title: A meta-ethnographic synthesis of fathers' experiences of complicated births that are potentially traumatic.
abstract: BACKGROUND
  birth is a natural and for many, life enhancing phenomenon. In rare circumstances however birth can be accompanied with complications that may place the mother and infant at risk of severe trauma or death. Witnessing birth complications or obstetric emergencies can be distressing and potentially traumatic for the father.
  
  
  OBJECTIVE
  the aim of this paper is to report on the findings of a meta-ethnographic synthesis of father's experiences of complicated births that are potentially traumatic.
  
  
  METHODS
  databases searched included CINAHL, Scopus, PubMed and PsycINFO with Full Text. The search was conducted in February and March 2013 and revised in February 2015 for any new papers, and the search was limited to papers published in English, full text and peer-reviewed journals published between January 2000 to December 2013.
  
  
  METHODS
  studies were included if they focused on fathers/men's experiences of witnessing a birth with complications including a caesarean section or an adverse obstetric event. Studies included needed to use qualitative or mixed methods research designs with a substantial qualitative component. ANALYTIC STRATEGY: a meta-ethnographic approach was used using methods of reciprocal translation guided by the work of Noblit and Hare (1988) on meta-ethnographic techniques. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool.
  
  
  RESULTS
  eight qualitative studies with a total of 100 participants were included in the final sample. The men ranged in age from 19 to 50 years.
  
  
  RESULTS
  Four major themes were identified: 'the unfolding crisis', 'stripped of my role: powerless and helpless', 'craving information' and 'scarring the relationship'. Participants described the fear and anxiety they felt as well as having a sense of worthlessness and inadequacy. Men did not receive sufficient information about the unfolding events and subsequently this birth experience impacted on some men's interactions and relationships with their partners.
  
  
  CONCLUSIONS
  witnessing a complicated or unexpected adverse birth experience can be distressing for men and some may report symptoms of birth trauma. Being informed by and receiving support from midwives and other health professionals appears to help mitigate the negative impact of birth complications. Effective support may help address men's confusion about their role, however genuinely including men as recipients of care or service in pregnancy, labour and birth raises important questions about whether the father is also a recipient of maternity care and if the transition to fatherhood is itself becoming a medical event?
authors.affiliation: Western Sydney University, School of Nursing and Midwifery, Campbelltown Campus, building 7, G. 33, Locked Bag 1797 Penrith, NSW 2751, Australia. Electronic address: r.elmir@WesternSydney.edu.au.
authors.forename: Rakime
authors.initials: R
authors.lastname: Elmir
authors.affiliation: Western Sydney University, School of Nursing and Midwifery, Parramatta South Campus, building EB, LG, Locked Bag 1797 Penrith, NSW 2751, Australia. Electronic address: v.schmied@WesternSydney.edu.au.
authors.forename: Virginia
authors.initials: V
authors.lastname: Schmied
mesh_terms: D000328:Adult; D005220:Fathers / Q000523:psychology*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D008880:Midwifery; D007744:Obstetric Labor Complications / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D013315:Stress, Psychological; D013548:Sweden; D055815:Young Adult
keywords: Complicated birth; Experiences; Fathers; Maternity; Men; Meta-ethnographic; Traumatic birth