Men and Maternity

Rosemary Mander

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781134476039
• Edition: 1
• Topic: Medicine
• Subtopic: General Health

Since the development of modern medicine, men have become increasingly involved in childbearing as obstetricians and, more recently, as fathers. This book argues that the beneficial contribution of men has been taken for granted. Certain changes to childbearing practice have resulted, which, together with men's involvement, have been encouraged without any reference to evidence and without adequate opportunity for reflection.Considering the findings of recent research and wider literature, and using qualitative research with mothers the text examines: · how men became increasingly involved in childbearing
· the medicalisation of childbirth
· the difficulties men experience with childbirth as fathers
· challenging situations, such as fathers' grief
· the taken-for-granted assumptions that men's increased contribution to childbearing is beneficialThis text will be of great interest to academics and postgraduate students of midwifery, obstetrics, medicine and health studies, as well as practising midwives and obstetricians, health visitors, childbirth educators and labor and delivery room nurses.

Chapter 1
Cultures and times

Introduction

In order to be able to describe the role of the man in childbirth it may be helpful to go back to our roots. This resonates with the old adage ‘If you want to know the way forward, you must know where you’ve come from’. In this chapter the aim is to examine where the society of which we are members has come from in this respect. Thus this chapter comprises, first, an analysis of relevant crosscultural issues. These issues will lead into an assessment of the literature on the history of the man in childbearing. By using these complementary approaches it will be possible to show why the man has traditionally been, and in many societies still is, excluded from childbearing related matters. This material will guide us to consider the series of events which, in modern Western society, have permitted this exclusion to be, not merely abandoned, but to actually be reversed.

Other societies

A cross-cultural approach will provide a pathway to facilitate understanding of the processes which influence attitudes to the role of the man in childbirth. Such an approach has been described by Laderman as ‘invaluable in assessing questions of universality and validity of current Western concepts and practices’ (1988:86). She goes on to emphasise the way in which people have a tendency to take for granted the practices that are current in their locality. Such complacency is compounded by assumptions that local practices are standard, innate and sensible to the point of being inevitable. Thus, in this section, the intention is not merely to show the wide range of differing practices which pertain, but to use this material to shed light on the attitudes and behaviours that are so commonplace that they are likely to pass unnoticed. This section draws largely on anthropological material. The convention in that science, however, of focusing on individual ethnic groups is constrained here by the need for brevity. Thus, certain generalisations may be necessary. Further, in considering the attitudes prevalent in different societies, it is crucial to bear in mind the dynamic nature of those societies. Inevitably any society features ongoing change and development. This means that different individuals in that society are likely to occupy different points on the continuum of change (Woollett and Dosanjh-Matwala, 1990). Again, generalisations may appear which may not be accurate.

Presenting symptoms

As has been mentioned already (see above, Introduction), unlike his woman partner, the man shows no visible sign that he is going through the process of becoming a father. In Western society a woman’s pregnancy is likely to carry with it certain privileges, such as the woman being excused from some social obligations. For example, at a celebration or office function a woman who is obviously pregnant would be unlikely to be questioned about why she refuses to drink alcohol. Any change in her male partner’s behaviour, however, is likely to be noted with interest, concern or even disdain.

In other societies pregnancy may be viewed differently, but in the West pregnancy is likely to engender friendly curiosity. This interest may be found to be supportive by the pregnant woman. Such support would not be available to any male partner, simply by virtue of the fact that his impending fatherhood is not visible to the naked eye. Thus a potential source of helpful support is denied to him.

Against this background of the invisibility of forthcoming fatherhood, the man has been found to manifest a range of symptoms and behaviours. Thus, the man ‘presents’ his changing state in ways which, either spontaneously or through custom and practice, are considered to be culturally appropriate. This presentation, which has attracted considerable research and other attention, has become widely known as ‘couvade’. This term is derived from the Old French verb ‘couver’, meaning to cover a nest of eggs in order to help them to hatch into chicks. The term was first applied to the human male by Tylor, an anthropologist, in 1865 when the new science of anthropology was just beginning to develop. Couvade is sometimes interpreted as meaning a ‘sympathetic pregnancy’ (About, 2002). In its relatively short history, the term ‘couvade’ has assumed or has been assigned a number of meanings, which may reflect the increasing interest in the man’s participation in childbearing.

When it was first introduced, the term ‘couvade’ was used to refer to the ritual behaviours of the man around the time of the birth and shortly afterwards. An example of this meaning is found in the work of Mead and Newton (1967:190) who describe the restriction of activities and ‘regulation’ of behaviours that are found in a wide range of ‘primitive’ peoples shortly after the birth. These behaviours were observed in peoples with beliefs in the power of magic or those who had only recently moved from a matrilineal society to one that was patrilineal (Dixon, 2000).

