Supporting and Sharing—Home Birth

Abstract

The planned home birth has provoked discussion around the world. Home birth has been described as a positive experience, but results regarding the safety of home birth are controversial. To date, the phenomenon has mainly been examined from the mother’s point of view, and there is only one previous study reporting fathers’ perspective. The purpose of the present phenomenological qualitative interview study was to investigate fathers’ experiences of planned home birth. Eleven fathers were interviewed, and the data were analyzed using Colaizzi’s phenomenological method. The fathers followed the woman’s wish in choosing the birthplace and set aside their own views. Furthermore, hospital birth was not an option for the fathers due to their own prior negative experiences of hospital births such as disturbing the natural progress of birth. The fathers’ experience of home birth included sharing the responsibility, supporting the woman, and participating in the home birth process. The experience was challenging; fathers had to take the role of a midwife, and no support or information on organizing home birth was offered by public health services. The fathers felt that the home birth connected them as family, and the experience was empowering. Our study results suggest that the health care professionals need more education and information on home birth and that the families (including fathers) interested in home birth need greater support from health care professionals. There is a need for proper national home birth guidelines, while family-and client-centered care has to be improved in birthing hospitals.

Introduction

Planned home birth is defined as a woman giving birth in her own home with the help of a midwife or a medical doctor, where the birth plan and arrangements are usually made in sufficient time before birth (Viccars, 2003). Giving birth at home has been described as an extremely positive and meaningful experience associated with improved self-confidence, increased autonomy, and participation of the whole family, including children (Christiaens & Bracke, 2007; Sjöblom, Nordström, & Edberg, 2006; Viisainen, 2001). Research regarding the safety of a home birth has been varied; a planned home birth has been considered to be as safe as giving birth in a hospital (Olsen & Clausen, 2012), whereas others associate it with adverse perinatal outcomes, such as low Apgar scores and increased risk of perinatal mortality (Wax et al., 2010).

The rate of planned home births varies around the world. In Finland, 99.8% of women give birth in hospitals (National Institute for Health and Welfare, 2013), and only a few families report a home birth; for example, 10 children were born at home in 2011 (M. Gissler, National Institute for Health and Welfare, personal communication, 2013). Overall, home births are less frequent in Finland compared with other Nordic countries (Lindgren, Kjaergaard, Olafsdottir, & Blix, 2014). In Europe, the prevalence of planned home births was highest in Netherlands, 16%. England reports 3% and Iceland 2% planned home births (Europeristat, 2013). In comparison, the United States and Canada report lower than 1% prevalence of planned home birth (Martin et al., 2011; Vedam, Stoll, Schummers, Rogers, & Paine, 2014).

Finland has free access to publicly funded obstetric and delivery care services, including antenatal and postpartum care. Private delivery care services, such as private maternity hospitals or birthing centers, are not provided. However, home birth services, not included in public health care system, are offered by a few private self-employed registered midwives. The delivery care service in all Finnish hospitals emphasizes safety and equity rather than individual choices and alternative options. Only few hospitals have been awarded the Baby-Friendly Hospital Initiative Certificate in Finland. Additionally, during the past decades, the number of delivery care units has been reduced in public hospitals. This has provoked a discussion in social media about the organization of the delivery services and the families’ need for alternative options such as private services.

