 Alright, so why are we here? We are here to listen to the finding of this awesome right researcher, educator, and lecturer. It is my great pleasure to introduce to you our speaker of the hour. She is a lecturer of nursing and midwifery at the prestigious Amadou, I hope I'm pronouncing these words correctly, Bella University, Arria, Nigeria. She is an international awardee to the Cardiff University in UK, where she completed her terminal degree focusing on midwifery workforce. She is no stranger to the IDM having been a presenter and a facilitator here also. She has written, published, and presented at national and international conferences. Today, she will be speaking to us on the burden Nigerian men experience of traumatic birth. I speak none other than Dr. Alima Abdul. So help me welcome her as she brings to us her findings. Thank you. Thank you. Over to you, Dr. Alima. Thank you very much, Dr. Sintia for having me and thank you everyone. And when call to the virtual international day of the midwifery, my topic of discussion my topic of discussion for today is men's experiences of attending the traumatic birth in hospitals in Nigeria by me, myself, and then my other co-authors are there, Bala Ribi Fatima, Abubakar Issa, and Ahmad Rufai, all from High Profile University in Nigeria. By way of introduction and background, evidence suggests that the negative impact of traumatic birth on an affected individual is so overwhelming and has led to research focus on this area. Existing literature has looked into women's experiences. There's lots of literature on women experiences of traumatic birth in both high-income countries and low- and middle-income countries. Also, we also have literatures that have looked about normal birth experiences of women and men in many of this country. However, with Nigerian high-level of maternal and unilateral mortality rates, nothing is known about men's experiences following the traumatic clinical events. By way of introduction, still on the matter, defining traumatic birth, the term traumatic birth is an emerging area in midwifery. The term traumatic have been used in midwifery in a variety of ways. So, describing traumatic birth experiences or the characteristics of traumatic birth experiences in other people, in other people, other than the women, is a bit difficult. However, a recent systematic review in 2016 by Greenfield described the defined traumatic birth as the emergence of baby from its mother in a way that involved event or care that caused deep distress or psychological disturbance, which may or may not involve physical injury but resulting in psychological distress of an enduring nature. This is by Greenfield. Still on the matter, White 2007 writes that, for a man, the scenario can become vivid, colourful, noisy, and dramatic and he may respond with intense fear, helplessness, and horror. This tells us that traumatic birth experiences do not only have overwhelming effects on the women but also on the men. What there's need for us to explore, what are the experiences of this man about this traumatic clinical birth event, for us to categorically say, this is how it looks like on the phenomenon. This is how they experience the phenomenon. Now, the operational definition of this term in the context of this study meant attendance in the study means physical presence of a man or his partner, physical presence of a man or partner while supporting his spouse during a hospital childbirth. Now, men's attendance in other studies may mean for the man to be a pet companion for his spouse while she's in labour, but in our own setting because of issues like privacy issues, men are usually not allowed into the batting environment because of issues of loss of women around with no spaces for privacy. So men may not be bat companion from their wife, but they could be physically present during childbirth when you're not at the bedside of your wife. So traumatic bat in the context of this study is a childbirth experience or event which created fear or psychological distress for the man who may not necessarily be a bat companion. Now, where is Nigeria? For those of us that don't know where Nigeria is, Nigeria is situated in West Africa. We have a population of over 211 million, which is literally much more than the population of Eastern Europe. We have a maternal mortality of about 512,000 to 100,000 lb, and neonatal and infant mortality rates of 39 and 67 per 1000 lb respectively. This is from the National Demographic Health Survey 2018. The religion of Nigeria are predominantly Christians and Muslims. Still on the introduction, in Nigeria, like I've said earlier, men are more likely to be present at their childbirth, but not necessary as bat companions because men are not allowed as bat companions due to lack of privacy issues in most labour wards in Nigeria. If that bat becomes traumatic, they may appear uninformed due to communication issues as well as other factors that have been talked about by other studies. So, these men may potentially be helpless. It may be so overwhelming for them, so they may become helpless with increased anxiety. It may affect their mental health and that of the mother by extension, which may result to poor bonding and transition to parental. And we all know mental health of the mother is very, very important for proper nourishing and taking care of the baby at the neonatal period or to the infanthood. Therefore, exploring men's experiences of a traumatic clinical event becomes important. The objective of this paper is to explore men's experiences of spousal labour and childbirth that was traumatic for them and to further explore the support system they got during their experience and also look into the coping strategies that have them survive and thrive at that period. Now, into the methodology and methods, the