Abstract:
Unfamiliarity of the treating obstetricians with the husbands of the
patients could affect the quality of care negatively and make difference
in the overall maternal health and child birth. All efforts should be
made so that husbands of the expectant mothers and their obstetricians
get know each other. This extended cordial doctor-patient relationship
would definitely help to have a better outcome in the child birth and
labour.
Key words: husband of the expectant mother; obstetrician;
unfamiliarity; child birth and labour; expectant father
Unfamiliar Expectant
Father: Indian Obstetrician’s Achilles Heel!
It is possible that the treating obstetricians at the hometown of the
expectant mothers may not be familiar with their husbands as they arrive
only at the time of childbirth. This could be an important factor which
could make the obstetrician’s job not only more difficult but also
affect the overall maternal and child health.
In Indian tradition, it is a common custom that the lady goes to her
parental place for of her first child birth. The expectant mother would
visit her obstetrician quite religiously and regularly when she was at
her husband’s place in the company her husband and complete all the
formalities of antenatal care. In the late third trimester she would
leave to her parental home following a ritual popularly known as ‘Baby
Shower’ which also has several other nomenclatures likeBayake;Simantha;
Godbharaai etc. depending on the regional and ethnic background. At her
maternal hometown, the expectant mother would approach the local
obstetrician who is well known to her as well as her family for further
management. Many a times the doctor would have been her mother’s
obstetrician also. Thus, the lady would be at utmost ease and maintain
good rapport with this new but very familiar obstetrician with good
mutual understanding and trust. The husband of this primigravida though
accompanied her during antenatal checkups back at his place of
residence, find it difficult to accompany due to the distance factor.
The expectant father’s attendance at child birth is not universal in
India unlike developed countries. The husband of the expectant mother
would arrive only when she goes for labour giving very little
opportunity for the obstetrician to interact with him. As the head of
the family the male members are contacted by the obstetrician only when
there are complications related to the child birth. In addition to the
unfamiliarity, the husband would also be quite ignorant about the
academic qualifications, experience, ability and reputation of the
obstetrician. Researches have shown that [1,2] many of the
husbands especially first-time fathers, lack knowledge about the birth,
mode of delivery and other obstetric related matters. This limitation
makes them feel helpless, suffer from anxiety, fear and discomfort while
waiting outside the labour ward which is again a domain of women.[3] When the expectant father is summoned by the
obstetrician to make decisions on the process of labour or update him
regarding the possible complications that might arise during the course
of childbirth, his unfamiliarity with the treating obstetrician could
make him vulnerable to misunderstanding, mistrust. He being ill-informed
and naive, could exhibit coercive behavior suggesting elective C-section
or vice versa requesting for natural birth. Now, the obstetrician is at
the mercy of this stranger who also happens to be the authorized person
to make decisions regarding the child birth. Unreasonable and
unnecessary request for a second opinion on the obstetrician’s
professional decision on child birth could also may surface which could
lead to unnecessary delay in obstetric intervention jeopardizing safety
of maternal and child health. Few would demand in the last minute for
cord blood banking which is a daunting task for the hospitals located at
the semi-urban and small towns. The violation of the obstetrician’s
professional autonomy could be the subject of contention and could boil
down to the patient being referred to a higher center. Thus, there could
be a complete disruption of the doctor -patient relationship
unnecessarily. The patient’s parents’ despite of having enough trust and
confidence in the ability of the obstetrician would find it difficult to
challenge the decision of their son-in-law. Thus, expectant father’s
unfamiliarity with the obstetrician could be an important factor
hindering the appropriate clinical decisions and probably fit into one
of the three delays mentioned in the literature contributing to the
maternal mortality. [4] In order to alleviate this factor,
governments all over the world are coming out with unique strategies to
encourage the husbands to accompany the wives’ during antenatal checkup
and delivery so that they are quite familiar with the care givers as
well as the child birth related events.[5] One way of
achieving and encouraging the participation of the husband of the
expectant mother is to give due priority to these couples in appointment
with the doctor at the clinic or hospital as an incentive over those
ladies who are not accompanied by their partners.[3]
The role of the husband in maternal health and child birth has been
overlooked and neglected since long. All effort should be made to make
the husband of the expectant mother familiar with the treating
obstetrician, labour related issues, possible complications and his role
in making timely medical decisions well in advance. Involving the
husband at all levels of maternal and child care could prove to be of
considerable benefit in the overall obstetric outcome. This extended
doctor-patient relationship could also prove to be beneficial while
making timely informed decisions related to childbirth and also to
convince the family in case of untoward and unexpected events occurring
during the child birth. The unfamiliarity of the obstetrician with the
husband of the patient could turn out to be the single most factor for
the potential medical negligence litigations if things don’t go as per
plan.