Fathers' engagement in pregnancy and childbirth: evidence from a national survey

Factors affecting the utilization of antenatal care services among women in Guinea: a population-based study

INTRODUCTION

Evidence suggests that a better understanding of determinants of antenatal care (ANC) utilization is crucial to reducing maternal and child deaths. Little is known about the utilization of ANC services in Guinea.

OBJECTIVE

The aim of this study was to explore factors determining utilization of skilled ANC in Guinea.

METHODS

This study focused on a sample of 7812 ever married women. Using multivariate logistic regression, factors associated with the utilization of ANC were identified. The output of the multivariate logistic regression was presented using adjusted odds ratio and the corresponding 95% confidence interval (CI).

RESULTS

Several factors had significant association with utilization of skilled ANC service in Guinea: having decision-making power (2.21, 95% CI: 1.63, 3.00), employment status (1.86, 95% CI: 1.39, 2.48), media exposure (1.60, 95% CI: 1.26, 2.02), maternal education (2.68, 95% CI: 1.36, 5.28), husband/partner education status (1.66, 95% CI: 1.08, 2.55), household economic status (2.19, 95% CI: 1.40, 3.44), place of residence (0.29, 95% CI: 0.16, 0.50) and ethnicity (0.40, 95% CI: 0.23, 0.69).

CONCLUSIONS

These findings suggest a variety of socio-demographic and economic factors as well as media exposure are associated with women's use of ANC. Policymakers should implement appropriate measures to address the existing variations and gaps in ANC services utilization among different subgroups of women in Guinea.

Development and Validation of a Measure of Birth-Related PTSD for Fathers and Birth Partners: The City Birth Trauma Scale (Partner Version)

Research suggests that some fathers and birth partners can experience post-traumatic stress disorder (PTSD) after witnessing a traumatic birth. Birth-related PTSD may impact on many aspects of fathers’ and birth partners’ life, including relationship breakdown, self-blame and reducing plans for future children. Despite the potential impact on birth partners’ lives there is currently no measure of birth-related PTSD validated for use with birth partners. The current study therefore adapted the City Birth Trauma Scale for use with birth partners. The City Birth Trauma Scale (Partner version) is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (G), and exclusion criteria or other causes (H). A sample of 301 fathers/birth partners was recruited online and completed measures of birth-related PTSD, bonding, and demographic details. Results showed the City Birth Trauma Scale (Partner version) had good reliability (α = 0.94) and psychometric and construct validity. The fathers/birth partners version has the same two-factor structure as the original scale: (1) general symptoms and (2) birth-related symptoms, which accounted for 51% of the variance. PTSD symptoms were associated with preterm birth and maternal and infant complications. Overall, the City Birth Trauma Scale (Partner version) provides a promising measure of PTSD following childbirth that can be used in research and clinical practice.

Engaging fathers in the first 1000 days to improve perinatal outcomes and prevent obesity: Rationale and design of the First Heroes randomized trial

BACKGROUND

Early pregnancy through the first year of life represents an important period for family health promotion and obesity prevention. Overall, preventive interventions in pregnancy and infancy have insufficiently engaged fathers. We describe the rationale and design of First Heroes, an intervention to improve perinatal and obesity-related outcomes among mother-father-infant triads beginning in pregnancy.

METHODS/DESIGN

First Heroes is a hybrid type 1 effectiveness-implementation randomized trial of mother-father-infant triads recruited in the second trimester of pregnancy from a large Obstetric practice in eastern Massachusetts and continuing through 12 months of infant age. Triads are randomized to the intervention arm or to an enhanced safety education control group. Triads randomized to the intervention arm receive three virtual visits with a health educator, in the 3rd trimester of pregnancy, at 3-4 weeks, and 3-4 months postpartum, and receive continuous multimedia education through text messaging, print material, and videos. The educational curriculum addresses parent health behaviors, family relationships, social determinants of health, and infant feeding, sleep, and development. The primary outcome is prevalence of rapid infant weight gain from birth to 6 months of age. Secondary outcomes include parent anthropometrics, parent obesogenic behaviors, family functioning, and infant behaviors.

DISCUSSION

First Heroes will evaluate the extent to which intentional mother-father dyad engagement, coaching on adoption of early life health behaviors, and addressing social determinants of health, influence obesogenic behaviors and outcomes in the first year of life. Findings from this work will inform future obesity prevention efforts, especially those focused on whole family inclusion.

