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Chapter 1: The Literature Review
Introduction
All operations involving the partial or complete removal of organs outside of a woman’s genitalia
for non-medical purposes are collectively referred to as female genital mutilation, or FGM. (Ali
et al., 2020, p1). There are four types of FGM, namely Type 1, 2, 3, and 4. Type 1 entails
removing the clitoral organs partially or in totality and the prepuce. Type 2 encompasses the
partial or total removal of the clitoral organs alongside the labia minora. It also may or may not
combine the removal of the labia majora (Nzinga et al., 2021, p. 750). Type 3, also called
infibulation, entails narrowing the vaginal opening by creating a covering seal formed through
the cutting and repositioning of the labia minora or majora. Sometimes, it is done through
stitching and may or may not include the removal of the clitoral prepuce. Type 4 FGM combines
the remaining harmful procedures to female genitals for non-medical reasons. These include
piercing, scraping, pricking, cautering, and incising the genital area (Nzinga et al., 2021, p. 751).
The FGM practice presents zero health benefits for affected girls and women. Instead, it results
in severe bleeding and urination issues. It also causes cysts, infections, and high infant
mortalities induced by complications during childbirth. This practice is recognized in Ireland and
internationally as a human rights violation against girls and women. FGM is usually practiced by
traditional practitioners on minors, violating children’s rights. Additionally, the practice violates
people’s rights to health, security, and physical integrity. Other violations include the right to be
free from torture and degrading treatment. Over 200 million girls and women living in the world
today have experienced FGM. At least 600,000 of these individuals live in Europe (Weny et al.,
2020, p.238). The most recent estimation reveals at least 3,170 women to be victims of FGM in
Ireland, highlighting the prevalence of the practice (Ahern-Flynn, 2023).
In Ireland, there has been a ratification of several international conventions against FGM. These
include UDHR, CEDAW, and the Convention against Torture (CAT), among many others.
FGM’s prevalence led to the establishment of a specific law seeking to suppress and eliminate
the practice from Ireland in 2012, named the Criminal Justice (Female Genital Mutilation) Act
2012. The law delegitimized the customary or ritual justifications for FGM while stipulating up
to 14 years in prison or a fine of EUR 10,000 for the sentence (European Institute for Gender
Equality, 2013).
Midwives’ Experiences
Midwifery includes the professional, knowledgeable and compassionate care of women who are
giving birth or have given birth, infants, as well to families during pre-pregnancy, pregnancy,
childbirth, postpartum, and the early weeks of life (Wood et al., 2021, p. 120). Midwives are a
crucial part of the treatment and care of FGM victims in Ireland and other parts of the world.
Exploring the experiences of midwives in providing care to women with FGM is crucial for
several reasons. Cultural sensitivity of the issue and competence reasons, peculiar health issues
caused by FGM communication-related aspects, implications on maternal health outcomes,
identification of gaps in training and resources used during curative sessions cultural as well
legal considerations were among such points that have been evaluated to understand its
significance for being contributing factor into broader sphere called cultural competence. The
exploration of midwife experiences will help enhance highly sensitive and respectful care to
FGM victims due to the key position that these practicing midwives occupy in maternal care as
well uniqueness related their innate abilities to deal with cultural relationships associated with
this practice. This could help design the special aspects of care required by these
victims. Considering the practices of midwives may assist in confronting communication
obstacles observed during treating victims at varying occasions, and enhancing relations between
patient-providers over time.
Midwives face a host of challenges in caring for women with FGM. Studies highlight a range of
issues that midwives encounter. These challenges include communicational barriers and cultural
sensitivities, impacts of maternal health outcomes and trainings as well as resources related to its
implementation. According to Turner and Tancred (2023, p. 799), a lack of consistent
identification or disclosure about FGM becomes an obstacle in providing the best healthcare for
women with this practice. The inadequate disclosure simply undermines the access and
continuity of care among women with FGM. The lack of proper information represents a major
challenge in midwives’ work as they primarily fail to carry out their roles well.
