|Year : 2014 | Volume
| Issue : 1 | Page : 43-47
Couvade syndrome among 1 st time expectant fathers
Department of OBG Nursing, The Oxford Educational Institution, Hongasandra, Bengaluru, Karnataka, India
|Date of Web Publication||15-Mar-2014|
No. 305, Ganesh Nivas, VI Cross Arakarae, Mico-Lay out, Bengaluru - 560 076, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Couvade syndrome reflects physiological changes in men in preparation for fatherhood. Objective: The objective of this study is to analyze the frequency of Couvade symptoms among1st time expectant fathers and their associations with socio-demographic factors. Materials and Methods: An exploratory study was conducted in three Private Maternity Hospitals, Bangalore. A total of 123 low risk 1 st time expectant fathers attending the antenatal clinic along with their low risk term primigravidae at 36-40 weeks of gestation were selected by purposive sampling. Each one of the 1 st time expectant fathers were interviewed on a four points ordinal scale for measurement of Couvade syndrome which included 29 symptoms. Results: The results revealed that 1 st time expectant fathers experienced Couvade syndrome related to physical symptoms - (changes in appetite, flatulence, constipation, indigestion, fatigue, nausea, vomiting, food cravings, diarrhea, abdominal pain, headache, fainting, tooth ache, weight loss, weight gain, back pain, leg cramps, skin problems) and psychological symptoms (insomnia, mood swings, irritability, feeling close to tears, night mares, feeling lonely, helpless, guilty, fear of being alone, resentful and not interested in usual activities). Socio-demographic characteristics were not associated with Couvade syndrome. Conclusions: Health-care providers should anticipate needs and problems of expectant fathers and assist them in working through the challenging aspects of fatherhood.
Keywords: 1 st time expectant father, Couvade syndrome, pregnancy
|How to cite this article:|
Ganapathy T. Couvade syndrome among 1 st time expectant fathers. Muller J Med Sci Res 2014;5:43-7
| Introduction|| |
Pregnancy and the transition to parenthood is a major developmental period with important implications for parents, for the infant-parent relationship and the infant's development. The transition to parenthood differs in times and ways between father and mother.  The transition towards fatherhood is not without a distress, since this is a moment of major changes and pressures on the father figure. The father must at one and the same time be capable of acting as a support, the "container" of his partner and the child, of ensuring the economic stability of the family in formation and adapting to a change in habits and life-style. 
In Indian culture, the pregnancy and childbirth have traditionally been considered as women's business and the woman, by tradition receives all the attention during pregnancy. There is a concern for the expectant mother's physical, mental health and total well-being throughout the pregnancy, from the health services, family and the others, whereas little attention and inadequate concern are shown on 1 st time expectant fathers well-being. Men obviously experience pregnancy, labor and early parenthood quite differently from women. In response, expectant men may develop somatic symptoms. However, within the literature it is often mistakenly implied that the concerns and emotions of expectant men and women are synonymous. Women usually start getting ready for parenthood during pregnancy, but many men don't start this process until after the birth. As a result, the reality of fatherhood can be quite a shock.
The form that is probably the most frequent and "benign" in expressing the distress experienced by the man is the "Couvade syndrome." Couvade is a term first coined by anthropologist Edward Burnett Tylor in 1865 to describe the child expectancy habits that he had observed among primitive communities. The habit consisted of the man co-participating in and imitating labor pains, where he imitated the behaviors of the pregnant woman, withdrew from the work of his tribe, ceased his everyday responsibilities involving physical work or avoided sexual activity. The ritual also involved imitating the behaviors of a woman giving birth (such as staying in bed and crying loudly). The woman handed a newborn baby over to her husband and he put it to his own breast, trying to emulate breastfeeding. The aim of such rites was to protect the baby and the mother against the powers of evil but also to make it possible for the man to establish a supernatural bond with the baby. As Couvade habits were practiced in a similar way in different cultures on different continents, it was assumed that this was a universal form of behavior. 