Factors contributing to men's grief following pregnancy loss and neonatal death: further development of an emerging model in an Australian sample

Background

Historically, men’s experiences of grief following pregnancy loss and neonatal death have been under-explored in comparison to women. However, investigating men’s perspectives is important, given potential gendered differences concerning grief styles, help-seeking and service access. Few studies have comprehensively examined the various individual, interpersonal, community and system/policy-level factors which may contribute to the intensity of grief in bereaved parents, particularly for men.

Methods

Men (N = 228) aged at least 18 years whose partner had experienced an ectopic pregnancy, miscarriage, stillbirth, termination of pregnancy for foetal anomaly, or neonatal death within the last 20 years responded to an online survey exploring their experiences of grief. Multiple linear regression analyses were used to examine the factors associated with men’s grief intensity and style.

Results

Men experienced significant grief across all loss types, with the average score sitting above the minimum cut-off considered to be a high degree of grief. Men’s total grief scores were associated with loss history, marital satisfaction, availability of social support, acknowledgement of their grief from family/friends, time spent bonding with the baby during pregnancy, and feeling as though their role of ‘supporter’ conflicted with their ability to process grief. Factors contributing to grief also differed depending on grief style. Intuitive (emotion-focused) grief was associated with support received from healthcare professionals. Instrumental (activity-focused) grief was associated with time and quality of attachment to the baby during pregnancy, availability of social support, acknowledgement of men’s grief from their female partner, supporter role interfering with their grief, and tendencies toward self-reliance.

Conclusions

Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement and validation from all healthcare professionals, family/friends, community networks and workplaces. Addressing male-specific needs, such as balancing a desire to both support and be supported, requires tailored information and support. Strategies to support men should consider grief styles and draw upon father-inclusive practice recommendations. Further research is required to explore the underlying causal mechanisms of associations found.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03514-6.

First-time fathers' experiences and needs during childbirth: A systematic review

OBJECTIVE

Fathers have been increasingly involved in childbirth since 1990. Attendance at childbirth is considered to benefit fathers' health as well as that of their partner and children. However, childbirth is a life event that parents may experience differently. First-time fathers' experiences have been barely studied and may differ from those of fathers who have already had a child. In order to adapt support and care during childbirth to the needs of first-time fathers, a deeper insight must be gained into their experiences and needs during childbirth.

DESIGN

A systematic review of qualitative studies was conducted using PubMed, Embase and CINAHL as well as the snowball method. Quality appraisal was performed and evaluated using the Critical Appraisal Skills Programme. A thematic best evidence synthesis was performed.

FINDINGS

Of 821 articles, eight qualitative studies and the qualitative data of one mixed methods study were included. amongst other feelings, fathers experience a lack of knowledge and a need to be better prepared. First-time fathers want to be more involved and need guidance, information and honest answers to help them fulfil a supportive role. Fathers disregard their own needs to focus on the needs of the mother. Meeting the baby for the first time changes the focus from the mother to the child, and fathers need time and privacy for this special moment.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

To adapt support and care during childbirth to the needs of first-time fathers, professionals must be aware of their needs. Professionals must realise the significant influence of their professional behaviour on first-time fathers' experiences. Care for first-time fathers should be formalised. Follow-up research must be conducted on integrating the preparation of first-time fathers into prenatal care. Education and training of professionals must be improved.

Comparing the effect of group- based training along with text messaging and compact disc- based training on men's knowledge and attitude about participation in perinatal care: a cluster randomized control trial

Background

Men’s participation in perinatal care is one of the key factors in promoting maternal and neonatal health. The effects of various methods of training on men’s knowledge and attitude about participation in perinatal care can be different. So, this study aimed to compare the effect of two methods of training on men’s knowledge and attitude about participation in perinatal care.

Methods

This cluster randomized control trial was conducted in three midwifery clinics in Tabriz, Iran between May and August 2018. Each clinic was randomly assigned to intervention (group- based training along with text messaging and CD- based training) and control groups. Seventy-five men were enrolled in three groups and evaluated for their knowledge and attitude about participation in perinatal care. Before and 3 months after the intervention, a researcher-made questionnaire was completed by the participants. Data were analyzed using descriptive and inferential statistics (paired t-test, one-way ANOVA, ANCOVA, chi-square, Kruskal-Wallis and Fisher exact tests).

