 Ond y ddechreuio ymlaeniau mewn gwirionedd, ac mae'n dwi'n mynd i ddweud y gwirionedd yn gyfnod o'r gweithio gwrthwyng, ac mae'r gweithio gwrthwyng yn ddechrau'n gweithio gwrthwyng yn gweithio'r gweithio'r gweithio'r gweithio'r gweithio'r gweithio. Mae'n gweithio'n gweithio i gyrfa i Eon Cemp. Eon gwirionedd yn cymorth eu gyrffi Cresenol a Gyrffyddol gyda'r ddweud i gael gyntaf eich gyfer y ddoedd y four. Dyna'r fawr, mae'n gweithio'r fawr yn iawn i chi i ein hefyd o'r hun, sydd wedi'i gweithio'r mwyfyrdd ddechrau, ac efo'r meddylch i'r hyffordd hefyd i'r meddwl a'r meddwl yn dechrau, mae'r meddwl yn ddefnydddoedd i'r meddwl, ac yn ddechrau'n meddwl, i wneud arddangos am y cyfnodau dda, i ddweud ar hyn o'r gennym ar hynny, i ddweud ar hynny'n meddwl i'r meddwl, byddwn yn ddechrau, ac yn ymgyrch i gysylltu mewn. yn ystod o gweithio i gwyfnodol a'r ffordd o'r gweithio, o'r ddysgu. Ian, rydyn ni'n gweithio i chi ddangos i gyd yn ei ddweud, ac yn gweithio i chi, fel y casio. Fel ydych yn ei ddim yn gweld o'r ffordd o'r gweithio i'r ffordd yw'r ddweud. almost 30 years ago, on the 20th of April 1989, my wife Julie went into labour with our first child, Christopher. I'd done all the preparation, I wasn't a midwife then, we'd done all the preparation, I'd done the anti-natal classes and when she went into her labour at the early hours of the morning we were in the local hospital, we went up to the hospital and we were met at the door by an elderly porter, elderly to me at the time. He asked me to wait in a room and he wandered off with my wife to the labour ward. I was in that room for about 45, 50 minutes, something like that and because I didn't know what was happening no one came and told me, you start making up what could be wrong and I'd worked myself into such a state so that by the time, I don't know whether there's a nurse or a midwife came in to get me at the end of that time, I was convinced they were coming in to tell me that my wife or my unborn baby had died or both. They hadn't, Julie went on to birth our baby, our eldest, Christopher, he just turned 30 and she went on to have another four children. That was a very traumatic, being left like that is one of the hardest things I ever went through, not knowing it's frightening, daunting, I was angry, I was it's horrible anyway but I put it to the back of my mind, we got on with being a father, I went back to work and Julie went on with bringing up the children and I then went on to be a midwife several years later and it was part of my student midwife that I was reminded of what had happened, I had been to a couple of general anaesthetic sections as a student midwife with my mentor and the women and it's great when you save mum and baby's lives or you part of the team that does it. One that we'd gone in for a spinal section and they had to convert to a GA section so dad and I had helped him dress, well I hadn't helped him dress, he'd dressed himself, we're both in our clubs in theatre because they had to go to GA section I took him out and I sat with him and I watched that for that and it reminded me so much of what I went through and that is what made me question because a student midwife meant to question so I'm going to run through the slides, baby's come into the world arriving in this world in several different ways, sorry, oh one second sorry getting used to the technology and the majority of dads attend the birth of the child at the time it's about 86% but I will say yes certainly from experience the majority attend the birth but what of the other 14% well work commitments are fairly common especially through the forces, it may be separated from mum, it may be that she doesn't want him there which is perfectly valid, similarly it may be that he doesn't want to be there, however there's a small percentage that aren't allowed due to the baby being birthed by a general anaesthetic cesarean section and it was this that sort of questioned after I saw that dad. Previous practice at my trust was the GA sections performed as an emergency, the priority is and was a live mum and baby which is is only right, yeah that got to be the priority. Once the baby was out and checked okay by the midwife or the pediatrician it was placed on a warming mattress in a cot never living mum's side even though she was unconscious, we had a policy where we were where baby shouldn't leave mum's side dad however is normally left in a waiting room or the labour ward room quite often they went outside to pace the floor and we didn't know where they were so we couldn't update them and of course we were all busy, they're usually informed of the birth et cetera but it's approximately two hours before he sees his partner on his newborn if babies were born in the middle of the night they didn't get them to see them morning after unless they hung around the left to see them being transferred I asked my colleagues why I didn't understand why I needed to understand it and as I say students we were asked to um we were asked to question practice um doesn't always get down well with the mentors but and according to my colleagues at the time they said men wouldn't like to see the partners like that well what naked