Eric Mogambi’s excitement over the new chapter in his life is clear for all to see, evident by the permanent smile on his face. Last month, Eric, 24, became a father for the first time when his 19-year-old wife Emma Kemunto delivered their son. But what is even more exciting for this young father is the fact that he witnessed his son’s delivery. He recalls the moment:
“I was with my wife throughout the labour — which lasted close to 10 hours. Even though it was a long and anxious wait, it was one that I gladly endured. The highlight was when I welcomed my son into the world, being the first person to hold him and even cutting the umbilical cord. It was such a joyous moment,” a proud Mogambi says.
But Mogambi’s close involvement in the life of his son did not start that day.
“When my wife missed her periods and began complaining of nausea, I quickly rushed to the chemist and bought a pregnancy test kit. We were both elated as we watched the test kit yield positive results,” he remembers.
Mogambi then accompanied his wife for her first antenatal visit and continued to do so throughout her pregnancy. This they did at a local private health center called Fremo, located in their Kawangware neighbourhood in Nairobi.
Aside from accompanying his wife for prenatal checkups, Mogambi would also assist her with household chores as the pregnancy advanced.
“I would cook, clean the house and do the laundry when I returned home from work. Since she particularly craved ugali and green vegetables, I would prepare them just the way she liked them,” says the security officer.
So it was therefore only natural that when she went into labour, Mogambi was by her side as they ushered their son into the world.
Interestingly, while growing up in a rural village in Birongo, Kisii county, Mogambi always knew that matters to do with reproductive health were solely a woman’s responsibility. In a predominantly male society, Mogambi had never heard of a man who involved himself in matters of pregnancy and childbirth. So what happened with him?
“When I came to Nairobi, I got work as a security officer at a health centre. It was there that I saw men coming with their wives to the clinic. I found it very odd at first and assumed the men were weaklings. But the more I enquired, the more I discovered that what they did was actually a good thing. They truly loved their wives and were not afraid to show it. It did not make them less of men and I concluded that I would do the same when my time came,” he says.
And indeed, when his wife fell pregnant, Mogambi did exactly that, offering unwavering support to his wife. But it was not only his wife who benefited from the experience. He too was gaining from it.
“During the prenatal checkups, the nurses would give us information about the pregnancy, labour and birth. I learnt new things every time, with each session helping us both psychologically prepare for the labour and birth,” he says.
In addition, the health centre would hold open days for pregnant women each quarter, sessions that Mogambi and his wife attended without fail. It is there at the couple would gain more information about breastfeeding, immunisation and family planning options after the birth of the baby. Information that came in handy after their son’s birth.
“My wife initially struggled to breastfeed as she could not get the latching technique correct. But I would patiently sit with her and help her correctly position both she and the baby for a comfortable nursing experience,” Mogambi says.
Since his son’s birth in May, Mogambi has been encouraging other men to be more involved in the pregnancy and birth experience of their children.
“Supporting my wife in this way makes me feel proud. It is very fulfilling and I believe it is the most responsible thing that a man can do for his family” he says.
His wife Emma expresses her joy at her husband’s hands-on approach to parenting.
“Because of his continued support, I have always felt relaxed and confident. During my pregnancy, I never worried about anything because he was always there with me. Even during labour when the pains were excruciating, it comforted me so much when he would hold my hand, rub my back and encourage me to be strong. I am lucky to have a man like him,” she chuckles.
Ibrahim Ondieki is the clinical officer who birthed the young couple’s baby. Ibrahim has worked at Fremo for two years, with one of the most outstanding aspects of his work being that of men taking lead roles in the planning of their families.
“Nowadays, we are seeing more men accompanying their wives for family planning services, antenatal clinics and the birth of their babies. At Fremo, over half of the women are accompanied by their spouses for antenatal visits while two out of every five women have their spouses present during childbirth,” he says.
The health centre encourages this kind of male involvement as one of the best ways to promote a family’s good health and well-being.
Dr Stephen Mutiso, an obstetrician/gynaecologist at Kenyatta National Hospital, similarly underscores the importance of this kind of practice — which is encouraged in all public and private health facilities.
“Men are key partners in the uptake of reproductive health services such as family planning, antenatal care, childbirth, postnatal care, prevention of sexually transmitted infections such as HIV, as well as screening and treatment for reproductive health cancers such as cervical and breast cancers,” he says.
During pregnancy, Dr Mutiso says, men who attend antenatal care together with their partners are provided with an ideal opportunity to learn about pregnancy.
