education of the Expectant Father for Chi ldbi r th ," Nursing C l in ics of North America 6 (No. 4, December 1970)! 598. 32 3 5 j o s s e l y n , "Fatherliness," p. 26?. 3 6 I b i d . , p. 267. 3 7 I b i d . , pi 270. 3 ®Engel, Psychological Development, p. 191. 3 % * H . Wainwright, "Fatherhood as a Precipitant of Mental I l l ness , " American Journal Psychiatry 123 (1966): 40-44, Cited by Jessner et a l . , "Development of Parental Att i tudes," p. 230. 40 Beatrice Liebenberg, "Expectant Fathers," American Journal of Orthopsychiatry 37 (No. 2, March 1967)» 3W. 41 Gerald Caplan, Concepts of Mental Health and  Consultation (Washington, D.C:. 1 U.S. Dept. of Health, Education and Welfare, 1959)» pi 59 i ^ E n g l i s h , "Role of Father," p. 513. Benedek, "Fatherhood," p. 177. ] 44 ^ I b i d . , p. 177. ?Erna Ziegel and Carolyn C. Van Blarcom, Obstetric Nursing. 6th ed. (New Yorki Macmillan, 1972), P. 777. 4 6 I b i d . , p. 777. 47 'Glen E , Haydenj Daniel C, Moore1 and L. Donald Birdenbaugh, "Maternity Care Should Be Family-Centered," The Modern Hospital 102 (No. 2, February 1964)1 104. 48 Charles Aldridge, " In i t ia l Experiences with Fathers in the Delivery Room," Michigan Medicine-:69 (No. 11, June 1970)i 489. ^John Mi l l e r , ". 'Return the Joy of Home Delivery' 1 with Fathers i n the Delivery Room," Hospital Topics 44 (No. 1, January 1966)» 106. ->°Wonnell, "Education of the Expectant Father," P. 598. 5 1 I b i d . , p. 592. 5 2 I b i d . , p. 592. 1 1 33 -'-'Robert A, Bradley, Husband-Coached Childbirth (New York| Harper & Row, 19651 J George Schaefer and Milton Zisowitz, The Expectant Father (New Yorki Simon & Schuster, T5>54) cc -'-'John H. Morton, "Fathers i n the Delivery Room— an Opposition Standpoint," Hospital Topics 44 (No. 1, January 1966)$ 103. 56 J Malcolm Al lan , "Husband-Attended Del iver ies ," Obstetrics and Gynecology 27 (No. 1, January 1966)t 147. J 'George Schaefer, "The Expectant Fathert His Care and Management," Postgraduate Medicine 38 (December I965)1 662, 3 C R . Climie et a l . , "Consumer Satisfaction i n the Labour Ward," Medical Journal of Austral ia 2 (No, 24, December 15, 1973)« 1083. ^Kathleen Dicker, "Husbands i n the Labour Ward," Nursing Times 65 (March 27, 1969)« 416. ^°Colman and Colman, Pregnancy, p. 135, 61 Al lan, "HusbandrAttended Del iver ies ," p, 146, 62 Morton, "Fathers i n the Delivery Room," p, 103, ^^Natalie Shainess, "The Psychologic Experience of Labor," Child and Family (Spring 1966)» 22, 64 . Al lan , "Husband-Attended Del iver ies," p, 147, ^Aldr idge , " i n i t i a l Experiences," p, 489. ^^Wonnell, "Education of the Father," p, 597o ^ C l i m i e , "Consumer Sat isfact ion," p. IO83. 68 Schaefer, "The Expectant Father," p. 662. "^Morton, "Fathers i n the Delivery Room," p. 103. ?°Robert N. Rutherford, "Fathers i n the Delivery Room—Long Experience Molds One Viewpoint," Hospital Topics 44 (No. 1, January 1966)* 100. 7 1 I b i d , , p. 97. 34 7 2 Wonnell , "Education of the Father," p. 600, Elaine W, Young, "Prepared Childbirthi I ts Impact on Nursing," Canadian Nurse 64 (No, 1, January 1968)i 41. ^Dicker , "Husbands in the Labour Ward," p. 416. ^^carl Goetsch, "Fathers i n the Delivery Room — •helpful and supportiveo*," Hospital Topics 44 (No. 1, January 1966)1 104. 7 6 Schaef fer , "The Expectant Father," p. 661. ^Rutherford, "Fathers in the Delivery Room," p. 97 7 8 M i l l e r , "Return the Joy," p. 105. "^Georgianna Fleming, "Delivering a Happy Father," American Journal of Nursing 72 (No, 5, May 1972)t 97. 1 80 Colman and Colman, Pregnancy, p. 134. 81 C. Y. Shu, "Husband-Father in Delivery Room?," Hospitals J .A .H .A . 47 (September 16, 1973)* 92. 8 2 I b i d . , p. 93. 8 3 D i c k e r , "Husbands in the Labour Ward," p. 416. Wonnell, "Education of the Expectant Father," P. 597. - . . 85colman and Colman, Pregnancy, p. 82. 86 Shelly Al len, "Nurse Attendance during Labour," American Journal of Nursing 64 (No. 7» July 1964)1 70-74. 8 7 Shainess , "The Psychologic Experience," p. 22. op Dicker, "Husbands in the Labour Ward," p. 417, 8 9 S h u , "Husband-Father in Delivery Room?" p. 93.* 9 °Jeannette L. Sasmort, Constance; R. Castori and Patr ic ia Hassid, "The Childbirth Team duringLabour," American Journal of Nursing 73 (No, 3, March!1973)* *46. *h 92, 9 l M i l l e r , "Return the Joy," p. 107. ' Ib id . , p. 109. 9 3 I b i d . , p. 107. 35 9 l f Goetsch, "Fathers i n the Delivery Room," p. 10*. ^Rutherford, "Fathers i n the Delivery Room," p. 100. 9 6 Wonnell , "Education of the Father," p. 597. 9 7 Fleming, "Delivering a Father," p. 97. 9 8 Goetsch, "Fathers i n the Delivery Room," p. 10*. " c i i m i e , "Consumer Sat isfact ion," p. 1083. 1 0 0 Hayden, "Maternity Care," p. 104. 1 0 1 G o e t s c h , "Fathers i n the Delivery Room," p. 104. 1 0 2 S h u , "Husband-Father i n Delivery Room?" p. 94. 1 0 3 G o e t s c h , "Fathers i n the Delivery Room," p. 104. ^ D i c k e r , "Husbands i n the Labour Ward," p. 4 l6. 1 0 %-ar£"on -Lesser and Vera Keane. Nurse-Pati ent i Relationships i n a Hospital Maternity Service, cited by Wonnell, "Education of the Expectant Father," p. 593. 1 06 Virg in ia L. Larsen, "Stresses of the Childbearing Year," American Journal of Public Health 56 (No. 1, January 1966)i 32-36. 1 G 7 A l l e n , "Nurse Attendance," p. 70-74. 108 A, Doreen Jordan, "Evaluation of a Family-Centered Maternity Care Hospital Program, Part I i Introduction, Design, and Testing," JOGN 2 (No. 1, January-February 1973)* 13-35. 1 0 9 I b i d . , p. 27. 110 A. Doreen Jordan, "Evaluation of a Family-Centered Maternity Care Hospital Program, Part IIt Anci l lary Findings and Parents' Comments," JOGN 2 (No. 2, March-April 1973)t 17. 1 1 1 I b i d . , p; 17. 1 1 2 I b i d . , p. 15-27. -'Linda R. Cronenwett and Lucy L.. Newmark, "Fathers' Responses to Childbirth.";Nursing Research 23 (No. 3, May-June 197*)» 210-217. 36 I l k Lois M. Kopp and Sharon L. Schindler, "Ah Exploratory Study of the Experiences of Fathers during the Intrapartal Period," (Yale University* School of Nursingi May 16, 1966) (Mimeographed) -'Jacqueline R. Hott, "An Investigation of the Relationship Between Psychoprophylaxis i n Childbirth and Changes i n Self-Concept of the Participant Husband and His Concept of His Wife," Dissertation Abstracts International 33 (No. 1-B, July 1972)* 296-297. l l 6 A l d r i d g e , " In i t ia l Experiences," p. 490 117 'Anne V, Bancroft, "Pregnancy and the Counter-culture," Nursing C l in ics of North America 8 (No. 1, March 1973)* 67-76. 118 Colman and Colman, Pregnancy, pp. 89-92. CHAPTER III RESEARCH DESIGN Introduction The central purpose of this study was to learn of the husband-father^s perceptions of labour and del ivery, his perceptions of his role during this period, and how he perceived the care provided t© his wife and himself. Because of the nature of the data desired, a retrospective study was designed. Contact with the father was in i t ia ted as soon after delivery as was feasible . Data were obtained through semi-structured interviews with fathers and from the perusal of the newly-delivered mothers' hospital records. These data were recorded by the researcher and the variables were subsequently analyzed by the use of content analysis and non-parametric s t a t i s t i c a l tests . The research design^will be elaborated upon i n the following sections of this chapter. The Setting The setting chosen for this study was an urban maternity unit i n a general hospital that records approximately 1 , 1 0 0 del iveries per year. Besides offering teaching and research opportunities to a 37 38 variety ef students i n the health professions, the maternity unit supports the philosophy of family-centered maternity care,* Husbands are permitted to stay with their wives during labour and, under most circumstances, are allowed to enter the delivery room, i f desired by the couple. The labour and delivery f a c i l i t i e s include four single labour rooms, three delivery rooms and a two-bed recovery room for the parturients. A waiting room for the husbands adjoins the labour rooms. A l l patients have access to nursing, anaesthesia, interne/resident, and personal physician services. Once the infant i s bom, his condition i s assessed. A l l newborns experiencing an actual or potential health problem are taken to the intensive care nursery which i s located near the delivery area. Those infants whose condition i s judged to be stable are transferredttotthe postpartum unit nursery, one f loor above. When the mother's condition stabi l izes after del ivery, she i s likewise transferred 'to the postpartum unit . In the postpartum area, both parents are permitted to see and care for their infant when and as much as they desire. V is i t ing hours are non-restrict ive for the fathers. The Sample of Subjects Cr i ter ia for Selection Twenty subjects were to be selected from the population of fathers. Their selection was based on the 39 following c r i t e r i a i . married to the mother of the baby . twenty to forty years of age • present for a l l or a portion of the labour . delivery must be vaginal . a healthy newborn of at least thirty-seven weeks gestation must be born . father must be Caucasian • father must be born i n Canada, United States, or Br i t ish Commonwealth countries , father must be fluent i n English The decision to control the cu l tura l - rac ia l variable i n this study was based on Newton and Newton's research of 2 cultural groups. They discovered a wide variety of male attitudes and practices surrounding the bir th process i n 122 cultures. For this study, husbands with one or more labour and delivery experiences were included. Two additional c r i t e r i a were appliedi the wife must be well enough to approve of her husband's part icipation and she must consent to his being interviewed without her being present. The hospital and delivery records provided information as to whether a father would meet the c r i t e r i a pertaining to marital status, race, type of del ivery, health of the newborn, gestation of the newborn. The remainder of the c r i t e r i a were established on talking with both of the parents. 40 Demographic Characteristics The sample consisted of twenty husband-fathers. Sixteen of the subjects were born i n Canada, four were Br i t ish bom. Data relevant to the fathers' age, marital status and years of education i s summarized i n Table 1. 7'TABLE 1 FATHERS• DEMOGRAPHIC DATA Age Number of Years Number of Years Married of Education 22-40 0.5-7.5 8-23 28.5 3.5 14.75 27.5 3.5 15 n= 20 subjects The fathers ranged i n age from twenty-two to forty yearss the mean was 28,5 years. The length of time that a l l fathers had been married ranged from six months to seven and one half yearsi the mean was 3.5 years. The to ta l number of years of education ranged from eight years to twenty-three» the mean was 14,75 years. Seventeen subjects were fathers for the f i r s t time; none of these fathers revealed a previous marriage with a labour and delivery experience. Three were fathers for the second time; the length of time between Range Mean Median 41 this delivery and the previous delivery ranged from eighteen months to three years; A deliberate selection of this part icular hospital was made by eight of the couples. Reasons given for the choice were related i n seven cases to the family-centered philosophy of care, both during the labour and del ivery, and the postpartum period. One father stated that he chose the hospital because he was born there, not because of the philosophy of care. The remaining twelve of the sample stated that they came to this hospital because their wives' physician was a f f i l i a ted with the hospi ta l . Obstetrical Characteristics of the Wives Sixteen of the pregnancies were cited by the fathers as being problem f ree . Within the group of women who experienced problems, one mother developed a third trimester bladder infect ion and another experienced f i r s t trimester bleeding with the passage of c l o t s . Once therapy and rest , respectively, were inst i tuted, these health problems were resolved. Two of the pregnant women experienced a prolonged health problemt one developed gestational diabetes and the other experienced frequent asthmatic attacks i n the f i r s t and second trimesters of pregnancy. The former was controlled by a dietary regimen, the other with hospital izat ion and medication. No emotional problems 4 2 were mentioned for any of the mothers. Previous Pregnancies The husbands were asked about their wives' previous pregnancies, labours and de l iver ies , and postpartum periods. In the f i r s t pregnancy, one wife had vomited intermittently for nine months, the second delivered f ive and a half weeks prematurely, and the third experienced a painful eighteen hour labour. The mother who delivered the premature infant also experienced an exacerbation of a r thr i t i s i n the early postpartum period. A l l children from these pregnancies were al ive and wel l . Three of the women i n the sample underwent therapeutic abortions at varying times i n the past. Of those revealed by the husband, one woman had a problem-free post-abortion period and another hemorrhaged, ,The data related by fathers regarding the previous pregnancies and the present pregnancies coincided with those which were recorded on the mothers' hospital record. Present Labour and Delivery The length of labour of the sample was recorded and the results are summarized i n Table 2, A,graphic method for studying the labours of primigravid and multiparous women was developed by Friedman, The mean duration of labour i n Friedman's sample for the 43 priraigravida was fourteen hours; the mean duration for the multipara was eight hours. TABLE 2 DURATION OF LABOUR FOR SAMPLE WIVES Duration of Labour for Total Sample (Hours) ' Duration of Labour for Primigravida (Hours) Duration of Labour for Multipara (Hours) Range 4.10-23.5 4.75-23.5 4.10-8.0 Mean 10i79 I l i 3 6 6.14 Median 10.33 10.33 6.75 n« 20 wives The length of labour for the study sample ranged from 4 hours and 7 minutes to 23 hours and 30 minutes. The mean length was 10i79 hours; the median was 10,33 hours• The range for the primparous woman was 4 hours and 45 minutes to 23 hours and 30 minutes; the mean was 11,36 hours; the median was 10i33 hours. The range.for the multiparous woman was 4hours and 7 minutes to 8 hours; the mean was 6 U 4 hoursi the median was 6,75 hours* The means of the study sample and that of Friedman's d i f fer s ign i f icant ly . The data needed to calculate the active phase of labour was not avai lable. Therefore, i t i s not known i f these women's labours were representative. 44 Analgesia and Anaesthesia Table 3 indicates the analgesia and anesthesia administered during the chi ldbir th experience. TABLE 3 ANALGESIA AND ANAESTHESIA GIVEN DURING LABOUR * AND DELIVERY 1 Analgesia Given Anaesthesia Given during Labour during Delivery (No. Wives) (No. Wives) Local In f i l t ra t ion 13 Demerol 9 Pudendal Block 2 Nisent i l 5 Epidural 3 No Analgesia 6 Spinal 1 ^ General 1 n= 20 wives During the labour, nine women received varying amounts of Meperidine hydrochloride (Demerol), f ive were administered Alphaprodine (Nisentil) and six received no analgesia or sedative medication. During the delivery, thirteen women were given a loca l i n f i l t r a t i o n of the perineum, two a pudendal block, three a lumbar epidural, and one a spinal anaesthetic. One mother received a general anaesthetic when fe ta l distress was diagnosed. In addit ion, one mother was administered a general anaesthetic during Stage III for retention of the placenta. k 5 Type of Delivery Fifteen of the women delivered spontaneously and five of the del iveries required the use of low forceps for fe ta l distress or prolonged second stage with fa i lure to progress. A l l of the fe ta l presentations were vertex. : - : . : : z ~ ^ . t lr.\J23s Newborn Data One of the c r i t e r i a for selection of fathers was the delivery of a healthy infant . However, two of the infants were given Apgar scores of less than 7 during the f i r s t minute after b i r th . One newborn received a rating of 2 and the other, 6, Both achieved 7 or better within f ive minutes. One additional infant of 3 7 i weeks gestation received an Apgar of 7 at one minute. He and the infant with the i n i t i a l Apgar of 2 were placed i n the intensive care nursery for twenty-four hours. Both sets of parents v is i ted and handled their babies during this period. Neither infant displayed any further overt signs of distress during the observation period. The data pertaining to the newborn at bir th i s presented i n Table 4; Apgar scores at one minute ranged from 2 to 9 with the mean being 7 .8 . At f ive minutes they ranged from 7 to 10 with the mean being 9.2. The infants ' bir th weight ranged from 2880 to 5000 Grams; the mean was 3 k51 Grams. 46 TABLE 4 NEWBORN DATA AT BIRTH Apgar at One Minute Apgar at Five Minutes Birth Weight (Grams) Range 2-9 7-10 2880-5000 Mean 7i& 9.2 3451 Median 8 9 3490 n« 20 newborns Previous Hospital and Pain Experiences of Husbands Additional information was gained from the husbands by asking them how comfortable they were i n a hospital and what previous experiences they had had with someone i n a lot of pain. They were asked these questions to determine possible additional stressors that they might be bringing to the labour and delivery experience. A l l of the husbands had been i n a hospital before, either as a patient or a v i s i t o r ; They were asked, on a nine-point scale, with 44 indicat ing very comfortable 1 and -4 indicat ing very uncomfortable, to reveal their degree of comfort when inside of a hospi ta l . The results are presented i n Table $, The mean was +1.05, the median 4-2, the range -4 to 44, and the standard deviation was 2.73. 47 TABLE 5 HUSBANDS * EMOTIONAL COMPORT WHEN INSIDE A HOSPITAL* Test Result Mean + 1.05 Median +2 Range -4 to +4 Standard Deviation 2.73 n= 20 subjects •Response to rating sca&e, 44 (Very Comfortable) to -4 (Very Uncomfortable) The results indicate that a s l ight majority of the sample f e l t comfortable i n hospitals but that the remainder experienced low or negative levels of comfort. As some fathers indicated, and the researcher would agree, that chi ldbir th i s the one time that posit ive feelings toward hospitals may be heightened. This i s particulary true i f the outcome of the labour and delivery was posi t ive . The large number of men i n the sample who admitted to discomfort or very low levels of comfort, seems to indicate that many men are faced with an' additional stress to overcome, besides the actual labour experience. The husbands were also asked i f they had ever, before they came to hospital with their wives, had 48 experiences with someone who they would consider had a lot of pain; Nine husband-fathers had such experiences. They were then asked how well they coped or managed, knowing that this person was i n pain; Of the four choices offered, f ive responded "very w e l l £ , four " fa i r l y wel l" , and no one selected the other alternatives of *hot very well" or "uncertain?t Responses to the question about the pain experience seemed to indicate an opennessson the part of some fathers to admit to d i f f i c u l t y with the person i n pain. For those indicat ing positive experiences i n coping when someone was i n a lot of pain, i t may mean that they are better able to cope with future episodes of pain encounters. It may also mean that the answers given are not re l i ab le , but soc ia l ly acceptable. The instrumental orientation of the male may influence him to respond that he was successful with pain experiences. 