Couvade Syndrome and Health Status of The First Trimester of Primigravida

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Advances in Health Sciences Research (AHSR), volume 2

Health Science International Conference (HSIC 2017)

Couvade Syndrome and Health Status of The


First Trimester of Primigravida
Tutu April Ariani

Departement of Nursing, Faculty of Health Sciences, University of Muhammadiyah Malang,


Indonesia
Jalan Bendungan Sutami 188A, Kota Malang, 65145
Corresponding author: tutuapril11@gmail.com, tutuaprilariani@umm.ac.id

ABSTRACT

Background: The Couvade Syndrome refers to physichal symptoms of varying intensity and
severity experienced by expectant father. Many husbands who experience physical symptoms
during pregnancy of the partner. This situation sometimes referred as Couvade Syndrome
(Fathering). Anxiety of the husband when facingprimigravida wife in the first trimester with emesis
gravidarum varies greatly from mild anxiety to panic. Objective: The aim was to determine the
relationship between Couvade Syndromeof the husband and the incident of emesis gravidarumin
primigravida wife in the first trimester. Method: This study used cross sectional approach. Data
collection of Couvade Syndrome by measuring the anxiety level of husbands was using DASS
questionnaires, while emesis gravidarum used a questionnaire based on the frequency of
occurrence. Data was analyzed using the Spearman Rank analysis (significant level of α = 0.05, p-
value <α) using a significant level. Result: Based on cross-tabulation between the occurrence of
emesis gravidarum with husband anxiety level indicates the incidence of emesis gravidarum in
moderate and severe level as many as 10 people (41.7%) and the most dominant anxiety level of
the husband that was moderate anxiety levels as many as 7 people (29.2%). Result of Spearman
Ranktest concluded that ρ value = 0.03> α = 0.05 (5%). Conclusion: Husband anxiety when
facing his wife with emesis gravidarum vary from no anxiety to panic, in this study the respond of
husband anxiety when facing his wife with emesis gravidarum is in the moderate level.
Keywords: Couvade Syndrome, Husband Anxiety Levels, The Incidence Of Emesis Gravidarum.

INTRODUCTION

In last decade, interest in fatherhood has increased. It is known that pregnancy can
have a profound physical, psychological and social impact on the expectant father. The
Couvade Syndrome refers to physichal symptoms of varying intensity and severity
experienced by expectant father. The Father has a new emerging role in pregnancy and
childbirth. The male can be affected by the pregnancy although he undergoes a series of
emotional and physical changes througtout the pregnancy. The progress and outcome of
the pregnancy are not dependent on his presence and fatherhood is essentially a social
invention (Dixon, 1978; Tudiver, 1981). In addition, resesarch result by Laplante (1991) is
the pregnancy produced slight changes in the social and family activities of many of the
fathers. A deterioration in their relationship with their spouse reported almost 33%,
generaly showed to increased sensitivity. Although 10 % noted an improvement.

Copyright © 2017, the Authors. Published by Atlantis Press. 105


This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).
Advances in Health Sciences Research (AHSR), volume 2