Subsequently, the terminology was appropriated by psychiatrists who sought to explain the male partner’s symptoms which were interpreted as mimicking the pregnant woman’s ‘minor disorders of pregnancy’. The psychiatrists recategorised the concept of couvade by subdividing it. They renamed the original form ‘ritual couvade’, and the newly described condition ‘couvade syndrome’ (Trethowan and Conlon, 1965).

Another reinvention of couvade syndrome was by a group of psychoanalysts; in this context it was used as evidence of male parturition envy (Bettelheim, 1954). The example which they use is the one that features in the fairy-story of ‘Little Red Riding Hood’. Even more recently, a sociological explanation of couvade syndrome has been advanced. The argument in this discipline is that couvade is used to seek to address the perceived marginalisation of the father in childbearing (Summersgill, 1993).

While, for obvious reasons, couvade is generally viewed from a masculine viewpoint, Jacqueline Vincent-Priya (1992) provides a woman’s eye-view. In her anthropological whistle-stop tour she describes the benefits of couvade to the pregnant woman. These advantages relate to the couvading man providing the pregnant woman with better support. Additionally, there may be a perception in the woman that the severity of his symptoms are a reflection of the depth of his affection for her. This perception is apparent in one Azark woman’s proud boast: ‘My man allus does my pukin’ for me’ (Vincent-Priya, 1992:47).

Symptoms

As well as its varying interpretations, the manifestations of couvade syndrome have been described in a variety of different terms. It would appear that the one common factor in all of the descriptions of couvade syndrome is that, as Summersgill observes, the woman is invariably excluded (1993:92). Originally ritual couvade, as it has become known, was described in terms of the man’s behaviour at the time of and after the birth being comparable with the woman’s. The man’s preparations comprised, first and foremost, preparing for himself a suitably secluded environment. In addition, he abstained from sexual activity, he avoided potentially harmful or stimulating food and drink, and he ensured he took adequate rest. After the birth he would be cared for and would put the baby to his breast (Dixon, 2000). The care provided for the father could be by the new mother and he might even assume her place to the extent of wearing her clothes (Mason and Elwood, 1995). Thus, in these practices the basis becomes clear for McClain’s (1982) suggestion that couvade may constitute a culturally approved method for resolving conflicts in the man’s sexual identity.

A more recent study has demonstrated a more culturally relevant insight into couvade syndrome. Researchers in Wales have described couvade syndrome in terms of alterations in the man’s health status (Thomas and Upton, 2000). These researchers undertook a quantitative study using a structured questionnaire to examine the male partner’s experiences and his responses and attitudes to impending fatherhood. Questionnaires were posted to ‘all partners of women who were pregnant and attending a hospital antenatal clinic for the first time during a two month period’ (Thomas and Upton, 2000:218). As well as an attitude scale the questionnaire included a checklist of somatic or bodily symptoms, on which each of the men was asked to indicate which problems he had experienced since the onset of his partner’s pregnancy.

Of the 52 per cent (n=141) of the population who responded to the questionnaire, only 63 (44.7 per cent) men reported experiencing no symptoms of couvade syndrome. Among the remaining 78 men the number of symptoms experienced varied between one (in 20 men=14.2 per cent) and six (in 6 men=4.5 per cent). These researchers chose to define couvade syndrome as the presence of two or more relevant symptoms. By using this definition, 49 of the respondents (34.8 per cent) experienced couvade syndrome. The symptoms which were included in these researchers’ checklist were (in descending order of frequency of reporting):

• Increased tiredness
• Increased stress
• Anxiety
• Inability to sleep
• Headaches
• Loss of appetite
• Weight gain
• Nausea/vomiting

(Thomas and Upton, 2000:219)

These researchers identified a negative correlation between socio-economic class and the incidence of couvade syndrome, although the correlation was not strong enough to reach the level of significance. Thomas and Upton conclude that the incidence of couvade syndrome together with their anxiety, though not high, indicate that the psychosocial needs of the father are not being met. They go on to suggest that couvade syndrome should be renamed ‘antenatal stress syndrome’, in order to attract more appropriate attention for the father from health care personnel and other sources of support.

Unfortunately, the definition of couvade syndrome offered by Thomas and Upton (2000) is rather imprecise and it corresponds with the general preparations of the birthing environment included by Summersgill and contributing to his definition: ‘Couvade…all behaviour associated with childbirth that involves the father giving up his normal routine activities and following new ritualised behaviour’ (1993:92).