Midwives have to contend with many challenges in delivering care for women who undergo
FGM. The challenges are mainly in the practice of their job descriptions. Turkmani et al. (2019,
p. 3) state that practice issues midwives encounter includes having difficulties in establishing
rapport with the women and working through interpreters. Moreover, midwives often suffer from
misunderstanding women’s cultures. Some midwives cite their inexperience with associated
clinical procedures and knowledge deficits regarding different types of FGM and data collection
(Carroll et al., 2018, p. 29). Please discuss midwives’ emotional experiences and what they have
encounter in relation to fgm. Also discuss midwives feelings in relation to that. (400 words ish)
please try to make the text flow like the example I’ve sent you.
Midwives’ Knowledge
Gallen et al. (2019, p. 125) studied nurses and midwives’ perceptions of their preparedness for
quality improvement and patient safety in practice in a cross-sectional national study in Ireland.
This study was inspired by the limited knowledge, skills, and competence among Ireland’s
nurses and midwives, even with patient safety and quality being the pillars of healthcare practice.
Gallen et al. (2019, p. 126) undertook a cross-sectional survey of nurses and midwives across
Ireland in 2016. This survey focused on their perceptions regarding the knowledge and skills
they possessed in facilitating safety and quality in healthcare. Their views of competence were
evaluated with the help of Quality and Safety Education for Nurses (QSEN) framework domains.
This study involved a sample population of 654 practicing nurses and midwives based in acute
hospitals and community healthcare organizations under Continuing Professional Development
(CPD) education in 2016. The researchers distributed 1787 surveys, analyzing data with IBM’s
SPSS software. Gallen et al. (2019, p. 125) reported an overwhelming lack of confidence among
the participants despite their high academic training. The lack of confidence was evident in
quality and safety methods and tools alongside QSEN competencies. Moreover, nurses and
midwives on the frontline highlighted their insufficient preparations compared to mid and seniorlevel colleagues. The lack of nurse and midwife engagement in quality and safety practice was
also evident. The study by Gallen et al. (2019, p. 125-130) exhibits a set of strengths. The first
strength is its national scope, which increased the study’s generalizability. The inclusion of a
diverse set of participants further backs generalizability. These include nurses and midwives
from acute hospitals and community healthcare organizations. The study also utilizes an
established framework, QSEN) providing a solid basis of structure and standardization in
approaching and evaluating the study participants’ perceptions.
Carroll et al. (2018, p. 29) investigated the knowledge, confidence, skills, and practices among
midwives in the Republic of Ireland in relation to perinatal mental health care. The main
objective was to explore midwives’ competency levels. The study employed an exploratory,
descriptive study design. It involved 438 midwives from Ireland. Researchers collected data
through surveys across two months. Carroll et al. (2018, p. 29) found that despite many
midwives caring for women with perinatal mental health issues, they exhibited limited
depression and anxiety-related knowledge. Most midwives also lacked the necessary skills to
open discussions with women on sensitive issues. The highlighted issues included sexual abuse,
domestic violence, psychosis, or crucial information regarding their partners and families.
Therefore, most midwives avoided inquiries on sensitive issues in what was termed a selective
approach to screening for perinatal mental health problems. Carroll et al. (2018, p. 35) concluded
that these practices hampered the realization of the best healthcare outcomes for the patients. The
study exhibits several strengths and weaknesses. Strengths include the large sample size of 438
midwives. This sample size enhances the study findings’ generalizability and robustness. Can
you discuss it in relation to fgm. Also please find articles that discuss midwives experiences of
caring for women with fgm. There are few from Australia and discuss those and their knowledge
then bring up the gap
The anonymous, self-completed surveys also ensure that the study bases its findings on honest
responses, ensuring the validity of findings and minimizing bias. However, there is still potential
for response bias. Some participants may provide socially desirable responses despite the
anonymity of the surveys, highlighting one fundamental weakness of the study.