When the wife suffered distress in pregnancy will affect the husband, because the
husband is the closest person to his wife. During the pregnancy, wife requires more
attention from the husband. The husband must help and assist pregnant wife infacing the
complaints of pregancyin order that wife does not feel alone because continuing wife
anxiety cause decreased appetite, physical weakness,and excessive nausea and vomiting.
When doing antenatal care (first trimester) pregnant women want to complain the
dizziness, excessive sweating, aches, and sometimes the husband missesthe moment when
wife is doing an antenatal medical examination at the hospital (Sawitri & Sudaryanto,
2008).
Anxiety of the husbandin facing primigravida wife in the first trimester withemesis
gravidarum (nausea and vomiting) can be caused by lack of knowledge or information
about emesis gravidarum, feel anxious when his wife nausea and vomiting is sustained
(Sawitri & Sudaryanto, 2008).
Continuous husband anxiety will have an impact on his wife, this can happen
because the husband was too busy thinking about something bad will happen to his wife if
nausea and vomiting constantly, so that the husband does not care about wife's pregnancy
complaints other than nausea and vomiting. Danger will happen to the wife if the husband
experiencing excessive anxiety, the wife likely will also experience anxiety even to stress
(Octaviadon, 2011).
Many husbands experience physical symptoms during pregnancy of the partner.
This situation is sometimes referred to as Couvade Syndrome (Fathering). In the study of
Arthur Brenan (2010) in Australia about the incident of Couvade Syndrome in Australia
that the shown symptoms include, weight gain, bloating nausea, vomiting, backache,
toothache, loss of appetite, or abdominal cramps, headache, irritability, malaise and leg
cramps are reported by future fathers too. Spouse restlessnessduring pregnancy is
symptoms that reflect sympathy and identification with the pregnant woman, or perhaps
reflecting worries and anxiety (Tudiver, 1981; Sponer, 1988; Ziegler et al, 2006; Brenann
et al, 2007; Kazmierzak et al, 2013). Sympathetic pregnancy symptoms in men are referred
to as 'couvade' indicating that men share some oftheir mate's pregnancy symptoms (Ziegler
et al, 2006).
Couvade Syndrome is the best examined from the anthropology perpsective.
Murphy (1992) writes about two types of the Couvade phenomenon: the ritual and modern.
The ritual form was practiced early as the Greece ancient, and still found among so-called
primitive societeies. The modern type refers to pregnancy-like symptoms which are
observed amongst the partners of pregnant women. Munroe et al (1973), Broude (1988)
distinguish two forms of the Couvade Syndrome, namely:1) classical or extreme and 2)
magio-religius. In the classic form, the father enacts a childbirth sc ene, imitating
symptoms experienced by the mother, also in labour. Munroe et al also found in their
cross-sectional studies, the most frequenly observed form is the magio-religious one,
which is assosiated with a spesific of prohitions for male behaviour such as a ban on
hunting or eating specific foods. At the same time, on an unconsious level, the man is to go
back to an identification with woman.
Nausea and vomiting is a common thing experienced by women in early pregnancy.
Pregnant women experience nausea and vomiting (retching) and termed withEmesis
gravidarum mostly in the first trimester, between 6 and 12 weeks, but it can continue until
20 weeks and lasts settle after this time in more than 20% of women ( Matthews, et
al ,2014; Mendoza and Amsler, 2017).

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Advances in Health Sciences Research (AHSR), volume 2

Vomiting with more than ten times daily or continuous nausea which occurred
during the last 20 weeks of pregnancy will continue to be hyperemesis gravidarum so the
mother's body becomes weak, pale face, and frequency of urination decreased dramatically.
Nausea and excessive vomiting also causes decreased body fluid and
hemoconcentrationthat slows blood circulation so that it can affect fetal development. The
first trimester is the phase of fetal organs formed (Hidayati, 2009).
Besides maternal physiological adaptations,various psychological stimulus can also
be an emotional factor that causes the symptoms of nausea and vomiting became worse.
Type of psychological stimulus in pregnant women is emotional distress. Psychological
stress condition that can occur due to lack of support from her husband, causing mothers at
first to adapt to the increase in hormones do not experience nausea and vomiting will
experience these events.
Support can be given by the husband is give calm to the mother, accompanyto
antenatal care, meet the desires for cravings, reminding to eat iron tablets, help in
performing household activities and give a light massage when mothers feel tired, little
things that the husband’s do have meaning in improve the psychological health of a better
direction. The support given by the husband is expected to help mothers pass the
pregnancy by feeling good and without depression. The husband must continue to provide
support to the wife in the pregnancy even though the husband is also sometimes
experience physical symptoms during pregnancy of wife (Jhaquin, 2010).
Preliminary studies were conducted on October 6, 2015, in the area of Public health
care of Singosari. By conducting interviews with the clinic, obtained that woman who
experience nausea and vomiting usually were not recorded in the check out book, the clinic
also just taking care of the pregnant women with hyperemesis gravidarum only. According
to the results of interviews with six husbands when doing antenatal care at Singosari health
center, showed that 4 of 6 husband felt anxious while she was experiencing nausea and
vomiting, and while the two husbands states that did not experience anxiety because it is
considered the norm in the early pregnancy if experiencing nausea and vomiting. While on
4 husband when asked about the treatment of nausea and vomiting of his wife when the
husband replied by giving food so the stomach does not empty and buy his wife's favorite
food. In 2 other husbands husband actually told his wife to sleep and do activities in order
the nausea and vomiting are not felt again. It can be concluded that the husband will also
feel anxiety when wives who experienced emesis gravidarum in the first pregnancy.
Based on data from the above background that researchers are interested to see
whether the husband feel anxiety of the wife when experiencing nausea and vomiting
(emesis gravidarum). If the view of the characteristics of the wife in a very excessive
vomiting cause the husband may feel anxious, so that husband anxiety can be seen when
accompanied the antenatal care, so the husband's role is very important.

