The Role of Fathers in Maternal and Child Health

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Tom Haederle
Men can have a significant influence in supporting and advocating for women during their pregnancy. And they also share a critical responsibility in child development. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Often in the mother and child dyad, the role of the father takes a backseat. Fathers, however, can serve as essential allies in creating better outcomes for mom and baby and addressing their needs along the way can improve the overall well-being of a family.

00;00;47;23 - 00;01;07;29
Tom Haederle
To explore the role of fathers in maternal and child health. Julia Resnick, director of AHA Strategic Initiatives, is speaking with Dr. Amina Alio researcher at University of Rochester Medical Center, and Jonathan Webb, chief executive officer of the Association of Women's Health Obstetrics and Neonatal Nurses.

00;01;08;02 - 00;01;25;06
Julia Resnick
Jonathan, Dr. Alio, thank you so much for joining me for this special Father's Day episode of Advancing Health. So I want to start with some introductions for our listeners. Can each of you give us some background about yourself and the organization and your work in this space? Jonathan, I'll start with you.

:00;01;25;09 - 00;01;48;19
Jonathan Webb
Yeah, Thank you so much for the invitation to be here. My name is Jonathan Webb. I am a husband and father of two. I'm currently the CEO for the Association of Women's Health Obstetric and Neonatal Nursing. Personally, I've done a good amount of advocacy around trying to elevate patient voices and bring about equitable health solutions and health systems.

00;01;48;22 - 00;02;01;14
Jonathan Webb
And I try to align that to my professional work, both in public health and in health care. I've been in the space for about 20 years, bring my lived experience and have that aligned with my professional experience. I'm excited to be here and share my experiences on both those fronts.

00;02;01;17 - 00;02;04;08
Julia Resnick
Wonderful. And Dr. Alio, over to you.

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Dr. Amina Alio
Thank you for having me, Julia. My name is Amina Alio. I am a public health researcher at the University of Rochester Medical Center in Rochester, New York. Much of my research focuses on health equity in maternal and infant health, and specifically, I've been working on understanding the impact of father's involvement on pregnancy outcomes for the past 15 years or so.

00;02;29;16 - 00;02;52;08
Julia Resnick
So you both are exactly the right people we want to be talking to for this conversation. So during pregnancy, there's a lot of attention devoted to the needs of the pregnant person. Yet we know that dads are also going through a major life change by becoming a parent. Can each of you speak to priority areas where health care organizations can support fathers as their partners go through pregnancy and labor and postpartum?

00;02;52;11 - 00;02;54;15
Julia Resnick
Dr. Alio, I'll start with you.

00;02;54;17 - 00;03;24;21
Dr. Amina Alio
I think most important is to recognize and understand the importance of a really holistic approach to maternal and child care. And by this I mean including fathers in all phases of reproductive services, and that includes before, during and after pregnancy. So it means recognizing that fathers are individuals that are in need of services, that are similar to those that we offer women and pregnant people.

00;03;24;24 - 00;04;12;09
Dr. Amina Alio
And that includes caring for the fathers on physical, their social and their mental well-being. And this is particularly important during pregnancy. But for males, this is also important before conception. Being a father does not just start when the baby's born, but it starts during pregnancy and even before pregnancy. So that should be included in family planning and reproductive life planning, because we know that this has been linked to helping to reduce unintended pregnancies, to increase the use of birth control, and reduce conditions like the sexually transmitted diseases that can be transmitted to the mother and the baby.

00;04;12;12 - 00;04;41;11
Dr. Amina Alio
But during pregnancy, the health issues that can affect both the father and the pregnant mother or person. And that includes something I want to bring up, which is mental health conditions like depression. It can include behaviors like smoking, which can be screened and addressed during pregnancy, just as we do with pregnant women. After delivery, fathers can participate in the care for the newborn, support for the mom.