Butler et al. (2018, p. 165-175) study the competence of basic midwifery. The researchers looked
to set a consensus or universal point of agreement among experts in midwifery across the globe
on the essential competencies for the practice. The study employed a modified Delphi approach
that utilized a three-round online survey (Butler et al., 2018, p. 169). This study involved
educators, regulators, and midwifery leaders across ICM countries and regions, including
Ireland. Butler et al. (2018, p. 170) collaborated with a Core Working Group and a Task Force to
develop preliminary competencies and components through content analysis involving existing
competency documents. These competencies were presented to all participants in the first round
of the survey, where essential items identified by a minimum of 85% of the participants were
endorsed. New items were then combined with the remaining ones and evaluated in Rounds 2
and 3 of the survey process. Butler et al. (2018, p. 171) saw a minimal number of midwiferyrelated competencies endorsed as essential. Some competencies relating to midwifery practice
were rejected. These competencies revolved around abortion-related care, gynecology, cancer
screening, and infertility. This study exhibits several strengths and weaknesses. One key strength
is its global representation. By incorporating participants across the ICM regions and countries, it
enhanced the generalizability of the findings. The study also utilized a collaborative approach,
which facilitates not only ease in result generalizability but also complete inclusivity. The
applied modified Delphi method enables relatively easy analysis of the complex issue and
ensures objective thinking, enhancing the accuracy of the study findings. Despite its strengths,
the study’s weaknesses include a limited representation of competencies relating to midwifery
care and a potential bias in initial competency selection.
Gaps in training for midwives is another significant issue. Seymour (2021, p. 324) argues that
whereas practitioners like the Midwives are charged with facilitating communication to women
suffering FGM, they do not have any suggested training on how to contact those ladies. This
issue is mirrored by Gallen et al. (2019, p. 125). This study identifies participants’ low
confidence in their academic training on quality and safety methods along with QSEN
competencies. Gallen et al. (2019, p. 126) also point out that front line midwives are not
adequately prepared for duty. In addition, they lacked the ability to start conversations with their
patients effectively thus limiting them in terms of getting information on such issues that would
have contributed significantly towards improved healthcare outcomes (Carroll et al., 2018, p.
29). These notes outline the glaring weaknesses in training which undermine midwives’ ability to
fulfill their agenda of taking care women with FGM.
Impact on Women’s Care
Can you discuss the impact on woman as an assignment first maybe 250ish words first then
include the rest (you’ve already done it) and make it flow
Researching on midwives’ stories might enable revealing more unknown effects of FGM in the
domain of victims’ maternal health prognosis and contribute to developing high-quality
approaches for enhancing care. Along with these breakthroughs, the exploration could reveal
niche areas in midwife training and resources provision that can improve the quality of
care. Care for FGM also involves cultural practices and legal considerations that would have an
impact on midwives’ presentation of healthcare. Investigating their experiences, therefore, could
highlight some of these points and result in optimized healthcare for the victims.
Maternal care involving FGM-affected women is primarily the work of midwives. Their duties
range from prenatal to delivery rooms. Midwives play a very critical role in providing prenatal
care. This involves regular checks and monitoring of pregnant women throughout their
pregnancies (Turkmani, 2020, p. 3). This makes the mother and developing baby
healthier. Prenatal care is integral to building strong relationships as well as educating and
empowering people. Midwives also play a very important part in labor and delivery because they
offer emotional support, pain relief, as well advice on this difficult time for FGM victims. Gallen
et al. (2019, p. 130) state that their training is paramount in the early identification of likely
complications to be experienced by women who have been mutilated. Postpartum midwives
assist new mothers in breastfeeding, recovery and emotional wellness.
Cultural competence is essential in midwifery practice. To provide culturally competent practice,
midwives need to understand the woman-specific cultural needs and requirements primarily. To
ensure this, midwives should exhibit good personal communication skills to enable FGM victims
to identify what is important to them in relation to midwifery’s provision or care. Fairl et al.