49 The Interview Method Kerlinger defines the interview ast . . . a face-to-face interpersonal role situation i n which one person, the interviewer, asks a person being interviewed, the respondent, questions designed to obtain answers to pertinent research problems.^ He describes the standardized or structured interview as one i n which the questions, their sequence and their wording are f ixed. The interviewer may be allowed some l iberty i n asking questions, but re la t ive ly l i t t l e . There are d i f fer ing views regarding the s t r ic ture , the c newest being the relaxation of it.-^ The standarized interview employs an interview schedule or questionnaire which includes three types of informations fixed-alternative questions, open-end questions, and rating scales. The fixed-alternative questions have the advantage of providing greater uniformity of measurement and thus greater r e l i a b i l i t y , but they also have several disadvantages. They are superf ic ia l and do not get below the surface response unless probes are used. They can also force responses, many of which are not re l i ab le . Kerlinger notes that f ixed-alternatives can be used to advantage i f judiciously written, used with probes, and mixed with open items. The second type of question, i . e . , the open or open-end items, are those which supply a frame of reference for the respondents* answers but put a minimum of restraint on the answers and their expression. 50 / i These questions have poss ib i l i t i es of depthi they allow one to make better estimates of the respondents* true intentions, bel iefs and attitudesi they allow for the detection of ambiguity; and encourage cooperation and rapport. The third type of item used i s the scale> "a set of verbal items to each of which an individual responds by expressing degrees of agreement or disagreement or some other mode of response," 6 Scale scores can be checked against open-end question data for r e l i a b i l i t y . It was this method of a standarized interview, using the three typeswof items, that was employed for this study. Pretesting was carried out by interviewing three husband-fathers. Their suggestions for improving the interview schedule and interviewing techniques were sought. I t became apparent, both from the in ter -viewees* responses and the observations of the researcher, that several modifications should be made i n the pretest schedule (see Appendix C), In addit ion, the or iginal intention of interviewing husbands within the f i r s t forty-eight hours after delivery was not feasible . Many had outside commitments which limited their available time, not only for v i s i t i n g with their wives, but also for talking with the interviewer. 51 Procedure for Collection of Data The nurse-researcher f i r s t enountered the subjects in the early postpartum period, after having screened the hospital and delivery records. (The c r i t e r i a of marital status, race, type of delivery, health and gestational age of the newborn were available i n the hospital records.) The researcher explained the nature of the study and the remainder of the c r i t e r i a necessary for part icipation i n the study. These c r i t e r i a were the birthplace of the father, his age, his presence during a l l or a portion of labour and his fluency i n Engl ish. I f the husband met these c r i t e r i a , he was invited to participate i n the study. On occasion, four or f ive potential subjects existed after the screen-ing of the delivery and hospital records. When this happened, the researcher chose every second father, approached him, and i f he met the remainder of the c r i t e r i a , invited him to participate i n the study. In most instances, a l l potenMa-1 candidates were eventually approached because the c r i t e r i a of age, birthplace, etc . were select ive. A convenient interview time for the father was established. As was noted ear l ier i n the study, no husbands refused to part icipate. However, four "multiparous" fathers were unable to keep their interview appointments. Reasons cited by the wives were fa i lure of the father to secure a baby-sitter, sickness of the 52 children or the father. Three of the husbands le f t word with their wives to make alternate arrangements and .the other husband became too involved with outside ac t iv i t i es to pursue an alternate time. None of these fathers were included i n the sample. The number of hours after delivery that the interview took place was recorded. These data are summarized i n Table 6. TABLE 6 INTERVIEW LENGTH;A»TIMEK AFTER DELIVERY Length (1 of Interview Jinutes) No, Hours after Delivery Range 30? 90 13-107 Mean 61 51.8 n= 20 subjects Table 6 i l l us t ra tes that the interview length ranged from 30 minutes to 90 minutes; the mean was 61,0 minutes. The number of hours after delivery that the interview took place ranged from 13 to 107 hours; the mean was 51.8 hours. The interviews took place i n an office-lounge on the postpartum uni t . Wives were not present. To fac i l i t a te relaxation of the husbands, smoking was permitted and hot beverages were avai lable. The researcher 53 was dressed i n street c lothing. I t was explained that the researcher would not be discussing their comments with their wives or with the nursing staf f . They were also reminded that they were not obliged to answer any question which they found to be too personal. They,were given a consent form to sign, a requirement of the hospital (see Appendix A) . To insure consistency, an interview schedule was used (see Appendix B). The subjects were informed that the researcher would be jott ing down abbreviated versions of their comments and that she would complete the recording after the interview had terminated. Several fathers expressed r e l i e f that no tape recording was being done. The sequence of the schedule was followed for the majority of interviews. However, several fathers seemed eager to describe certain aspects of the labour and delivery experience before their appearance i n the schedule. The fathers* spontaneity was encouraged. For those questions requiring the selection of one answer from several alternatives, a printed card with the question or state-ment arid the alternatives was presented to the subject. Those statements involving rating scales were handled by giving the father a penci l and a copy of the statement with the rat ing scale. Explanations of how to use the scale were given to the husband. Demographic and obstetr ical data were obtained from the mothers* hospital records before the interview 54 took place. However, knowledge of this data was not introduced by the researcher unless done by the fathers. The interviewer did not reveal this data because of the poss ib i l i ty of influencing the fathers* perceptions. In the hour following the completion of the interview, the researcher completed the recording of the observational data. Data Analysis Two methods of data analysis were employed. Content analysis of the husbands* responses to the open-end questions was carried out and nonparametric s t a t i s t i c a l tests were used for assessing significance between some extraneous independent variables and the dependent variables, Holsti defines content analysis as "any technique for making inferences by systematically and objectively 7 identi fying specified characterist ics of messages,"' The f i r s t step i n the procedure was the establ ish-ment of the categoriesi a framework for categorization was adapted from the l i terature where possible. Data were segmented into analytic units and these were subsequently sorted into the categories. The analytic unlets were the word and themes, drawn from open-end questions posed to the husbands, A quantitative analysis was carried out with each item assigned an equal weight, Nonparametric s t a t i s t i c a l tests were chosen for three major reasons; There was a question as to whether this sample was drawn from a normally distributed population. 55 Secondly, the sample size was small, and f i n a l l y , many of the measures were nominal and ordinal i n nature. The Chi-square was used to detect whether signif icant differences existed between the observed population and the theoretical population. Single variable analysis was included, more spec i f i ca l l y , the mean, median, range and standard deviation were calculated. The Independent and Dependent Variables The independent variable was the labour and delivery experience of the couple. Specif ic demographic and obstetr ical characterist ics were considered as extraneous independent variables. The extraneous variables relat ing to the mother were her previous obstetr ical problemsi those re lat ing to the father were his attendance or non-attendance at prenatal classes, his attendance or non-attendance at a previous labour and delivery, his past experiences with someone i n pain, his attitudes about hospitals . The dependent variables were three inter-related areas of perception! the husband-fatherms thoughts and feelings about labour and del ivery, his perception of his role during this time, and his perception?of the care received by his wife and himself during labour and del ivery. The father*s 3 perceptions of labour and del ivery, i . e . , the f i r s t aspect of perception, were divided into 56 f ive subsets. These were! • his expectations of labour and delivery . his rat ing of the experience of labour and delivery . h i s focus on his wife, baby, and se l f during labour and delivery • his assessment of the amount of pain experienced by his wife during labour • his periods of ease and uneasiness during laboiir and del ivery. The second aspect of perception was how he perceived his role during labour and del ivery. This was divided into f ive subsets which were! , some aspects of the decision-making process related to his attendance at labour and delivery • h i s role preparation for labour and delivery • his reasons for attending the labour and delivery . h i s role assumed during labour and delivery • his assessment of how helpful he was to his wife during labour ttand del ivery. The third and f i n a l aspect of perception was his evaluation of the care provided to his wife arid himself during labour and del ivery. There were two subcategories! . what he saw as helpful , what he saw as non-helpful. 57 Limitations of the Study In reading this study, the reader i s cautioned that there are some l imitat ions. The study i s retro-spective i n nature and, therefore, much of the r e l i a b i l i t y of the data i s based on the subjects* a b i l i t y to r e c a l l their thoughts and feel ings; Fathers were interviewed over a time period ranging from 13 to 107 hours after del ivery! I t i s possible that had a l l fathers been interviewed within a smaller time range, the data would have been s l ight ly d i f ferent; The sample size was small, the rac ia l -cu l tu ra l variable was control led, and a l l twenty subjects had attended prenatal c lasses. In addit ion, ninety percent of the sample were present at the delivery of the baby; The setting was a family-centered maternity uni t , the deliberate choice of eight couples. The tool*s va l id i ty for measuring the husbands* thoughts and feelings was not well-established; In the stage of data analysis, the lack of existing categories and rules for sorting the data into these categories did not exist i n the l i terature; FOOTNOTES Bernadet Ratsoy, "Maternity Patients Make Decisions," Canadian Nurse 70 (No. 4, Apr i l 1974)i 42-44, 2 Niles Newton and Michael Newton, "Childbirth i n Cross-Cultural Perspective," i n Modem Perspectives  i n Psycho-Obstetrics, ed. John G. Howelis, (Edinburghi Oliver & Boyd, 1972)i 150-172. 3 E l i s e Fitzpa tricks. Sharon R. Reeder: and Luigi Mastroianni, Maternity Nursing. 12th ed. (Philadelphia! Lippincott, 1971)» 217. k Fred N. Kerlinger, Foundations of Behavioral  Research. 2d e d , , (New Yorks Holt, Rinehart & Winston, 1973), P. 481. ^Charles F, Cannell and Robert L, Kahn, "Interview-i n g , " i n The Handbook of Social Psychology. Vol II ed. Gardner Lindzey and E l l i o t Aronson, 2d ed, (Reading, Mass: Addison-Wesley, 1968), pp. 526-595. ^Kerlinger, Behavioral Research, p. 485, ?01e R, Ho ls t i , Content Analysis for the Social  Sciences and Human! tiesT (Reading, Mass.s Addison-Wesley, 1969), P. 2 58 CHAPTER IV FINDINGS: ANDiDiSCUSSI ON Introduction In this chapter, three aspects of the husband*s perception w i l l be presented. These are the husband's thoughts and feelings about labour and del ivery, his perception of his role during this period, and his perception of the care provided to his wife and himself during labour and del ivery. In the f i r s t section, the husband's thoughts and feelings w i l l be discussed. More spec i f ica l ly the subsets aret . his expectations of labour and delivery . his rating of the experience of labour and delivery , his focus during labour . his focus during delivery . his emotional relaxation and uneasiness during labour and delivery In the second section, the husband's perception of his role w i l l be examined. The subsets for this aspect arei . some aspects of the decision-making process related to his attendance at labour: and delivery , the husband's preparation for his role during labour 59 6o and delivery . the husband*s role enactment during labour and delivery • his assessment of his role during labour and delivery In the f i n a l section of this chapter, the husband's evaluation of the care provided by others w i l l be presented. The areas to be discussed aret i" his rating of the overal l care . his perception of helpful and non-helpful nursing care The results for each of the specif ic subsets w i l l be presented and then followed by a discussion and interpreta-t ion of the resul ts . The discussion and interpretation w i l l be guided by Sarbin and A l l e y s concept of role theory; Perceptions of Labour and Delivery Expectations of Labour and Delivery In order to learn i f the labour was congruent with the husband-fathers* expectations, the following question was posedt "In terms of what you had expected, how well did this labour go for you?" Table 7 i l lus t ra tes the husbands* responses to the four categories which were provided for him; Some husbands gave more than one answer to the question, i . e . , one aspect might have been better and another worse than he had expected. 61 ' TABLE 7 HUSBAND RESPONSE TO HOW WELL LABOUR WENT Response Number of Responses* Better than expected 12 Same as expected 5 Worse than expected 3 Uncertain what to expect k n= 20 subjects •Some husbands gave more than one response According to twelve fathers, the labour went better than expected for the following reasonsi the length was shorter, there were no complications, their wives coped better than they had anticipated, ;orl the pain was less than they had expected. For three husbands, the labour went worse than they had anticipated because of the amount of pain. Five husbands stated that the labour went as they had expected, the common response being, "it went just l ike the textbook," Four husbands admitted that they were uncertain of what to expect. The husbands were also asked how well the delivery went. Again, some husbands provided more than one response to the fixed categories. Table 8 summarizes their responses to the question. Thirteen husbands believed that aspects of the delivery went better than 62 they had expected. Their reasons were that the pain experienced by their wife was less than they thought i t would be, that their (husbands) own reaction was far more personal than they had anticipated, or the attitudes of the health team members were better than they had expected, Reasons - given' for the'Cworse &than/rexpected " category were the baby who fa i led to breathe at b i r th , the need for the manual removal of the placenta under general anesthesia, and the behavior of the health team members. The lat ter example w i l l be discussed i n the third section of this chapter, TABLE 8 HUSBAND RESPONSE TO HOW WELL DELIVERY WENT Response Number of Responses* Better than expected 13 Same as expected Worse than expected 2 Uncertain what to expect 3 n= 20 subjects * Some husbands gave more than one response The results indicate that the majority of husbands brought a set of expectations to labour and del ivery. These expectations, whether they were postive or negative, provided him with a frame of reference, 1 He had a set 63 of c r i t e r i a against which he could assess the r e a l experience of labour and d e l i v e r y . These expectations centered on the length of time of labour, the amount of pain, t h e i r wives a b i l i t y to cope with the contractions, and the eventual outcome of the experience© Included were the husbands* own reaction and the behavior of others, namely the health team members. For the majority, the labour and d e l i v e r y surpassed t h e i r expectations i n a p o s i t i v e sense; f o r the minority t h e i r expectations were surpassed i n a negative sense. For some, i n spite of prenatal preparation, they were uncertain of what to expect. Congruence of expectation was indicated by a small number. In i n t e r p r e t i n g these findings, one must be;careful not to equate the expectation with good or bad; For example, the response of "better than expected" could have been the r e s u l t of a good or a poor experience; One can only state that t h i s f i n d i n g indicates that the degree of congruence between expectation and perceived r e a l i t y was low. Because of t h i s , the fathers had to expend a d d i t i o n a l energy during the labour and d e l i v e r y to adjust or adapt to these d i f f e r e n c e s . Rating of Labour and Delivery The husbands were asked to rate what kind of an experience the labour was f o r them, A nine-point r a t i n g scale,..ranging from +;k (excellent experience) to -4 (very bad experience), was used. The r e s u l t s f o r both 64 labour and delivery are provided i n Table 9, TABLE 9 HUSBANDS• RATING OP LABOUR AND DELIVERY* Test Result for Labour Result for Delivery Mean +1.60 +2.26 Median +2 +3 Range -3 +4 -3 +4 Standard deviation 2.062 1.78 n= 20 subjects •Response to rating scale +4 (excellent) to -4 (very bad) The results for labour indicate a mean of +1,60, a median of +2, and a range of -3 to +4, The standard deviation was 2.062, Many of the husbands who raited the experience on the positive end of the scale qual i f ied their select ion. The ambivalence i n their minds i s i l lust ra ted by the comment of one husbandt "How can you say i t was an excellent experience when your wife i s i n so much pain. It was a very meaningful and valuable experience but that does not mean that i t was pleasant." The husbands were asked to rate what kind of an experience the delivery was for them. The results for delivery are contained within Table 9* . Eighteen fathers were present at the bir th of the baby. Those not present were invited to complete the rating scale» one did and the other was unable to state what kind of an experience the 6 5 d e l i v e r y was. The r e s u l t s obtained f o r delivery i n d i c a t e a mean of +2,26, a median of +3, a range of -3 to +4, and a standard deviation of i;78. The r e s u l t s seem to indicate that the husbands f e l t more postive about the d e l i v e r y than they did about the labour. These findings compare favourably with those of Kopp and Schindler,~even though the husbands i n t h e i r 2 study did not attend the d e l i v e r y . The r e s u l t s also show that the degree of p o s i t i v i t y towards labour was s l i g h t l y more variable than that towards d e l i v e r y ; Possible reasons f o r the differences i n the r a t i n g and the variance are multiple. Labour was a waiting period, a time i n which progress was suggested by the incongruous! increased pain, f e e l i n g s of helplessness and hopelessness, and " a n t i s o c i a l " behavior. During the labour, the father was forced to accept that h i s wife must submit to the contractions and that he must encourage her to do so* From the husband's point of view, the i n t e r a c t i o n with these elements was usually new and/or p o t e n t i a l l y threatening to him i n h i s r o l e as a man and a husband. The male's orientation, which i s more instrumental than expressive, stresses the a b i l i t y to solve problems. 