Results

The mean (SD) score of men^, s knowledge and attitude about participation in perinatal care had a significant increase in group- based training along with text messaging after the intervention compared to the score of before the intervention (p < 0.001, p = 0.005, respectively), but the mean (SD) score of men^, s knowledge and attitude had not a significant increase in CD- based training and control group after the intervention compared to the score of before the intervention. The mean (SD) score of men^,s knowledge and attitude about participation in perinatal care in group- based training along with text messaging were significantly higher than in CD- based training (p < 0.001, p = 0.039, respectively) and control group (p = 0.001, p = 0.021, respectively) after the intervention, respectively. However, the mean (SD) score of men^, s knowledge and attitude in CD- based training were not significantly different from the control group after the intervention.

Conclusion

Group- based training along with text messaging was more effective in improving the knowledge and attitude of men about participation in perinatal care compared to CD- based training. So, its implication in educational programs for the men is recommended.

Trial registration

IRCT, IRCT20160224026756N4. Registered 27 May 2018.

Leaving no one behind: using action research to promote male involvement in maternal and child health in Iringa region, Tanzania

INTRODUCTION

Male involvement has been reported to improve maternal and child health (MCH) outcomes. However, most studies in low-income and middle-income countries have reported low participation of men in MCH-related programmes. While there is a growing interest in the involvement of men in MCH, little is known on how male involvement can be effectively promoted in settings where entrenched unequal gender roles, norms and relations constrain women from effectively inviting men to participate in MCH.

METHODS AND ANALYSIS

This paper reports participatory action research (PAR) aimed to promote male participation in pregnancy and childbirth in Iringa Region, Tanzania. As part of the Innovating for Maternal and Child Health in Africa project, PAR was conducted in 20 villages in two rural districts in Tanzania. Men and women were engaged separately to identify barriers to male involvement in antenatal care and during delivery; and then they were facilitated to design strategies to promote male participation in their communities. Along with the PAR intervention, researchers undertook a series of research activities. A thematic analysis was used to analyse the data. The common strategies designed were: engaging health facility committees; using male champions and male gatekeepers; and using female champions to sensitise and provide health education to women. These strategies were validated during stakeholders' meetings, which were convened in each community.

DISCUSSION

The use of participatory approach not only empowers communities to diagnose barriers to male involvement and develop culturally acceptable strategies but also increases sustainability of the interventions beyond the life span of the project. More lessons will be identified during the implementation of these strategies.

Men and maternal health care utilization in India and in selected less-developed states: evidence from a large-scale survey 2015-16

Male involvement in maternal health care utilization is an important contributor to maternal health, especially in male-dominated societies. This study aimed to understand the variations and determinants of women's antenatal care (ANC) utilization and institutional delivery in India and three socioeconomically less-developed states (Bihar, Madhya Pradesh and Uttar Pradesh) using NFHS-4 data (2015-16). Husband's knowledge of pregnancy care and delivery, having a non-violent marital relationship and a respectful attitude towards his wife, better education and wealth, higher exposure to mass media and fewer children substantially enhanced the probability of him being present at his wife's ANC visits. Furthermore, men's presence at any ANC visit was shown to be an important factor influencing institutional delivery in India as a whole, as well as in the three less-developed states. The two major hurdles in maternal and child health care utilization in India were incorrect perception of 'unnecessary' maternal health care by families and high cost as reported by husbands. Furthermore, the proportion of husbands who received knowledge from health workers on maternal and child health was too low to achieve the maternal health SDGs by 2030. The dissemination of knowledge on maternal care among husbands, and encouraging their presence during antenatal care, may help secure better maternal health outcomes in India. It is imperative that the husband-involvement agenda is strengthened in India if the SDGs for maternal care are to be achieved.

Correlates of HIV-Positive Fathers' Involvement in Prevention of Mother-to-child Transmission Programs in Northern Nigeria

BACKGROUND

The involvement of men in prevention of mother-to-child HIV transmission (PMTCT) programs could accelerate the elimination of vertical transmission. Yet, little research has focused on HIV-positive male partners. This study determined the predictors of male partners' PMTCT knowledge and involvement in a tertiary hospital in northern Nigeria.

METHODS

A clinic-based sample of 401 HIV-positive male partners of women who delivered within 12 months prior were interviewed using structured questionnaires. PMTCT knowledge and involvement scores were computed. Adjusted odd ratios (AOR) for predictors were derived from multivariate logistic regression models.