METHOD

The population in this study were all expectant father who has a primigravida
pregnant wife at the area of Public health care of Singosari as much as 78 expectant father.
This study was implementing the inclusion criteria for the respondents, namely: Husband
who had first trimester pregnant wife, a husband who has a wife who pregnant for the first
time (primigravida), a wife who was having emesis gravidarum, willing to become
respondents. Sampling techniques used in this study was quota sampling.

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This type of research is correlational analysis with cross-sectional approach. In this


study, researchers wanted to determine the relationship of Couvade Syndrome of husbands
and the incident of emesis gravidarum in the first timester primigravid women. The
instrument in this study was a questionnaire. Couvade Syndrome of the husband that
experienced anxiety was measured using a GAD (Generalized Anxiety Disorder) anxiety
questionnaire, amounting to 10 questions adapted from the journal of the American
Psychiatric Association in 2013. The validity test results obtained by researchers began p
<0.37 to p <1.00. Reliability shown by these questionnaire is α = 0.898 (using Cronbach
Alpha measurement). While emesis gravidarum using structured questions as many as 7
questions and the validity of the test results p <0.39 to p <1.00, with reliability according
to Cronbach Alpha worth α = 0.884.
Both variables included in this study using ordinal data scale. Couvade Syndrome
distinguished by five levels, namely: there is no anxiety, mild, moderate, severe and panic.
On the other hand,Emesis gravidarum is distinguished from the frequency of occurrence as
follows: mild, moderate and severe. Therefore, to answer the correlation between two
variables, then used a statistical test of Spearmen Rank (Rho)with a significance level ρ
<0.05, which signifies acceptance of this research hypothesis. Analysis of the data in this
study using SPSS 16 software program.

RESULT AND DISCUSSION

Table 1 The frequency distribution of respondents by age (in Public health care of Singosari,
January 31 to February 14, 2016)
No Age Groups Husband Frequency Percentage

1 Late adolescents (17-25 years) 7 29.1

2 Early adulthood (26-35 years) 16 66.6

3 Late Adulthood (36-45 years) 1 4.1

TOTAL 24 100

From Table 1 it can be seen from 24 husbands (respondents) of the first trimester
primigravida mother, majority of respondents aged from early adult group (26-35 years),
as many as 16 people (66.6%). Age is one factor that can affect a person's anxiety. In this
research note the data that more couples in early adulthood, which at this early adulthood
phase sometimes many couple get new experience and untried having first married that age
affects the occurrence of anxiety in a person.

Table 2 The frequency distribution of respondents by husband last education (in Public
health care of Singosari, January 31 to February 14, 2016)
No Husband Education Frequency Percentage
1 Primary school 3 12.5
2 Junior high school 7 29.1
3 Senior High School 10 41.6
4 College 4 16.6
TOTAL 24 100

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From Table 2 can be seen that average majority of husband last education is high
school as many as 10 people (41.6%). High levels of education will extend a person's
pointview and scope of the association, so that a higher level of education would facilitate
a person to receive information about health. Likewise if the lower latest education then
someone will narrow the pointview and easy to experience the anxiety due to less exposure
to the information in the scope of life.

Table 3 The frequency distribution of respondents by husband's occupation (in Public health
care of Singosari, January 31 to February 14, 2016)
No Husband Occupation Frequency Percentage
1 Civil servants 3 16.6
2 Private employees 7 75
3 Entrepreneur 10 8.3
TOTAL 24 100

From Table 3. Known that majority of husband's occupation (the respondents) are
private employees about 18 people (75%). Private employees here is intended as a private
sector company employees or laborers of the company, in this study the husband have
more time outside, sometimes more than 8 hours work, so that the husband could not
accompany his pregnant wife for 24 hours.