00;04;41;14 - 00;05;07;10
Dr. Amina Alio
But again, it's important to treat them as individuals, as well as fathers. So again, treating the behaviors and then the physical and mental health conditions that can impact the way that they support the mother and take care of the newborn. Clinicians, maternal and child health programs where they should be aware of the existence of postpartum depression among dads,

00;05;07;15 - 00;05;35;22
Dr. Amina Alio
the need to screen, diagnose and treat them. But also importantly, programs should help prepare fathers in their role as partners during pregnancy. As a parent of the newborn. And this means being inclusive of fathers during clinical visits, engaging them in the process, providing them with knowledge about what to expect, as well as what their role could be during and after the pregnancy.

00;05;35;24 - 00;05;43;18
Julia Resnick
Absolutely. And Jonathan, as a dad yourself, can you can you answer that question, too, and talk about any of your experiences in becoming a parent?

00;05;43;20 - 00;06;23;04
Jonathan Webb
Yes, I would say Dr. Ali's response was extremely comprehensive, and I would I would ditto all of that from a professional standpoint. From a personal perspective, there are there are a few things. I would first say that the priority should always be my opinion on the birthing a pregnant person so that that is paramount. But with with that individual's permission, I would ask the father to be woven into all the things Dr. Alio mentioned because it is a change in life dynamics for both individuals within that unit.

00;06;23;07 - 00;06;58;06
Jonathan Webb
The same sort of supports from an emotional, mental, physical perspective should be provided to the father as well. I think there's a level of education and support that can be also given to the father to make sure that he's in a position to support and provide some of the ... understand the the ramifications of stress during the prenatal process, understanding some of the life changes that might happen, understand how to navigate different challenges

00;06;58;06 - 00;07;24;23
Jonathan Webb
they may experience. So all of those types of supports, I think, would be would be great from a health care perspective. I also believe that if there are ways to value their lived experience with, which is not always something that providers do a great job of because understandably providers have been well trained and have gone through a number of years of education.

00;07;24;25 - 00;07;57;06
Jonathan Webb
I think sometimes the interaction with their patients can almost be paternalistic in nature. So if there's some training around how to really value those experiences, value what individuals are bringing to the table the unit brings to the table, I think that would be really, really important. As well as trying to find opportunities built into the system to have fathers and units to connect with as many individuals who may potentially play a role in the delivery of that child.

00;07;57;08 - 00;08;21;19
Jonathan Webb
My wife, from my experience, we went through an extensive process. I had a detailed birthing plan, worked with doulas and things of that nature and had a really supportive care team. And at the last minute, our doctor was not able to be part of our delivery of our first child. We were dealing with an on-call physician and care team that we had no familiarity with.

00;08;21;19 - 00;08;49;17
Jonathan Webb
And they're trying to navigate our birth plan on the fly. So having ways to socialize and the family and the patients with the members of the care team, as many members of the care team as possible with some level of familiarity I think would be extremely helpful. And the last but not least from a professional standpoint and personal, there's a great deal of focus and attention now being placed on implicit bias.

00;08;49;19 - 00;09;13;22
Jonathan Webb
And the CDC has a great campaign around "hear her" that I think could also be expanded. It's like hear them, but definitely hear her - those types of trainings to make sure that providers and systems are seeing people and valuing them for who they are, trusting their voice, trusting their experience so that they're seen as partners, not just patients, would be really important, in my opinion.

00;09;13;24 - 00;09;26;14
Julia Resnick
Yeah, I really like how you're expanding it from just being about one person to the C unit, and that's a them instead of just a singular. I think that's just a more inclusive way to bring expecting fathers into the process.

00;09;26;16 - 00;09;49;21
Jonathan Webb
Yes, I do want to be careful, though, as I mentioned earlier, to make sure that's done with the permission of the birthing person or pregnant person, because there may be some dynamics where it could be problematic to have fathers engage too much in conversations, always going to censor that individual first, but with their permission. Definitely expanding that because fathers will be advocates, should be advocates.