RESULTS

The proportion of respondents with adequate PMTCT knowledge was 40.9%. Less than half (43.6%) of the respondents participated in PMTCT, with median involvement score of 2.00 (interquartile range, IQR = 0, 5.0). One quarter of respondents (25.7%, n =103) reported >1 sex partners, 10.5% consistently used condoms, and 20.7% had disclosed to all partners. Fathers' involvement in PMTCT was predicted by paternal education (AOR = 0.30; 95% Confidence Interval (CI): 0.12-0.77, no formal vs. post-secondary), HIV-positive child (AOR = 3.85; 95%CI: 1.41-10.54, yes vs. no), treatment duration (AOR = 4.17; 95%CI: 1.67-10.41, ≤1 vs. ≥10 years), disclosure to partner(s) (AOR = 1.21; 95%CI: 1.15-3.52, 'disclosed to all' vs. 'not disclosed'), condom use (AOR = 5.81; 95%CI: 3.07-11.0, always vs. never), and PMTCT knowledge (AOR = 0.62; 95%CI: 0.31-0.92, inadequate versus adequate).

CONCLUSION

The involvement of fathers in HIV PMTCT programs was low and predicted by paternal education, HIV-positive child, duration of antiretroviral treatment, disclosure to partner, consistent condom use, and level of PMTCT knowledge. Our findings will inform the development of policies to increase male partner involvement in PMTCT in Nigeria.

Validation of the Wijma delivery expectancy/experience questionnaire for pregnant women in Malawi: a descriptive, cross-sectional study

BACKGROUND

Fear of childbirth is a common health concern for women during pregnancy. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is widely used to measure childbirth fear during pregnancy. However, this instrument is yet to be validated in Malawi, Africa. Our study aimed to assess the psychometric properties of the W-DEQ questionnaire in Malawi.

METHODS

Healthy pregnant women in the third trimester (N = 476) at a district hospital in Malawi were included. Fear of childbirth, depressive symptoms, and quality of life were assessed using the W-DEQ, the Edinburg Postnatal Depression Scale, and the World Health Organization Quality of Life scale, respectively. The construct validity, reliability, and convergent validity of the W-DEQ were examined using exploratory and confirmatory factor analyses, Cronbach's alpha, and Pearson correlations.

RESULTS

The mean age of participants was 28.2 (standard deviation = 6.8) years. Exploratory and confirmatory factor analysis of the Malawian version of the W-DEQ indicated a multidimensional structure with three factors: fear, negative appraisal, and a lack of self-efficacy, with acceptable goodness of model fit. The Malawian version of the W-DEQ showed a satisfactory internal consistency (α = 0.84) and was significantly correlated with depressive symptoms (r = 0.23, p < 0.001) and quality of life (r = - 0.17 ~ -0.26, ps < 0.05).

CONCLUSIONS

Our findings support the Malawian W-DEQ version being a reliable and valid instrument for measuring childbirth fear in African women.

Informal and formal social support during pregnancy and joint maternal and paternal postnatal depression: Data from the French representative ELFE cohort study

BACKGROUND

Insufficient social support has been intensively studied as a risk factor of postpartum depression (PPD) among mothers. However, to date, no study has examined the role of informal and formal dimensions of social support during pregnancy with regard to joint maternal and paternal depression after birth.

AIM

Study associations between insufficient informal and formal support during pregnancy and joint parental PPD.

METHODS

Using data from the nationally representative French ELFE (Etude Longitudinale Française depuis l'Enfance) cohort study (N = 12,350), we estimated associations between insufficient informal and formal support received by the mother during pregnancy and joint parental PPD in multi-imputed multivariate multinomial regression models.

RESULTS

In 166 couples (1.3%), both parents were depressed. The likelihood of joint parental PPD was increased in case of insufficient informal support (insufficient partner support: odds ratio (OR) = 1.68 (95% confidence interval (CI): 1.57-1.80); frequent quarrels: OR = 1.38 (95% CI: 1.19-1.60)). We also observed associations between formal support during pregnancy and joint parental PPD (early prenatal psychosocial risk assessment: OR = 1.13 (95% CI: 1.05-1.22); antenatal education: OR = 1.13 (95% CI: 1.05-1.23)), which disappeared when analyses were restricted to women with no psychological difficulties during pregnancy.

CONCLUSION

Insufficient informal social support during pregnancy appears to predict risk of joint PPD in mothers and fathers and should be identified early on to limit complications and the impact on children.