Expecting a child and childbirth are viewed as significant events in fathers’ lives. It has been suggested that men’s participation in childbirth promotes positive feelings about the birth experience, helps fathers adopt their role, and strengthens family bonding (Pestvenidze & Bohrer, 2007). In Western countries, fathers’ attendance at birth is very common. In Finland, fathers have taken part in childbirth since the 1970s, and today almost all fathers take part in childbirth, and they are also encouraged to participate in antenatal care and parent education. Whereas much is known about fathers’ experiences of childbirth in hospital, research of home birth fathers has so far been scarce. Previous Swedish studies have identified that childbirth participation by fathers is a significant and life-changing experience (Fägerskiöld, 2008; Premberg & Carlsson, 2011) that generates strong emotions, ranging from euphoria to agony, and is viewed as demanding due to feelings of discomfort and struggles with fears (Johansson, Rubertsson, Rådestad, & Hildingsson, 2012; Premberg & Carlsson, 2011). Fathers have also expressed feeling marginalized and like an outsider within the context of childbirth (Dolan & Coe, 2011; Premberg & Lundgren, 2006) and stated that they struggled to find a role during the birth (Longworth & Kingdon, 2011). Furthermore, fathers have been reported to have conflicting feelings of their participation in the birth and even view their participation as a responsibility and an obligation (Eriksson, Salander, & Hamberg, 2007). The authors located only one study that examined fathers’ experiences of home birth, conducted by Lindgren and Erlandsson (2011). Eight Swedish fathers who had experienced childbirth at home were interviewed. The data were analyzed by using inductive content analysis, in which three categories and eight subcategories formed the main theme, which was named “She leads, he follows.” The fathers’ experience was described as a dance; father is a follower and woman is a leader. The fathers described their home birth experience as a process in which they were compliant with their partner’s decisions, followed their partner’s wishes, and shared her fears and happiness. The experience was described as a powerful and overwhelming event, and also feelings of being different were expressed (Lindgren & Erlandsson, 2011).

As mentioned before, to the best of our knowledge, previous studies on fathers’ experiences of home birth are scarce. The subject and qualitative method was therefore justified. The aim of the present study was to describe and evaluate fathers’ experiences of childbirth at home and to produce a comprehensive structure of meaning.

Method

Data Collection

Eleven fathers were recruited for the study through midwives carrying out home births, the authors’ previous acquaintances, and by the snowball sample, which can be used in contacting the groups that might be harder to reach. In Finland, home births are rare, and thus there is a lack of informants. The study author reached fathers as a first contact to participate in this research, and these fathers were requested to inform other fathers about the research. Fathers who wished to participate contacted the first author directly by e-mail, and they were then sent the main information sheet and given time to consider their interest in participation. After the fathers confirmed their willingness to participate, a date for the interview was agreed. Midwives were also informed about the research via a short information sheet, including the study author’s email address (first author). All interviews were carried out between November 2010 and May 2011.

The method of open interview was used because it is common in phenomenological research to let participants explain their experiences in their own words (see, e.g., Burns & Grove, 2005; Polit & Beck, 2006). The fathers were simply asked to narrate their latest birth experience at home. The births took place between 2005 and 2010, among which eight took place during 2009 to 2010. All the interviews were tape-recorded and lasted between 60 and 120 minutes, providing in total a written transcript of 127 pages with a standard font and line spacing. The first author made notes in a research diary during the interviews. Fathers were free to tell their stories in their own words prompted only by a few additional questions.

Data Analysis

Before the analysis process, the first author wrote down her preconceptions. Data were analyzed using Colaizzi’s phenomenological method, which was justified because it is suitable for exploring lived experiences (Colaizzi, 1978; Mackey, 2005). The analysis proceeded in seven partly overlapping stages (Burns & Grove, 2005; Colaizzi, 1978; Penner & McClement, 2008). The first author listened to the recorded interviews and then transcribed them verbatim, which helped give a good overview of the data. All written interviews were read through several times by the first author to gain a deeper overview. The first author returned to individual interviews and extracted significant statements, which were coded. By reviewing these data again, further statements were identified (in total 248 statements). Based on these significant statements, the authors spell out formulated meanings, which were also coded. This stage was repeated twice. The authors returned to interviews all the time to prevent disappearing of the connection to original data. Meanings were sorted on the basis of the study question, and 13 clusters of themes were identified. The findings were integrated into an exhaustive description of the fathers’ experiences of childbirth at home, which was named as “Sharing Responsibility and Supporting the Woman.” The analysis process was fully discussed with all authors.