to this to my mind that's how they got there in the first place um staff haven't got time to deal with partners if they get upset or annoyed and they don't allow partners into the theatre on the general side so why should this be any different I went um after doing my I had to do a master's degree in midwifery in order to become a consultant midwife so we had to do a research proposal so part of my research proposal was doing a literature search into this subject because it never really went away um Copped on Kaiser they looked at dad's who's newborns in the neonatal intensive care unit and instead of answering questions they wanted to talk about the birth they felt they were abandoned literally as midwives you can understand that we just abandoned them and went off with with mum to save lives and at the end of the road they felt like they couldn't take anymore um I'm not saying for one second that my experience was anything like theirs but yeah you just fit it's awful it's awful and they just felt like they were at the end of the rope and like they couldn't take anymore they just wanted to call it a day um Robinson was one of two anesthetists um who were they had a an aesthetic debate sounds like a hoot but it was published and it was going to come up um he cited maternal satisfaction and choice as a reason to allow partners in um and he quantified this by saying that partners could cope with being there as it's now common practice for parents to be present when the children are anaesthetised and when you're a witness in resuscitation um so he argued for at the debate um smile sorry and the debate smiley was arguing against it and they basically said mum and dad have no rights aesthetically women don't want men there um most men don't want to be there and those that do will prevent the anaesthetist doing the job thereby causing morbidity and mortality he can't support us she's unconscious um if men think they will see the trust on this was a real no we're talking 30 years ago this was a real um uh concern back then and also they said it was a loss of a bargaining tool which would result in a rise in g.a sections so from my experience women that were choosing to birth their baby right as they were in section um spoke to the anaesthetist and in the in the antenatal period um and obviously it's better for mum and baby for mum to have a spiral and stay awake um and when they're discussing this some mums obviously wanted to be put to sleep and just woke up they didn't want to feel any pain any concern about that um so they said if you stay awake we can let your partner come in that his concern was that if we put um let everybody in irrespective then you would lose that bargaining tool um these three researchers or this group of researchers they looked at the incidents of psychological distress in women at birth of babies by general anaesthetics as they were in section it was higher um not surprisingly these women uh frequently cited a missing piece of the birth so basically they went to sleep pregnant and woke up with a baby as such they weren't sure if it was their baby um this causes big problems with bonding with their baby uh one of the outcomes of this is it's less likely they are less likely sorry to initiate breastfeeding ycoati um focused on men whose partners had an emergency serian section with any anaesthetics or spinal or general anaesthetic they cited the level of fear and anxiety felt by these men too high to measure which resonated with certainly the way I felt and the dad that I was watching that day and they argued that it said as much an emergency for partners as it is for mum and baby um I won't really do all my research methods primarily because I struggle to say off of these words I don't know what's an age thing or my false teeth um but the method was in depth semi structured interview so I wanted to find out what I wanted to do but I also wanted to enable them to tell their story so um almost prompts if you will um I had a purposive sample purposive in that I only asked women and their partners whose baby has been birthed by serian section under the general anaesthetic due to a delay in the research getting ethical approval like I was only able to interview eight participants in a total of five interviews um I asked each five set questions of all the same interviews were audio recorded on a small dictophone they were then transcribed and then analyzed um semi structured questions were here because you tell me what happened at the birth of your son or daughter what were your thoughts and feelings at the time do you feel any differently now that several weeks have passed um sorry I forgot to mention I interviewed them normally at home they were invited to hospital but they all chose to be interviewed at home in their own homes in your opinion should expected fathers be allowed to accompany their partners and finally could you give me a reason why they should or should not um like I said I got ethics approval first from the reason thing was a bit daunting uh then from my university which was you university of central Lancashire and then the R and D department of my trust thematic analysis I was told there's a way you