3 His success i n dealing with the behaviors e l i c i t e d during labour r.was a r e f l e c t i o n of h i s r o l e expectation and degree of s k i l l i n r o l e enactment. One could s a f e l y predict that among the fathers there was considerable v a r i a t i o n i n these two areas; Successful 66 intervention by himself and/or by others was more l i ke ly to produce a feel ing that was more posit ive than instances where interventions fa i l ed ; An additional factor would seem to play a part i n the differences i n rat ing. The experience of pain i n labour i s one that i s not accepted i n North American and k Bri t ish cultures; When pain i s perceived, the usual remedy i s to seek r e l i e f through the use of medication. When this r e l i e f i s withheld or given judiciously, as was the case i n labour, the experience may have been seen as more threatening than i f the pain had been el iminated. v The positive features of delivery seemed to be that an "end was i n sight", and that i t was a period when the wife was more able to act ively engage i n the labour by pushing; Progress was made obvious to the couple by the sight of the ever-descending fe ta l head and medication was used that controlled some, i f not a l l , of the pain; Thetonus t© perform as he had been doing was reduced for the father because of the presence and ac t iv i t i es of the professional team members; In North American de l iver ies , the husband-father assumes a less active role i n comparison to that which he enacts before coming to the delivery room. The fathers confidence i n the health team members• expertise l i k e l y contributed to the posit ive end of the ra t ing . I f , however, he saw them as lacking expertise, his evaluation of the delivery was lower; The period of bir th i s cul tura l ly defined as a period of happiness. I t was the beginning 67 of fatherhood and motherhood, whether i t was for the f i r s t or second time. There was always the poss ib i l i ty that things could go wrong during the delivery hut when they did not, the sense of r e l i e f added to the posi t ive . When complications did occur y for either the mother or the baby, the delivery was seen less posi t ive ly . F i n a l l y , one can not underestimate the fascination and awe that accompanied the sight of b i r th i the transformation of an imagined baby into a rea l ind iv idua l ; The s l ight ly greater variance seen i n labour than i n the delivery may be accounted for i n terms of the p o s s i b i l i t i e s that existed for negative attitudes to develop i n labour; Many of the forementioned state-ments made about delivery were common to the majority of fathers; However, during labour, the degree of var iab i l i t y i n such areas as the amount of pain or the fathers* feelings of helplessness were perhaps much greater; Rating of Labour and Delivery and the  Independent Extraneous Variables Certain questions were asked related to certain independent extraneous variables and the husband-fathers rating of labour and del ivery. The speci f ic questions asked werei . Was there a signif icant relationship between the fathers* past experiences with labour and delivery and his rating of this labour and delivery? The results of the Chi-square indicated no 68 signif icant relat ionship. (The level of acceptable significance was .05 for this and the remaining questions. This and the remaining questions were handled by using a 2x2 contingency table. The posit ive rating scores and the negative (plus the neutral) scores were compared with the two sides of the extraneous variable, e .g . experience versus no'" experience,) The lack of significance may be interpreted to mean that factors other than experience influence the rating of labour and del ivery, . Was there a signif icant relationship between the presence of obstetr ical problems i n the mother or baby and the father's rating of labour and delivery? The results of the Chi-square indicated that no signi f icant relationship existed. The lack of significance may be attributed to the fact that even though there were problems, the eventual outcome was a posit ive one for both mother and baby. Thus, the r e l i e f that a l l eventually turned out well may contribute to a s l ight ly more positive rat ing of labour and del ivery. Was there a signif icant relationship between the deliberate selection of this maternity unit and the husband's rating of labour and delivery? Results of the Chi-square indicated that no s i g -n i f icant relationship existed. 69 This may be interpreted to mean that parents who deliberately selected this setting did not rate the labour and delivery s igni f icant ly higher or lower than parents who made no deliberate choice to come to th is set t ing. • Was there a signif icant relationship between the husband's past experiences with someone i n a lot of pain and his rat ing of labour and delivery? The Chi-square result for labour was 4,55 with p <.05. This indicates that there was a signif icant re la t ion-ship between the father's past experiences with someone i n a lo t of pain and his rat ing of labour. These fathers tended to rate the labour lower than the rest of the sample. Results of the Chi-square indicated no signif icant relationship existed between the father 's rat ing of delivery and his past experiences with someone i n a lot of pain. These results may be attributed to the negative regard that the Anglo-Saxon cultures have for pain. Seeing someone i n a lot of pain again may serve to re-emphasize the point of view that pain i s essential ly a negative experience. Labour may be equated with the negative for th is reason. Delivery may be view-ed as less negative because of better pain control and because of the positive orientation that th is culture has toward b i r th . 70 • Was there a signif icant relationship between how the father rated labour and delivery and his presence or absence at delivery? The results were suspect because of the fact that only two fathers i n the sample did not attend the del ivery. (A signif icant relationship existed between attendance at delivery and the rating of labour. These fathers tended to rate the labour higher. The Chi-square obtained was 5;63 p<,025.) a The results for attendance or non-attendance at delivery and the rating of delivery were not calculated as only one of the non-attenders at delivery rated the del ivery, . Was there a signif icant relationship between how the fathers rated labour and delivery and how they rated their degree of comfort when inside of a hospital? The results of the Chi-square indicate that there was no signif icant relationship between the two variables. One may interpret this to mean that the fathers' f e e l -ings about being inside of a hospital do not s igni f icant ly affect how he w i l l rate the labour and del ivery. 71 Husband Focus during Labour The focus of the husband on the baby, himself, and on his wife was ascertained i n two ways. He was f i r s t asked v ia a rating scale i "How much did you think about (the baby, yourself , your wife) during labour?" A nine-point rating scale with + 4 representing " a l l the time" and -4 representing "never" was used. He was f i r s t asked about the baby, then himself, and f i n a l l y about his wifei The second way of estimating his focus was by asking him an open-end question! "Would you describe what happened during the labour?" The result ing data were content analyzed i n order to reveal who he talked about as well as what aspects of that person's behavior or thoughts caught his attention. The results of the rating scale w i l l be presented for each person, followed by the results of the content analysis for that person. This i n turn w i l l be followed by a discussion and interpretat ion. The results of the rating scale for the husband's focus on his wife, himself and the baby are presented i n Table lo?, Focus on Self The husband's focus on himself received a very low rat ing. The mean was -2,80, the median -3 , the range -4 to 0, and the standard deviation was 1.005. References to sel f iwjhen asked to 'substaritiate his rating were 72 expressed as the need for food, f l u i d s , sleep and the need to go to the washroom. Content analysis of the open-end question revealed a somewhat different f inding. References to se l f were made frequently but i n re lat ion to the husbands' role enactment with their wives. Admissions of feel ing calm, confident, useless, and out of control were accompanied by the events that produced these feel ings. The discrepancies noted i n the amount of perceived energy devoted to himself, as indicated by the rat ing scale, and that indicated by the content analysis are understandable. The husband's interpretation of the question which asked him to indicate how much time he spent thinking about himself may have differed from that of the researcher. A second reason i s that cultural conditioning may have played a part i n influencing a set response. According to Josselyn, the expectation i s that one loves another more than 6 one does oneself. The third reason relates to the amount of ident i f ica t ion and empathy displayed by the father when his wife i s i n labour. Seven levels of organismic involvement are mentioned by Sarbin and A l l e n , ' At the lowest end, the role and sel f are easi ly differentiated but at the higher leve ls , se l f and role are not di f ferentiated. In terms of the father's focus on se l f versus others, i t was l i ke ly that his focus on his wife (and later on the baby) and 73 his awareness of se l f became fused into one. The ab i l i t y to differentiate se l f from the other probably became very d i f f i c u l t for him, i f not impossible. TABLE i o HUSBAND FOCUS ON PERSONS DURING LABOUR* Test Person Focus Self Baby Wife Median -3 -1 +3 Mean -2.80 +3.25 Range - 0 - 4 44 -4 4-2 44 Standard .639 deviation 1.005 1.820 n= 20 subjects •Response to rating scale 44- (a l l the time) to -4 (never) Focus on Baby The husband's focus on the baby received a low rating during labour; Infant scores from the rating scale are presented i n Table l o . These were a mean of -.9 a median of - 1 , a range of -4 to 44, and a standard deviation of 1,820, For many husbands, this question l e f t them at a loss for words and what might be in ter -preted as apologetic. Some were surprised that they had not thought very much about the baby during labour. Expressions were "he wasn't an individual to me then" or "I hate to admit i t but I didn't think about i t 7* very much." This real izat ion seemed to prompt the "amazed"fathers into trying to r e c a l l some instances related to the baby. For those who did think about the baby, they stated that the poss ib i l i ty of fe ta l d is t ress, the lack of normalcy, and the sex of the baby occupied their thoughts. Content analysis of the open-end question asking fathers to describe what happened during the labour revealed rare references to the baby. These references were related to l istening to the heartbeat of the baby and knowing that the baby was okay because of the nurses' assessments. The results may be interpreted by the fact that the baby was not yet a rea l i t y , even though the father had f e l t the movements, heard the heartbeat and tr ied to imagine what fatherhood would be l i k e . This should not be construed to mean that the father did not care about the babyt to the contrary. A common thought was the well-being of the baby. When the health of the infant was i n jeopardy, as was the case i n two instances, the fathers admitted to experiencing panic and sinking feelings. In labour, the father had to imagine what the baby was doing and what he looked l i k e . He was powerless to do anything for him which was not the case with his wife, Focus on Wife The major focus of the husband during labour was on his wife. The results of the rat ing scale (Table 10 indicate a mean of +3,25, a median of +3, a range of 75 +2 to +4 arid a standard deviation of .639. Content analysis of the open-end question about what happened during the labour revealed f ive items related to his wife. These results are summarized i n Table C1JY, TABLE 11 HUSBANDS• REFERENCES ABOUT WIFE DURING LABOUR Reference about Wife Number of Husbands Responding* 1. Body sensation and bodily response to labour 18 2. Contractions 14 3. Verbal and body response to husband 14 4. Progress and outcome 9 5. Breathing pattern 8 n# 20 subjects *Some husbands gave more than one response The f i r s t and most commonly noted reference about their wives was that of body sensation and bodily response to the process of labour. Ear ly i n the labour, most of the husbands noted that their wives were comfortable or relaxed during the contractions. The later phases of labour received the majority of thefthusbaridsf commentse 76 Comments such as "she had a lot of pain • • • she told me that she couldn't stand i t anymore" and "I could see "by her eyes that a few of the contractions freaked her out" were contributed by husbands. The element of surprise was evident for some husbands as indicated by two' observations! "I've never seen J . l ike that before — her body was l ike a board, her hands and feet were a l l twisted" and "the pushing contractions were so powerful — her face was purple— i t wasn't l ike a bowel movement — no bowel movement i s that powerful," One aspect of body sensation was also measured by a category rat ing scales this was the amount of pain that husbands thought their wives experienced during the labour, A category rating scale was offered to the husband and the results are presented laV foi lows, Nine husbands thought that their wives experienced an extreme amount of pain, two fe l t that i t was between a lot to extreme i n amount, and five husbands stated that she had a lot of pain. Three husbands stated that their wives had a l i t t l e to a lot of pain and one husband stated that his wife had a l i t t l e pain. The second area of reference to his wife i n the open-end question centered on the detai ls of the contractionsi their frequency, duration, and intensity (effect on his wife). Awareness of the changes i n the nature of the contractions as labour progressed was revealeds "the contractions never seemed to leave — she never got any rest , " "she would no sooner f in ish one and another would 77 come," and "after she had the Demerol, they [contractions] changed — they didn't come as often." The third reference area made by the husband was his wife's verbal responses and bodily responses to others. These included the types and/or lack of verbal exchanges made by the woman in labour and were commented on by fourteen husbands. Sample comments werei "She told me •don't touch me'," "I told her to go ahead and cry — we cried together," and "she clammed r ight up." Some husbands explained that their wives pushed them away during the contractions and then looked for them once the contraction was over. Recall of events related to progress i n labour and the outcome i s the fourth category noted by nine fathers. Some thoughts werei "She was already having a lot of d is t ress . I wondered how she'd make i t , " and " i n awhile I*m going to be a father," The breathing patterns of their wives was the f i f t h category result ing from the husbands description of what happened during the labour. The husbands recal led incidents when the breathing was not helpful , when they forced their wives to breathe along with them, and the independence of their wives i n establishing their own patterns, These data indicate that the husband's primary focus during labour was on his--wife. His socia l izat ion and enculturation had already defined that the direct ion 78 i n which his concerns and energy should go was toward his wife; The person who placed the most demands on him i n the roles of husband and father-to-be was the woman i n labouri She provided him with concrete behaviors through-out the labour and he was expected and l i ke ly expected, because of prenatal teaching, to react i n varying ways to them; The husband brought some s k i l l s to help his wife, and he learned of others during the experience. His energy was directed toward helping her achieve a successful outcome. In interpreting the findings of the open-end ques-t ion asking the husband to describe what happened during the labour, the researcher cautions the reader against placing too much emphasis on the tota l number of responses i n each category (see Table 11), Because some fathers were more art iculate than others, the tota l responses may have been a ref lect ion of their communicative a b i l i t y . An individual i s expected to behave i n certain ways, 8 i n the sense that the behavior i s predictable. When the husband interacts with his wife i n the non-pregnant state, there i s a degree of predictabi l i ty %o her response. This o response i s perceived as an organized pattern or whole. During labour, the usual no longer existed. Certain res-ponses became the foc ia l point, i . e ; , the wife's responses of pain, contractions, the breathing patterns, and her changing verbal response. Progress and the outcome 79 became important to the husband because they signi f ied the end of unpredictabil i ty and the resumption of the opposite, predic tabi l i ty , The influence of prenatal preparation was probably s igni f icant i n direct ing the husband's thoughts towards certain of his wife^ behaviors. Sarbin explains that the individual can acquire the role expectations long 10 before he actually occupies the ro le . Thus, i f the husband was taught what to expect from his wife i n labour, or i f he drew on previous related experience, he was able to anticipate and look for certain responses. However, because he was allearner i n the ro le , even though he may have had previous experience, the element of unpredictabil i ty of outcome was s t i l l a large one. Therefore, the progress that his wife made was important. The results also indicate that husbands believe that their wives experienced a great deal of pain, border-ing on extreme i n amount for the mean of the sample. Pain and labour may almost be synonymous. 