(2021, p. 340) note that self-awareness, assessment and honesty are also the basics of culturally
competent maternal care. That is why the midwives have professional responsibilities to define
their role in culturally competent care of establishing and overcoming any inequality or bias.
A qualitative study on maternity care provision for women living with FGM was carried out by
Turner and Tancred (2023, p. 790) in the UK in an environment of high asylum-seeking
dispersal. The researchers set out to explore the perspectives of midwives and gynecologists or
obstetricians issuing care to FGM victims. The study took a qualitative approach, covering four
hospitals with maternal healthcare services. The researchers interviewed these participants and
then carried out a data analysis to theoretical saturation. Turner and Tancred (2023, p. 795)
unearthed a disconnect between the Home Office dispersal and healthcare policies. Moreover,
the participants highlighted an inconsistent identification or disclosure of FGM. This
phenomenon constrained the potential or appropriate follow-up and care needed before labor and
childbirth. The study also highlighted concerns among the participants. They acknowledged the
importance of the existing safeguarding policies and protocols in protecting female dependents.
However, the participants regarded these policies and protocols as potentially detrimental to their
relationships with people with FGM and to women’s care. Turner and Tancred (2023, p. 799)
also highlighted the unique challenges in facilitating access and maintenance of continuity of
care for women seeking asylum as a result of dispersal schemes. Lastly, the researchers noted
participant challenges revolving around the lack of specialized training to support clinically
appropriate and culturally sensitive care for women with FGM. Overall, the study revealed the
apparent need to harmonize health and social policy to facilitate a holistic approach to providing
care for women with FGM. The study is not without its strengths and weaknesses. The
researchers’ use of a qualitative approach allowed for the comprehension of participant
perspectives, enabling the study to achieve its objectives. The study also presents diversity in the
number of participants, thereby providing multidimensional insights into the study topic.
Thematic analysis further adds structure to the study findings, ensuring clarity in presentation.
Despite this, the study could face limited generalizability by focusing on a single geographical
area. This problem could be worsened by the small sample size of 13 participants, which may not
represent a more comprehensive view of the issues at hand.
Seymour (2021, p. 1) critically examined the postpartum care experiences that FGM-affected
women currently receive from the UK’s NHS services. The study utilized a focused ethnographic
(FE) approach to conceptualize the postpartum experiences and needs of FGM-affected women.
Utilizing a focused ethnographic approach facilitated a cultural conceptualization and
comprehension of occurrences. Moreover, the study’s three-phase approach facilitated a culturalbased view of women’s experiences through their pregnancy and postpartum journeys. One
crucial finding by Seymour (2021, p. 520) was that healthcare practitioners are tasked to ensure
communication with women with FGM. However, these practitioners, including midwives, do
not have any suggested specific training to accomplish the critical goal. This study’s strength lies
in its innovative focus. Innovation in focus is illustrated through the studies’ critical literature gap
of postpartum experiences of women with FGM in the UK using NHS services. The study
further exhibits methodological rigor through its FE approach, which enables researchers to
contextualize the postpartum experiences. This approach enables a thorough subject exploration.
However, the study suffers from the small sample size that limits the generalizability of results.
Gaps in Existing Research and Need for Further Investigation
These studies significantly contribute to the knowledge base of such matters as midwifery and
women with FGM. However, they leave a number of important research gaps that need to be
filled. The first gap is rather limited focus on FGM. Although some studies discuss aspects of
FGM, the literature reveals absence of clear focus on how Ireland midwives care for women with
FGM. This provides an opportunity for researching and addressing this knowledge gap. Another
important gap is between FGM and various aspects of perinatal mental health. Carroll et al
(2018, p. 31) study the knowledge, confidence, skills and practices of midwives in Ireland about
perinatal mental healthcare. Mental health is one of the basic aspects that informs women with
FGM during maternal care. Nevertheless, there is no specific mention of the special mental
health demands – for women in a state during pregnancy, childbirth and post-childbirth
associated with FGM necessitating its own study in this area.