can get a q computer program all the was at the time and you fed all your information into there your data into there and it threw out the things I however different I'm different I had a friend who had um he chose to do it by bits of paper on the floor I just did this all over my wife's new wallpaper and in the lounge um I don't even see that a bit closer um so this is what we look for themes so similar things that people said I don't know what is going on uh nobody spoke to me um and stuff like that I sorted them all into different areas um I came out with seven themes um that was missing pieces of birth which had been found already similarly bonding with a baby men's feelings were when abandoned um communication or should I say lack of a lack of antinatal preparation then the basic question of should dad's be at the birth because albeit these people have formulated ideas saying they don't want them there etc no one had asked them to my knowledge and then risk obsessed which I wasn't expecting the last one these are the quotes so basically time where everything was written so it's not that my bad english it was just um what we're doing so missing piece of the birth I didn't even know what planet I was on that was why I missed the feelings afterwards I saw my sister with a baby and I thought she'd had a baby um bonding with a baby I didn't hold him straight away it was a couple of hours after I didn't have a connection I felt like I didn't have a bond with him and the last one the second one to me was sad still now he won't look at me for ages he just did not look at me he looks at everyone else but he'll just look around me I hold him and it's like he's just not bothered about me I was with this lady when she was interviewing the baby was looking perfectly like any baby would look at the mother but her perception of what we've done was midwives to her um men's feelings when abandoned um this is the whole reason I kicked off with this research it's awful it's the worst thing you can ever imagine a thousand questions a minute if everything was all right they would have told me by now there's quite a lot of anger really I wanted to protect my wife but I knew I wasn't allowed frustration and you've got some stupid electrician at the end of the corridor saying something about flatlining and that's winding me up even more because I didn't know he was an electrician at the time I got the date of this gentleman and his wife's date of birth um I went back and partly there was service in just outside the theatre where this dad was sat he'd been brought in and then gone to GA so he'd been sat outside so he was sat on a chair outside the theatre looking at the double doors just around the corner we have our defibrillator and there was service in the machine and that's the only thing I can assimilate to that someone had been in there saying yes it's doing its flatline there's service in it but because no one was with him he thought that was his wife was baby communication and this is the whole point about communication is because you don't get told I certainly as a midwife was never ever taught to discuss all potential outcomes for birth in antenatal classes and obviously it's a bit rush trying to do it and from the data point of view their communication or lack of was they weren't told antenatalism but they weren't told what was going on during you know the procedure antenatal perspiration in the UK we have a problem called one born every minute I don't watch it I choose not to watch it but it does it's at the birth it sort of glamourizes birth and makes makes midwives out to be drinking tea eating cake and then just rushing for emergencies there was one who went for GA yeah the father like all the scubs and they're never ending going up with a waiting a bit to see either of them I said when everything's all right if that happened to her she wanted him to be with his dad but no one ever asked her no one ever said if it happened maybe we should be asking should dad's birth every single participant said yes um I expected some people to say no especially men I thought maybe with a risk but every single one was an infat it yes um the men not the women but the men were a bit risk obsessed I don't know what society we live in or just the UK but they were worried about whether we brought germs in and or getting in the way of doctors and stuff like that um but not to interfere what doctors and nurses do this reminded me of a program called some others do have them where Michael Crawford was the baby arrives I think it's called if there's a link I believe somewhere you could watch so what does cause these problems these arguments were were remarkably similar to those that were cited against allowing dads into normal birth in the 60s previous to this a home birth on hospital nurse dads were left to go to the pub paste the corridor it was in it was quite used as a comical thing in cartoons and films of the period um and then when women women wanted the partners to be there for spinal sections in the 70s um and again aside from my research nothing in return to relatives um they were allowed into a substation of loved ones or parents into the anesthetic