The demographic data of the participants in this study show that Malawian men who attended childbirth were educated and professional men. This group of men could be likened to middle-class men in the industrialized countries. Although it is not a tradition in Malawi for male partners to attend the birth of their children, the participants demonstrated that men can be labour companions for their partners just as women. Given an enabling environment, such as individual labour and childbirth rooms that provide privacy and pro-male partner labour companion policies, men can effectively assume the role of labour companions. Meerabeau stated that in the American society, the admission of male partners into the labour room was constructed as a public statement of family togetherness, a sign of a strong middle-class marriage . However, this belief was not established in this study.
The findings of this study have illuminated on the importance of midwives, women and male peers as motivators for men to be labour companions. Male partner’s presence during labour and birth could contribute to continuous labour support in situations of midwives shortage. The role of midwives as educators and client advocates cannot be over emphasized. The midwives should take every opportunity to educate and advocate for male partner involvement in childbirth whenever possible.
Couple communication is vital for male partners’ attendance at childbirth. In this study, the couples discussed and made a joint decision on whether the male partner would be present. Feyisetan argued that spouse communication about reproductive health issues is greatly enhanced when both spouses have similar levels of education or close to one another . He further argued that at higher levels of education and with little difference in educational attainment, partners appear to feel more comfortable discussing issues that were traditionally thought to be under the control of men .
The findings of this study have shown that informal male peer motivation moved some men to attend the birth of their children. Men who had attended the birth of their children tended to inform peers about their experiences and if positive, most likely encouraged them to participate. Avogo and Agadjanian found that men and women’s discussions in gendered networks are significantly associated with subsequent spouse communication in family planning . They further asserted that social influence was directly reflected when informal social networks exchange information on childbearing .
The male partners in this study had multiple motives for attending the birth of their children. Whereas some of the participants stated that they attended the birth of their children out of curiosity, others did it to welcome their babies or be there for their partners. Unlike in the western society where prospective fathers are expected to attend and assist their partners at the time of childbirth , in Malawi men are not obliged to attend their children’s births. Their attendance at childbirth depends on among other things, the infrastructure, hospital policies, midwives’ attitudes towards men’s presence, and willingness of both the men and the expectant mothers. Nevertheless, midwives should endeavour to assist the male partners so that they should have an effective and positive experience.
Regardless of the motives to be present during childbirth, the men in this study assumed different roles including that of being their partner’s advocate and provider of psychological and emotional support. The men viewed being able to offer psychological and emotional support as positive experience. Somers-Smith stated that the mere presence of the partner makes the birthing woman feel valued, cared for, and appreciated . Men’s presence during labour and childbirth has also been observed to reduce pain, anxiety, shorten the duration of labour, and less need for pain medication [33, 34]. However, some studies have found less impact of partner’s attendance. For instance, Ip  found an increase in the amount of pain relieving drugs used and length of labour in women who had practical support from their partners. In addition, father’s support was not shown to reduce mother’s perinatal anxiety and pain . Similar findings are also reported by Gungor and Beji in a study done in Turkey .
The negative experience of not being able to offer physical support to a partner in labour was attributed to lack of knowledge and skills related to unpreparedness. This finding confirmed previous findings . Yardely asserted that fathers require information in order to provide the best support to their partners . Longworth and Kingdon further suggested that if the male partner is more receptive to information on how to cope with labour and birth, he could relieve some of the pressure on both his partner and the health professional. They further expressed that an effective, positive birth scenario is one where the midwife, the woman and her partner work together to support each other .
The negative emotions of fear, anxiety, frustration and a sense of helplessness were also reported by other researchers [17, 39, 40]. According to a study conducted in South Africa, men reported fear of labour, operative interventions including episiotomy, not being a good father, and loss of marital closeness . Chapman made a supposition that childbirth classes could possibly assist men in preparing for the changes they would witness in their partners during the labour experience . Knowing that these changes are normal might reduce men’s levels of anxiety, frustration, and sense of helplessness .
However, it was not surprising to note that almost all of the men reported that they hid their negative emotions from their labouring wives. They pretended to be strong, as if all was well. In their study on men’s experiences with post-perinatal loss, O'Leary and Thorwick reported that fathers were reluctant to express fears because of the need to protect their partner . According to Courtenay, men often viewed expressions of fear as a sign of weakness, and as such were reluctant to acknowledge it . Nevertheless, health care providers should anticipate negative emotions from male partners and be able to assist them.
Lack of knowledge or preparation for labour, birth and their role in these processes contributed to men’s negative experiences. In turn, it created tension between the men and health care providers. Some of the men reported to be labelled ‘difficult’. Koppel and Kaise argued that hospital staff tended to underestimate and ignore the stress that fathers were going through when their partners were involved in an emergency birth . Although Mapp and Hudson stated that during a stressful situation everyone including midwives and doctors, becomes stressed which makes communication difficult . Nevertheless, the fathers who were prepared participate actively in the labour process, and their partners’ birthing-experiences tended to be better . Even where fathers were minimally prepared, positive effect on the general experience for both men and women was observed [16, 48].
Lack of involvement in decision making about the care of a spouse was perceived by the participants in this study as a negative experience. In most cases, women’s or couples’ input in the childbirth care was not sought. The women and their partners were just informed about the decisions made by the health care professionals. Consequently, the participants in this study perceived this behaviour by the health professions as a negative experience. Active involvement in decision-making by women and their male partners has been identified as an essential element of women-centred care [49, 50]. This entails that women and their male partners are given adequate information so that they can make informed decisions that are best for them . Therefore, maternity care providers should endeavour to provide opportunities for women and their male partners to be partners in decision-making. However, Dugas et al. asserted that coping with informed consumers in busy practice settings presents a challenge to health care providers who are accustomed to more paternalistic approaches .
The desire to have more children diminished in some of the men who attended the birth of their children. Similar results were reported by Carter in a study done in Guatemala . However, there is need for further research to investigate the relationship between male partner’s attendance at childbirth and subsequent pregnancy intentions and practices.
Limitations of the study
Recall bias could have been present even after restricting inclusion of men whose spouses delivered within the last 24 months prior to the study. Two years is a long period to remember much detail about one’s experiences. However, the inclusion period was extended to two years because of the scarceness of men who attended childbirth in the participating hospitals. The semi-structured approach coupled with in depth probing of the interviews helped to jog the memory of the participants and reduced recall bias.
Another limitation was that since the study population was urban, the findings may not be entirely applicable to other settings in Malawi. However, we gained insights into how similar populations can be targeted to improve male partner involvement during childbirth.