The term "Couvade" is borrowed from French (where it is derived from the verb cover "to brood, hatch"); the use in the modern sense derives from a misunderstanding of an earlier idiom faire la Couvade, which meant "to sit doing nothing." Various explanations have been advanced for this curious, still poorly understood phenomenon: Medical, such as the increase in the secretion of cortisol and other hormones that mime the behavior of the female body at a lower level and psychological, such as anxiety, identification with the fetus, jealousy towards the woman or the fetus itself.  In any case, the phenomenon appears to be far more frequent than is imagined.
Despite much speculation as to the relationship between paternal transition and the syndrome there is also a notable scarcity of studies here in India. It is often assumed that the physical and psychological effects of pregnancy are only experienced by women, a concept that is reflected in the bulk of literature addressing this theme. However, pregnancy also affects male partners in ways that relate to their physiological and psychological constitution, a concept of potential importance in reproductive health.
Klein states that pregnancy constitutes one of the most cataclysmic periods for the expectant man. Men usually accept pregnancy without any concomitant physical changes to reinforce its reality. In such instances some men may experience higher than normal levels of physical symptoms during their partners' pregnancy. Impending fatherhood is one of the most crucial phases in human life  and men are not as likely as women to compare and share feelings and symptoms with other expectant fathers and a man experiencing morning sickness during his wife's pregnancy may think he is the only one to have such signs. He may also be too embarrassed to mention his problems.
Some male partners may have no insight concerning the association between the syndrome and pregnancy. It is imperative that the relationship between both is made explicit in antenatal consultations. It is also important to raise awareness and provide greater educational input to 1 st time expectant fathers about the syndrome and its transient nature. The debilitating and distressing nature of Couvades symptoms may deteriorate the quality of support men offer to their gestational partners with adverse health consequences. With information about possible Couvade symptoms, he may feel more comfortable voicing his concerns and getting his needs met. With this in mind the present study is interested to explore the frequency of Couvade syndrome among 1 st time expectant fathers to provide relevant care, information and advice during that period of transition to get through the more challenging aspects of fatherhood.
| Materials and Methods|| |
The study was conducted from January to April 2013 at three Private Maternity Hospitals, Bangalore, Karnataka. Researcher identified all low risk term primigravidae who were between 19 and 35-year-old, who were attending the antenatal clinic regularly in three private maternity hospitals during the last trimester of pregnancy around 36-40 weeks of gestation accompanied by their partner during their visits. Purposive sampling was undertaken to include the 1 st time expectant fathers.
All gave their written informed consent, after receiving oral and written information by the researcher. Inclusion criteria were 1 st time expectant fathers with no personal or family history of mental health issues, a lack of practical and emotional support, relationship difficulties, stressful events in life (recent loss of a loved one, loss of a job, moving house), past and present obstetric complications, including fertility problems and medical complications for them and their wives during the pregnancy. Having experienced or noted minimum of three symptoms in them during their partner's pregnancy was used as the criterion to define the presence of the Couvade syndrome.
Exclusion criteria included 1 st time expectant fathers with polygamilal relationship, age above 35 years, unplanned and unwanted pregnancy.
The study protocol was approved by the Ethical Committee of the Hospitals. Before the interview, the researcher discussed the study, assured confidentiality and ensured that the men understood that they could withdraw from the study at any time with no adverse effects on the care that their wives would receive. She also asked permission to record the interview and a consent form was signed.
The researcher interviewed each one of the 1 st time expectant father between January and April 2013, during the last trimester of their wives pregnancy who were around 36-40 weeks of gestation and who came for regular antenatal checkup. Details about the 1 st time expectant fathers and their wives history, socio-demographic factors were recorded. Each one of the 1 st time expectant fathers were individually interviewed approximately 40-45 min during which questions on 29 different symptoms selected from the literature as indicative of the Couvade syndrome related to physical symptoms (n = 18) - (nausea, vomiting, changes in appetite, flatulence, constipation, indigestion, food cravings, diarrhea, tooth ache, weight loss, weight gain, back pain, leg cramps, fainting, head ache, abdominal pain, fatigue, skin problems), psychological symptoms (n = 11) - (mood swings, irritability, insomnia, nightmares, feeling close to tears, helpless/worthless, feeling lonely, feeling guilty, fear of being alone, not interested in usual activities, resentful) were asked and rated on a four points ordinal scale (1 = Not at all experienced/noted, 2 = To some extent experienced/noted, 3 = Lot more experienced/noted, 4 = Very much experienced/noted). The tool had a high degree of reliability: Cronbach's alpha = 0.89 and statistical analysis were done by IBM SPSS Modeler version 15.