research design was qualitative research. Why? Because we want to find rich and deep information about their experiences so that we could better inform, inform knowledge and also guide midwives on how to support them. Phenomological approach was used. Why? Because the lived experiences of these men was desired to be explored. The population of study were men who have experienced traumatic clinical events within the last 10 years. Why? Because we believe that those that have experienced within 10 years will be able to tell us, give us more and the memories may likely be still close to their heart for them to share with us and that was why we decided to look at that. And then from other studies, we also found that most studies also looked at in other countries look at men's experience within 10 years so as to inform them, to get rich information from these men. Recruitment. Now, this study was planned right from last year around February. We tried to recruit from the labour ward of some of the tertiary hospitals and in particular tertiary hospitals where the authors reside. But at first, it was difficult to get this men. So we resorted to advertise on social media, different WhatsApp group and then we were able to get to pull up around 14 participants. They agreed to participate in this study initially. So, propulsive sampling was used because of course we need people that would believe we'll have rich information or they'll have experience regarding this phenomenon on the study. I said earlier that we had a total population of 14 but when we started data collection, we realized that some of them their experiences were over 10 years and then they let us know that it's not as if the path was not really traumatic for them and then finally we came down with a sample size of seven. That was not only the reason. I will talk about why we arrived at sample size of seven as well. Ethical approval was sought from the ethical review board of a tertiary hospital where the study was conducted which was all granted. Method of data collection, interviews was conducted, face to face interview was conducted. We decided to choose a particular location in one of the tertiary hospitals. The participant that agreed to participate for the study contacted us and then we all agreed on the day to meet. So, we had an office where we had the face to face interview in one of the tertiary hospitals. So, overall we interviewed six participants face to face and the seven participants were struggling to come down to where we are due to security challenges and then we decided to have the interview on Skype. Now, before we do this we need to rewrite another ethical approval because that was not part of the initial plan. So, we had to do that and then we got another ethical approval for that and then we had one interview on Skype. So, after the seven interviews we realized that we have achieved data saturation and because we achieved as soon as we realized we've achieved data saturation we decided to terminate the data collection and begin the process of data analysis. Now, the data analysis. For data analysis initially we wanted to use the interpretative phenomenological approach. The IPA is a qualitative analysis approach that aims to provide tail examination of individual lived experience. However, IPA tends to analyze individual cases in greater depth before attempting any integration between cases. Now, due to lack of research on mainstream traumatic experiences, we decided that a more specific focus on patterns across participants are very important. So, we resolved to use thematic analysis. So, the ground and cloud thematic analysis was employed and then the six steps were used. The six steps which involved, of course, you have to do transcribing first. With reading and familiarization of the transcript, we started coding and then we searched for teams, we reviewed the teams, we defined and named the teams and finally we wrote the analysis. Invovo 12 was used to support our data analysis because we had, the, in some of the interview lasted for about one to 30 minutes and then we had a lot of data. So, using Invovo would be nice to support the huge amount of data we had, even though it was from seven participants. Exclusion criteria was traumatic experience over 10 years and those persons that felt the experiences were not actually traumatic for them. Now, in the hospital, we involve, because it's a traumatic, we're trying to explore mainstream traumatic experiences. We try to inform the psychologists that this is what we'll be doing and then we'll be giving the contact number, the contact numbers to the men to contact them for those persons that felt emotional at the time of data collection. So, we refer them to them for further debriefing and counseling. Here's slide 24. So, RIGOR in qualitative research to maintain credibility and then to take care of subjectivity associated with qualitative research and we try to look at the trustworthiness of our findings. For credibility, concurrent data analysis was done. I would say when we collected the first transcript, we started transcribing immediately and as we're doing that, we try to look out for codes and then refine some of them and then we did triangulation. We use field notes so that gestures, non-verbal communications, why we took some decisions and then we try to make sure we try to take care of our, we didn't want our professional experience to interfere with the quality of the data we're collecting. So, we tried as much as possible to write down every action we did. So, we did lots of field notes writing and then we wrote a lot of memos. Also, we did a member checking just to ensure credibility. Then, like I said earlier, we terminate data collection as soon as we realize we've achieved data saturation. Now, for dependability and