Ethical Issues

Fathers were informed about the study via information sheets sent by e-mail and were also invited to read the study plan. Fathers then confirmed their interest in participation via email. Privacy was maintained in individual interviews, for example, fathers were able to choose the place and time for the interview. The fathers’ occupations or other background information (except age) were not asked in order to provide confidentiality and to protect their identity. All participating fathers invited the first author to their home. The author ensured that the fathers fully understood the content of the information sheet before the interviews took place. All the fathers were asked to sign a written informed consent form. The recorded interviews were transcribed verbatim by the first author, and no other individuals had access to the interview material at any stage of the study. Ethical approval for the study was obtained from the Pirkanmaa Health Care District in March 2010.

Results

This study was based on interviews of 11 fathers who had been present when their child was born by a planned home birth. The mean age of the fathers was 35 years (range = 29-42 years). The fathers had experienced 26 births, of which 18 were planned home births.

The findings were compiled to give an exhaustive description of fathers’ experiences of childbirth at home. The exhaustive description was named as “Sharing Responsibility and Supporting the Woman” (see Figure 1). Sharing responsibility meant that the fathers took part in the decision to give birth at home and risks related to the decision together with the woman. In home birth decision, the mother’s wish was more important than fathers’ own views. The home birth decision was also supported by fathers’ previous unpleasant experiences of hospital births, views of natural nature of birth, and some arrangements not possible in hospital, such as participation of children. The fathers supported the woman in home birth decision, in making arrangements related home birth, and during the birth. Home birth experience strengthened family relations. Fathers’ experiences of childbirth at home could be divided into 13 clusters of themes as described in detail below.

Figure 1.

Fathers’ home birth experiences.

Complying With the Woman’s Choice of Birth Place

Complying with the woman’s wishes started from the decision to give birth at home. Fathers set aside their own views and let their partners make the plans and lead the process. After the decision to give birth at home, the fathers devoted themselves to supporting their partners and abiding by their wishes, even though some of them had reservations about a home birth.

To me, it is most important that my wife is satisfied with the arrangements of the birth and I have given her a free hand.

I first resisted the idea but gave up because it was so important to her.

Realizing and Accepting the Possibility of Losing the Woman and Child

The realization of risks related to home birth was a key consideration in the fathers’ decisions to give birth at home. The fathers understood clearly that choosing a home birth carried the risk of losing the woman and/or child. It was not an easy decision for the fathers; they accepted the risks but also struggled with worrying about them. On one hand, the fathers described that these thoughts disturbed their sleep and were frequently on their minds. On the other, they highlighted that the nature of the birth has some elements that cannot be controlled and that birth and death are part of life.

These things came to my mind a lot . . . sometimes I could not sleep.

Yes, all kinds of things can happen but it is part of life.

Own Participation and Woman’s Autonomy Unrealized in Hospital

The fathers had a negative view of previous hospital birth experiences. Fathers’ experiences were marked by feelings of being an outsider and losing their own autonomy, as well as the woman’s autonomy. The loss of autonomy was particularly related to the care plan and their partner’s wishes, which seemed to be ignored. The fathers explained that the routines and busyness of the hospital were barriers to their participation and that the staff wanted to do everything by themselves. Therefore, they felt excluded from their own child’s birth.

They decided which position my wife had to give birth.

Everything happened in front of my eyes, but I was not able to participate in anything. . . . I wanted to give the baby a bath, but they said that it takes too long a time . . . another family was waiting for that room.

Hospital as an Environment That Controls the Woman and Disturbs the Birth

According to the fathers, the hospital was a controlling environment that presided over the woman and birth, and supplanted the fathers in the birthing process. The fathers expressed hurt because they were asked to go home, and they felt that the hospital undervalued their role during the birth. Many of the fathers believed strongly in a natural birth and felt that the routines of the hospital disturbed the birth process. They considered that any measures and medical procedures were unnecessary and even dangerous.

The hospital owns the birth . . . my wife was asked for nothing and I was ordered to go home because they will take care of my wife.

Those routines and measures disturb that progress of the birth . . . there was no peace at all!