00;09;49;23 - 00;09;59;29
Julia Resnick
Absolutely. So Dr. Alio is a researcher in this space. Can you tell us what the research says about the impact of fathers on maternal and child health outcomes?

00;10;00;01 - 00;10;32;09
Dr. Amina Alio
There's been quite a bit of research about the importance of having fathers involved during childhood, during adolescence and so on, but not so much about the impact of fathers during pregnancy, their involvement during pregnancy, and how that might affect actual health outcomes for the infant as well as for the mom. But for the past, let's say probably 20 years has been a bit more research about it.

00;10;32;11 - 00;11;04;27
Dr. Amina Alio
And from what we've seen is that fathers support their involvement, their engagement during pregnancy has an indirect impact on fetal growth, on preterm birth, on infant birth weight, and even on infant hospitalization and infant mortality. This just really emphasizes the need to think about the child as kind of the center of the unit that Jonathan was talking about.

00;11;05;00 - 00;11;33;27
Dr. Amina Alio
If we keep the child in mind then we know that we we will do all we can to make sure that both parents are involved somehow in the process. So in addition to this indirect impact on on outcomes for the infant, we've seen that fathers can really impact maternal stress. And I think Jonathan mentioned this as well.

00;11;33;29 - 00;12;06;20
Dr. Amina Alio
But during pregnancy, by reducing that maternal stress, it helps improve maternal wellbeing. The father can provide emotional, physical and financial support and really be an encouragement to the mother during the pregnancy process. And we've seen this in research that shows that when fathers are involved, pregnant women or pregnant people tend to eat right - a lot more than those whose partner is not involved.

00;12;06;22 - 00;12;36;02
Dr. Amina Alio
They tend to exercise more, they tend to smoke less, and they also tend to tend to go to prenatal care appointments a lot more than when the father's not involved. So fathers can really be an important part of the pregnancy process. And again, during labor and delivery, as we mentioned earlier, they can be advocates for mothers. When something goes wrong, they can be advocates for mothers.

00;12;36;04 - 00;13;04;23
Dr. Amina Alio
As far as the stress level is concerned, they can help reduce maternal stress. We have found that fathers support during labor and delivery can actually help reduce the risk of maternal mortality in light of the increase that we see in maternal mortality, especially for black women, I think that really preparing fathers to to to engage during labor and delivery as well as postpartum is really important.

00;13;04;26 - 00;13;32;10
Dr. Amina Alio
And speaking of postpartum, the research indicates that the fathers can contribute to to the mother's decision to initiate and breastfeed for a lot longer. Fathers can also help mothers who are dealing with postpartum depression. They can be a great support at that time. They can help recognize the signs and they can actually provide the physical assistant with the care of the infant while the mothers recovering.

00;13;32;12 - 00;14;10;26
Dr. Amina Alio
So the research overall indicates that across the continuum of reproductive care, of maternal care, that fathers really should be involved. And we need to maximize their contribution to this process. And we should probably also mention that when we talk about fathers in general, that it might be important to specify that when we say fathers, we're not necessarily saying the biological father of the child. Because a father can be anyone who steps in to take on that role and that responsibility.

00;14;10;28 - 00;14;37;16
Jonathan Webb
I don't know if I can jump in, Jordan. One of the things I like about this and exciting to have this sort of conversations because your doctor also laid out all these really impactful points about how the father impacts overall health of their child and supports their child or the child that they're taking responsibility for if they're not biological and how they also support their their partner.

00;14;37;19 - 00;15;04;29
Jonathan Webb
But it also sort of is connected and comes at a really good time, in my opinion. When you have CDC data that was done a couple of decades ago, about a decade ago that showed that fathers are more interested and more involved in their kids lives now than they were a generation ago. So you got this really interesting blending of data points where you have - you see the impacts of father engage, maternal paternal engagement.