Another evident research gap entails aspects of quality improvement and patient safety. Gallen et
al. (2019, p. 125) explore the perceptions of preparedness for quality improvement and patient
safety. While this study explores competency aspects of practitioners, including midwives, it
lacks the specificity of populations such as women with FGM. This presents a research gap in
the midwife’s experiences of improving quality and enhancing patient safety in issuing care to
women with FGM.
The literature review also reveals an existing gap in maternity care provision in Ireland. While
Turner and Tancred (2023, p. 791) studied maternity care provision for women with female
genital mutilation/cutting, they only focused on the UK. There is no study specific to Ireland
focusing on the republic’s midwives’ experiences in providing care for women with FGM. This
necessitates an Ireland-specific exploration of the subject. The literature review further highlights
a gap in Ireland’s postpartum experiences. Seymour (2021, p. 501) explored the current
postpartum experiences of women with FGM using the NHS service. However, a close
exploration of the literature reveals the lack of Ireland-specific study on the issue. Therefore,
there is a need to study the postpartum experiences of women with FGM in Ireland to fill the
gap.
Research Question
What are the challenges and insights gained from midwives’ experiences in providing care for
women with Female Genital Mutilation (FGM) in Ireland?
Study Aim
The study aims to explore the experiences of midwives in caring for women with FGM in
Ireland.
Objectives
The study seeks to fulfil the following objectives:
–
To examine midwives’ perspectives in caring for women with FGM in Ireland.
To identify challenges in providing care for women with FGM.
To assess the potential effects of FGM on maternal care.
Bibliography
Ahern-Flynn, E., 2023. Female genital mutilation and the healthcare professional in Ireland.
Ali, S., Patel, R., Armitage, A.J., Learner, H.I., Creighton, S.M. and Hodes, D., 2020. Female
genital mutilation (FGM) in UK children: a review of a dedicated paediatric service for
FGM. Archives of disease in childhood., pp. 1-4 https://doi.org/10.1136/archdischild-2019318336
Butler, M.M., Fullerton, J.T. and Aman, C., 2018. Competence for basic midwifery practice:
Updating the ICM essential competencies. Midwifery, 66, pp.168-175.
https://doi.org/10.1016/j.midw.2018.08.011
Carroll, M., Downes, C., Gill, A., Monahan, M., Nagle, U., Madden, D. and Higgins, A., 2018.
Knowledge, confidence, skills and practices among midwives in the republic of Ireland in
relation to perinatal mental health care: The mind mothers study. Midwifery, 64, pp.29-37.
https://doi.org/10.1016/j.midw.2018.05.006
European Institute for Gender Equality., 2013. Current situation of female genital mutilation in
Ireland.
https://eige.europa.eu/sites/default/files/documents/current_situation_and_trends_of_female_gen
ital_mutilation_in_ireland_en.pdf
Fair, F., Soltani, H., Raben, L., van Streun, Y., Sioti, E., Papadakaki, M., Burke, C., Watson, H.,
Jokinen, M., Shaw, E. and Triantafyllou, E., 2021. Midwives’ experiences of cultural competency
training and providing perinatal care for migrant women a mixed methods study: Operational
Refugee and Migrant Maternal Approach (ORAMMA) project. BMC pregnancy and
childbirth, 21(1), p.340. https://doi.org/10.1186/s12884-021-03799-1
Gallen, A., Kodate, N. and Casey, D., 2019. How do nurses and midwives perceive their
preparedness for quality improvement and patient safety in practice? A cross-sectional national
study in Ireland. Nurse Education Today, 76, pp.125-130.
https://doi.org/10.1016/j.nedt.2019.01.025
Nzinga, A.M., De Andrade Castanheira, S., Hermann, J., Feipel, V., Kipula, A.J. and Bertuit, J.,
2021. Consequences of Female Genital Mutilation on Women’s Sexual Health–Systematic
Review and Meta-Analysis. The Journal of sexual medicine, 18(4), pp.750-760.