Birth as a Part of Everyday Life and Confidence in Its Natural Progress

The fathers emphasized the normal nature of childbirth; it was not a disease or medical event, and therefore they considered that it was not necessary to go to the hospital. Birth was viewed as part of everyday life; it was not separate and happened naturally at home. Fathers also had strong confidence in the capabilities of the woman’s body and natural progress of birth. They believed that the woman’s body had everything that was needed to give birth without any medical procedures. This attitude was connected with the family’s way of life and the belief that human beings are part of Nature.

It is very natural . . . the woman’s body has been built to give birth and it knows what must be done.

It is not a disease; it is a normal part of the life like eating and drinking!

Feeling of Safety and Control in the Familiar Home Environment

The home environment was considered opposite to the hospital environment in several ways. The home environment represented a safe and peaceful place that could readily be prepared according to the woman’s wishes, in contrast to the unsettling noise and smells of the hospital. Fathers were able to control the familiar home environment and felt that they were able to help and participate more because of that. They also felt in control of their own role, feeling like a “man of the house”; nobody gave orders, and there were no necessary routines or schedules.

It was much easier for me to participate in the birth at home, because the places were familiar and we were allowed to decide on everything ourselves.

I hate the noises of the hospital, they frighten . . . it was so different at home, peaceful and calm!

Seeking Confirmation for the Choice of Birth Place and Trust in the Professional Skills of the Midwife, Woman’s Health, and Alternative Treatments

Fathers sought reassurance of their choice of birth place throughout the process; they not only wanted to justify the choice to others but also to themselves, and they aired matters that would help them succeed. They strongly trusted the woman’s health and capability to give birth, as well as the effectiveness of alternative treatments like acupuncture and homeopathy. The midwife’s presence and skills were significant to the fathers and made them feel safe with the home birth plan. In some cases, confirmation that the family had been able to employ the midwife sealed the fathers’ decision on the birth place.

I thought that we have so good a midwife that all goes well.

My wife is healthy and strong . . . and she can give birth, I had seen it many times.

Pain can be more effectively relieved natural way . . . acupuncture is very effective!

Children’s Participation as an Experience That Connects the Family and Strengthens Children

Children’s participation was not only important to the fathers but also a compelling reason to give birth at home because their participation was not possible in hospital. Fathers devoted a lot of time to preparing children and telling them the facts about childbirth. They considered it was important for children to see the beginning of life, and there were no risks connected with children’s participation. Fathers strongly believed that such experiences connected the family and would make the children closer to each other and reduce their fears toward childbirth in later life. They also felt that the experience strengthened children as individuals and made them stronger personalities.

They saw how their brother came to the world. . . . I think it makes them feel closer.

My daughter was there all the time and she was so happy . . . and my heart told me that when she has her own children, she will not be afraid because of this beautiful experience.

Own Participation Through Preparation of the Birth Environment and Supporting the Woman

The fathers described their own participation at two different levels: both physical and emotional. They devoted themselves to supporting the woman and took responsibility for the preparation of the birth environment. They arranged for necessary equipment, like a birthing pool, and even made repairs to the house to facilitate the birth. Supporting the woman meant being present and on standby, and offering comfort and encouragement.

I did repairs to the bathroom so that all would go well.

I gave everything I could. . . . I massaged her back all the time and I was there for her from begin to end!

Fear and Feeling of Empowerment From Unexpectedly Having to Take the Role of a Midwife

Fathers sometimes had to take care of the birth because the midwife came too late. This unexpected experience was both fearful and empowering to the fathers. Not only were they proud of the fact that they had been able to take care of the birth, but they also described their shock and of having an emotional reaction even a long time after the birth. They not only felt fear but also great joy when the baby was born successfully. The experience was considered empowering by fathers, and they felt that they were now much stronger and capable than before. However, fathers hoped that the experience would not be repeated.

I saw the child’s hair more and more. . . . I was so afraid and prayed that all would go well! Then she just slipped out and cried so much, I have no words to tell that feeling!