Although Thomas and Upton supposedly focused on the more somatic forms of symptoms, their checklist features a large component of stress-related conditions. It would be invidious to suggest that the psychological symptoms reported by these researchers’ respondents constitute ‘ritualised behaviour’. This study may be further criticised on the grounds that there is no indication of the chronology of the appearance of symptoms. For this reason it is necessary to rely on the older work of Klein (1991) to identify the timing of the occurrence of couvade. This researcher identified a biphasic incidence. His study identified an onset of symptoms during the third month of pregnancy, followed by their disappearance and reappearance again shortly before term.

The significance of couvade

In the same way as the interpretation of the presentation of couvade has undergone a number of reincarnations (see page above), so too has its significance changed over time. In their analysis of ritual couvade in ‘primitive’ peoples, Mead and Newton (1967) show how these behaviours create a role for the man in childbearing. These authors argue that fatherhood is a concept which does not occur naturally. They suggest that it is an artefact or a ‘fundamental social invention’ (1967:189). To support their argument that ritual couvade assists the perpetuation of this artefact, they draw on evidence from anthropology and the culture of the twentieth-century American middle class.

The usual pattern of human parenting, according to Mead and Newton, is that the man makes provision for the children of whoever is his sexual partner at the time. This provision is made regardless of the children’s biological origins. This providing role may be assumed by the state in highly organised societies, when a surrogacy arrangement pertains, through taxing the man in order to pay financial allowances to the mother.

In more ‘primitive cultures’, though, beliefs are widespread that the father’s behaviour will affect the development of the fetus and child as much as anything which the mother does. Partly because of his potential to influence the child’s health and partly because of his very variable exclusion or involvement in the birth process, couvade rituals have evolved to demonstrate his importance (Mead and Newton, 1967:190). These authors go on to draw comparisons with American middle-class culture, where there is an emphasis, not on fatherhood, but on the wedding. This emphasis is associated, first, with the financial support of the family. The second reason is that, when these authors were writing, the American man was not involved with the birth; he was either totally excluded or had very restricted contact with the woman and child (Mead and Newton, 1967:190). Thus, the couvade rituals were effectively brought forward in time to precede, hopefully, even the conception. Clearly the involvement of the man at the birth has moved on, but the rationale may still apply for the absence of ritual couvade around the time of the birth.

Issues

I have examined some aspects underpinning the phenomena which have, collectively, become known as couvade syndrome. I now attempt to identify the currently important issues. These issues serve to indicate some of the reasons why couvade is still significant in an industrialised society at the beginning of the twenty-first century.

The research interest aroused by couvade includes a large qualitative study by Dixon (2000). His study used oral history research methods. His data collection involved undertaking discursive interviews with 26 midwives and 25 fathers. In both groups he found that there was a wide age distribution and a wide range of backgrounds and experience. The main focus of Dixon’s research was on the father’s need to relate to the newborn infant.

Dixon’s main finding was the paradoxical views of the two groups. These views contrasted markedly. This contrast manifested itself in the fathers being mainly concerned with their relationship with the newborn child, whereas the midwives perceived that the father was there to provide helpful support for his partner. Inadvertently, in spite of this, the midwives were found to be very adequately ‘ministering’ to the emotional needs of the new father. In this way, Dixon concluded, the midwives were unknowingly encouraging ‘couvading’ behaviours in the father. The father was thus able to express his psychosocial needs, and also the midwife was able to help him to meet those needs. Examples of this form of couvade emerged in two ways. The first was the multiplicity of supposedly ‘small’ activities which the midwife would ask the father to undertake. These included asking him to hold the woman’s hand, give her sips of water, or mop her brow and face. As Midwife U observed of the fathers: ‘They’ve taken part of our role, which is good’ (Dixon, 2000:281).

The further example of a way in which couvade manifested itself was in a highly specific and more ritual ritual; that is, the cutting of the umbilical cord by the father. This is an intervention which Dixon’s midwife informants were keen to give as an example of the father’s extending role. Dixon relates it in terms of its symbolism to the action of the Siriono people of Eastern Bolivia, for whom the cutting of the cord is a way of claiming paternity. He contends that this action is becoming a ‘nascent ritual of modern childbirth’ (2000:281). The midwife informants in Dixon’s study were unable to explain the origins of this practice. This fact may mean that cutting the cord is a true ritual in that it is undertaken more for its symbolic meaning than for any functional reason. It is interesting to note, though, that this ritual developed at a time when anxieties about infections borne by body fluids, including their splashing, were becoming more prominent. Summersgill (1993:93), on the other hand, is more scathing about the development of this ritual. He uses it as an example of condescending attitudes among maternity personnel. He argues that staff have patronisingly invented such ‘token’ actions for the father because of their inability to take him seriously. In spite of this, Dixon’s research findings present a much more positive impression of the staff’s acceptance of and the father’s satisfaction with the couvade available to him in maternity units. Thus he concludes that this form of couvade is seen by all involved as facilitating the relationship between the father and baby, rather than just helping the father to cope with a challenging situation.