rooms of children they've all been brought in now and they were proved to be wrong that there is no evidence whatsoever to keep dads out and in fact Great Ormond Street Hospital which is a children's hospital in London world renowned um they their vision is not vision their values is that the parents have more rights to be there than the staff and I think and as far as GA sections are I think partners do as well I agree with that does size matter um I'm assuming for you ladies on the call that size doesn't but as a man I need to tell you it does so at my trust um there were just over two and a half thousand births um between January and October inclusive in 2008 this is how long on my research was I did it in 2011 590 of these were cesarean section you can tell the section rate was a lot smaller than 54% or 2% of the sections were under GA obviously it's not a large number but but then this percentage is applied to the number birth in England and Wales in the same period it is much larger I couldn't get the data of Scotland and Northern Ireland for some reason it just doesn't want to work that's over 13 and a half thousand um potentially babies at the bone however my research highlighted the excluding partners from a GA section is not confined to the UK and it was certainly common practice in the country studied and it may even be worldwide talking to friends and stuff like that therefore if your percentage of GA sections were applied to the 133 million plus live birth worldwide each year the number is considerably more that's 2.7 million babies it matters to these women because they are more likely uh if we exclude uh for GA section to have a missing piece of their birth if dad is allowed in that one of the common questioned statements women made um was that they didn't know if the baby cried when it was lifted out did it need resuscitation did it need little things did it wee straight away on dad that bit is missing that seemed to be really important to women and the midwives and obstetricians we don't document that we write that yes we resuscitated five inflation best whatever they have a missing piece of their birth these women um they are more likely to not bond with their baby and that caused all the inherent subsequent problems they are more likely to develop depression or post traumatic stress disorder and to me the more importantly the more unlikely to be unsatisfied with their birth it matters to these 2.7 million babies um because if mum if dad provides skin to skin whilst mum can't because she's fast asleep babies do stop crying and become calmer and less stressed twice as fast um thermal regulation has achieved sooner you're going to get less babies being unschedule babies being admitted to the neonatal unit and it helps with prefeeding behaviour which promotes breastfeeding initiation i am not for one second suggesting that skin to skin with dad is the same but it's got vast leaps and bounds in neonatal intensive care units what they call kangaroo mother care but it it's not as good as mum but it does come a close second it matters to these 2.7 million dads because they feel abandoned and excluded um they have little or no paternal satisfaction they are less likely to bond with their baby and child this has no kind of effect so dads are less likely to children and more likely as they grow that they aren't involved with dad from the outset uh don't have a good bond they do less well educationally they have more um more likely to get in trouble with the police they have higher IQs um if they get bond with the dad more likely to develop depression or post-traumatic stress disorder and i've met dads who because of traumatic burst not just g.a sections that they don't go they will have sex with the partner again and the marriage breaks down it just couldn't think some of whom um feel like this and that is in for me thank you i'm sorry i've seen a few questions now but i don't um i'm happy to answer any questions i will start going i'm not sure this works i will start going sorry that's um me forgetting to turn my microphone all right sorry thank you ian for that um wonderful summary of your research in 2011 um so we can open the floor now to any questions that anybody has for ian so you can either put your hand up and i can turn your mic on if you have one or as we've got a lot of people just listening to the presentation if you're happy typing your questions ian can you see the public chat at the moment uh yes i can see the list down the side yep so um we've got a question from Portia there just questioning the the use of your last image there don't just explain a little bit more how that came about from your research um the the closing slide they felt that the end of the telly they couldn't take anymore they just wanted to get out of it and if that meant it was one dad that was talking to it wasn't part of my research and he said the end of it just it was at the end of the rope it couldn't take anymore it just wanted to get away and stop the hurt it was feeling um and his words he was talking about ending it all um i just linked it when they said the end of the rope to me that was a natural progression but i am a bit of