| Results|| |
Total of n = 123 1 st time expectant fathers whose low risk wives between 36 and 40 weeks of gestation attending antenatal clinic were selected for the study. Among them 5 (4.1%) voluntarily withdrew from the study after answering minimum of three to five symptoms. Among the rest of the total participants n = 118, 27 of them n = 27 (22.8%) reported that they neither experienced nor noted any symptoms of Couvade syndrome in themselves. The results revealed that the participants mean age were 28.3 years, all of them (100%) were literates, 61.3% had a university education; nearly 30.4% had technical education and 8.3% had allied health professional education. Regarding socio-economic class 71.3% belonged to upper middle class and 28.7% were from average middle class. Regarding occupation 43% had self-employment; 39% were government employee and 18% were private employee. Twenty three first time (25.27%) expectant fathers modified their smoking and alcohol consumption habits. Seven fathers (6.59%) completely stopped smoking for the sake of baby and none stopped their drinking habits, but reduced the frequency and amount of alcohol consumed and stated the reason as sleep disturbances and unknown fear about their future role.
Nineteen expectant fathers (20.88%) reported that they experienced three to nine symptoms. Thirty seven (40.66%) had reported 10 to 18 symptoms and 35 (38.46%) reported more than 19 symptoms. Among the physical symptoms of interest, most of them (89.56%) reported flatulence, 82.69% changes in appetite, 81.86% having constipation, 78.51% having indigestion, 76.92% reported fatigue and 68.68% had headache. The least reported physical symptoms were leg cramps 39.01%, tooth ache 38.46% and skin problems among 34.11%.
The highest reported psychological symptoms was insomnia (90.11%), mood swings (83.52%), irritability (66.44%), night mares (57.14%), not interested in usual activities (52.19%) and feeling close to tears (51.37%). The least reported psychological symptoms were feeling guilty (39.84%), being resentful (39.01%) and fear of being alone (32.42%) [Table 1].
|Table 1: Mean percentage of Couvade symptoms among 1st time expectant fathers N = 91|
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Among the participants 29% had sought medical advice for their physical symptoms and 15% had an Ayurvedic treatment, 13% took some home remedies, 43% ignored the symptoms by a few simple lifestyle and diet changes and modifying their smoking and alcohol consumption habits.
| Discussion|| |
Frequency of the Couvade Syndrome
Findings of the research on the frequency of the Couvade symptoms indicated that most men had experienced a minimum of three to a maximum of 29 symptoms during their partner's pregnancy period. However, it is important to highlight the fact that 27 of them (22.8%) reported that they neither experienced nor noted any symptoms of Couvade syndrome in themselves. This could be due to a culturally preferred gender role, macho attitude of men in Indian culture, where they are expected to hide their emotions, symptoms of the syndrome that would indicate their weakness.
Supportive findings were reported by Thomas and Upton who conducted a questionnaire and attitude scale survey among 141 expectant fathers in UK reported that a significant proportion of expectant fathers not reported symptoms of Couvade during their wives pregnancy as they felt embarrassed to report the symptoms. The study suggests that it would be beneficial for health-care professionals to recognize the needs of the father-to-be in a more holistic manner to gain a better understanding of men's psychological response to pregnancy in their partners.  This provides a good rationale for further investigating the explanatory factors that might account for their reluctancy to report such symptoms.
The participants were homogenous with regards to their age, education and income as analyzed by Chi-square/Fisher's exact probability test, which indicated that there is no correlation between socio-demographic factors and the incidence of Couvade syndrome.
Similar findings were reported by Patricia among 31 sample of the partners of women who gave birth between July 15 and July 29, 1987, at the Arthabaska, France reported that level of education, income and socio-economic status had no relationship with the occurrence of Couvade symptoms.  Studies on a larger sample size with different age, education, occupation and hospital setting may be needed to find out the reasons for these insignificant association.