conformability, peer-depriving by co-authors and then we try as much as possible to remain reflexive by opening reflexive journals. We wrote every decision we took. Each and every one of the authors took notes of that, wrote everything regarding to this so as not to interfere with the quality of our data. Now, the results. Men were recruited were all from Northwestern Nigeria, which is where we are resided. Bet experience, we are mainly in tertiary health institutions, they were all willing to share their experiences. Traumatic but experiences of this man were between two to five years. Still on the result matter. So, following our thematic analysis, we were able to come up with three themes. This is, I would like to say this is preliminary findings because data analysis is still ongoing. This is the preliminary findings which we decide to present on this conferences at this conference. And then the team one is experiences of trauma. And then we have some of the codes there being ignored and lost. This is one of sub themes from the analysis, loss of control, negative attitude of staff with some of the experiences of the trauma, difficult relationship with staff was part of the experiences of the trauma. On team two, we looked at impact on men's well-being. And some of the codes there, we have having sleep disturbances, they were depressed and at their wit ends, there's feeling of guilt and being responsible and then there's fear, there was fear with subsequent pregnancy. Then team three looked at how this men survived this phenomenon. What are those factors that helped them to deal with it at that period. And then it was spirituality and faith was going to be very useful to the men from their discussion. Psychological support from staff was very, very important. Then social support from both their colleagues and support from the family, we believe to be therapeutic to them. And I'm going to go through some of the excerpts, which we use for the transcription and directly into the slides. And still on the results, the first one being ignored and lost. When we arrived at the hospital, this is one of the father, initially we decided to use pseudonyms, but at this stage we now decided to refer to them as father one, father two, father three, father four, father five, father six, father seven. When we arrived at the hospital, this is from father one, he said the nurses just ignored me and left me outside the ward. They kept on coming out telling me to just go and get this. The three dots here are some words that we try to reduce just to allow space for the presentation. And then for the slide, I was just left alone and lost, I was left, I was just left alone and lost not knowing what is going on. No one was saying anything to me. Then from the sector third father, my wife lost an expensive pregnancy from IVF, IVF, which is in vitro fertilization, four years now. You can imagine that no one cared about me. Attention was all on my wife. I was severely traumatized. I kept asking, is there a problem? No one called me. I just stood outside the ward alone. There is a sense of being left alone and then the men felt that they had been ignored and that actually impacted on their experiences. And then this has also been reported by many other studies. Many of the men described, like in the study in the United Kingdom, where the men were described as being viewed as mere passengers. They were not part and parcel of the whole bad process of their life, which even increased to their feeling of psychological distress. They're still on it. Lots of control, still on the experience of the trauma. One of the men said, that's father too. As I brought my wife in, I was told to go out of the labor ward. That was all. My wife was just there alone in pain with her first baby. I could hear her screaming in pain. I wish I could sit by her, but I had no control of what was happening. And then I was told she would go in for caesarean section. It was all so fast. This was typical of many of the fathers that they were not in control of all the happenings, all the batting process for their wife, which also affected or traumatized them as well. Now, still on the matter, the attitude of the staff where there was a sense, there was a sense of the attitude of the staff being viewed as negative because many of the participants talked about not being supported as much as they want. And then here is some few experts from one of the fathers. My wife was convulsing. I was brought to the hospital. Dinos ignored me, as if it was not the tough case. She just wouldn't listen. I kept pointing at somebody to see us. Another father said, Dinos kept yelling at me to go and pay for my wife bills and get blood for transfusion and all sorts. She wouldn't explain anything. And then finally, I lost my baby. It was sad. Still on the relationship with staff, even this is another poll that talked about difficult relationship with staff. And then one of the fathers said, even after I lost my baby, the nurses would not allow me in to see my wife, even when she was alone. I pleaded but they refused, but allowed someone in earlier when we arrived to see his wife. The staff were all busy and never cared about the relative. They just came out, yelled at us, and then asked one of us to go get some things to use on the woman. And that's all. They were not friendly at all. This is from father three. All these shows create a sense of difficult relationship with the member of staff, which impacted on their experiences. Now, team two, which is impact on their well-being. Father two talked about, father two and father seven talked about impacting on their sleep disturbance, having sleep disturbances after the experience. After the loss of my baby, I couldn't sleep for almost three months. It was so difficult as I kept having flashback