00;15;05;02 - 00;15;22;14
Jonathan Webb
You have a group of individuals who are desirous of being more involved. So let's do what we can as the health care nation or health care friendly nation to support with this group of individuals really ready to do and willing to do.

00;15;22;17 - 00;15;46;21
Julia Resnick
Yeah, it seems like there's a lot of opportunity there. So I want to pull on one of the threads that Dr. Alio brought up about maternal mortality and morbidity that's rising in this country, particularly for women of color. So Jonathan, can you share some recommendations for how health care organizations and providers can address maternal and infant health inequities and what role dads can play in improving outcomes?

00;15;46;23 - 00;16;15;02
Jonathan Webb
Yeah, I really appreciate that question because the U.S. maternal mortality crisis is a problem in the nation, obviously. But there's even greater disparities when you look at the the challenges that we experienced for black, which had a mortality standpoint. So I really appreciate being able to elevate this. Going back to my comments from earlier, some of the things that the health care organizations can do is really censoring the patient.

00;16;15;05 - 00;16;48;17
Jonathan Webb
The implicit bias training that I mentioned earlier is, I think, a really great step to making sure that providers are cognizant and aware of how they may be seeing individuals differently, bringing their own personal experiences into the the clinical environment and how that may impact the care they receive. I do, though, think that the implicit bias train that's available is one step. Because now that people know better, what mechanisms can we put in place to make sure they do better?

00;16;48;19 - 00;17;24;24
Jonathan Webb
How are we tracking different procedures? How we blinding different case studies to to better understand if Patient A should receive the same services or similar services for similar conditions as Patient B? Are we doing things like building simulations of that that help us to identify those bias, those biases that exist in our medical education process? So all of these types of things, I think are ways that we can build that implicit bias into our system, but then try to figure out some accountability metrics that can then be visible for the patients when they're making decisions.

00;17;24;24 - 00;17;47;05
Jonathan Webb
And hopefully those accountability metrics can also be used as teaching moments for the clinical care team. Or if there's if there's more need for incentives, a stick that might help to hold people more accountable to the care they receive. So I think those are a few of the of the things that can be done to address that issue.

00;17;47;05 - 00;18;14;09
Jonathan Webb
I can tell you from some a lived experience standpoint, seeing firsthand some of the experiences that my wife and I had to endure because she is a young African-American and Latino woman who looks young, came just came to a visit in sweatpants because she was in law school. And she came by herself with my mother in law because I was working.

00;18;14;11 - 00;18;40;00
Jonathan Webb
The treatment that she got from the care team at the time was one that I would not wish on anyone. She was treated very harshly. The procedure that she was getting was done rather uncomfortably. The feedback that the provider gave to my mother in law when when challenged around the tumor that she was given was that it was almost like a scared straight of the more difficult I am with this individual.

00;18;40;05 - 00;19;04;08
Jonathan Webb
She will think about the actions she's had and won't have have a young pregnancy by herself and all of these assumptions and stereotypes that were were came into the clinical environment that were one, not true because we've been married for three years at the time and we were 27 and 30 when we had our first child so we weren't entering into this decision lightly.

00;19;04;11 - 00;19;27;04
Jonathan Webb
And even if we were, even if she was, is that the most appropriate way to deal with a person who might be scared as a young mother? So some of these things, I think valuing centering the patient, having implicit bias training, having some metrics that are based in accountability that can be actionable, I think are a few things that I would recommend.

00;19;27;07 - 00;19;42;07
Jonathan Webb
And supporting fathers, black men who are put in situations to be advocates when they see things going off the rails, making sure their voice is heard and elevated, to be able to make a difference to protect their their family.

00;19;42;09 - 00;19;49;29
Julia Resnick
Thank you for sharing that story. And I think that piece about men being advocates for their partners is really important. Dr. Alio, it seems like you want to chime in there.

