The Life of Dad

by Anna Machin

  This man is a contemporary Thai Malay from the beautiful coastal region of Satun, in the south-west of the country. The Satun people believe that the placenta is the same-sex sibling of their baby and, as such, its destiny is intertwined with that of the living child. By burying it within their village, they can ensure that their child’s attachment to their community is maintained as, despite what the future may hold, they will not wish to stray permanently from their twin. But the exact location of its burial is dictated by the child’s sex and gives a telling insight into the strict sex roles that persist within this culture. Fathers will bury the placenta of their son on the nearest street corner to encourage their child to seek a future beyond the confines of the village, whereas that of their daughter will be buried as close to the family home as is practicable. A daughter’s future place is with her parents. Fathers attach considerable cosmological power to the ritual of the placenta burial. Beyond its importance in anchoring a child to its ethnicity and community, it has a role in protecting the child’s future well-being. Hence a man must not be distracted by his surroundings on his journey to the burial site, lest his wandering eyes lead to eye problems for his child. Likewise, the placenta must not be buried too near to water, to avoid future stomach troubles.

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  Becoming a father is not a moment in time, it is a process; one that can start many years before a child is born, when the desire for a child might emerge, and continue for several years after birth. But pregnancy and birth are a special time in this process of change – a time of growing recognition of a new future and a new role. This period constitutes one of life’s key markers, the moment when attention shifts from the ‘I’ to the ‘we’ and life, in all its guises, is fundamentally and permanently changed.

  In this chapter I want to explore dads’ experiences of birth. While in many cultures birth is a time of ritual, here in the West it is more usually a time dominated by hospitals, doctors, appointments and paperwork. This has consequences for the man’s experience, which, in some cases, can lead to issues coping with his new life and identity. I want to explore the causes and consequences of these issues and what the new dad can do to help his experience of birth be as positive and joyous as it can undoubtedly be.

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  ‘Couvade’ is a term derived from the French word couver, meaning to hatch or brood, and adopted by anthropologists to describe the phenomenon present in many societies of a series of ceremonies, rituals and psychological and physiological experiences that occur as a man becomes a father. Thought to have originated in Ancient Egypt, these occurrences and experiences are deemed to be important because they help the father, kept at a distance from the physical experience of pregnancy, to adapt to his new role, assert his significance to the family and gather essential support from his community. As a consequence, they have a vital role in helping the man deal with the practical and psychological impact of becoming a parent.

  Couvade is split into two distinct categories of behaviour. The first set of behaviours fall under the heading of couvade rituals and are performed by the man to involve himself more fully in the process of pregnancy and birth, to provide protection to his child and the mother or to cement his new child’s place within their community. They are rituals that acknowledge both that becoming a father is a life-changing experience for a man and that the birth of a child is a community as well as individual matter. So, our Satun man will not only carry out the ritual of placental burial after birth but will fill the long pregnancy hours with practical jobs to support his wife once the baby is born, including constructing a wooden bed, the khrae, on which she will rest with her baby for forty-four consecutive days following birth. During this time, mum and baby will be warmed by a fire that the father will continuously tend to to ensure it doesn’t go out.

  Why is the couvade a significant process for the men who take part? For women, the connection to their child is physical, visceral. For a man, his connection is social – made by the interactions he enjoys with his child and the social recognition of his role. By performing couvade rituals, he is publicly taking on the mantle of the father and, more vitally perhaps, asking his community for their help and support in successfully navigating the journey from man to father. Beyond this, many rituals are also tied up with the future protection and support of the child. Picture the Thai man burying his son’s placenta on the street corner. He is carrying out this ritual to ward off illness and also to encourage his child’s loyalty to his community but, in addition, his choice of burial location reflects his hopes that his son’s future will extend beyond the village. In these wishes are reflected two themes that I will return to again and again in this book. That is, regardless of the vagaries of time and the challenges of the environment, at the heart of every father’s role is the drive to ensure his child’s survival and to teach and guide his child so that he or she can operate separately as a successful, autonomous being when the time comes to enter the adult world.

  Practices such as those of the Satun people were once widespread. But with the onset of the medicalization of childbirth, even in remote areas, the opportunity to carry out such ceremonies, particularly around birth, has diminished. For Thai men, who are traditionally excluded from birth, the moment of new fatherhood today is more likely to be marked with hospital bureaucracy and endless form-filling than the careful removal and burial of the placenta. Such ceremonies only remain for those who choose home birth or who have the confidence and time to wade through the metres of red tape that are required before a placenta can be removed from the hospital setting. But what remains in societies after these rituals have died out is an astonishing physiological phenomenon that is perhaps the body’s reaction to the profound emotional and practical experience of becoming a father.

  Having a kid is life-changing! It is obvious to say, but it really is . . . I don’t know where my time went before or what I used to do, what I spent my time doing, because I don’t seem to get any time now! I mean, I have to make it, which involves getting up at stupid o’clock and doing things then.