The present study findings indicated that most of the 1 st time expectant fathers experienced both physical and psychological symptoms. The most commonly reported physical symptoms were related to gastrointestinal disturbances such as changes in appetite either increased or decreased or with some participants experiencing both alternatively, constipation, flatulence, indigestion, nausea, diarrhea and abdominal pain in varying degrees and duration. Men reported that their physical symptoms coincided with their partners pregnancy symptoms and perceived that their dietary patterns, worries, concerns about the pregnancy could be the influencing factor. However, 29% of them sought medical advice, subjected to multitude of investigations with neither definitive diagnosis nor underlying pathology found.
In contrast to physical symptoms, psychological ones were less common and included insomnia, mood, irritability and night mares. Men described their insomnia as difficulty in getting off to sleep coupled with nocturnal restlessness and short intermittent sleep. Insomnia appeared to be linked to other symptoms such as tiredness and lethargy or pregnancy-related worries and demands. While participants did not consult for psychological symptoms they still tried to make sense of them which they perceived as arising from the financial, physical and emotional demands of pregnancy as well as concerns about the health of their partner and unborn baby during gestation. Other participants perceived that psychological symptoms occurred because of physical ones and seemed preoccupied with their impact on general health. Consistent findings were reported by Khanobdee et al. who investigated the incidence and duration of the syndrome among a purposive sample of 172 Thai men throughout pregnancy. The results revealed that most men experienced appetite loss, increase of appetite, toothache, constipation, weight gain, nausea and vomiting and psychological symptoms included mixed feelings of sadness and happiness, poor concentration, anxiety and increased sleep. 
| Implications for Practice|| |
Pregnancy is a crucial period for fathers-to-be as well as their mates, a time when physical symptoms may occur as an expression of deep psychological stress as they anticipate the births of their children.  Whether Couvade syndrome is a physical or psychological in origin, the best way to help men to overcome is to firstly understand that it really does exist and it is simply a basic human reactions to the partner's pregnancy.
Although men may not talk about it much, these symptoms are not uncommon and the manifestation of the condition may vary widely from simple to more complex form. In general little attention is given to expectant fathers and inadequate concern is shown for relieving their anxieties and physical symptoms. When caring for childbearing families, it is important that health professionals focus on the physical and psychological well-being of expectant fathers. After assessing fathers' needs, health-care providers should suggest interventions to promote holistic health.
Jordan names the struggle of prospective fatherhood as ''laboring for relevance.'' This involves incorporating the paternal role into the man's identity. Expectant men have to come to terms with a changed sense of self during this period of on-going transition. In some instances the developmental process remains incomplete, so that not all men achieve actualization as involved fathers. 
Armed with an understanding of the variety of responses normally experienced by men during their partners' pregnancies, health professionals will be better able to provide education and support necessary for fathers to work through this challenging growth process and to make a real contribution to the health and well-being of new fathers and their families.
| Limitations of the Study|| |
- The study findings have a limited ability to generalize the findings to expectant parents with any medical, surgical and obstetric risk factors complicating pregnancy.
- The study lacks the correlations between the manifestation of Couvade symptoms of 1 st time expectant men with their gestational partners symptoms.
| Conclusion|| |
Impending fatherhood is one of the most crucial phases in human life and Couvade syndrome is a reactive response to the developmental crisis of pregnancy.  Men feel uncertain about the future in their new role as a father and are afraid of the family man responsibility, in particular for the baby. Fathers simply need the rite of Couvade and support after childbirth.  Midwives should communicate with 1 st time expectant fathers effectively by providing supportive interventions which address the intensity of the expectant man's distress, not merely the nature of his symptoms to boost their sense of confidence as a father to have a beneficial influence on the manner of infant care at home and to redefine the father's role in a more unambiguous way.
Expectant fathers genuinely struggle with the need to balance their own transition to fatherhood and that of their partner. Their status and feelings are sometimes overlooked and may cause conflict with their other roles. It may take time for fathers to adapt to their new role and they may need access to support and advice. Maternity care staff can offer valuable support and encouragement to 1 st time expectant men which will help them with their new role and responsibilities to adjust to fatherhood.
| References|| |
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