80 Husband Focus during Delivery The focus of the husband during delivery was ascertained through analysis of an open-end question asking the father to relate what happened during the del ivery. Discussion of the data w i l l be placed at the end. Before the bir th of the baby the husband centered his attention on his wife, the ac t iv i t i es of the health team members and on the baby. Focus on Wife The husband*s attention i n the lat ter part of the second stage of labour was focused on his wife 's response to pushing and the progress that she was making; Several fathers were struck by the apparent comfort of their wives i n comparison with what had preceeded their coming into the delivery room. Five husbands remarked on the pain that was experienced by their wives during this period. Evidence of the progress being made was evident in the ever-descending fe ta l head,' I t was at this time that some husbands realized that the baby was a r e a l i t y . Focus on Others The husbands seemed to be fascinated by the ac t iv i t i es of other persons i n the delivery room; The draping procedure, the administration of the local and epidural anaesthetics, and the performing of the episiotomy caught their attention. Eight fathers commented on the 81 type and/or size of the episiotomyi three fathers expressed concern about the amount of "cutting" that was done. Although forceps were used i n three of the del iver ies that fathers attended, only one mentioned their use. Focus on Baby The delivery of the baby was described i n varying amounts of deta i l by f i f teen fathers. Three fathers who accompanied their wives into the delivery room, chose not to watch the actual delivery because of "squeamishness". There was fascination by some, i n the birth"process, but there was also an over-riding anxiety related to the eventual health of the baby. Once the baby was born and pronounced healthy, the husband*s focus seemed to shi f t towards himself. However, i f the baby presented some problems according to the father's perception, his shi f t to himself seemed to be delayed. Focus on Self Once the baby was born and pronounced healthy the father's attention went towards himself. Ten fathers tr ied to express their feelings associated with the bir th of their baby and most had d i f f i c u l t i e s f inding adequate wordsi I t was indescribable," "I can't t e l l you how happy I was," and " I t was far more personal than I could ever have imagined, I can't t e l l you how I f e l t , " Two fathers were unsure of how they f e l t , re lat ing the b i r th i n a f l a t , matter of fact matter. One husband's response was " Some fathers get off on seeing their chi ld born, I don' t ," 82 Two fathers described their feelings as a • 'relief that i t i s over," and another as "Now we can get back to l i v i n g . " Thoughts -on f i r s t seeing the baby The husbands were asked to describe their thoughts on f i r s t seeing the baby. Table 12 provides a summary of this data. TABLE 12 FATHERS' THOUGHTS ON FIRST SEEING THEIR BABIES Aspect of Baby Completeness Health General appearance and act iv i ty Reality of the baby Sex Number of Fathers Responding* 8 10 6 3 k n= 20 subjects * Some fathers responded more than once The majority of thoughts on f i r s t seeing the baby centered on the infant 's health and completeness. Health of the infant was noted by 10 fathers and included comments about the breathing, colour and cry of the baby. These seemed to be the aspects that indicated health to the fathers "He turned pink and that was what I was looking 83 for ," "the baby was blue and i t s cry was a whimper," and "I heard him breathe — I thought, holy doodle, he's going to be okay." Completeness was indicated by comments from eight fathers such as» "He was so complete," "I wanted a f u l l shot of him to see that he was a l l there — he was." Remarks relat ing to the general appearance of the baby included the amount and colour of the hair , yawning, general musculo-skeletal ac t iv i ty , and the size of the baby. That the rea l i ty of the baby did not occur to them unt i l after the actual bir th was mentioned by three husbandsi "I was crying, , . then I realized that i t was rea l" or "a l l of a sudden i t h i t me. He was real ," Remarks about the gender of the infant were made by both f i r s t and second time fathers. Two fathers expressed a definite preference for the sex of the infant but the remainder stated that the sex did not matter. Focus on Wife References to their wives during the few moments after bir th were rare. None of the fathers commented on their wives' reaction to the baby. One father said that he was so enraptured and happy with the baby that a l l that existed for him, at that moment, was the baby. 84 The results seem to indicate that late i n the second stage of labour a shi f t i n the husband's focus occurred. It would seem that because his wife was usually experiencing less pain than previously, that he was able to direct his energy elsewhere. His attention became directed toward those events which had a cur iosi ty valuet the surgical techniques of draping, anesthesia and the episiotomy. These aspects held a challenge for him. The legend of men faint ing i n the delivery room at the sight of blood or needles, the annoyance of the nurses and physician, and his embarrassment caused by the faint ing are well cited i n the l i terature and i n dai ly l i v i n g . He evaluated his own reactions to these events. Sometimes he was surprised that "it wasn't l ike that at a l l " and sometimes his "squeamishness" was confirmed. As Stage II reached i t s completion, he tended to respond to the baby as less of a poss ib i l i ty and more of a rea l i t y . Engrossment i n the newborn, his completeness and his health status seemed to occupy his thoughts. For a br ief time at delivery, i t seemed that the role of father superseded that of husband. This would seem to have been true for fathers with babies who presented no health problems at bir th as well as for those who d id . The need to know that the baby was healthy and complete seemed to be paramount i n the father's mind. He brought a set of c r i t i e r i a to delivery that assisted him i n his assessment and he seemed to apply these very 85 rapidly. He seemed to be very aware of the baby's colour, the quali ty of the cry, and he looked for evidence of breathing. I f the baby did not measure up to the c r i t e r i a , he studied the reactions of others and based on their behaviors, made the judgement that a l l was or was not wel l . Most fathers revealed that they did not verbalize their concerns, indicating again, the reluctance of the husbands to express their anxieties to either their wives or the health team members. For the majority of fathers, the speci f ic gender of the baby did not seem to be an ultimate concern. However, there were definite preferences noted by some. Relating the father's response to the newborn to Josselyn's theory of fatherl iness, i t appeared that fatherliness was only minimally active i n labour but that i t became more active when the poss ib i l i t y or actual i ty of threat to the baby's health was recognized. Expressions of fatherliness seemed to be heightened when the second stage progressed to reveal the presenting part. The birth and viewing of the baby further increased the rea l i t y . Greenberg and Morris describe a similar phenomena which 11 they c a l l engrossment, They noted that some fathers were not engrossed or, i n other words, the individual infant had not assumed large proportions for them. It i s l i ke ly that the f l a t , casual and dismissing tones used by a few of the fathers during the description of the birth and their feelings was evidence of a lack or low level of engrossment or fatherl iness. However, 86 the researcher i s reluctant to interpret these behaviors as such, especial ly i n view of how l i t t l e i s known about early fathering behaviors. A second reason for this reluctance, was that some fathers may have been hesitant to admit such feelings to an interviewer. This was an observation made by Greenberg and Morris i n their sample of fathers. 87 Relaxation and Uneasiness during Labour and Delivery Labour The fathers were asked about their feelings of ease and uneasiness during labour. The specif ic question; related to the former was» "When did you feel relaxed or calm during this labour?" Six fathers stated that they fe l t calm or at ease during the early stages of labour, thirteen answered that they fe l t calm during almost a l l or a l l of the labour and one father stated that he never fe l t calm during the entire experience. The fathers were then asked i f there were times that they fe l t uneasy or worried during the labour. The results are presented i n Table I/3, TABLE 13 UNEASINESS EXPERIENCED BY FATHERS DURING LABOUR Cause Number of Fathers Responding* Related to wife her behavior pro gre s s and outc ome Related to baby actual fe ta l distress concerns about health and normalcy Related to se l f own performance n =-16 subjects : *Some fathers responded more than once 15 6 6 88 Sixteen fathers cited examples of uneasiness during labour. These were categorized according to the c r i t e r i a established for the sorting of data seen i n Table 10. Fifteen fathers gave examples of their wives behavior or concerns about the progress and outcome. Uneasiness was caused by the mother's verbal and physical responses to pain as well as her loss of control . Concerns about the progress and outcome of the labour were i l lus t ra ted by comments such as " I t seemed that she didn't make any progress for two hours," "It was always i n the back of my mindt I hope everything goes okay," and "when she dilated so suddenly, no one was around," One father was confused about how much progress his wife was makingt "For four or f ive hours I thought she'd have the baby i n the next half hour, I was confused about how far dilated she was," Six fathers gave examples of uneasiness related to the fetus. In two instances, fe ta l distress was detected just pr ior to delivery and i n the case of four other fathers, the poss ib i l i ty of something going wrong with the baby was a worry to them. The last cause of uneasiness relates to the husband's role expectation and his actual enactment of that ro le . Doubts about how well they would be able to help their wives and i f they would remember a 11 that they were taught were expressed by a few fathers. During the later phases of labour, four fathers expressed feelings of helplessness 89 uselessness as their repetoire of s k i l l s to help their wives'had been exhausted. The results seem to indicate that the majority of fathers fe l t relaxed and calm i n the ear l ier phases of labour. However, as the labour became more act ive, the experience became more stressful for the fathers. The results also seem to indicate that many of the items that were included i n the fathers'- focus during labour were also the cause of his uneasiness. Uneasiness during labour seemed to stem from two sourcesj rea l and imagined. The real sources were those actual behaviors of his wife or baby which triggered his anxiety. Expressions of pain, evidence that he was no longer helpfu l , and pronouncements of fe ta l distress were common examples. The poss ib i l i ty that something might go wrong, i , e ; , u t h e imagined, included the thoughts that the baby might be i n d i f f i c u l t y , or not normal; that his wife might not be a l l r ight; or that he wouldrnot be able to help her. It would seem that labour was stressful for the husband; and that his ab i l i t y to cope with those stressors was influenced by his role s k i l l s and those of others» Delivery The fathers were asked i f there were times that they fe l t uneasy during the del ivery. Nine fathers from the tota l sample stated that there were times of uneasiness or worry. The results are presented i n Table 14. 90 TABLE 1.4 UNEASINESS EXPERIENCED BY FATHERS DURING DELIVERY Cause Number of Fathers £ Responding* Related to wife 3 Related to procedures 4 Related to baby 4 n= 9 subjects •Some fathers responded more than once Three husbands fe l t uneasy because of the amount of pain that their wives were experiencing during del ivery. Four husbands expressed uneasiness on seeing the needles used for the administration of the anaesthetic agents and on seeing the episiotomy and the suturing of same. Much of the worry about the baby was related to i t s oxygenation. Comments from the fathers i l lus t ra te th isi "The baby was purple and he faded to grey," "It seemed sthat the head was out forever, I wondered i f the baby was s t i l l getting oxygen from the cord," and " she was purple — more than I expected — I wasn't worried rea l ly — actually I was freaking out," The results for delivery uneasiness would seem to indicate a s imi lar i ty between the husband's focus during delivery and the causes of his uneasiness. His wife's discomfort continued to affect him, and the procedures 91 performed on her contributed to his pain and anxiety, Schilder believes that one experiences sensation when one 12 sees the body of others. Assaults to that body are perceived as assaults to one's own body. Therefore, the loss of body integr i ty through deliberate penetration of the skin or deliberate cutting as i n the case of the episiotomy, has the potential for anxiety and pain production i n man. Incongruence between how he perceived that the baby should look and the overt behavior of the baby, namely colour, cry, and respirat ion, accounted for varying levels of uneasiness. The almost equal emphasis on the integr i ty of the infant as demonstrated by the father's need to see that the baby was a l l there, suggest another possible source of anxiety. In instances when the baby was not breathings as well as he should be, the father's awareness of others' expectations of him kept him fastened to his seat. He watched the ac t iv i t i es of others and was very aware of his powerlessness. Summary of Findings A summary of the husband-father's perceptions of labour and delivery reveals thati , the majority of husbands believed that the labour and delivery went better than they had anticipated, • labour and delivery were seen as positive 92 experiences by the majority, with delivery viewed more posit ively than labour. • the major focus of the husband during labour was on his wife with low focus on the baby and himself. • uneasiness during labour was common and was at t r ibut -ed to the pain experienced by his wife, his worries about her progress, and his worries about the outcome for his wife and the baby. • the major focus of the husband during late Stage II was on the baby and his own emotions surrounding the b i r th . . observation of the newly-delivered infant focused on his/her health status and completenessi gender of the infant received minimal discussion, • uneasiness during delivery was attributed to the b ir th procedures (episiotomy, needles) and the health of the baby, independent of the Apgar ra t ing, • there was a signif icant relationship between how the father rated labour and delivery and his past experiences with s^omeone i n a l lo t of? pain. 93 Husband's Perception of Role In this section, the husband's perception of his role w i l l be discussed. The subsets of this aspect of perception arei o . some aspects of the decision-making process related to his attendance at labour and delivery . the husband's preparation for his role during labour and delivery . the husband's role enactment during labour and delivery . his assessment of his role during labour and delivery. Decision-Making Process Decision to Attend or Not Attend The decision of whether or not husbands would be with their wives during labour and delivery was made at various times. Two husbands stated that they and their wives had taken i t for granted that they would be there for the labour and delivery. Four couples had decided prior to pregnancy, f ive on learning that their wives were pregnant, and eight during the second and third trimesters of pregnancy. One father entered labour undecided regarding whether or not he would stay for either the labour or the del ivery. A l l fathers, with the exception of one, adhered to the or iginal decision of attendance or non-attendance during del ivery. (One husband planned to attend the delivery but was unable to do so because of exhaustion^ ) 94 Source of the Idea to Attend The husbands were asked whose idea i t was that they attend labour, and attend or not attend the del ivery. The results are summarized i n Table 1-5• TABLE 15 HUSBAND RESPONSE REGARDING WHO SUGGESTED • THAT HE ATTEND LABOUR AND DELIVERY Source of Idea Attendance during Labour Attendance during Delivery Non-Attendance during Delivery Husband 3 6 1 Wife 7 8 Both 8 Friend 1 0 Uncertain 1 1 n= 20 subjects Attendance at labour was primarily the idea of the wife(seven) or the couple(eight) whereas attendance at delivery was primarily the idea of the husband(six) or the wife(eight). One husband explained that his wife wanted him to be there during the bir th but had le f t the decision up to himt "My wife wanted me to be there i f I wanted to be there, not because i t i s i n vogue now," The decision of not to attend the delivery was made by one father i n the sample. He explained that his wife hoped that he would change his mind during the labour but 95 he did not. He statedi "The doctor can have the f i r s t few seconds with the k id: I've got years with him." One husband attributed his attendance during labour to a:..source/ outside of the family and one husband was uncertain about whose idea i t was that he be there during labour and delivery. At the time of decision-making, thirteen husbands were content with the idea that they would be present during labour and present or absent during the del ivery. Seven fathers were uneasy about their attendance at labour and/or del ivery. Their uneasiness was decreased considerably after they attended prenatal classes v k v; v . c The decision to attend labour and attend or be absent during the delivery seemed to be a ref lect ion of the husband's perception of his ro le . His decision to attend was l ike ly based on two interdependent factorsi the commitment he has to the norms established by socia l forces and his estimation of the reward and punishment by his role pa r tne r . 