  Dylan, dad to Freddie (six months)

  If you are a father, then Dylan’s story will be familiar to you. Having a child causes an inevitable disruption to your daily routine. The demands of work and home need to be juggled, so you grab food whenever there is the opportunity and a full night’s sleep is but a fond and distant memory. For many of you, these changes in lifestyle will have had a physical consequence – you put on weight. Gone are the days of frequent gym visits or Sunday morning five-a-side, to be replaced with a diet heavy in carbohydrates, fat and sugar, to fuel the long days and broken nights. But for some of you, the impact of impending fatherhood on your physical health may be more severe and striking. You might suffer stomach cramps and diarrhoea and feel listless and lacking in appetite. If this is you, then you are exhibiting the second category of couvade behaviour: couvade syndrome.

  Couvade syndrome is a difficult phenomenon to grasp. Its diverse set of symptoms, which focus largely on the digestive system but can stretch to muscle cramping, loss of libido and toothache, are hard to pin down. As such, diagnosis is difficult, and men’s complaints are often dismissed. One consequence of this is that we have little idea of its frequency in modern populations; global estimates from a number of studies range from 11 per cent to 50 per cent. What we do know is that it is largely a phenomenon of industrialized cultures. It is most likely to occur with first pregnancies and be at its most severe in the first and third trimester, symptoms more often than not disappear once the baby is born, and there are certain categories of father and personality types who are more likely to experience it. Teenage first-time fathers, men whose fathers were absent when they were growing up and the fathers of unplanned pregnancies are at increased risk, as are men who are closely bonded to their partner and exhibit strong empathizing skills. In addition, unluckily for them, men who are also keen to be closely involved in their partner’s pregnancy increase their chance
of experiencing this – in all probability, psychosomatic – syndrome.

  All these men have one thing in common. They all probably experience heightened anxiety about becoming a father. For the teenage boy or son of a single mother, simple youth and inexperience or the lack of an adequate fathering role model can mean they find impending fatherhood more anxiety-inducing than most. For the father of the unplanned child, the gentle transition into fatherhood afforded by a planned pregnancy is denied him and he must quickly come to terms with this unforeseen, and possibly unwelcome, change in his circumstances. Men who are closer to their partner and more in tune with her experience may take on some of her concerns, worry and distress, resulting in this physical manifestation of a psychological state. Indeed, psychologist Anne Storey and her colleagues from Memorial University of Newfoundland, Canada, have found physiological evidence for this phenomenon. In their study of thirty-four Canadian first-time parents, fathers-to-be who experienced two or more couvade symptoms not only exhibited lower testosterone and higher prolactin levels (the hormone linked to milk production in mothers) than those who did not, making them more responsive partners and fathers, but their female partners also showed raised cortisol levels, indicating that they were experiencing significant levels of stress during pregnancy, a state of being that the men might well be mirroring.

  The question remains as to why couvade syndrome exists and why it is a modern phenomenon, largely confined to developed countries. There have been numerous attempts at explanation, utilizing every argument from male envy at the female’s ability to bear a child to jealousy of the foetus’s close relationship with the mother. For me, the reason is more clear-cut and grounded in the father’s everyday experience. It is an unconscious manifestation of the father’s lack of recognition and support as he undergoes this key developmental stage. This lack of recognition and support will be particularly pertinent for those men who wish to be closely involved in their partner’s experience during pregnancy or those who might require additional support due to lack of life experience or an adequate role model. Couvade rituals, as described above for our Thai father, allow men to take a distinct role during pregnancy and birth, and to display not only their new role to the community but to advertise their need for support. They find security in having a firm, socially mandated role and being clear about what it involves. Their role is acknowledged as important by their community. Within the West, where all sectors – social, commercial, medical – focus exclusively on the mother, a lack of overt couvade ritual means that fathers can struggle to identify a role and garner recognition and support for their experience. This can lead to greater anxiety and, as a consequence, the symptoms of couvade syndrome. This lack of recognition is evident in Steve’s experience of antenatal care:

  [The check-up] I did go to, my partner got on the seat and the midwife drew the curtain [in front of] me and my partner said, ‘He can watch,’ and she said, ‘Oh, right,’ and I thought, Well, I am the husband . . . in a month’s time I’m going to be seeing everything. And the midwife was a bit weird, as though I shouldn’t be there.

  Steve, dad to Anna (six months)

  Over the years I have spoken to many new fathers, and what is clear is that, alongside excitement, pride and fear, many men, like Steve, find the experience of pregnancy and birth marginalizes them. With the medicalization of pregnancy and childbirth, many of the processes that could have afforded an opportunity for public ritual are removed from the community to the hospital. As such, men are denied the opportunity to gain public acknowledgement of their role. Despite dad being a presence in the birthing room for nearly forty years, stories of exclusion are common. Dads who are asked to wait outside while mums are examined, questions regarding wishes for the birth or aftercare directed solely at mum, fathers left to let their worst imaginings run riot when their partner is whisked off for an emergency procedure. This exclusive focus on the mother can be to the detriment of the father’s well-being – many men report being made to feel like an imposter or a spare and unwelcome part. Unfortunately, this sense of exclusion is a constant subject of discussion during my conversations with fathers:

  I’m sat there thinking . . . I’m exhausted helping to look after you, you’ve been sick all morning. No one asks you how you are; no one ever does . . . Men aren’t seen to be that vulnerable and that involved in the pregnancy process; the baby’s not inside me, is it?

