Table 3.

Themes and Outcomes based on original clinical research, marked as [finding], or opinions, marked as [claim]

Con
Theme	Quotes
The OR is only for surgery	‘Health-care professionals who persist in viewing a caesarean birth as first, and only, surgery’ [claim] Leach 198421 ‘An OR is only for surgery, not “family care”‘ [claim] Paravicini 199638
The OR is an unpleasant environment	‘A claim is that the OR is not a place for a companion’ [claim] Brüggemann 201529 ‘[Fathers] found the theatre, clothes, temperature and the prospect of blood disturbing and contributing factors to their raised anxiety’ [finding] Ceronio 199527 ‘The smell in the OR, or wearing a facemask is difficult for the partner’ [claim] Paravicini 199638 ‘experiencing the operating room as an uncomfortable, scary environment’ [finding] Lindberg 201328 ‘Some claim that the environment is not adequate’ [claim] Maziero 202033
Wish to protect the integrity of the mother	‘Some and perhaps many women would choose not to have their partners see them intubated and paralyzed under general anaesthesia’ [claim] Smiley 200441 ‘Purported reasons for fathers continued exclusion include staff perceptions that men do not want to see their partner “like that”’ [claim] Hugill 201530
A CS is not a normal birth	‘A caesarean section is a pathological process, as opposed to the natural birth’ [claim] Paravicini 199638 ‘It is similarly rather silly to try to pretend that one can treat a surgical procedure under general anaesthesia as if it were a normal, “natural” birth’ [claim] Smiley 200441
Fear that the partner will disturb the concentration of the staff	‘His exclusion has been justified with concerns that he might faint, contaminate the sterile field or violate another patient's privacy’ [claim] Leach 198421 ‘I found the induction of general anesthetic stressful’ [finding] Russell 1989 ‘The staff completed the operation without mishap in an atmosphere of increasing menace and threat of assault’ [finding] Gadelrab 198935 ‘He risks contaminating the sterile area or otherwise harm his wife’ [claim] Paravicini 199638 ‘the very real possibility that the anesthesiology-surgical team will perform less well under the observation of the woman's partner’ [claim] Smiley 200441 ‘Most frequent risk identified were staff distractions, desterilisation of equipment and partners fainting’ [claim] Watts 20166 ‘The companion interferes during the professionals’ procedures, besides not being able to understand what is happening’ [claim] Maziero 202033
Mother under general anaesthesia is not ‘present’	‘A woman who has delivered a child under general anaesthesia cannot experience the birth, determine the health or sex of the infant, or welcome it into the world’ [claim] Leach 198421 ‘There is no way for the family to share the moment when the mother is not present’ [claim] Smiley 200441
Medico-legal complaints	‘Someone who witnesses an injury to a loved one can sue for and collect damages for the emotional trauma of being present when the event happened’ [claim] Smiley 200441 ‘I feel that this [asking the partner to leave] is mainly because of the medico-legal consequences if matters go wrong’ [claim] Robinson 200440 ‘Having the father in the OR could turn into a legal right, so he would also demand (and call for an attorney) to be present the next time, and the ‘movement’ to allow lay people in the OR will spread to other specialties’ [claim] Paravicini 199638
Emotional trauma for the partner	‘Feeling coerced into the situation without being adequately prepared, and therefore did not feel in control of the situation’ [finding] Ceronio 1995 ‘Feeling faint, physically shaken, excited, or shocked were stated’ [finding] Ceronio 199527 ‘one risks the possibility that he will witness a failed intubation, the subsequent struggle with ventilation or other modes of support, and potentially worse. Even if the outcome is not an injured mother or neonate, the emotional trauma to the partner can be significant’ [claim] Smiley 200441