Table 4 Table of Emesis gravidarumFrequency


No. frequency Percent
Mild 4 16.7%
Moderate 10 41.7%
Severe 10 41.7%
Total 24 100%

Based on Table 4 shows that the first trimester primigravida mothers were
experiencing moderate level of emesis gravidarum as many as 10 people (41.7%), and the
severe level of 10 people (41.7%). The incidence of emesis gravidarum have occurred due
to various factors many of which can also occur because the emotions of the wife unstable
due to possible lack of attention to her husband's busy working outside the house.
Identify the level of anxiety ofthe husband.
Nausea and vomiting is one of the earliest symptoms, the most common and cause
stress associated with pregnancy (Tiran, 2007). For pregnant women, nausea and vomiting
are often overlooked because it is considered as a normal consequence of early pregnancy
without knowing the great impact that can caused. Nausea and vomiting are usually
experienced by mothers during the first trimester. The first trimester pregnancies with a
gestational age between 0-12 weeks (Vivian, 2011). The average age of the pregnancy of
respondents is around 4-12 weeks.
Physiologically, the nausea caused by increased estrogen levels in the blood
thereby affecting the digestive system. Yet nausea and vomiting that occur continuously
can lead to dehydration, hyponatremia, hypochloremic, and a decrease in urine chloride

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(Yuni, 2009). Hypokalemia can occur due to excessive vomiting and excretion, further
increasing the frequency of vomiting and damage the liver. Mucous membranes of the
stomach and esophagus can be damaged, so it can lead to gastrointestinal bleeding. In
addition to factors that increase estrogen levels, nausea and vomiting in pregnant women
can be caused by psychological factors.
Results obtained from 24 respondents, the incidence of emesis gravidarumthere
were moderate and severe categories is equal to each of 10 respondents (41.7%). Emesis
gravidarumsaid to be moderate if the nausea experienced by the wife is not more than 3
times a day and said to be heavy if vomit more than 3 times a day. It supports by the results
of observation (participatory) to the wife and questionnaire distributed to the husband
about the incidence of nausea and vomiting of his wife.

Table 5 Table of Anxiety Rate Frequency


Information Frequency Percentage
No anxiety 3 12.5%
Mild 8 33.3%
Moderate 7 29.2%
Severe 4 16.7%
Panic 2 8.3%

Based on Table 5 shows that husband anxiety when facing the wife who experience
emesis gravidarum is in the mild to moderate level. This is because some husbands may
lack information about new things so prone to feel anxiety.
The results showed that husband anxiety level when facing of his pregnant wife in
the first trimester with emesis gravidarumis vary. The number of respondents in this study
were 24 respondents and the majority of respondents experiencing mild anxiety, in this
study said mild anxiety if the husbands were still able to anticipate the anxiety that occur
while seeing his wife who experience nausea and vomiting as many as 8 respondents
(33.3%), and minority of respondents have panic anxiety as many as 2 respondents (8.3%).
Husband anxiety level can be known based on the characteristics of the husband, where
husband characteristic include age, education level and occupation.
Age is one factor that can influence the occurrence of anxiety in a person, it is in
accordance with the opinion of Miraswati (2006) which says that generally the anxiety of a
person develops in adolescence and early adulthood, this condition can become frantic in
their late teens to their 30s. The anxiety that arise due to aging somewhat related to past
experiences the same thing or even a new experience that has not previously been
experienced. The average age of the respondents in the age range 26-35 years. Besides the
age factor of anxiety can be seen also through the educational level of a person.
Furthermore, education is a major factor in shaping the human person. Education
plays an important role in shaping the human person is good or bad according to the size of
the normative. Education is a supporting factor that plays an important role in all sectors of
life, because the quality of life of a nation very closely with education (Karsidi,
2005) .From the results of research there are two respondents with secondary education
level, it is known that a person's education level will affect a person's level of anxiety as
more higher education will be easier to catch or receive information as well as mindset will
grow when getting a new experience. It is supported by the results of studies showing that
these respondents experienced a panic anxiety level. The resulting data were obtained from