into the incident and how my wife suffered with carrying that pregnancy. And then father seven talked about, after my wife had a prolonged labor, she ended up with an operation to bring the baby out. She went through a lot. That night, my heart was troubled and I couldn't sleep for many weeks. Still on team two, many of the fathers talked about being depressed and at their weak ends. And one of them talked about, after my wife lost her baby, which we had from IVF, I was withdrawn, not talking to anyone. I became depressed. I didn't know what to do because everyone feared we should just be okay as a man. This is from father two. And then I can't forget that experience. My wife bled and bled and nearly died. Even after the childbirth, I was tea-skilled. I was completely at my wit end. I would have lost her. It was really traumatizing, honestly. I became withdrawn a bit after the incident. Feeling of guilt and being responsible. After I lost my baby, I felt guilty. This is tea on the impact on their well-being, as if I was responsible for the loss. That aspect affected me so much each time I tried to recollect. And then I nearly lost my wife from conversion with her first baby. I still feel bad because I feel I'm responsible because of my delay in taking her to see the head walker. It was totally my fault. All these were believed to have a sense of impact on their well-being. Still on team two, which is still impact on their well-being. There was fear with subsequent pregnancy and childbirth. One of the father talked about, after the first difficult experience, I suffer anxiety. Each time my wife comes down pregnant, it's even worse when she starts labor. And then another father said, it's difficult to forget the experience, especially if what you went through was very, very tough. Kai is a dialect, yeah, or where I stay. Meaning emphasis on how hard the situation was. And that was why I put it in square brackets. With the last pregnancy, my heart was always pounding when I get a phone call. And at times at night, it becomes hard to fall asleep due to fear that something might happen or she may start another conversion again. That's from father seven. Now the team three. The three is how they survive, what helped them to deal with the situation at that time. And the first one was spirituality and faith. Spirituality and faith was believed to support the father from our interaction. And one of the father talked about, I'm grateful to God, my Lord. He gave me strength to cope at that time and I'm up till now. That's the father one. Then with my wife's deconversing then, I cannot see her. I just kept praying to God for her life and his grace. And my God helped me. And then still on it, after I lost my baby, I depending on God, as I believe he would give me another one. And I was so glad God gave me another child. I would have saved my faith in God, really helped me survive that trauma because it was a tough period for us. That's from father two. Still on the results, psychological support from staff was also identified as a source of, which is not surprising. That has been documented by all the study as well. When the incident occurred, there was a particular nurse that was so nice and polite. She approached me and explained everything to me. Honestly, I was calm afterward. Her words are kind and very soothing. That's from father four. Even though I felt bad, the midwife explained the cost of that and kind of gave a psychological support. And what I need to do is help me a lot to get over it. That's from father two. And social support. My family were so useful for me and they were around me to help me, to help my wife after she had the operation. We were never left alone. And then still on the matter, my mom stayed with us for a while to support my wife and that helped us to cool generally. Now, conclusion, finding sure that a complicated childbirth experience have an overwhelming effect on the man, especially if it was traumatic to them. Building rapport with men and being informed by a midwife, you can see from the results an other head professional appears cushioning the impact of bed complications. Faith, I would like to say, faith was one of the original contribution of this study to knowledge. Why? Because earlier study that I've looked on never mentioned spirituality or faith. This may not be surprising in this area. Why? Because majority of the participants were predominantly Christian or Christian and Muslim religion, which may explain the reasons for their hoping, as mentioned by some of the fathers. And then from the, from scriptural perspective, it is believed that believing God, the Christian believe in God for strength and then for the part of the Muslim, the Muslim believe on what we call Kader el-Laou that is believed in faith for whatever, whatever, before anybody. And that was the source of strength and comfort. And the God's providence was the strength of resilience for these participants. Recommendation, mind you, I would like to say this is still the preliminary report from some of our initial findings. Education about the women's condition should be provided to men at every point of childbirth services. You will agree with me. Applying good communication skill to the practice of midwifery and respectful maternity care should be encouraged at all level. Midwives in contact with fathers should provide support and also provide a mechanism for the discussion of men's mental health because some of these men were dealing with this issue. They didn't know the need to report to psychiatrists or other member of the team for psychological support. Supporting men at this crucial period, you agree with me, is also supporting the entire family for your positive transition to parental. I would like to say finally, thank you all for your complete attention.