“The couple is informed about the expected date of delivery and how many babies are expected. Emotional aspects of pregnancy are also discussed, with men getting to understand some of the anticipated changes to be expected due to hormonal influences during his wife’s pregnancy,” he says.
During prenatal care, the couple is given information about sexually transmitted infections and their prevention, including HIV. However, according to Ibrahim, many men unfortunately tend to use their wife’s HIV status to diagnose their own status.
“Since most of these men know that an HIV test is one of the requirements in early pregnancy, they demand that their wives reveal the results of the test to them. If the wife is negative, they assume a similar status too, not knowing that cases of discordant couples exist — where one is positive and the other negative. Unfortunately, we have had cases where pregnant women test HIV negative in their first and second trimesters, only for them to test positive in the third trimester. This means that they became infected in the course of their pregnancy,” he says.
Unfortunately, many such women who ‘unexpectedly’ turn HIV positive have been victims of violence from their husbands.
“If the woman is HIV positive, both she and her baby are put on medication — with the baby receiving prophylaxis. Some men are knowledgeable about HIV drugs and once they see their wives and newborns taking this medicine, they become violent, accusing the woman of having had extramarital affairs and ‘bringing’ HIV home. That is why attending clinics is important for the couple because it is here that they are encouraged to test for HIV together and receive the necessary information about staying healthy based on their respective status,” Ibrahim says.
It is also during prenatal visits that the couple is encouraged to make birth plans, which includes decisions about hospital choice and anticipated charges (if any). Prenatal sessions also provide couples with the opportunity to learn about pregnancy complications which empowers them to be prepared in case of an emergency. Together with the service provider, the couple is able to draw up a tentative plan in the case of unforeseen eventualities, which includes blood donation and mobilisation of blood donors.
“An effective birth plan should be finalised by the time the woman is 34 weeks pregnant,” says Dr Mutiso.
When his wife goes into labour, the man should not just stop at accompanying her to the hospital and facilitating the hospital admission, adds Dr Mutiso.
“This is because the presence of a birth partner has been shown to have better birth outcomes. Such men play an important role in easing their wife’s pain by offering them words of comfort, massaging their backs, helping them take recommended walks as well as guiding them with appropriate breathing exercises. In addition, men who ‘labour’ together with their partners tend to appreciate and respect their wives more,” he says.
Reasons for staying out of the delivery room
Despite the heightened efforts by both the public and private sectors in Kenya to promote male involvement in reproductive health issues, the uptake remains low.
“Interestingly, despite some men’s interest in participating in antenatal checkups and delivery, their wives are the ones who deny them this opportunity. Some women dismiss their men’s requests to accompany them to the prenatal clinics, saying that the men should bother themselves with looking for money to feed the children. We also see many women calling on their sisters to be their birth partners instead of their husbands, some of them citing shyness, while others fear that the episode will affect the couple’s future sexual relations,” says Ibrahim.
Career demands and other commitments keep men away from attending antenatal care together with their partners and being present in the delivery room. Some employers do not offer their men paternity leave either, a missed opportunity for the man to offer his wife the needed post-partum support, as well as bond with his newborn.
In addition, long queues at the prenatal clinics discourage men from accompanying their wives. Moreover, many public health facilities lack conducive environments that would encourage men to be present during the labour and birth of their babies.
Jonathan Bitere — a father of four who has never been present for the birth of any of his children, all born in a public hospital — says that even if he would have wished to be present during the birth of his children, it would never have been possible.
“Being allowed in the labour wards is perhaps possible in private hospitals, but not in the public hospitals I’ve been to. The maternity wards are so packed such that pregnant women share beds, so your additional presence would be unwelcome to other mothers and the busy nurses. I would never have dared approach a nurse with such a request for fear of rebuke,” he says.
But even when men are present in the labour ward, some challenges arise, as experienced by Ibrahim.
“Labour can take long, and men get very impatient. After hours of labour, with his wife in excruciating pain with every contraction, some men become agitated and demand to transfer his wife to a different hospital where she can undergo a caesarean section. They yell at us, accusing us of doing nothing to stop the wife’s pain. Unfortunately, once the woman sees her partner in that state of aggravation, it starts affecting her too and she begins panicking, thinking that something is wrong. This can affect the birth process. That is why we encourage men to not only be present for the birth, but to also attend antenatal clinics with his wife as it is here that he can learn about labour and the birth process,” he says.