00;19;50;01 - 00;20;25;02
Dr. Amina Alio
Yes, I wanted to expand that and thank you for sharing that, Jonathan. Expanding on the implicit bias training, it's not just the providers, but also the staff, everyone from the receptionists to the security guards. I remember a father talking about actually a couple of fathers talking about advocating for their partner who had just delivered, had just given birth and something was wrong and they were trying to get the attention of somebody out there.

00;20;25;05 - 00;20;57;24
Dr. Amina Alio
The button wasn't working. They were trying to get the attention of nurses or someone and almost getting arrested. So, you know, we want fathers to advocate. And yes, they should advocate and we should form health care providers. But that training has to go beyond that, because if we think of a black man making a scene, quote unquote, because of advocating for the partner that needs to be done in a way that's safe.

00;20;57;27 - 00;21;13;22
Dr. Amina Alio
Father does not end up in prison or jail because they're trying to advocate for their partner. So I think that training needs to go beyond that. If we want fathers to be to be advocates, because that makes sense.

00;21;13;24 - 00;21;45;03
Jonathan Webb
It makes perfect sense. I'm actually glad you raised that because without sharing all these stories, I had another experience where my wife had several experiences where the the frontline team, the reception team, who is a part of your care, mimics some of the biases that we experience with the provider. One one such example I can think of as I was attending one of my wife's regular appointments, we were coming out of the pandemic.

00;21;45;10 - 00;22;11;27
Jonathan Webb
The guidance was varied on how many people you could have in the waiting room, a reception area when you were coming in for appointments. When I came in to be with, I parked the car. My wife went in before I did and I came in to be with her all during her visit. And I'm walking through the reception area and I was told I couldn't be in there with her and I didn't think anything of it at the time.

00;22;12;00 - 00;22;35;28
Jonathan Webb
And it didn't cause a scene or anything, but I was told I couldn't be with her because of the the restrictions. As I walked out and turned around and saw the people who were sitting in the in the reception area, there were a whole bunch of couples mom, white mom and daughter, white mom and husband who are sitting in these spaces together.

00;22;35;28 - 00;23;14;16
Jonathan Webb
And I was you know, I didn't make a big deal of because I didn't want to interrupt my wife's appointment. She had a conversation with them over several minutes on her own and they invited me back in. But there was no clear description or explanation as to why I was initially turned away. But other folks who didn't look like me were able to have their supports in this space. So that training - for whatever whatever trigger or whatever flag they use to determine, assuming it's not just blatant discrimination, whatever trigger a flag they use to make those that assessment, if it's based on some level of bias, I completely agree with the idea that the training

00;23;14;16 - 00;23;19;26
Jonathan Webb
should extend beyond just the clinical care team to everyone's going to impact and touch that patient.

00;23;19;28 - 00;23;37;16
Julia Resnick
Absolutely. I think that really points to the importance of implicit bias training and accountability for actions after that training. So I want to wrap things up on a bright note. If there was one recommendation each of you had for expecting fathers or new fathers, what would it be?

00;23;37;19 - 00;24;02;08
Jonathan Webb
And if this is advice for the dad, I would say to one, enjoy the experience because it is a gift. So enjoy the experience, but also lean in so their voice and their power, no matter whether it's your first child or the fifth child, lean into that power and be an advocate for your family where you need to be.

00;24;02;10 - 00;24;20;20
Dr. Amina Alio
That's that's a challenging, challenging question. But I think the most important concept is to keep in mind during pregnancy and postpartum care, that an important resource that we need to capitalize on to ensure healthy pregnancies and baby.

00;24;20;23 - 00;24;40;07
Julia Resnick
Excellent. Well, Jonathan, Dr. Alio, thank you so much for joining me today for the special edition of Advancing Health. These are really important insights and I want to thank all of our listeners for tuning in as well. There are more AHA resources on maternal and child health on our website. And I just want to thank you for your time and for listening.

00;24;40;07 - 00;24;49;19
Julia Resnick
Happy Father's Day.

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