1 3 I f a husband believed that the protection and support of his wife during labour took pr ior i ty over other norms defined by society for him, he was more l ike ly to attend. A c r i s i s has high pr ior i ty on a Ik person's time and ef for t . Some authors have used the term " c r i s i s " to describe the chi ldbirth experience. D t I f the husband saw the benefit of his attendance for himself and/or his wife or was cognizant of the punish-ment from se l f and signif icant others for not meeting 96 their expectation, i t i s more l i ke ly that he would attend. The idea that husbands attend labour and delivery was acceptable to many wives and husbands. However, for some husbands, the idea of attendance was not congruent with their perception of their ro le . With incongruence came uneasiness. This meant that the husbands who fe l t uneasy had to try and resolve this anxiety. For many, this was accomplished as a result of attendance at prenatal c lasses. Sarbin and Allen note that conformity to expectation can occur without a strong commitment on one's part. I t i s l i ke ly that some of the husbands i n the sample conformed to their wives'wishes without feel ing very committed to the idea of attendance at labour. However, as their attitudes changed and their concept of sel f became congruent with what was expected, involvement and 18 commitment were l i ke ly heightened. The results related to the source of the idea that husbands attend labour and delivery d i f fe r somewhat 1'° from those results obtained by Aldridge. 7 In the study sample twenty percent (four) of the couples were responsible for the idea of attendance at delivery whereas i n Aldridge's sample forty percent of the couples came up with the idea according to the husbands. Uneasiness about attendance seemed to be greater i n husbands whose wives wanted them to be there during the labour and del ivery. When the husband was the source of the idea, the uneasiness seemed to be less . Preparation for Role Enactment A l l of the sample attended prenatal classes during this or the previous pregnancy. The fathers were asked what they though of the prenatal classesi their responses are recorded i n Table 16, TABLE 16 HUSBANDS• RATING OF PRENATAL CLASSES Rating Number of Husbands Responding Good to Excellent Neutral Fair to Poor n= 20 subjects Sixteen fathers thought that the classes were good to excellent, onefather.was neutral,'arid three rated the classes as fa i r to poor. Of significance was the fact that seven fathers were uneasy about labour and delivery before they came to the classes. They attributed the classes with decreasing their anxiety and with i n s t i l l i n g positive attitudes about the c h i l d -birth experience. The fathers who rated the classes as " fa i r to poor" and some who rated the classes as "good" had some suggestions for their improvement. Based on their lb 1 3 98 experiences during labour, four fathers asked that more emphasis be placed on the coping of pain during labour, both from the wife's and husband's point of view. Some found the presentation of classes to be boring and three fathers cited the teaching of incorrect information. A small group of fathers mentioned that some of the material was not relevant to their roles as fathers, as for example, breast feeding and infant clothing. Additional Preparation for Labour and Delivery Four fathers had additional preparation for the upcoming labour and del ivery. Three were present during the labour and delivery of their f i r s t chi ld and one had assisted women during labour as part of his occupation. These fathers stated that they entered labour feel ing confident about their role,with their wives. It i s believed that formal chi ldbir th education prepares a father for an effective performance and there-fore "makes his role i n chi ldbirth congruent with the strength and competency characterist ics of the husband r o l e , " 2 0 To achieve this objective, the fathers learned what acts they were to perform and developed s k i l l by practicing them. Inherent i n this education was the awareness of what others expected of them. When these expectations were not congruent with their view of them-selves, as i n the case of the fathers who did not see aspects of infant care within their ro le , the expectations of:others.were probably rejected. Prenatal education would seem to have been effective i n producing positive attitudes 99 toward ch i ldb i r th . Many of the parents i n the sample had completed university education and were delving into the l i terature on pregnancy, chi ldbirth and infant care. This meant that they were able to evaluate the quali ty of information offered by the instructor . Reasons for Attending Labour and Delivery The reasons given for attending the labour and delivery centered around three areas. These were the need expressed by their wives, secondly, the desire to share the experience as a couple, and th i rd ly , the desire to experience the labour and delivery of their c h i l d . The results are summarized i n Table 17. It should be noted that some husbands offered more"than one reason for being present. HUSBANDS• REASONS FOR ATTENDING LABOUR AND DELIVERY Role Enactment TABLE \W Reason for Attending Number of Husbands Responding* Wife needed or wanted him 15 To share the experience 6 To see the labour and the bir th 5 n= 20 subjects * Some fathers gave more than one response 100 Fifteen husbands stated that they came because their wives needed them, Comments such as "my wife wanted me there" or I wasn't going to let her go through that alone" were common^  Six husbands emphasized the team aspect of their marriage and stressed ideas such as "sharing the responsibi l i ty for the bir th" and "strengthening the bond between us ." Five husbands wished to experience the labour and to see the bir th of the baby. The results would seem to indicate that the reasons for attending the labour and delivery were a ref lect ion of the man's role as husband and father-to-be. The majority saw their role as supporting and protecting their wives while others saw i t as a joint or cooperative ef for t . The observation of the r i tes of passage, i . e . , the transit ion from father-to-be to father entered for those who expressed the desire to watch the bir th and experience the labour. Role during Labour Once their wives were i n labour, the husbands stated that they performed a mul t ip l ic i ty of functions. These data are i n response to the question* "What did you do during the labour?" and are summarized i n Table 18. The categories were a result of the content analysis performed on their responses to the question. The categories were moral support and encouragement, bodily care to their wives, assistance with breathing and pushing, and assessment of the contractions. 101 , TABLE 18 HUSBANDS' PERCEIVED ROLE DURING LABOUR Role Function Number of Husbands Responding* Moral support and encouragement 18 Bodily care 18 Assistance with breathing and pushing 13 Assessment of contractions 5 n= 20 subjects *Some husbands responded more than once Moral support and encouragement included items such as the presence of the father, holding the wife's hand, and giving verbal reassurance. These were functions cited by eighteen fathers. Many fathers stated that they would not leave their wives, even to get something to eat. Some who did take a break, explained that they fe l t gui l ty about leaving their wives when they were i n pain. The only reason that they did leave was because the nurses stayed with their wives. The second category, bodily care, included massaging, effleurage, application of cool cloths and the offering of f l u i d s . Eighteen fathers stated that they performed these functions. Assistance to their wives by helping them with the breathing levels and pushing techniques taught at 1 0 2 prenatal classes was given by thirteen husbands. Recording the frequency, duration and effect of the contractions was done by f ive husbands. Two of the husbands kept a diary of the major events of the labours they planned to share this with their wives i n the days following del ivery. Role during Delivery Many of the husbands continued Ito help their wives with the pushing when they were i n the delivery room. Others stated that they encouraged their wives and helped them to stay i n control when they experienced pain. For the most part, the husbands* role was a less active one as they sat beside their wives and watched the ac t iv i t i es performed for the babies* a r r i v a l . The results indicate that the husbands* functions i n labour and delivery were directed toward supporting and encouraging their wives. This then indicated congruence between why the husband wanted to come and what he was able to do. This f inding concurs with that of Jordan and Cronenwett i n two independent studies of couples who 2 1 2 attended prenatal classes, labour, and delivery together. * Other functions not usually performed by husbands i n their role of husband and man were undertaken. Bodily care, assistance with breathing, and the timing of contrac-tions were functions defined for him i n the prenatal classes, Kopp and Schindler observed that husbands who 103 had attended prenatal classes tended to play a more active 2 3 role i n their wives' care. ° : The results of the study sample would seem to support their observations. The functions performed by f i r s t time fathers and those who were fathers for the second time did not seem to d i f fe r . The only difference may have been i n the lat ter groups confidence and s k i l l , areas that were not measured i n this study. The role performed by the father i n the delivery period was a much less active one. I t would seem to be one which allowed him to s i t back and let others care for his wife. The Right to Attend Delivery Because of the controversy expressed i n the l i terature and i n many obstetr ical settings about the husbands* r ight versus privi lege to be present at the b i r th , an attempt was made to learn of the husbands* opinions. The husbands were asked to react to the statement "I believe that i t i s my;,right to see my baby bomi" On a nine-point rat ing scale, ranging from +4 (strongly agree) to -4 (strongly disagree), the fathers were asked to indicate their choice. The results are presented i n Table 19. The results were a mean of +2.4 , a median of +4, a range of -3 to 44, and a standard deviation of 2.161. 104 TlBLE 19 ^ FATHERS' RESPONSE TO HIS RIGHT TO ATTEND DELIVERY Test Result Mean +2.4 Median +4 Range -3 +4 Standard deviation 2. 161 n«= 20 subjects Some of the fathers who fe l t moderately strongly and many of those who expressed some disagreement that i t was their r ight to attend the bir th explained their choices. The large majority stated that they wanted to be there during the bir th but only i f their presence did not endanger the health of their wives or the babies. They would abide by the wishes of their wives, the physicians or the nursing staf f . Those who indicated strong disagreement stated that i t was the right of the physican to allow them into the delivery roomp and that the father did not have the right to demand entry.into the case room. The results to this question would seem to indicate that there are rights associated with the father role and that the majority saw one of those rights as seeing the bir th of their c h i l d . The sample majority 105 seemed to fee l that i t was their r ight "but would give up the r ight i f their presence i n any way affected the comfort of their wives or the medical care provided to their wives and babies. He seemed to know that his presence may not be desired by others and that i t might be a detriment. Birth of a Potential ly Unhealthy Newborn and  Father Attendance Many health team members who care for parents i n the delivery area have expressed concern about husband attendance during the bir th of a sick or malformed baby. The researcher presented the fathers with a hypothetical s i tuat ion. They were asked what they would choose to do i f there was" a question about the health of their baby which was detected before del ivery. There were three options given to the husband: to stay with his wife during the del ivery, not to stay with his wife during del ivery, and uncertainty about what he would choose to do. Nineteen fathers wanted to be with their wives during such a delivery and one father did not. That lat ter father i s the father who did not choose to be with his wife during this past del ivery. The fathers* reasons for wanting to attend are summarized i n Table 20';. Fifteen fathers wanted to be there for their wives* sakes, three fathers for both of their sakes, and two fathers expressed the need to see the baby themselves. A l l noted that i t would be a d i f f i c u l t time for them both 106 but most thought that i t would be more d i f f i c u l t for their wives. Some of the husbands stated that they wanted to see the baby for themselves and i f need be to contribute to the decision about whether or not i t should be allowed to l i v e . Some fathers stated that they and their wives had already discussed the poss ib i l i ty of infant abnormality and had done so at the prompting of the prenatalj\class instructors. TABLE 20 FATHERS' REASONS FOR WANTING TO BE PRESENT DURING THE BIRTH OF AN UNHEALTHY INFANT Reason for Attendance Number of Fathers Responding* To comfort wife 15 For both wife 's and husband's sakes 3 For father's sake 2 n= 19 subjects *0ne father gave two reasons The results tend to indicate that the majority of husbands wanted to be present during the delivery of an infant with a potential health problem. The majority saw i t as their duty to be present i n order that their wives could be comforted. It would also seem that the;, concern for infant normalcy and health i s shared by both expectant parents and that some are discussing the 107 poss ib i l i ty of abnormality prior to labour. This could well be a factor that might assist parents i f a malformed chi ld i s born. Husband Assessment of Role during Labour and Delivery The husbands were asked to evaluate how helpful they thought they were i n assist ing their wives during labour and del ivery. Table 21 summarizes their responses to the f ixed-alternative question providing them with the choices of "a lot?? ® a l i t t l e ^ ' "no helpfat a l l " , and ;"uncertain". .'Two of the husbands fe l t that their choice would l i e somewhere i n between the given alternatives. TABLE 21 AMOUNT HUSBANDS0 HELPED WIVES DURING LABOUR AND DELIVERY Amount of Help to Wife Number of Husbands Responding A lot A l i t t l e to a lot A l i t t l e Uncertain n= 20 subjects Fifteen husbands stated that they helped their wives a l o t , two believed that they helped a l i t t l e to a lot and two stated that they helped their wives a l i t t l e . 15 2 2 1 108 One husband was uncertain regarding how much help he was to his wife. Of interest was the fact that husbands with previous labour and delivery experience (four) replied that they had helped their wives a l o t . However, this was not s t a t i s t i c a l l y s igni f icant . Help to Their Wives Most of the husbands were able to ident i fy ways that they were able to help their wives. Comments such as "when each contraction was over, she would keep looking for me" or "I would make her breathe with me and sheM get r ight back on track" are two examples. The functions performed during labour (Table 18) were deemed, i n most cases, to be helpful to their wives. Several husbands expressed confidence i n performing them. It became apparent, because of the way that the husbands answered the question asking them how much help they had been, that many husbands believed that they were of very l i t t l e assistance during labour. I t was only on discussing their role with their wives i n the early postpartum period that they learned that they had been more helpful than they had coritginally thought. It i s l i ke ly that had the researcher talked to these husbands shortly after delivery that their responses to the question might have been quite di f ferent . Not Helpful to Their Wives Even though the majority of husbands believed that 109 they helped their wives a lot during the labour, there were areas and times, during the labour that many (fifteen) husbands believed that they were not able to help their wives. These areas related to the intense pain experienced by their wives and to their wives' lack of control i n the transit ion phase of labour. Some husbands stated that they were unsure i f they were helpful , especial ly when they were pushed away by their wives or when their wives reached r 'a^ non-communicative stage of labour. Three husbands stated that they were unable to help when they lost control themselves. This loss of control i n the husbands was precipitated by the diagnosis of fe ta l distress and by panic feelings i n their wives. Many fathers were quite open about their own feelings during the "d i f f i cu l t " times of labour. Some ex-pressed feelings of helplessness, uselessness, and intense frustrat ion. One father noted "I'm used to doing things to overcome a problem — this time there was nothing I f e l t I could do," The results would seem to indicate that the aspects of their wives'behavior which were beyond their capabi l i t ies were pain experienced by their wives and maintenance of their wives' control during labour. Incongruence resulted when the father came to the labour believing that he could help his wife and then found that his efforts were not always successful. Feelings of frustrat ion and helplessness resulted when he realized that he had exhausted his repertoire but s t i l l wanted to 110 1 ! be effective i n his ro le . It would seem that the early postpartum period i s an important time for the husband to review his performance with his wife and vice versa. It seemed that many discovered that they had been effective i n their role which should i n turn lead to increased feelings of self-esteem. Husband Role i n the Event of Another Pregnancy The husbands were asked i f they wished to be with their wives during labour and delivery i n the event of another pregnancy. Nineteen would choose to be with them during the next labour and Eighteen would want to be present during del ivery. One husband was uncertain about whether or not he would be with his wife during the next labour and del ivery, but would come i f she asked him. The husband who had not planned on attending the delivery this last time, would not choose to be present during the delivery i n a future pregnancy. I t would seem that this labour and delivery experience had not altered the husbands^ desire to be with their!wives during future labours and be or not be present with them during the next del ivery. I l l Summary of Findings A summary of the husband^father•s perception of his role during labour and delivery reveals thati . the decision to attend labour and delivery was made by f i f t y percent of the sample pr ior to pregnancy or during the f i r s t trimester. The remainder had decided by the eighth month of pregnancy, , u attendance at labour was primarily the idea of .the wife or the couple whereas attendance at delivery was primarily the idea of the husband or the wife, • prenatal classes were attributed with creating posit ive attitudes about labour and delivery and reduced much of the uneasiness of several fathers, , major reason for attendance at labour and delivery was the support of his wife with less emphasis placed on the team:aspect,c '><•> , major functions performed i n labour were moral support and encouragement, provision of bodily care and assistance with breathing and pushing; , overal l majority would want to be with their wives during the birth of a potential ly unhealthy infant , majority believed that i t was their r ight to 112 attend the delivery hut would waive the right if their presence was a deterrent to the safety of their wives or babies • overall majority believed that they had done everything possible for their wives during labour and delivery • many husbands had to confirm with their wives about how much help they had actually been during the labour and did this in the early postpartum period • overall majority wanted to be present for future labours and deliveries • majority recommended attendance at prenatal classes for fathers-to-be . some husbands recommended that more emphasis be placed on coping with pain during labour in the prenatal classes. 