Pro
Theme	Quotes
Parents’ wish for presence	‘All 17 fathers felt that they were supporting the mother. 16 felt as participants’ [finding] Svensen 198523 A large majority of mothers and partners agreed or strongly agreed that it was important for the partner to be present during the CS in both regional and general anaesthesia. [finding] McIlmoyle 201243 ‘Being present during the caesarean section was described to include family togetherness, during which time fathers could continue in their roles as partners’ caregivers and supporters’ [finding] Lindberg 201328 ‘All the mothers talked about the emotional significance of no-one close to them or their baby being there in theatre. […] This was more important because they were “asleep”’ [finding] Hugill 201530 ‘Common benefits expressed included reduces anxiety for both mother and partner’ [finding] Watts 20166 ‘I wish the father could have been in the operating room’ [finding] Perede-Goikoetxea 201932
Better experience with CS	‘The couple related more positive circumstances in the hospitalisation period following CS’ [finding] Cain 198422 More patients found the CS experience ‘good’ or ‘great’ if partner was present. [finding] Svensen 198523 ‘Fathers who were present during preparation and the operation expressed appreciation for not being excluded’ [finding] Lindberg 201328 ‘Common benefits expressed included reduces anxiety for both mother and partner, improved communication’ [finding] Watts 20166
Bonding with the baby	‘Both parents handled the baby earlier’ [finding] Cain 198422 ‘No feelings of exclusions were noted, but rather a feeling of possession towards their newborn’ [finding] Ceronio 199527 ‘There is evidence of potential benefits of fathers’ presence at CSGA, […] for the father (presence easing the transition to parenting); and for the baby (initiating skin-to-skin contact)’ [claim] Hugill 201530
Parents’ right to presence	‘It is not for the anaesthetist to make this decision but for the couple to decide irrespective of the gravity of the situation’ [claim] Robinson 200440 ‘I see no reason to deny the father the right to see his baby being born, even if the mother does not want to be awake’ [claim] Russell 198937
Not worse clinical outcomes	‘No difference in infectious complications […] or length of postoperative hospitalisation’ [finding] Sakala 198824 ‘Higher Apgar at 5 min with father present’ [finding] Sakala 198824 ‘15 fathers felt good during the CS, two felt some discomfort, but did not get unwell or had to leave the OR’ [finding] Svensen 198523 ‘Complications and procedure time was alike between groups’ [finding] Svensen 198523
Waiting time (when not present) very trying	‘Expressions of fear, frustration, and helplessness related to not being able to do anything for the mother and the prospective child’ [finding] Lindberg 201328 ‘Fear of seeing his wife for the last time’ [finding] Lindberg 201328 ‘Described waiting on operation results as a very trying, apprehensive period that made them lose track of time’ [finding] Lindberg 201328 ‘For the fathers being unprepared for a CS, coupled with being uninformed about their partner gave rise to feelings of powerlessness, abandonment and anger’ [finding] Hugill 201530 ‘Anxiety while waiting for prolonged periods […] time moving too slowly […] anxiety about wife's safety’ [finding] Kondou 201831
Father as ‘family witness’	‘She may also harbour doubts as to the ownership of the infant’ [claim] Leach 1984 ‘It is important that the father witnesses the birth – experiencing it as only a parent can. The mother who is unconscious during the birth depends upon the father to describe the birth from a parents’ perspective’ [claim] Leach 198421 ‘Mothers who have operative delivery under general anaesthesia sometimes believe that the baby presented to them afterwards is not really theirs. […]This can be alleviated by the husband, if present, acting as a ‘family witness’ of the birth’ [claim] Bogod 199036 ‘There is evidence of potential benefits of fathers’ presence at CSGA, for the mother (filling in the missing pieces of the event)’ [claim] Hugill 201530

For each quote from the manuscripts, we have stated whether it is a clinical finding based on original clinical research (marked in blue and as [finding]) or whether it is an expression of personal opinion (marked in red and as [claim]). Quotes are listed as examples of the themes but are not an exhaustive list of available quotes for each theme.

CS, caesarean section; CSGA, caesarean section under general ’Wang; OR, operating room.