After that birth, nothing seems impossible to me!

Replacement of Fear With Happiness When the Child Was Born Alive and Well

After all the planning, arrangements, and expectation, the child’s birth was usually a positive experience and full of feelings. The child’s first cry represented success and release from danger, and fathers talked a lot about that moment. The fathers described the unforgettable and overwhelming feeling of happiness, which moved them strongly even years later. The fathers were very grateful for the child’s life and described the moment as very relieving.

I saw that the baby had all its fingers and toes! We cried and laughed at the same time, it was true and it was relieving!

All my fears gone away when he cried for the first time and that happiness almost crushed me!

Strengthening of Family Relations

Fathers felt that the home birth strengthened the family’s relations. The experience improved their relationship with their partner; the relationship became closer and warmer, and fathers felt that together they could cope with anything in the future. Family relations were also strengthened between the parents and children and between the children. Fathers felt that the family started to spend more time together after the experience and were “pulled” in the same direction.

I feel much closer with my wife . . . everybody told us that we would not succeed but we made it together!

After that, our family has been like a team . . . we do everything together!

To Become Hurt Due to the Choice of the Birth Place

Families seemed to avoid talking about the home birth, but some of the fathers reported that they had talked about it openly. Friends, relatives, colleagues, and neighbors reacted differently to the home birth, and fathers sometimes faced negative feedback, which hurt them deeply. The fathers were particularly upset that their choice was judged and that instead of congratulations, criticism was presented. Negative feedback also came from health professionals, but fathers did not take their criticisms so hard and even tried to understand them. Usually, because of earlier negative experiences, the fathers did not wait for support from the health professionals when making their decision to have a home birth.

I felt so bad when the neighbor asked why I wanted to endanger my family.

They did not support us even in the hospital, they ignored all my wife’s wishes . . . so, I did not expect any support from them this time either!

The doctor was quite angry, but I think it was her job to be. It is not a choice for everyone!

Discussion

The aim of this study was to describe fathers’ experiences of planned home birth in Finland. The decision to give birth at home was based on the woman’s wish and complied by the fathers. Giving birth at home was influenced by several facts such as previous negative hospital birth experience, considering birth as a natural event, and participation of siblings. In the present study, the fathers’ experience was of sharing the responsibility, supporting the woman, and assisting them in the home birth process. The experience was challenging; no support was offered by public health care, and some of the fathers had to take on the role of a midwife. Giving birth at home was empowering and connected the family members.

Families who have chosen a home as a place of birth usually have different thoughts of the ideal birth, and they might have had negative experiences associated with previous births in a hospital setting (Boucher, Bennett, McFarlin, & Freeze, 2009). In the present study, fathers strongly trusted in births’ natural progress, and they described it as a part of everyday life that was in line with the results of the several previous studies from Canada, Sweden, and Finland (Kornelsen, 2005; Lindgren & Erlandsson, 2011; Viisainen, 2001). Also, our study identified that one of the most important reasons for giving birth at home was the presence of other children, and this was in accordance with previous studies (Lindgren & Erlandsson, 2011; Sjöblom et al., 2006). The fathers’ previous experiences of hospital births were stamped as feeling like an outsider and losing control, both of which affected the fathers’ decision against a subsequent hospital birth. These results were in line with previous studies (Dolan & Coe, 2011; Premberg & Lundgren, 2006; Viisainen, 2001). An interesting finding, as reported by previous studies, was lack of information concerning home birth option in public health care (Lindgren & Erlandsson, 2011; Viisainen, 2001), but according to our study, fathers said they did not expect any support from public health care for the home birth plans.

An interesting finding in the present study was father’s experiences of taking the role of a midwife; that not only made the experience unexpected and fearful but also empowering. In Finland, home birth services, such as organizing skilled birth attendances, are not a part of the public health care, and the families are responsible for all arrangements and costs. For example, fathers described difficulties in hiring a midwife; and midwives who are carrying out the home births are scarce. Furthermore, because giving birth at home is not an official choice, it is not dealt with in parent and birth education, and families are on their own regarding getting information. These conditions might lead to emergency situations in unexpected health changes in the mother or the newborn.