https://doi.org/10.1016/j.jsxm.2021.01.173
Seymour, R.J., 2021. A Critical Analysis of the Current Postpartum Care Experiences of Women
with FGM Using NHS Services in the UK (Doctoral dissertation, Coventry University)., pp. 1543. https://pure.coventry.ac.uk/ws/portalfiles/portal/44245350/Seymour2021.pdf
Turkmani, S., 2020. The maternity care experiences and needs of migrant women with female
genital mutilation living in Australia (Doctoral dissertation).
https://opus.lib.uts.edu.au/handle/10453/140567
Turkmani, S., Homer, C.S. and Dawson, A., 2019. Maternity care experiences and health needs
of migrant women from female genital mutilation–practicing countries in high‐income contexts:
A systematic review and meta‐synthesis. Birth, 46(1), pp.3-14. https://doi.org/10.1111/birt.12367
Turner, J. and Tancred, T., 2023. Maternity care provision for women living with female genital
mutilation/cutting: A qualitative study from a high asylum‐seeking dispersal context in the
UK. The International Journal of Health Planning and Management, 38(3), pp.790-804.
https://doi.org/10.1002/hpm.3625
Weny, K., Silva, R., Snow, R., Legesse, B. and Diop, N., 2020. Towards the elimination of FGM
by 2030: A statistical assessment. Plos one, 15(10), p.e0238-782.
https://doi.org/10.1371/journal.pone.0238782
Wood, R., Richens, Y. and Lavender, T., 2021. The experiences and psychological outcomes for
pregnant women who have had FGM: A systematic review. Sexual & Reproductive
Healthcare, 29, p.100-639. https://doi.org/10.1016/j.srhc.2021.100639
Broad Guidelines for Research Proposal
1. Pick a topic that you have a genuine interest in!
2. Be VERY CLEAR and SPECIFIC about WHAT it is you want to research and amongst WHOM you want to
conduct the research – form a question – i.e – What is lived experience of breastfeeding twins for first time
mothers?/How many first time mothers of twins choose to breastfeed in Ireland/Co. Louth/Lenister
3. It should be clear, once you have chosen your question, which research paradigm will be best suited –i.e
positivist/quantitative or interpretivist/qualitative – you must be clear about this as it will be expected that
you will write at least a paragraph on paradigm choice in your proposal
4. Once your paradigmatic approach is clear you should then decide on research methodology e.g.
phenomenology etc. (qual) or descriptive survey (quant)
5. When you decide on methodology you must decide on data collection method e.g semi structured interview
(qual) / survey questionnaire (quant)
6. All decisions must be justified and detailed in your proposal
7. Literature review:
a. Detail your search strategy – what databases? Why? From when?
b. You would need to include a link paragraph detailing the THEMES to be discussed in your literature
review
c. There must be clear evidence throughout the literature review of how you are linking the literature to
YOUR study – this is the purpose of a literature review – to look at existing knowledge and detail WHY
your research study is required / will add to this
d. When critiquing the literature in your review be explicit about what type of study was undertaken –
quant/qual and what data collection method / sample size /relevance to your study etc. etc. – critique,
critique, critique!!!
e. Avoid sentiment and bias in your writing. Be careful with your writing style and attempt to be objective
in your reporting of the literature.
f. Avoid unsupported statements –references are required throughout (Harvard style) – please do this as
unsupported statements hold negligible value
g. Please avoid using ‘I’ in your proposal – this is an academic piece of work and normal academic
conventions should apply – the use of the term ‘the author’ should replace ‘I’ throughout.
These are the dates for review of work:
Chapter 1 Literature review Chapter 2 Methodology Final Draft March TBD – review for completion only
I will review one draft of each of these documents – I will work on the assumption that any feedback given will be
incorporated into the final piece of work. Therefore, it is entirely in your hands how effective I can be for you – if you
give me completed drafts I will review complete drafts –I will not review drafts after the dates above.