113 Husband's Evaluation of the Care In the f i n a l section of this chapter, the husband's evaluation of the care provided to his wife and himself w i l l be presented. The areas to be discussed arei • his rat ing of the overall care during labour and delivery • his perception of helpful and non-helpful nursing care Evaluation of Overall Care Each husband was asked to rate the overal l care received by his wife during labour. Table 22, a summary of the fathers' rating of care during labour and del ivery, indicates that twelve fathers rated the care during labour as "excellent" and two fathers believed that the care was "good to excellent", the lat ter category being devised by the fathers. Five fathers rated the care as good and one was uncertain how he would rate the care during labour. The husbands' perception of care provided during delivery reveals similar results (see Table 22), Twelve fathers rated the care as "excellent", f ive as "good" and one father stated that the care was poor. Two husbands were not present during the del ivery. 114 TABLE 22 FATHERS* RATING OF CARE DURING LABOUR AND DELIVERY Labour Delivery Rating Number of Fathers*"" Responding Rating Number of Fathers r Responding Excellent 12 Excellent 12 Good-excellent* 2 Good 5 Good 5 Poor 1 Uncertain 1 Not present 2 np 20 subjects •Category devised by the fathers The need of husbands to be informed of their wives progress during labour and delivery was indicated by two 24 2 5 studies, ' J For this reason, husbands were askedi "How well were you kept aware of your wife 's progress during labour and delivery?" Table 2'0 reveals that twelve believed that they were well informed, three indicated that they were informed just enough and three responded that they were not informed enough. Two husbands were uncertain about how well informed they were about their wives'progress. The husbands'specific comments w i l l be incorporated into the next area of this chapter. 115 TABLE 23 EVALUATION OF HOW WELL HUSBAND WAS KEPT AWARE OF WIFE*S PROGRESS Kept Aware Number of Husbands Responding Very well 12 Just enough 3 Not enough 3 Uncertain 2 n= 20 subjects Evaluation of the overal l care to the husbands* wives by means of a category rating scale revealed that the overwhelming majority of husband-fathers believed the care to be good or excellent. The majority of fathers also indicated that they were adequately or well informed of their wife's progress during labour and del ivery. The researcher has some question about the va l id i ty of the ratings provided by some, but not a l l , fathers. When asked to rate the care or the amount of information given to them, the husbands seemed to be protective of the nursing and medical s ta f f . The husbands made excuses for the nurses stating that they were busy and therefore unable to assist their wives and themselves, Kerlinger notes a d i f f i c u l t y i n category rating 2 6 scales» namely the errors of leniency. He describes these as the tendency to rate a l l individuals too high. 1 116 The researcher suspects that this may have happened with some of the fathersi In addition, i t seemed that asking the fathers to rate the care was interpreted by many as meaning only the physical or technical aspects. Helpful and Non-Helpful Nursing Care The data i n this section resulted from the answers to three questions posed to the husband-fathers. These were t , What did the nurses do that was helpful for your wife and for yourself during labour and delivery? , What did the nurses do that was not helpful to your wife and yourself? • What ways could the nurses have helped your wife and yourself more? A content analysis was performed and the data were sorted into two major categories. These were "affective" and "presence of the nurse". The f i r s t category included the responses and attitudes displayed by the nurses and secondly, the nurses* inclusion of the husband into the labour and delivery experience, Tfie&"presence of the nurse" category included four sub-categoriesi assessment of the mother and baby during labour with an explanation given to the couple, contact with the nurse for reasons other than assessment, provision of bodily care to the wife by the nurse, and f i n a l l y , the bringing of needed items to the couple by the nurse. 117 I t should he noted that i n rea l i t y , the "affective" and "presence of the nurse" category are not mutually exclusive of each other, however, for purposes of sorting the data, they were treated as such. A summary of the findings i s presented i n Table 24, The results for each of the sub-categories w i l l be presented and then followed by a discussion of that sub-category. TABLE 24 FATHERS• EVALUATION OF HELPFUL AND NON-HELPFUL ASPECTS OF NURSING CARE Category of Nursing Care Number of Fathers Responding Total Number of ^Responses* "f Helpful Non-Helpful Affective Attitudes and responses of nurse 15 15 4 Inclusion of husband _ 16 16 5 Presence of ;Nurse Assessment and explanation i; 16 9 11 Contact with nurse 10 6 4 Bodily care 16 14 3 Provision of care items 15 14 1 n= 20 subject's •Some husbands gave more than one response 118 Affective Category Attitudes and Responses of the Nurse Attitudes and responses!of the nurse that were perceived as helpful by f i f teen husbands were "thoughtful", "kind", "interested", "pleasant", "smiling", and "cheerful". Many husbands stated that these responses and attitudes establ ish-ed a relaxed atmosphere for themselves and their wives,at a time that was anxiety producing. Husbands observed that the nurses oared about their wives and one husband stated that he trusted the nurse because of the way that she related to his wife and himself. The one husband who entered labour undecided as to whether or not he would stay, attributed his decision to stay to the manner of the nursing s ta f f i "they made me fee l confident that I could handle t h i s , " Four husbands related incidents that they labelled as "dehumanized", "impersonal" or "uninterested". One father notedi "When we came through the door, the nurses looked up and said 'oh no, not another one. Well I guess we don't/ get to coffee th is morning*." Another remarked on tlie laughing and dancing of the nurses i n the corridor outside the labour room where his wife was i n active labouri "I can appreciate that you have to laugh i n a place l ike this but when they didn't stop I kept looking at my wife i n pain and thought to myself *my God, what can they find so funny?*." A comment which has relevance was a father 's observation! "When the nurses aren't as excited about the 119 birth of your baby as you are, i t has a dampening effect on you, I t ' s not a cr i t ic ism of them, just an observation Sarbin notes that one aspect of role s k i l l i s the affective response made by individuals toward another. "Social sensitivity","empathy", ."identif ication" and ^ r o l e taking" are terms indicat ing the a b i l i t y to put oneself i n the place of the other, to understand and 27 be able to sympathize with the other, ' To convey this empathy, one uses the motoric s k i l l s , i . e . , the move-ment of body parts, f a c i a l expression, and tone of . voice. The expressive actions of the person reveal the involvement of the person while he i s performing certain roles and i n many ro les , the expression of a part icular emotion i s the most important characterist ic of that ro le , 7 The attributes of empathy seemed to be highly valued by the husband-father during labour and del ivery. The number who labelled the nurse's attitude as helpful and important supports t h i s , Young states that "human beings are so designed that they need to feel that people care about them," 3 0 It would appear that, just as the woman i n labour i s sensitive to the responses of others toward her, so was the husband just as sensit ive. His cognizance of the nurse's response was made through observation of the interaction between the nurse and his wife and/or between the nurse and himself. Because the chi ldbir th ! ! 120 experience was a very personal event for many of the couples and because the husbands were highly involved with their wives, i t seemed that they were very vulnerable to the reactions of others. Inclusion of the Husband Inclusion of the father by the nurses seemed to be greatly appreciated. This sub-category was commented upon by sixteen fathers. One father noted that the nurse made him fee l that he was important and meefdjeS^aarid another statedi "she would ask© me i f I would help her dp something with my wife — she made me feel usefu l , " Most of the husbands did not expect the nurses to gp out of their way to include them, When the nurses d id , however, i t brought complimentary responses from the fathers. One husband stated? "the nurse showed me the baby's head when my wife was pushing and I l istened to the baby's heartbeat on the amplif ier . They were two extra bonuses that I hadn't expected," Inclusion was also conveyed to the father by certain behaviors of the nurse, as for example, when she brought him coffee or when she'"spelled" him off while he had a rest , ' Inclusion of the father seemed to acknowledge his worth and importance, not&only as the husband of the woman i n labour but also,as a: person. The nurses' response of providing the husbands with a time to rest and something to drink was akin to a g i f t , A g i f t 121 t has been described as "a vehicle of expression which i s one element i n a communication process, l i e . , a message i s conveyed to the receiver from the giver through a material object ." 3 * Rubin notes that the giving of food can indicate a relationship i n which the receiver i s honored, a c c e p t e d . , , " 3 2 I t i s l i k e l y that the single cup of coffee, as mentioned by almost half of the sample, was interpreted as more than mere "nourishment". That husbands did not expect such attentions, i . e . , specif ic acts of inc lus ion, i s indicative of their perception of the nurse's r o l e . They expected that; the nurse's energy would be directed toward their wives, not toward the two of them as a uni t . Another aspect of inclusion involved the issue of allowing the husbands to stay during pelvic examinations of their wives. Four husbands mentioned that they were allowed to stay and appreciated not having to leave. Of those who were asked to leave, four did not wish to go and one welcomed the opportunity to have a break. It seemed that d i f f i c u l t i e s occurred for some of the husbands when they were asked to leave and therefore, separate from their wives. Being asked to leave was perhaps interpreted by those who objected as a negation of their importance or of their acceptance. Another facet enters when one remembers that the couple i n labour are two complementary partners or a uni t . Most fathers were very aware of thee\?importance_'ofV;:-122 I their presence to their wives and they most l i ke ly re l ied on the v isual experience to reassure themselves that their wives were a l l r ight . I t seemed that there was a period of time that the husband could manage being apart from his wife, but,after that period had elapsed his anxiety level increased. Jordan observed similar reactions i n the husbands whom she interviewed,^-' I t i s possible that an outside force such as the nurse provided the husband who stated that he did not mind leaving when his wife was being examined with an acceptable reason for taking a rest . As reported ear l ier i n this study, many husbands expressed gui l t about spending time away from their wives. Presence of the Nurse Category The second category of nursing care included those ac t iv i t i es which required varying amounts of interaction between the nurse and the couple. Table 24 indicates the subdivisions of assessment and explanation, contact with the nurse, bodily care and provision of care items. Assessment and explanation The assessment and explanation category included the assessment of the mother and baby through use of one or more of the assessment techniques available to the nurse-pius!v.-explanatidh-';to the couple about the results of that assessment. The subcategory was not divided into two separate ones because of the manner i n which the husbands 1 I 123 described their evaluation of the care. Examples of the comments indicating positive feelings about the care were! "the nurse didn*t hesitate to t e l l me anything" or her explanations of what was happening were brief but to the point," The need for more frequent and/or accurate assessment by the nurses was cited by eleven fathers. One father-to-be-commented thatshe wished the nurses had been watching his wife more careful ly i "there was panic at the end •— no one was keeping track of her progress," Another father provided an example of inaccurate assess-ment! "she was told to push . . . then the nurse le f t . . . she had a lot of pain . . . i t turned out she had a rim l e f t . " Several fathers explained similar incidents to this onei "I had to go out and get the nurses a few t imes. . . they could have anticipated how quickly she was progressing." One father whose baby developed fe ta l distress commented that "they were oblivious to my presence. I kept trying to figure out what they were saying and I'd get b i ts about what they were talking about." Some fathers stated that the nurses told them that their wives were doing "just f ine" . The husbands explained that they would have l ikeda l i t t l e more information. The results would seem to indicate that many husbands needed more feedback regarding their wives performance. Sarbin believes that an important function 124 of the coach, or the nurse i n this instance, i s to provide feedback.-" For the father, this feedback was the need to know how well his wife was performing i n the labour. The need for information about progress seemed to serve as a milepost or means of orientation for the husband. In prenatal classes he had learned what behaviors to expect with what phases of labour. When the behaviors demonstrated by his wife and the amount of d i latat ion were congruent he was orientated. However, when he observed a set of behaviors but was lacking the nurses assessment, he was often confused and le f t without d i rect ion. The response that everything i s "fine" told the father how the nurse assessed the situation but did not provide him with enough information about why his wife was reacting as she was. That a l l was judged to be a l l r ight was not always reflected i n the father 's feelings about the s i tuat ion. Seeing his wife i n pain or being unable to help was not congruent with"fine". The fathers* acquisit ion of knowledge at prenatal classes or from previous experiences meant that some fathers were able to evaluate the assessments of the nurse. I f the nurse's findings were not congruent with what he was observing i n his wife, the nurse's assessment was mentally questioned';.-. Being cognizant of his ro le , few fathers shared their doubts with the nurse• 125 Contact with the Nurse Contact with the nurse, other than f o r assessment purposes, i s the second sub-category. Six husbands stated that they saw the nurse enough, whereas four wished to see her more often. Remarks such as "we saw the nurse just enough" or "they l e t us do our own thing" were included on the h e l p f u l side of nursing care. One father observed* One nurse was just exceptional; She'd say that she would bring such and such i n f i f t e e n or twenty minutes and then she would. You knew that you only had to go f o r f i f t e e n minutes, not forever, before she'd come back. As noted, four husbands wished to see the nurse more often and one father stated that he wanted a nurse who was interested i n themF One nurse came i n and then she'd leave a f t e r one contraction; You could t e l l that she wasn't very interested; Nurses have a responsibility* to be there and to be int e r e s t e d . There seemed to be a f i n e balance between seeing the nurse enough which was the case of a small majority and not enough as i n the case of the remainder of the fathers; Some couples wanted to "do t h e i r own thing" and others desired much les s i s o l a t i o n i s m . For the l a t t e r group, i t seemed as i f the presence of the nurse was comforting and contributed to the father's r e l a x a t i o n . Young writes that care "encompasses the provision of comfort,,.. This also includes the physical presence and support of one person for another.