Debrah Lewis started noticing the gap between private and public health care in Trinidad and Tobago whenever she had to transfer a labouring mother to the hospital. The first thing that struck her was the look of anguish on the faces of the parents-to-be. “We have a concern about the condition of your baby,” she would gently explain. Barely had the word “hospital” come out of her mouth than the mother would whimper, “But I'll be all alone!” and the father would add, “And I won't be able to be there for the birth!”
Lewis, a midwife for thirty years, and a staunch advocate for parents and families, found the situation heartbreaking. In Trinidad and Tobago – as in many other Caribbean territories – fathers are routinely denied the right to witness the birth of their children. Lewis, largely through the Trinidad and Tobago Association of Midwives, has been lobbying for years to get the situation changed.
While changes have been coming, progress is slow and often random. The San Fernando General Hospital (the main health facility in the southern part of the island), still refuses to allow fathers into the delivery room. At the Sangre Grande hospital, which serves east Trinidad, fathers must sign a form agreeing to abide by certain regulations. In Port of Spain, the country's capital, the hospital has too many conditions to count and even if you satisfy all the requirements, including attending birth classes, there is no guarantee. Being allowed into the delivery room is often up to the whim and fancy of the medical staff, who often come up with excuses not to include the father. “We're too busy.” “We don't have time to deal with that.” “It's a ward situation.” “It's our decision.”
Lewis is arguing that it's not. One father actually called her crying in the middle of the night, begging her to intervene. He had jumped through all the hoops to ensure that he would be there when his child was born; when the time came, staff denied him access. Despite her contacts, Lewis couldn't change their minds. She finds the stance of the public health system towards this issue hypocritical. “This child is never going to be born again,” she explains. “But then people will turn around and complain that our society is deteriorating; that fathers do not maintain an active presence in the lives of their children. Yet, when that child first comes into this world, the fathers are not allowed to be there.”
As the Executive Director of the Mamatoto Resource & Birth Centre, a community-based childbirth centre founded in 2004 to help address the demand for family-centered pregnancy care, the contradiction must seem especially bizarre to Lewis. “I don't think most people realise that the discrepancy between public and private care is so wide,” she says. “They don't understand the large number of fathers who are not afforded the opportunity to see their child being born.”
At the end of November last year, Lewis gave a talk at TEDxPortofSpain. The theme was “Connecting” and many in the audience expected her to talk about the maternal connection. Instead, Lewis stood up for women by furthering the cause of the men in their lives. “I'm a feminist,” she says, “but feminism has often given men the short end of the stick. They get blamed for things we don't allow them to do. Men may have issues, but we're part of the problem. The middle of the spectrum is where we need to be, but we're at the other end.”
Regionally, policies are not based on current research or empirical evidence – and even when new guidelines exist, they are not implemented. For instance, the Mount Hope medical facility, which wanted to achieve baby-friendly status, has a much more modern policy, but it is not put into practice. Lewis maintains that there is an easy fix for the situation and that it lies in the hands of parents. “People have to demand it,” she says, “and when enough of us do, all the Ministry of Health has to do is make it a national policy. There's something called the Patient's Charter of Rights – once the right of fathers to be present at the birth of their children makes the list, the public hospitals will have to abide by it. They will no longer have an excuse.”
In anticipation of that day, Lewis has been focusing on educating the public. The Association of Midwives and Mamatoto speak anywhere they are invited: churches, schools, community centres. Their mission is simple: to educate people about their choices so that they can make informed decisions. “We just give people the information,” Lewis explains. “We don't try to influence them in any way.” When she goes into schools, it's more about increasing awareness as to what exactly midwives do, and she is always guided by the questions of students. But therein lies the root of the problem. “We've been told to shift the line of questioning if girls ask at what point in their menstrual cycles they can get pregnant. Members of Parent Teacher Associations have asked us to leave if we bring up the topic of safe sex. So why are we baffled, then, when faced with the levels of fear and ignorance when it comes to labour and childbirth? Let's all just talk about it.”
This month, Lewis, with the involvement of fathers’ groups (including the Single Fathers Association of Trinidad & Tobago), hopes to get the public to respond in greater numbers to change the bent of public hospitals on the issue. “More people need to say ‘no’,” she says, and she isn't just referring to the public health service. Many companies operating in Trinidad and Tobago – even multinationals – are not supportive of fathers. Most local firms will grant a new dad one day off work; foreign-owned entities are slightly more gracious, offering two to three days’ leave. Maternity leave conditions are not much better. While developed countries like Canada give new mothers an entire year off work, in Trinidad and Tobago, they still get three months – well, now fourteen weeks instead of twelve, thanks to the lobbying of the organisations Lewis represents – but the timing is still out of whack, considering the Ministry of Health wants to encourage breastfeeding for at least up to six months postpartum.
Sometimes the whole battle feels like a Herculean task to Lewis, but then she hears a first-time father say something like, “I have a son! They let me see him!” and she's inspired to keep on going. “That's so sad,” she says. “Imagine if that man had held his baby at the moment he was born? That moment begins each family's relationship – mother, father and child – regardless of whether the parents are married or not. It imprints a relationship with that child that is difficult to recreate. Men's protective instincts kick in; their role as provider comes to the fore and the development of their relationship with that child – and with the child's mother – begins in that moment.”
Check out PRI's The Ninth Month (#ninthmonth) series on maternal health around the world.