The historical development of couvade syndrome (Mason and Elwood, 1995) shows that the evidence relating to couvade is invariably socio-anthropological rather than physiological. Such evidence relates to the incidence, risk factors and psychoanalytical explanations of the man’s symptoms. The behavioural aspects of couvade syndrome are interpreted by these authors as appropriate preparation for the man’s impending fatherhood. The plea by Mason and Elwood for a more biologically oriented study of couvade is based on the incidence of infanticide among a range of lower mammals. These authors attempt to argue that couvade syndrome is a hormonally determined precursor to effective parenting behaviour. The final trigger to such behaviour is his physical proximity to the woman approaching term. On this basis, a health intervention to prevent sub-optimal parenting is proposed as the ultimate benefit, although the feasibility of introducing such an intervention is difficult to assess.

Mason and Elwood’s argument of the absence of a biophysiological model for couvade is more persuasive than their ultimate recommendation. Although it may not be these authors’ intention, their argument showing the uncertain basis of couvade syndrome and, hence, fatherhood serves to support the contention advanced by Mead and Newton (above) that fatherhood is no more than a ‘fundamental social invention’ (1967:189).

In another opinion piece, Summersgill (1993) also focuses on the local current place of couvade syndrome. He first regrets the limited attention paid to fatherhood and compares this unfavourably with the abundant attention which motherhood receives. This neglect is regarded as a form of marginalisation of both the father and fatherhood. Summersgill develops his argument to suggest that the lack of interest in the father leads him, in turn, to feel that he should lack interest in parenting. In this way, a self-fulfilling prophecy will have been created. This is supported by the widespread view that the father has no real role between the conception and the baby being brought home. Against this rather bleak background, Summersgill suggests that the father becomes acutely aware of the pregnancy-related changes in his partner. In response, he ‘adopts’ (1993:95) the symptoms which he has observed in her, to help him to cope with both his transition to fatherhood and her transition to motherhood.

The argument emerges that the underlying problem of new fatherhood is the lack of any formalised ritual couvade. Summersgill proposes that new forms of couvade may have been introduced, such as home improvement or ‘DIY’, or surfing the net for relevant research evidence or ‘technology watching’. These new rituals, however, have not supplanted the more long-standing and meaningful couvade rituals. Thus the father is destined to remain in this marginalised limbo. Such a dismal scenario does not appear to be amenable to easy solutions. Perhaps inadvertently, though, Summersgill raises the question of why the father, in spite of his marginalisation, should choose to accompany the woman during childbirth. I would venture to argue that this question needs to be extended to include some consideration of who it is who is intended to benefit from his presence.

An answer to the latter question may be found in an anthropological study of the men of Karembola in southern Madagascar (Middleton, 2000). This researcher describes a Karembola man who is practising couvade by gathering herbs, preparing his wife’s food and making himself unattractive to other women to avoid sex. His intention is to assert his involvement with the recent birth of his daughter. Middleton maintains that this man’s behaviour is a demonstration of his paternity, which is intended to contrast with the claims of the ‘ownership’ of childbearing by women. In this way couvade may be seen to involve daily routines which have been subjected to gender reversal. The Karembola man could accurately be described as ‘mothering the mother and baby in his house’ (2000:118) with the intention of proving that women do not have the monopoly on birth. This man is therefore seeking to assert his authority or control over a situation, new fatherhood, which otherwise verges on the uncontrollable.

This examination of the issues relating to ritual couvade and couvade syndrome shows that couvade is indubitably about the balance of power in childbearing. In the next section the importance of power relations surfaces again in a cross-cultural setting through an examination of the concept of pollution.

Pollution

I have suggested that couvade practices may be the man’s method of assuming some control over his partner’s childbearing experience. Similarly, the concept of pollution may reflect a society’s control or power over some of its members. This concept is of additional significance in relation to men and childbearing because pollution is likely to be one of the reasons why, in many traditional societies, men have avoided becoming involved with childbearing. In considering pollution, what emerges as crucial is the relationship between the society in its broadest terms and the ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgements
• Introduction
• Chapter 1: Cultures and Times
• Chapter 2: The Midwife and Medical Men
• Chapter 3: Fathers and Fatherhood
• Chapter 4: The Labour and the Birth
• Chapter 5: The Reality of Fatherhood After the Birth
• Chapter 6: Childbearing and Domestic Violence
• Chapter 7: Men and Loss in Childbearing
• Chapter 8: How to Help—the Midwife’s Role
• Chapter 9: Conclusion
• References