* J J Some husbands 126 f e l t that the onus of t o t a l support and care of t h e i r wives had been placed on t h e i r shoulders. The need to search for the nursing s t a f f i n order to obtain pain r e l i e f f o r t h e i r wives or to f i n d someone who would come when t h e i r wives f e l t l i k e pushing l e f t some fathers anxious, confused and angry. Their perception of the nurse's r o l e seemed to be that she should be there to help t h e i r wives when they f e l t that they could not- longer cope or when they had questions or doubts about her status. The concept of the father's perception of time i s relevant to the need f o r contact with the nurse. Know-ing when and t r u s t i n g that the nurse would return was s i g n i f i c a n t f o r the fathers. The nurse who set the short term goals of f i f t e e n to twenty minutes had placed a small but seemingly achievable goal i n front of the father. For those fathers who knew when the nurse was going to return, i t seemed that t h e i r uneasiness during labour was lower i n amount. For those fathers who were not provided with an i n d i c a t i o n of when the nurse would return i t was l i k e as one father statedt "waiting u n t i l some unknown point i n i n f i n i t y , " Many husbands stated that they knew the nurse was outside and that a l l they had to do was ask her to come. However, they seemed to f e e l reluctant to do so because of looking f o o l i s h or.*"knowing that the nurse probably couldftnot do anything anyways," Josselyn adds a dimension to the observation that husbands are 12 7 reluctant to seek the assistance of the nurse by explaining that men experience d i f f i c u l t i e s when they are dependent on someone, e s p e c i a l l y i f that someone i s a woman.^ The researcher perceived that some husbands knew that progress was taking place but that t h e i r anxiety focused on aanother p o s s i b i l i t y . The p o s s i b i l i t y that t h e i r wives would d e l i v e r the baby when they were alone with her was noted by two fathers. For those husbands who stated that they did not want to see the nurse more often, there may be several reasons f o r t h i s . Some may have desired l e s s v i s i b i l i t y because of t h e i r need to maintain an emotional closeness during the labour. That i s , an outsider may have been viewed as an intruder, A second reason may be the need to proceed through labour with the minimum amount of outside assistance. For some couples, feelings of accomplishment may be greater i f they are able to r e l y on each other rather than on a professional person. Sarbin provides a t h i r d explantion, i . e . , that i f enactment or r o l e performance i s v i s i b l e to an outsider f o r a long time, the r o l e performer may be placed under heavy s t r a i n . The husband-father was a learner i n labour, e s p e c i a l l y i f t h i s was h i s f i r s t time through the experience, and as a learner h i s s k i l l s and self-confidence may not have been as well developed as he would have l i k e d . Some fathers may, therefore, 128 have f e l t self-conscious when performing i n front of the expert, i i e . , the nurse. Bodily Care The t h i r d sub-category, bodily care to the woman i n labour, included those nursing interventions which modified the patients* behavior. These were suggestions to change a breathing pattern, rubbing the mother's back, or the administration of pain medication. One husband was p a r t i c u l a r l y impressed by the astuteness of the nurset "I had been tapping my wife's , shoulder to help her with the rhythm i n breathing. When I l e f t , the nurse picked up on i t without my saying any-thing," Others pointed out that the nurse had just the ri g h t t r i c k to get t h e i r wives back i n c o n t r o l . One husband questioned the number of times that the nurse was "asking h i s wife to push with each contraction and two others noted problems i n getting pain r e l i e f f o r t h e i r wives. Provision of Care Items The provision of care items accounted f o r a large number of responses from husbands. Fourteen husbands noted that they were given i c e water, i c e chips, back rub l o t i o n etc, and that they appreciated t h i s . One father, seemed to echo the thoughts of others t "We didn't lack fo r anything. They brought us whatever we needed," According to Lysault, the lay public sees comfort 129 and the r e l i e f of pain as one of the major functions of the n u r s e , 3 8 The number of husbands who observed "comfort*' functions of the nurse seems to support Lysault , Js f i n d i n g s . The nursing interventions directed at t h e i r wives' comfort were w e l l accepted by the husbands. The bringing of items to the couple seemed to convey to the couple that the nurses cared. I t was only when t h e i r wives* comfort was not achieved that the husbands stated that the care was lacking, as i n the instances of husbands t r y i n g to get pain r e l i e f f o r t h e i r wives. When pain r e l i e f i s not achieved, f r u s t r a t i o n and disillusionment o c c u r , 3 9 Additional. Comments The number of people caring f o r the couple during labour has been noted by Jordan as a d i f f i c u l t y i n 4o patient care. One husband stated that there were too many people involved i n h i s wife's care and that he found i t d i f f i c u l t to s e t t l e i n t o h i s r o l e as coach when new people would a r r i v e . Two fathers noted that i t was d i f f i c u l t to "give up" the good nurse at the end of a s h i f t and then have to get used to another personality. I t would seem that the need to adjust to another i n d i v i d u a l i n the nursing r o l e required extra energy f o r these husbands, energy which they had intended to devote to t h e i r wives. 130 Summary of Findings A summary of the husband-father's evaluation of the nursing care reveals thatt . the overal l care was rated as good or better, • the majority of fathers were kept well informed of their wife's progress during labour and , delivery^ • attitudes and responses of the nurse to the couple were cited as very important. , the majority of husbands fe l t that the nurse had included them i n the chi ldbirth experience.' • many husbands would prefer to stay with their wives ;wh:ensp^3;yi.c' examinaMons^a^e.i4$njg;- in ' labour . , a major strength of the nursing care was the comfort care provided by the nurse to the wife, • major weaknesses of care centered on the inadequate r presence of the nurse for i .assessment and explanation of progress during labour .support;to. the husband and wife during the active phase of labour and early Stage II. 131 FOOTNOTES ^Theodore R. Sarbin and Vernon L. A l l e n , "Role Theory, i n The Handbook of S o c i a l Psychology. V o l . I ed. Gardner Lindzey and E l l i o t Aronson, 2d ed, (Reading, Mass . i Addison-Wesley, 1968), p. 503. 2 Lois M. Kopp and Sharon L. Schindler, "An Exploratory Study of the Experiences of Fathers during the Ihtrapartal Period." (Yale University, School of Nursingt May 16, 1966) '(Mimeographed), p. 52, 3 -• • •'Leonard Benson, Fatherhoods A S o c i o l o g i c a l  Perspective. (New Yorki Random House, 1968), p. 21, ; L Mark Zborowski, "Cultural Components i n Responses to Pain," i n A S o c i o l o g i c a l Framework f o r Patient Care ed, Jeannette R, F o l t a and Edith S, Deck. (New Yorki Wiley, 1966), p. 259. ^Susanna L. Garner and Pamela H, M i t c h e l l , "Comfort and Sleep Status," i n Concepts Basic to Nursing, ed, Pamela H. M i t c h e l l (New Yorki McGraw H i l l , 1973)» P. * * 5 . 6Irene Josselyn, "Cultural Forces, Motherliness and F a t h e r l i n e s s , " American Journal of Orthopsychiatry 26 ( A p r i l 1956)i 26*n " 7 S a r b i n and Allen , "Role Theory," p. *92-*95. 8 I b i d . , p. 502. 9 I b i d . , p. 5*5. 1 0 I b i d . , p. 5*7. **Martin Greenberg and Norman Morris,- "Engrossment 1 The Newborn's Impact Upon the Father," American Journal  of Orthopsychiatry ** (No. *, July 197*)* 521. ~" 1 2 J u d i t h R i t c h i e , "Schi.lder's Theory of. Jhe. Sociology of the Bady-Image," Maternal-Child Nursing Journal 2 (No, 2, Summer, 1973)* 1*6. ' l 3 S a r b i n and A l l e n , "Role Theory," p. 539 l 4 I b i d , , p. 539 ^ N a t a l i e Shainess, "The Psychologic -Experience of Labour,? New York State Journal of Medicine 63 (October 15, 1963)1 2923. 132 16 Dyanne Affonso, " C r i s i s of Labor and B i r t h , " i n Maturational C r i s i s of Childbearing (University of Hawaiii School of Nursing and College of Continuing Education and Community Service, May 1971)1 23, 1 7 S a r b i n and A l l e n , "Role Theory," p. 502, 1 8 I b i d . , p. 526, 1 9 C h a r l e s Aldridge, " I n i t i a l Experiences with Fathers i n the Delivery Room," Michigan Medicine 69 (No, 11, June 1970)1 " 20 Linda R; Gronenwett and Lucy L, Newmark, "Fathers* Responses to C h i l d b i r t h , " Nursing Research 23 (No, 3, May-June 197*)t ,215g= 2 1 I b i d „ 21k. 2 2Doreen A, Jordan, "Evaluation of a Family-Centered Maternity Care Hospital Program, Part It Introduction, Design,and Testing," JOGN 2 (No, 1, January-February 1973)t 13-35. 2 3Kopp and Schindler, "Experiences of Fathers," p. *2. 2 2*Ibid?7: p. 29, 2*5 "'Jordan, "Evaluation of Maternity Program^" p, 17 o £ - - -Fred N, Kerlinger, Foundations of Behavioral  Research. 2d ed, (New Yorki Holt, Rinehart & Winston, 1973), p. 5*9. 2 7 S a r b i n and Al l e n , "Role Theory," p. 515. 2 8 I b i d . , p.515. 2 9 I b i d . , p. 515. 30 * J Janet Marie Young, "One Mother's Perception of G i f t s , " Maternal-Child Nursing Journal 2 (No. 3, F a l l 1973)* 1597 ' 3 1 I b i d . , p. 165. 3 2Reva Rubin, "Food and Feedingi A Matrix of Relationships," Nursing Forum 6 (1967)1 202, 33 .-'Jordan, "Evaluation of Maternity Program," p. 17, J Sarbin;,and A l l e n , "Role Theory," p. 5^8, 133 3%oung, "Perception of G i f t s , " p. 169/ -^Josselyn, "Motherliness and Fatherliness," p, 271. 3 7 S a r b i n , "Role Theory," p. 533. J Garner and M i t c h e l l , "Comfort and Sleep," p. 445. 3 9 I b i d . , p. 445. 4o Doreen A, Jordan, "Evaluation of a Family-Centered Maternity Care Hospital Program, Part I I I i Implications and Recommendations," JOGN 2 (No. 3, May-June 1973)* 18. CHAPTER V -SUMMARY, MAJOR FINDINGS, IMPLICATIONS - AND RECOMMENDATIONS Summary and Ma.ior Findings This study was concerned with the husband-father's perceptions of labour and delivery, how he perceived h i s rol e during t h i s period, and his perceptionss of the nursing care provided to h i s wife and himself. The sample s e l e c t i o n was by random sampling and included twenty husbands. A l l were Caucasian, B r i t i s h or Canadian bom, between the ages of twenty-two arid f o r t y years of age, and a l l had attended prenatal c l a s s e s . Eighteen fathers attended the de l i v e r y . Seventeen fathers were fathers f o r the f i r s t time; three were fathers f o r the second time. Data were obtained v i a one interview with the husband during the f i r s t three days postpartum. An interview schedule was used and consisted of r a t i n g scales, f i x e d - a l t e r n a t i v e and open-end questions. The data were subsequently analyzed by single variance analysis, nonparametric (Chi-square) t e s t s , and by content analysis of the open-end questions, I34 135 The major findings w i l l be discussed i n this chapter. Specif ic findings are summarized at the end of each of the preceeding sections of Chapter IV, Findings related to the husband-father's perception of labour and delivery werei • the majority believed that labour and delivery went better than expected • labour and delivery were seen as positive experiences with delivery viewed more posi t ively than labour • the major focus of the husband during labour was on his wife, with low focus on the baby • uneasiness during labour was common for husbands; major causes were the pain experience of his wife, worries about her progress and the outcome for herself and the baby • the major focus of. the husband during late Stage II was on the baby and his own emotions • observation of the newly-delivered infant centered on the health and completeness of the newborn and was independent of the Apgar ratings Findings related to the husband-father's perception, of his role during labour and delivery werei • the idea for attendance at labour was in i t ia ted by the wife or the couple whereas the idea for attendance at delivery was in i t ia ted by the wife or husband 136 • major reason for husband-attendance at labour and delivery was support of his wife . major functions performed by husbands during labour were moral support and encouragement, provision of bodily care to wives ; overal l majority believed that they had helped their wives a lo t . majority believed that i t was their r ight to attend the bir th but would waive the r ight i f their presence was a detriment • overwhelming majority wished to be present during the delivery of a potential ly unhealthy infant • overwhelming majority of husbands wanted to be with their wives during future labours and del iveries • many husbands recommended that more emphasis be placed on coping with labour pain/discomfort i n prenatal classes • prenatal classes had a positive effect on the husbands' attitudes toward labour and delivery Findings ar is ing from the husband-father's evaluation of nursing care during labour and delivery werei • covera'Il care was rated good to excellent • majority of fathers f e l t well informed of their wives' progress • major stengths of nursing care were the nurses' attitudes and responses, their provision of 137 n bodily care to the wives . majority of husbands f e l t included i n the experience . major weakness of the nursing care centered on the inadequate presence of the nurse fort • assessment of the wife's progress • explantiti6n«bf progress and re l a t e d events • support to husband and wife during the active stage of labour and early Stage I I , Implications and Recommendations  fo r Nursing Practice The implications f o r nursing a r i s i n g from these findings are multiple. They have implications f o r the r o l e preparation of the father-to-be, the r o l e performance of the husband-father during labour and de l i v e r y , and i n the postpartum period; Nurses are involved i n a l l of these phases and i t i t l i k e l y that an increased emphasis w i l l be placed on nursing the family as a u n i t , A preliminary step i n the approach to nursing care i s cognizance of the feedback offered by husband-fathers. The recommendations a r i s i n g from t h i s studyLfor , the prenatal education of parents arei • that i n s t r u c t o r s be cognizant of the f a c t that many husbands may f e e l uneasy or be undecided about t h e i r p a r t i c i p a t i o n i n the labour and/or d e l i very C; , that an assessment of husbands* and wives* expectations f o r labour and d e l i v e r y be done 138 for congruence with rea l i ty , that an increased emphasis be placed on teaching the husband how to evaluate his effectiveness^ during labour and delivery . that an increased emphasis be placed on helping the parents cope with the pain/discomfort of labour , that parents be encouraged to review the labour and delivery together i n the postpartum period and that this review include an assessment of the husband's effectiveness during labour and delivery The recommendations ar is ing out of this study regard-ing the husband-father's role performance during labour and delivery a're'i . that nurses, when possible, assess at the beginning of labour how much contact the couple desires with the nursing staff during the labour and that reassessment take place when the nature of the labour changes . that nurses be cognizant of the fact that their attitudes and responses play a signif icant role i n assist ing the husband . that nurses be aware of the increased need for their presence during the active phases of labour and second stage » that nurses assist the husband i n evaluating his effectiveness i n supporting his wife during the labour 139 • that nurses establish short term goals for the husband during labour • that nurses keep the husband informed of his wife's progress • that nurses, whenever possible, provide breaks for the husband during the labour • that nurses allow the couple to decidefiif the husband should leave during pelvic examinations . that nurses interpret the health status of the newly-delivered baby, independent of the Apgar rat ing, to the couple . that nurses observe the husband-infant-wife interaction at delivery and that this be communicated to those caring for the couple i n the postpartum period. The recommendations ar is ing from this study for the role enactment of parents i n the postpartum period arei . that couples be encouraged to review the labour and delivery together or with a small group of parents and that some emphasis be placed on the assessment of the husband's effectiveness during labour and delivery • that nurses observe the father-mother-child interaction i n order to ident i fy fathering and possible non-fathering behaviors . that husbands, along with their wives, be 1*0 i i encouraged to verbalize their concerns or questions about the chi ldbir th experience. Recommendations for Further Study Because so l i t t l e i s known about the husband-father during the time of labour and delivery and the early post-partum period, the following recommendation for further study are madei • that repl icat ion of this study be done on a larger scale, that i t be cross-cul tura l , and that i t include a comparison between husband-fathers i n a family-centered maternity setting and one which i s more t radi t ional , that a double-barrelled study of this nature be done on husbands and wives for the assessment of s imi lar i t ies and differences i n perceptions of labour and delivery and the (nursing care . that a prospective study be done during labour and delivery on fathers*needs, reactions to nursing interventions, and engrossment i n the newborn i that a study be done to learn of the effects of husband performance during labour and delivery , on fathering and on the marital relationship • that a study be done to learn what effect a review of the labour and delivery has on future fathering. 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Concepts of Mental Health and- Consultationi Their Application i n Public Health S o c i a l Work. Washington, D.C.i U.S. Department of Health, Education and Welfare, 1959. Chaplin, James P. and Krawiec, T.S. Systems and Theories of Psychology. 3d. ed. New Yorki Holt, Rinehart & Winston, 197^. Colman, Arthur and Colman, Libby. Pregnancy1 The Psychological Experience. New Yorki Herder & Herder, T97n Disbrow, Mildred A, "Changing Roles and SeIf-Concepts of People." In Maternity Nursing Today, pp. 5-33. Edited by Joy P. Clausen et a l . New Yorki McGraw H i l l , 1973. Duvall, Evelyn M. Fami jy Development. 4th ed. Philadelphia! Lippincott, 1971. 1*2 Engel, George L. Psychological Development i n Health and  Disease. Philadelphiai Saunders, 1962. English, 0. Spurgeon. "The Psychological Role of the Father i n the Family," In Marriage and Family i n the  Modern World, pp. 513-523. Edited by Ruth S. Cavan. New Yorki Thomas Y. Crowell, i 9 6 0 . Ford, Loretta G.