a dramatist i believe thank you have you had any experience of um of men or partners female partners as well being allowed into general anaesthetic or to our own sections i haven't but there was an anaesthetist and i was trying i was i was trying to find the emails following my research there was an anaesthetist in scotland who obviously thought similar to me didn't think dad would cause the problems and they were doing a small trial and i cannot find where it is but their initial feedback the emails was that it wasn't causing any of the problems that people surmised it would um but i do think we need to have longer term studies to see if if dad can fill in the missing piece of the birth for mum if it's reducing post traumatic stress disorder we need more work the only reason i've revisited and i know it was a time at this was 2011 it's still going on like i'm still going into maternity units at the minute in my current role and we're still excluding dads it's not there's no reason for it if we're evidence-based care there's no reason what to have for it there's a question from meg here um which i'll read for the people that are accessing via their phones or don't have the chat function we must be able to start enabling partners to attend ga sections but do you think that the common reason for a ga fetal distress is what prevents the providers to protect the partners from further distress yes i think that was part of the reason i mean the main thing like i said in the presentation the main thing is the emergency you need to get mum and baby out and be in part of that team albeit junior as a student midwife first year student midwife you're on a buzz don't you know i mean it's wonderful you've done it uh i never gave a thought to dads until access or the one they are i think they are trying to protect them they're saying dads don't want to be there and they're not going to have any use um so yes they probably are but no one's looked into it and i don't think similar to when they were trying to get dads into normal birth in the 60s and dads into spinal anaesthetics cesarean sections they were had greater numbers certainly we've got a great number now of spinal sections these numbers are still relatively small despite my painting up the big picture still relatively small um there's probably not a very great voice i would say and have you seen any have you seen any um any thoughts on the birth trauma association Margaret's asking there what their views are on dads being allowed um do you know i honestly don't know i've never thought of that sorry i don't know i wasn't aware of anybody um looking at dad's trauma other than your coty having said that i never looked for it to be fair i fan that other one by accident so that's an interesting point i would have to have a look at that but thank you and have you managed to get your work published tollian it was in um yeah i was starting my job as a consultant midwife at the time so it was published through my dissertation tutor and one of the one of them i ended up having four uh linked people so yes it did get published in the pats in midwife back in 2014 which i think is a shame with a lot of things you get it published whatever but it's not changed it doesn't seem to have changed anything so i i obviously didn't apply enough we need to work on it more so this is why i'm having another go now to see if we can crack this one yeah i think that you're right there's a lack of research in this area of birth partners and their involvement but um as as perhaps we look at the title of international daily midwife being the defenders of women's right it's actually women and their families yeah i mean i was looking for this as a part of the father being a dad um and being in that room for 40 i used to call it a cell it wasn't a cell i wasn't locked in but it you know you just told stay like like you told the dog you stay in that room and it it was awful um and i looked it from the dad's perspective but there are benefits to baby of being there there's a south african doctor and i can't remember his name who did research and with some other people that have done research into skin to skin with dads and it is does come as a close second you can get benefits for baby but also for a moment if this can help take away that missing piece of the birth i don't know even when we went on to film a birth maybe i don't i don't know what the answer is but i do think we need to do something just it's a small number but um from the from the the dad's that you spoke to we've got another question there about um shortly it's possible for babies to be taken to the partner as soon as possible if they come out with great app guards and high fives everyone in the room can't this baby be taken to the partner within a short space of time did the dads you spoke to find that they did have um their babies brought to them quickly or was there a delay no uh they weren't they weren't brought to the i believe it's happened occasionally sometimes but basically because dad's not in theatre there's no midwife is where dad is and midwife has a role responsibility of mum and baby um well until the obstetrician's finish so the midwife was