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questionnaires of question number 1 and 2 were expressed about the feel frightened when
he saw his wife nausea and vomiting and feeling anxious and nervous when facing his
wife's nausea and vomiting.
Another factor that anxiety can also be seen from the characteristics of respondents
by respondent’s occupation. Majority of the husband's occupation is private employees as
much as 18 respondents, it is known that the work be one of the factors that may affect the
anxiety of a husband who has a the first trimester primigravida pregnant wife with emesis
gravidarum. Husband have more work outside the house becomes idle in caring his
pregnant wife. It is also supported by the study (Haafiz, 2007) states that the factor which
cause husband’s role become unprepared is work. Husband have more time outside the
house so the husband sometimes skipped wife complaint about her pregnancy. Most
husbands would work from early morning until late afternoon, sometimes their working
hours until evening. It can make the husband think of anything bad will happen to her
when he was not at home. This negative thinking that can lead to anxiety to her husband
when he left his pregnant wife

Table 6 Crosstabs of Spearman Ranktest in Emesis gravidarum and Anxiety Levels


Anxiety level Total
No anxiety Mild Moderate Severe Panic

Emesis Mild Count % 2 1 1 0 0 4


Gravidarum of Total 50% 25% 25% 0% 0% 100%
Moderate Count % 1 6 3 0 0 10
of Total 10% 60% 30% 0% 0% 100%
Severe Count % 0 1 3 4 2 10
of Total 0% 10% 30% 40% 20% 100%
Total Count % 3 8 4 7 2 24
of Total 12,5% 33,3% 29,2% 29,2% 8,3% 100,0%

Table 6 explained that the results of cross tabulations on data analysis for the
husband who has a wife experiencing mild anxiety as much as 8 (33.3%) of people, and
for the incidence of moderate emesis gravidarum of the first trimester primigravida women
was 10 (41, 7%) and severe level as much as 10 (41.7%) people. It can be concluded that
the incidence of emesis gravidarum correlated with anxiety in different husband anxiety
level.

Table 7 The result of Spearman Rank Test


Emesis gravidarum Anxiety level P <0.05
Emesis gravidarum Correlation 1,000 .583 0,003
Coefficient
Sig. (2-tailed) , .003
N 24 24
Anxiety level Correlation .583 1,000 0,003
Coefficient
Sig. (2-tailed) .003 ,
N 24 24

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Advances in Health Sciences Research (AHSR), volume 2

The result of Spearman Rank Test above can be concluded that value of ρ = 0.03>
α = 0.05 (5%). The hypothesis the researchers received, so it can be concluded that there is
a relationship between theincidenceof emesis gravidarum in the first trimester pregnant
women with the husband anxiety level in the Public health care of Singosari.
Couvade Syndrome has been linked with male empathic responses to female
partner pregnancy/ labour signs (Morse et al, 1998). Hoffman ML (Hoffman, 2003)
acknowledge the emotional andcognitive components of empathy, they believe that
physical side of empathizing cannot be ommited. As empathy is commonly defined as
sharing emotions (usually negative) with another person. They define such physical
responses to others’ distress as compathy, an example of which is Couvade Syndrome.
Couvade Syndrome become one of the signs of spouse’s deep emotional engagement in
pregnancy and childbirth. (Kazmierczak, 2013).
According to Stuart and Sundeen (2006), the level of anxiety characterized by
physiological responses are mild, such as mild muscular tension, cognitive responses such
as visual field extends passive awareness on the environment, and if seen from behavior
and emotional resposes as the weakened voice, facial muscles relaxation, capable of
performing ability or skill games automatically, there is a feeling of security and comfort.

CONCLUSION

It can be concluded that there is a relationship between Couvade Syndrome and the
incidence of emesis gravidarum in pregnant women in the first trimester in the area of
Public health care of Singosari. The results of this study found a significant relationship
between the incidences of emesis gravidarum in the first trimester pregnant women with
husband anxiety level in the area of Public health care of Singosari. So the incidence of
emesis gravidarum in the first trimester pregnant women had to do with the anxiety level
of the husband, if the incidence of emesis gravidarum is mild, then husband anxiety level
can be resolved.

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