Summary:
Be very clear about WHAT you want to study – be specific
Be very clear about WHO you want to study – who is your population? How will you reach them? Where is your
population frame?
Be very clear about WHERE your study will take place – location location location!
Be very clear about WHY you want to do your study – personal and professional and research justification
“What are Birth Partners Experiences of Support from Midwives During Traumatic
Childbirth in Ireland?”
Introduction Although the presence of male partners during childbirth is a relatively new
phenomenon in the last 60 years, there has been ample research on the benefits their
presence can have. Two Cochrane reviews have highlighted their role in a positive birth
experience as a trusted companion, potentially reducing caesarean section rates, the use of
pharmacological pain relief and increasing birth satisfaction (Bohren et al. 2017; Bohren et al.
2019). The benefits for partners include increased infant bonding, a deepened appreciation
for their partner and a sense of belonging (Longworth et al. 2021). This relatively new
‘family-orientated’ childbirth introduces the partner as a ‘new person’ the midwifery team
also cares for. This increases the need for further research into their experiences regarding
the influence of midwifery care in which awareness and sensitivity of the partner’s needs are
addressed. Vischer et al (2020) demonstrate that male partners are the most prevalent birth
companion with over 90% attending births. For this reason, the focus of this literature review
will be father’s experience of traumatic childbirth. It is difficult to find a definition of
‘traumatic childbirth’ that does not focus on the experiences of women. Greenfield et al.
(2016) reviewed literature defining birth trauma and created one inclusive definition that will
be used. “Traumatic birth’ is a concept … used to describe a series of related experiences of,
and negative psychological responses to childbirth. Physical trauma in the form of injury to
the baby or mother may be involved but is not a necessary condition” (p. 265). Literature
included in this review examined birth trauma through unanticipated modifications to the
birth plan, emergency caesarean sections and insufficient staff care. While there is preexisting literature discussing father’s experience of childbirth reporting positive emotions
(Sweeney and O’Connell, 2015; Jouhki et al. 2015) fewer examine solely their experiences of
birth trauma, with no such Irish research available. A detailed discussion on the research
databases and search terms used to undertake this literature review are outlined in Appendix
A. 9 The aim of this literature review is to examine pre-existing research surrounding father’s
experience of traumatic childbirths. Several key themes were highlighted; ‘The Rollercoaster’
describing the prevalent variation of emotions reported by fathers, ‘What About Me?’
describing the influence midwives had on their perception of the events and ‘Life After
Trauma’, discussing the longer lasting impacts of experiencing a traumatic childbirth for
fathers. The Rollercoaster In literature surrounding fathers experience of traumatic
childbirth, the ‘rollercoaster’ describes the uncertainty and change of events, bringing about
intense feelings of helplessness and profound fear, anxiety, and horror, with no sense of
euphoria (Etheridge and Slade 2017). Other words used to describe experiences in this study
included “catastrophe”, “traumatic”, “TV drama”, “terrifying” and “utter helplessness”.
Findings from UK studies by Inglis et al. (2016) and Steen et al. (2012) on paternal mental
health following traumatic childbirth indicated that fathers had an idealised version of
childbirth, reporting a lack of knowledge surrounding the true events of labour, unaware of
the potential risks. This left them feeling unprepared and aware of the strain on their
presumed gender role. Participants detailed how increased antenatal education may have
better prepared them, however, studies by Hughes et al. (2020) and Longworth and Kingdon
(2010) dispute this. Fathers in these studies who had taken part in antenatal education
classes or had previously attended a birth admitted their pre-existing knowledge did not
positively impact their reactions to traumatic childbirth. The usefulness of antenatal
education is also questioned in a UK qualitative study by Longworth et al (2021), detailing
how fathers who attended antenatal classes still struggled with understanding their desired
roles during labour, and felt unprepared during adverse events. Participants of this study felt
classes were mainly focused on women and found this a barrier in asking questions and
influenced their feelings of being a peripheral observer during labour. However, a syst