expected to keep an eye on mum um to me the no brain is like exactly like you say nothing wrong with that give baby to dad that would be a compromise but that wouldn't sort the missing piece out but that that would certainly um that would that would certainly um help with the baby thermal regulation pre-feeding behaviour any babies calm down as long as dad's not been overseas or working on a little rig babies hear dad's voice as well from 16 20 weeks that it is a calming effect on baby and it keeps them warm are you less lap yeah and we've got an interesting viewpoint there that it takes a man midwife to identify this is the traumatic experience so maybe actually we should be advocating for for more males to enter the profession um my i think the best person to do the job should be doing it irrespective of the genitalia ad i'm not a great believer of getting more dad's in i know i believe in the uk we've got about 120 um and i've met quite a few of them they are good midwives but yeah the best people should be doing the job not not just getting more but yeah it certainly brings another perspective to it it's really interesting that actually we've got um some comments coming up here now that they have seen dad's at section when their partners have been under general anaesthetic so we've got one um that they have seen two general anaesthetics for sections where both dads were there one was fetal distress one was a failed spinal and they would never exclude them for that reason and they do skin to skin with the dad um in the theatre what a brilliant advocate yeah so forward thinking and and i can understand the concerns and like i say as a midwife at the start when you just run in you save in lives and you tick a box another cup of tea onto the next one do you know i mean you feel like you're doing the right thing but these women and babies are going on with the dads and if we don't include them from the outset the benefits of inclusion dads and the problems caused by excluding them is is is yeah is yeah we need to look at all problem is maternity services having enough time to do it isn't it having someone to come and talk to dad having someone to sit with him while he's in theatre and say do this do that but like i say when you go into resuscitation now in resuscitation a relative or child or whatever they stay in the room well it's quite common practice in this country and actually perhaps it's highlighting another issue about communication skills and empathy like somebody else has mentioned we as midwives really need to be mindful of giving that informed information to the partner the mother in whichever situation happens yeah one dad and in my research did suggest that we had a laminated sign on the wall he said just stand me in front of the sign that says plan a we're going to section because of distress we're going to do this we're going to do this it's going to be 50 minutes whatever he said and then someone could just come to me and say no let's get that we've gone to plan B we've had to resuscitate baby like a he called it an idiot proof guide and i know we don't have spare staff to sit around with people that's the labour ward's quiet and that's fair enough but yeah we're just i wasn't taught this in my degree and i'm not aware that partners that were taught to look after it and midwives i don't know whether we have the time or the capacity where i know a lot of areas you're cutting back on parent craft classes for example um antinatal classes so okay is there any more questions for Ian before we move on i think that you've provided us with some some great insight here into perhaps an avenue that some of us haven't even thought of and and definitely have provoked more thinking i can't see any more questions coming up okay so thank you very much Ian for for presenting that research and and i hope you get chance to explore it further and and maybe do some studies on the effects if fathers are allowed into the births yeah i mean i ever think there are some research again i found it so it's really great i forgot to mention there are um there's some studies done one in the 70s and one later on mentioned in denish walsh's normal birth books that's where dads are trained appropriately they can keep birth normal and there was almost as good as doolers i think dads will be as good as doolers but they could be there to support they can fill in and this is just a certain aspect of it but it's having someone yeah it's it's getting the funding to do it isn't it the problem is in maternity services certainly in this country it's all stretched but thank you and there's a suggestion there about you um going on the maternity outcomes matter page on facebook and and talking about your research i think that's something that maybe you could take forward yeah i'm more than happy uh margot to do that yes i um i've not been on that one i don't think i don't think but yes i'm more than happy to yeah anything that publicised is to get this stop but thank you brilliant thank you thank you and uh it's a reminder that we're just not only defending the women but the birth partners as well and keeping them informed and part of the decision making process