^"The Development of Family Nursing." In Family Health Care, pp. 3-17. Edited by Debra P. Hymovich and Martha U, Barnard. New Yorki McGraw H i l l , 1973. Fulcomer, David M. "The Nuclear Family." In Maternity Nursing Today.' pp. 109-132. Edited by Joy P. Clausen et a l . New Yorki McGraw H i l l , 1973. Garner, Susanna L. and M i t c h e l l , Pamela H. "Comfort and Sleep Status." In Concepts Basic to Nursing, pp. **5-*62. Edited by Pamela H. M i t c h e l l . New Yorki McGraw H i l l , 1973. H o l s t i , Ole R. Content Analysis f o r the S o c i a l Sciences and Humanities. Reading, Mass.i Addison-Wesley, I969. Jessner, Lucie 1 Weigert, Editht and Foy, James L. "The Development of Parental Attitudes during Pregnancy." In Parenthood1 I t s Psychology and Psychopathology. pp. 209-244, Edited by E. James Anthony and Therese Benedek, Bostoni L i t t l e Brown, 1970. Keane, Vera R. "Is the Focus on.the Family?" In ANA  C l i n i c a l Conferences, pp. 321-32*. New Yorki Appleton-Century Crofts, 1970. Kerlinger Fred N. Foundations of Behavioral Research. 2d : ed. New Yorki Holt, Rinehart & Winston, 1973. Newton, N i l e s and Newton Michael. "Ch i l d b i r t h i n Cross-C u l t u r a l Perspective," In Modem Perspectives  In Psycho-Obstetrics, pp. 150-172. Edited by John G, Howelis. Edinburgh1 Oliver & Boyd, 1972. Sarbin, Theodore R. and A l l e n , Vernon L, "Role Theory," In The Handbook of S o c i a l Psychology. Vol, I pp. 488-567, Edited by Gardner Lindzey and E l l i o t r Aronson, 2d ed, Reading, Mass.i Addison-Wesley, 1968. Schaefer, George and Zisowitz, Milton. The Expectant  Father. New Yorki Simon & Schuster, 196*. "~ 1*3 Selye, "Hans. "The Stress Syndrome." In A S o c i o l o g i c a l  Framework f o r Patient Care, pp. 253-257, Edited by Jeannette R. Fo l t a and Edith S, Deck, New Yorki Wiley, 1966. Siegel, Sidney. Nonparametric S t a t i s t i c s f o r the Behavioral  Sciences. New Yorki McGraw H i l l , 1956. Tanner, Leonide M. "Developmental Tasks of Pregnancy." In Current Concepts i n C l i n i c a l Nursing. V o l . II pp. 292-297. Edited by Betty Bergersen et a l . c St. Louis1 Mosby, I969. Wiedenbach, Ernestine. "The Helping Art of Nursing." In Nursing Fundamentals, pp. 16-24. Edited by Mary E. Meyers. Dubuque, Iowai Wm. C, Brown, 1967. Zborowski, Mark, "Cultural-Components i n Responses to Pain." In A S o c i o l o g i c a l Framework f o r Patient Care, pp. 258-271. Edited by Jeanette R. F o l t a and Edith S. Deck. New Yorki Wiley, I966. Periodicals Aldridge, Charles. " I n i t i a l Experiences with Fathers i n the Delivery Room," Michigan Medicine 69(No, 11, June 1970)i 489-491. Allan, Malcolm, S. "Husband-Attended D e l i v e r i e s . " Obstetrics  and Gynecology 27 (No. 1, January 1966)1 146-148. A l l e n , Shelly. "Nurse Attendance during Labour." American Journal of Nursing 64 (No. 7. July 1964)1 70-74. Bancroft, Anne V. "Pregnancy and the Counterculture." Nursing C l i n i c s of North America 8 (No. 1, March 1973)1 67-76. """" ~ " Clark, Ann L. "The Beginning Family." American Journal of  Nursing 66 (No. 4, A p r i l 1966)1 802-805. Glimie, C. R, et a l . "Consumer S a t i s f a c t i o n i n the Labour Ward." Medical Journal of A u s t r a l i a 2 (No. 24, December 15, 1973)* 1081-1084. Colman, Arthur. "Psychological State during F i r s t Pregnancy." American Journal of Orthopsychiatry 39 (No. 4, July 1969)1 788-797. Copp, Laurel A. "The Spectrum of Suffering." American Journal of Nursing 74 (No. 3, March 1974)1 491-495. 14 4 Gronenwett, Linda R, and Newmark, Lucy L. -"Fathers • Responses to C h i l d b i r t h . " Nursing Research 23 No. 3, May-June 1974)! 210-217. Dicker, Kathleen. "Husbands i n the Labour Ward.^Nursing  Times 65 (March 27, 1969)1 416-417. Dreussi, Gina M. "Special Book Provided f o r Fathers* Comments." Hospital Topics 48 (December 1970)1 60. Goetsch, C a r l . "Fathers i n the Delivery Room—*helpful and supportive*," Hospital Topics 44 (No. 1, January 1966)1 104-105. Hayden, Glen E . j Moore, Daniel C . i and Birdenbaugh, L, Donald,- "Maternity Care Should Be Family-Centered," Modern Hospital 102 1(No. 2, February 1964) t 104-105. Hines, Jeanette D, "Father — The Forgotten Man." Nursing Forum 10 (No. 2, 1971)i- 176-200. Greenberg, Martin and Morris, Norman, "Engrossment! The Newborn's Impact Upon the Father." American Journal of Orthopsychiatry 44 (No. 4, July 1974) i 520-531. Hott, Jacqueline R. "An Investigation of the Relationship between Psychoprophylaxis i n C h i l d b i r t h and Changes i n Self-Concept of the Participant Husband and His Concept of His Wife." D i s s e r t a t i o n Abstracts  International 33 (No. 1-B, July 1972)i 296-297. Jordan, A. Doreen. "Evaluation of a Family-Centered Maternity Care Hospital Program, Part I ! Introduction, Design, and Testing," Journal of Obstetric. Gynecologic. and Neonatal Nursing 2 (No, 1, January-February 1973)» 13-35. Jordan, A. Doreen. "Evaluation of a Family-Centered Maternity Care Hospital Program. Part II1 A n c i l l a r y Findings and Parents* Comments." . JOGN Nursing 2 (No. 2, March-April 1973)» 15-27. Jordan, A. Doreen, "Evaluation of a Family-Centered Maternity Care Hospital Program, Part I I I ! Implications and Recommendations." JOGN Nursing 2 (No. 3, May-June 1973)» 15-23. Josselyn, Irene M. "Cultural Forces, Motherliness and Fatherliness." American Journal of Orthopsychiatry 26 ( A p r i l 1956)i 264-271. 145 Larsen, V i r g i n i a L, "Stresses of the Ghildbearing Year." American Journal of Public Health 56 (No. 1, January 1966)1 32-36. Liebenberg, Beatrice. "Expectant Fathers." American Journal of Orthopsychiatry 37 (No, 2, March 1967)» 358-359/ M i l l e r , John, " •Return the Joy of Home Delivery• with Fathers i n the Delivery Room," Hospital Topics 44 No. 1, January 1966)1 105-109. Morton, John H. "Fathers i n the Delivery Room — An Opposition Standpoint." Hospital Topics 44 (No. 1, January 1966)1 103-104. Rising, Sharon S, "The Fourth Stage of Labor»Family Integration." American Journal of Nursing 74 (No. 5» May 1974)1 870-874. Ritchie, Judith. "Schilder*s Theory of the Sociology of the Body-Image." Maternal-ChiId Nursing Journal 2 (No, 2, Summer 1973)« 143-153. Robischon, Paulette and Scott, Diane, "Role Theory and I t s Application i n Family Nursing, Part I i — An Examination of Role Theory," Nursing Outlook 17 (No, 7, July 1969)i 52-54. Robischon, Paulette and Scott, Diane. "Role Theory, the Family and the Nurse," Nursing Outlook 17 (No. 7, July 1969)i 54-57. Rubin, Reva. "The Family-Child Relationship and Nursing Care." Nursing Outlook 12 (No, 9, September 1964)t 36-39. Rutherford, Robert N, "Fathers i n the Delivery Room — Long Experience Molds One Viewpoint," Hospital Topics 44 (No, 1, January 1966)1 97-102. Sasmor, Jeannette L.1 Castor, Constance R.t and Hassid, P a t r i c i a , "The Ch i l d b i r t h Team during Labour," American Journal of Nursing 73 (No, 3, March 1973)» Schaefer, George, "The Expectant Father1 His Care and Management," Postgraduate Medicine 38 (December 1965J* 658-663. Shainess, N a t a l i e . "The Psychologic Experience of Labor." Ch i l d and Family (Spring 1966)1 12-25. 14 6 Shu, C,Y, "Husband-Father i n Delivery Room?" Hospitals J.A.H.A. 4? (September 16, 1973)i 90-94. Smith, Barbarai Prlore, Robert M.i and Stern, Mona K. "The Transition Phase of Labour." American  Journal of Nursing 73 (No. 3t March 1973)t 448-450. Wonnell, Edith B. "The Education of the Expectant Father for Childbirth." Nursing Clinics of North America 6 (No. 4, December ijfoji l5i-6oV Young, Elaine W. "Prepared Childbirth! Its Impact on Nursing." Canadian Nurse 64 (No. 1, January 1968)i 39-43. Young, Janet Marie, "One Mother1s Perception of Gifts," Maternal-Child Nursing Journal 2 (No. 3, F a l l 1973)i 165-188, "Are Fathers Really Necessary?" The Medical Journal of  Australia 1 (No. 19» Saturday May 12, 1973)! 920. "Babies Have Fathers, Too." American Journal of Nursing 71 (No. 10, October 1971)» 1980-1981. Unpublished Material Kopp, Lois.M. and Schindler, Sharon L, "An Exploratory Study of the Experiences of Fathers during the Intrapartal Period." Yale University, School of Nursing, May 16, 1966. 14 ? APPENDIX A CONSENT FORM 1 *8 * CONSENT FORM I agree to pa r t i c i p a t e i n a study of husbands' thoughts of and experiences during labour and del i v e r y . I understand t h a t i . what I say w i l l be c o n f i d e n t i a l . there are no r i s k s involved , only one interview of approximately one hour i s necessary • the discussions with husbands w i l l form the basis of the interviewer's thesis • the aim of the study i s to improve the experience of husbands during the time* of labour and del i v e r y . Signature of Participant Signature of Interviewer Date 149 APPENDIX B FINAL INTERVIEW SCHEDULE 1 5 0 PART I GENERAL INFORMATION Delivery Date and Time Interview Date and Time # Hours Post-Delivery Birthplace # Years i n Canada Age # Years Married Education (Total # Years of Schooling) PART II PREVIOUS RELATED EXPERIENCES Have you ever been i n a h o s p i t a l as a patient or a v i s i t o r before coming t h i s time? Yes.. How do you f e e l about being i n a h o s p i t a l , , generally? Please place a cross i n the appropriate box. No Very Comfortable Very Uncomfortable Have you ever had previous experiences with someone who was i n a l o t of pain? How well did you cope (or manage) considering that he/she was i n pain? 1 . Very well 2. F a i r l y well 3. Not w e l l k. Uncertain Yes No Your reason f o r saying that? PART III PREVIOUS AND/OR PRESJN'T^PREGNANCY, LABOUR, DELIVERY AND POSTPARTUM Gravida Abortions Premature__ Parity-Pregnancy # Date df Delivery , Problems during Problems during Outcome f o r Mother, and Hospital Pregnancy Labour and Delivery Baby, De t a i l s of Present Labour and Delivery O f f i c i a l Length S i g n i f i c a n t events during labour, delivery occurring to mother, infant? Forceps Yes No Medications, anaesthetics administered during labour and delivery? Infant weight Sex Apgar 1 5 (From Records) 152 Did you attend prenatal classes for t h i s or previous labours? Yes No. i f yes, What did you think of the classes? a Did you stay with your wife during -previous labour? Yes No_ ...delivery? Yes No_ Had you planned on staying with your wife during t h i s labour? Yes No_ ...delivery? Yes No_ When did you decide to be with your wife during t h i s labour? When did you decide to be (not be) with your wife during t h i s delivery? Whose idea was i t that you be present f o r the labour? Labour , Delivery delivery? Husband Wife Both ' Other (Who?) Were you happy with these decisions at the time? Yes No. Why did you want (or agree) to come to the labour? delivery? 153 PART IV PRESENT LABOUR AND DELIVERY Did you or your wife make a deliberate choice to come to St. Paul*s Hospital? Yes How many hours were you present during labour? What did you do when your wife was i n labour? How well did t h i s labour go f o r you? 1. better than you expected 2. same as you expected . worse than you expected . uncertain what to expect i f 1-3 What was better/same/worse? Please rate what kind of an experience t h i s labour was f o r your. Please place a cross i n the appropriate box. Excellent Experience Very Bad Experience Would you describe what happened during the labour? When did you f e e l relaxed or calm during t h i s labour? When did you f e e l uneasy or worried during t h i s labour? 154 How much pain do you think your wife experienced during the labour? 1, an extreme amount 2. a l o t . a l i t t l e • none 5. uncertain During labour, how much did you think about the baby? A l l the Time about yourself? A l l the Time about your wife? Never Never A l l the Time Never For those at the + end fo r baby and s e l f , what were your thoughts? How would you rate the care that your wife received during labour? 1. excellent 2, good . f a i r • poor What was (his choice) about i t ? Were you present f o r the baby's birth? Yes No How well did t h i s d e l i v e r y go f o r you? 1, better than you expected 2, same as you expected , worse than you expected • uncertain what to expect What was better/same/worse? 15$ Please rate what kind of an experience t h i s d e l i v e r y was f o r you. Excellent Experience Very Bad Experience Would you describe what happened during the delivery? What were your thoughts when you saw the baby? How much were you able to help your wife during t h i s labour and delivery? 1. helped her a l o t 2 . helped her a l i t t l e 3. was no help to her h, uncertain What ways do you think that you were helpful? Were there any ways that you were not able to help her? Yes No i f yes, What were they? How would you rate the care that your wife received during delivery? 1. excellent 2 . good . f a i r • poor •  What was (his choice) about i t ? 15$ How well were you kept aware of your wife's progress during labour and delivery? 1. very well 2. just enough 3. not enough k, uncertain i f not enough, what was lacking? You mentioned that the nurses were h e l p f u l , (name ways that he noted) What other ways did the nurse help your wife during labour and delivery? What ways could they have helped her more? What ways did the nurses help you during labour and delivery? What ways could they have helped you more? I f your wife were to become pregnant again, would you want to go through labour with her? Y e s delivery? Y e g " _No_ Ne What are your fee l i n g s about the following statement? "I believe that i t i s my r i g h t to see my baby born." Strongly Agree Comments? Strongly Disagree I f there were a question about the health of your baby which was detected before delivery, would you chooset 1. to be with your wife during d e l i v e r y or 2. not to be with your wife during d e l i v e r y or 3. uncertain what you would choose Comments on choice? 157 APPENDIX G PRETEST INTERVIEW SCHEDULE 15 8 PART I GENERAL INFORMATION Delivery Date and Time Interview Date and Time # Hours Post-Delivery Birthplace # Years i n Canada Age # Years Married Education; Highest grade attained i n school or # years post-secondary schooling PART II PREVIOUS RELATED EXPERIENCES Have you ever "been i n a h o s p i t a l "before? Yes No_ How do you f e e l about being i n a hospital? 1. don/t mind 2. neutral feelings 3. d i s l i k e i t k, uncertain -Have you ever had previous experiences with someone who was i n a l o t of pain? Yes No How well did you cope (or manage) consider-i n g that he or she was i n pain? 1. Very w e l l 2. F a i r l y w e l l 3, Not well 4 , Uncertain Your reason f o r saying that ( 1 - 3 ) ? PART I I I WIFE'S PREVIOUS AND/OR PRESENT PREGNANCY, LABOUR, DELIVERY AND POSTPARTUM Para Gravida Pregnancy # Date of Delivery and Hospital Problems during Pregnancy — Problems during Labour and Delivery Outcome of Pregnancy for Mother, Baby De t a i l s of Present-Labour and-Delivery Length S i g n i f i c a n t events during labour, delivery occurring to mother, infant? Medications, anaesthetics administered during labour and delivery? (From Records) 160 Did you attend prenatal classes for this or previous labours? i f yes, How often did you attend? 1. at least £ or more of the classes 2 . less than £ of the classes Did you stay with your wife during a previous labour? ... delivery? Had you planned on staying with your wife during this labour? ... delivery? When did you decide to be with your wife during this labour? When did you decide to be/not to be with your wife during this delivery? Whose idea was i t that you be present for the labour? Whose idea was i t that you be present for the delivery? (or not be i f appropriate) Husband Labour Delivery Wife Both Other (Who?) Were you happy with these decisions at i : ^ the time? Yes No Why did you want (or agree) to come to ; the labour? Yes No Yes_ Yes No. No Yes_ Yes No_ No 1651 PART IV PRESENT LABOUR AND DELIVERY Did you or your wife make a deliberate choice to come to St. Paul's Hospital? Yes How many hours were you present during labour? What did you do when your wife was i n labour? How well did the labour go f o r you? 1, better than you expected 2 , same as you expected , worse than you expected • uncertain what to expect i f 1-3 Can you remember what you thought the labour would be l i k e ? Please rate what kind of an experience t h i s labour was f o r you. Place a cross i n the appropriate box. Excellent Experience Very Bad Experience What stands out i n your mind about the labour? When did you f e e l relaxed or calm during t h i s labour? When did you f e e l uneasy during t h i s labour? How much were you able to help your wife during t h i s labour? 1, helped her a l o t 2 , helped her a l i t t l e 3, was no help to her 4, uncertain 162 What ways do you think that you were helpful? What ways were you not able to help her? Were there ways that you wanted to help her more, or l e s s , during the labour? i f yes, What ways? Yes No How much pain do you think your wife experienced during the labour? 1. an extreme::, amount 2. a l o t 3. a l i t t l e k, none 5. uncertain During labour, how much did you think abou* the baby?; A l l the time about yourself? A l l the Never Never about your wife? A l l the time Never (For those at the + end, what were your thoughts?) How would you rate the care the care that your wife received during labour? 1. excellent 2. good 3. f a i r k, poor 163 How well were you kept aware of your wife's progress during labour? 1. more than enough 2 . just enough 3. not enough k, uncertain i f not enough, what was lacking? What ways did the nurses help your wife during labour? What ways could they have helped her more? What ways did the nurses help you during labour? What ways could they have helped you more? Were you present f o r the baby's b i r t h ? Why did you attend the delivery? How w e l l d i d t h i s d e l i v e r y go f o r you? 1. better than you expected 2 . same as you expected 3. worse than you expected k, uncertain what to expect i f 1-3, /' Can you remember what you thought i t would be l i k e ? Please rate what kind of an experience t h i s d e l i v e r y was f o r you. Excellent Experience Very Bad Experience 164 What stands out i n your mind about the delivery? What were your thoughts when you saw the baby? How well were you kept aware of your wife*s progress during delivery? 1, more than enough 2 . just enough • not enough . uncertain How would you rate the care that your wife received during delivery? 1, excellent 2 , good •, ' 3. f a i r 4. poor What ways did the nurses help your wife during delivery? What ways could they have helped her more? What ways did the nurses help you during delivery? What ways could they have helped your more? I f your wife were to become pregnant again, would you want to go through labour with her? Yes No_ ... through delivery? Yes No_ I f no, why not? 165 What are your feelings about the following statement? " I t i s the r i g h t of every father to see h i s baby born." Please place a cross i n the appropriate box. Strongly Agree Strongly ^Disagree I f there were a question about the health of your baby which was detected before delivery, would you choosei 1. to be with your wife during the d e l i v e r y or 2. not to be with your wife during d e l i v e r y or 3. uncertain what you would choose. 

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