Fathers’ experiences reflected two specific aspects of hospital births, losing autonomy and excessive use of medical interventions. Due to economic and safety reasons, small birthing units in Finland have been closed in the last few decades, and births have been concentrated into larger hospitals (Hemminki, Heino, & Gissler, 2011). This has resulted in less birthing options for families outside the large public care system. On the other hand, there is evidence of benefits of one-to-one midwifery and continuity care (The Joanna Briggs Institute, 2009; National Institute for Health and Care Excellence, 2007). Centralized hospital services have been questioned (Hemminki et al., 2011), but they are still an ongoing trend in Finland. Another consideration in this context is medicalization, such as increased use of obstetric interventions (except caesarean sections and episiotomy) in recent years (National Institute for Health and Welfare, 2013).

The results of the present study are very important and could be applied in medical education and health care services. It seems that further education is needed for midwives on the changing expectations of couples for home birth. Health care professionals need to understand the expectations of the families planning to give birth at home and should offer them evidence-based information and experience-based knowledge to ensure a safe home birth. It would be beneficial to include information about home births in parent and birth education, to make sure families are informed about the arrangements they should make, as well as knowledge and resources to aid, if there is an emergency. Efforts should be made toward increasing support for couples that choose home birth. The home birth guideline has been included in new antenatal care guidelines in Finland (“National guidelines for maternity care,” 2013), but the main message of this guideline is that home birth is still separate from the official system of birth in the country. More detailed and concrete instructions are needed to achieve safe enough and pleasant birth to all families. Both “Ethical Grounds for Good Practice in Obstetric Care” (National Advisory Board on Social Welfare and Health Care Ethics, 2010) and Finland’s legislation (Ministry for Social Affairs and Health, 2010) state that attention has to be paid to the individual needs, wishes, and expectations of the parturient’s and her family and the autonomy of families has to be respected. Perhaps, discussion on whether inclusive birth practices should include family and children should be promoted.

The present study has some strengths and limitations. First, it is of importance to note that reaching or expressing other people’s lived experiences are challenging or even impossible, as previously noted by Rolfe (2006). The results of the present study were consistent with the previous studies on fathers who were involved in home births (Lindgren & Erlandsson, 2011; Viisainen, 2001) that increased the validity of our findings, but some new aspects were also identified. It might be speculated that the results did not represent all home birth fathers, but all the interviewed fathers had fresh and subjective experiences of the phenomenon, and they were willing to talk about their experiences, which increases trustworthiness. Interviews were carried out in participants’ homes in their natural environment, and noninhibiting and comfortable atmosphere, which again increases the trustworthiness (Åstedt-Kurki, Paavilainen, & Lehti, 2001). The open interview method gave fathers an opportunity to talk about experiences in their own words and also encouraged free speech. Potential weakness was that time can have an effect on memories, but in this study, the time that elapsed between the birth and interviews was no more than 5 years, in most cases 1 or 2 years, or less, which also enhanced trustworthiness in the responses. Concreteness relates to the applicability of study findings to practice (DeWitt & Ploeg, 2006). The present findings are applicable to improving maternity care services. As all authors took part in the analysis, this enhanced the credibility.

Conclusion

This study confirms that father’s home birth experience means sharing responsibility and supporting the woman in the home birth process. The findings indicate a need to educate health care professionals on different birth options, including knowledge of medical and social aspects of home birth. Both parent and birth education classes should include information of the home birth option. Hospitals providing birthing services should pay additional attention to family and client centered care, and to families’ autonomy and personal wishes. As home birth option is not included in public health care services, problems in the small number of home birth arrangements and associated emergency situations should be considered as a possibility and should be addressed and remedied. The present study is an exploratory research of a previously unresearched area, and it warrants further study.