  Theo, dad to Lila (six months)

  What is surprising is that these experiences are from the very recent past, when it is accepted best practice, both nationally and internationally, for a father to be fully involved with pregnancy and childbirth as an equal member of the parenting team. Numerous reports from bodies as esteemed as the World Health Organization and the United Nations have repeatedly stated that fathers should be fully included in all decisions and processes surrounding pregnancy and birth for the good of the mother, the baby and the man. Indeed, a number of recent studies have reported that the health outcomes for mum and baby, and the continuing health of the new family, are improved by fathers being involved in all aspects of antenatal care and birth. But such reports don’t appear to have influenced real-world practice. This sense of being a bystander is not just voiced by the men I have interviewed in the UK; it is a problem that is evident across Western culture. In her analysis of pregnancy and birth experiences from nine countries, including the UK, Sweden, the USA, Japan, South Africa and New Zealand, Mary Steen, a professor of midwifery at the University of Chester, summed up the overall experience of fathers as being that of someone occupying the no man’s land between being a patient and being a visitor. They are not undergoing a physiological process that requires medical intervention, hence they are not a patient, but they are also not in the category of hospital visitor; they are more than this. They are undergoing a life-changing experience alongside their partner, which, within medical circles, defies definition. And as it defies definition, no one quite knows what to do with them, either emotionally or physically. Steen recounts an incidence where one father was asked to stand in the corner and ‘not interfere’ during birth, and concludes that while men are now regularly in the birthing room, they still feel excluded from the process, even though physically present. Again, the dads in my study echo this experience:

  Since getting home with our baby, the midwives would come, the health visitors would come, and even though I’m here, they don’t really acknowledge me, that I’m here. I don’t think there is any real support there for fathers, and if something had gone wrong at any stage, I don’t think there was anyone there to support the father. When the health visitors were here, no one said to me, ‘How are you?’ It was almost as if I were intruding, coming into the room when Kate was talking to the health visitor. It was like, ‘Huh, you’re here as well? Okay.’ It was like they didn’t know how to deal with it. But why should I not be here? He’s my son as well.

  David, dad to Harry (six months)

  Why does it matter how fathers are treated by healthcare professionals? Why should we be concerned that they are having to deal unsupported with significant psychological, if not physiological, change during the period encompassing pregnancy and birth? It matters for two main reasons. Firstly, fathers who are involved in pregnancy and birth are much more likely to be involved fathers after birth. Numerous studies among all socio-economic classes and ethnicities of father have shown that by involving a father from the early stages of pregnancy you are instilling in him a habitual routine that will naturally continue after birth. This is of importance to him because fathers who have an identifiable role are much more likely to transition to parenthood smoothly, which in turn will have a positive and significant impact on his partner and child. One of the key, and arguably easiest, ways health and social care practitioners can make sure fathers feel involved and encourage them to take on a role is to acknowledge them as a significant player. It is a simple and cost-neutral act to ensure they are included in all discussions regardin
g their baby, to enquire after their health and well-being, listen to their queries and concerns and support them in their chosen role during pregnancy and at the birth. To empower them to embark on the process of becoming a dad. Those of us who research and campaign for fathers just need to find an effective way to get this message across.

  The second reason for recognizing dads during pregnancy and birth is that, alongside the quality of his relationship with his partner, how well a father navigates the journey to fatherhood is significantly impacted by how he is treated by healthcare staff. The transition to fatherhood can last a significant period of time, up to two years after birth, compared to around nine months in mothers, meaning that, arguably, fathers may require support for longer than mothers. And it can include some key points of change that have the potential to cause significant distress. Many of these can occur in the first few weeks after the birth, when the resources available to dads – professional and personal – are probably at their lowest. These significant events are the birth itself, the immediate post-birth period and the return to work. For many men, the birth is a time with huge emotional and practical consequences. There is the need to cope with your own psychological and emotional experience and to identify a practical role within the birthing room. Again, in some cultures a series of couvade rituals define this period and provide a clear route for dad to follow that can ease his anxiety. In both historical and contemporary non-industrialized societies, such as the aboriginal people of Australia and the Basques of Spain, men are reported to imitate the behaviours of their pregnant partner – withdrawing from work, displaying swollen stomachs and, when the day of birth itself arrives, remaining in their bed and imitating the sounds and actions of labour. Significantly, many of these men will be excluded from the birth itself, unlike fathers in the West, but will ensure their involvement and cement their bond with their wife and child by this public display. Without such prescribed public rituals to fall back on, it is this need to identify a role during birth that often causes dads in the West the most difficulty. And being among the first generation to enter the birthing room, there are few traditions to follow or role models to emulate.