Paternal Psychological Stress After Detection of Fetal Anomaly During Pregnancy. A Prospective Longitudinal Observational Study

Background and Aims

Knowledge of carrying a fetus with a prenatal diagnosed anomaly may cause acute psychological stress to the parents. Most studies focus on maternal stress, yet fathers are often present at the ultrasound examinations and birth, and therefore may be affected, similarly, to the expectant mother. However, to date no existing studies have examined how detection of a fetal anomaly emotionally affects the expectant fathers throughout the pregnancy. Our aim was to longitudinally examine general health perceptions, social dysfunction and psychological distress in a subgroup of men where fetal anomaly was detected during pregnancy.

Methods and Results

This study is part of the SOFUS study, a prospective, longitudinal, observational study. Participants were recruited when referred for an ultrasound examination conducted by a specialist in fetal medicine at Oslo University Hospital on suspicion of fetal malformation (study group). We examined differences between the men in the study group (N = 32) and a comparison group (N = 83) on the General Health Questionnaire (GHQ), Impact of Event Scale (IES) and Edinburgh Postnatal Depression Scale (EDPS) across four time points in pregnancy. Results from repeated measured ANOVA suggests that depression decreased over time among men in both groups (η² = 0.15, p < 0.001). This effect was stronger in the study group, and differed from the comparison group (η² = 0.08, p < 0.001). There was also a main effect of time on IES scores, which decreased over time for both men in the study group and in the comparison group (η² = 0.32, p < 0.001). That is, men in the study group were higher on IES initially, but this effect decreased more in the study group than in the comparison group. Men in the study group and comparison group did not differ on perceived general health (GHQ: p = 0.864).

Conclusion

Results suggests that detection of a fetal anomaly has implications for paternal mental health during pregnancy. Expectant fathers scored higher on EPDS and IES than the comparison group in the acute phase after detection of fetal anomaly, thus there is impetus to provide psychological support for fathers, as well as mothers, at this difficult time.

Male participation in antenatal care and its influence on their pregnant partners' reproductive health care utilization: insight from the 2015 Afghanistan Demographic and Health Survey

Afghanistan has made remarkable progress in reducing maternal mortality over the past few decades, and male participation in their pregnant partner's reproductive health care is crucial for further improvement. This study aimed to examine whether male attendance at antenatal care (ANC) with their pregnant partners might be beneficially associated with the degree of utilization of reproductive health care by the pregnant partners. Data for 2660 couples (women aged 16-49 years) were taken from the 2015 Afghanistan Demographic and Health Survey (AfDHS). Bivariate and multivariate logistic regression models were employed to explore the association between male attendance at ANC with their pregnant partners and reproductive health care utilization outcomes, including adequate utilization (four or more visits) of ANC services, ANC visits during the first trimester (up to 12 weeks) of pregnancy, rate of blood and urine testing during pregnancy, rate of institutional delivery and utilization of postnatal check-up services. The results indicated that the rate of male attendance at ANC with their pregnant partners was 69.4%. After controlling for covariates, pregnant partners who were accompanied to ANC by their male partners were more likely to adequately utilize ANC services (AOR=1.42; 95% CI: 1.18-1.71), commence ANC visits even during the first trimester (AOR=1.21; 95% CI: 1.03-1.42), give birth at a health facility (AOR=1.23; 95% CI: 1.03-1.47) and present themselves for postnatal check-ups (AOR=1.24; 95% CI: 1.04-1.47) than those who were not accompanied by them. The study demonstrated that participation of male partners in ANC was positively associated with their pregnant partners' utilization of reproductive health care services in Afghanistan. The findings suggest that, to improve maternal and child health outcomes in the country, it would be worthwhile implementing interventions to encourage male partners to become more engaged in the ANC of their pregnant partners.

Impact of Marriage on Birth Outcomes: Pregnancy Risk Assessment Monitoring System, 2012-2014

Marriage has been associated with improved pregnancy outcomes. However, as Americans become increasingly accepting of pregnancy and childbearing outside of marriage, many believe the father can support the mother without the parents being married. Some question whether the present normalization of childbearing outside of marriage will negate the protective effect of marriage on pregnancy outcomes. Data from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System were used to obtain data from a sample of 138,118 live singleton deliveries from 2012 to 2014. Odds ratios were compared between married and unmarried mothers for outcomes of preterm delivery, a small for gestational age infant, neonatal intensive care unit admission, vaginal delivery, and breastfeeding initiation. Logistic regression analyses were used to adjust for maternal age, maternal and paternal race, maternal medical comorbidities, maternal smoking status, and receipt of Medicaid. Adjusted odds ratios (AOR) showed married women had a lower risk of preterm delivery (AOR = .877, 95% confidence interval [CI; .811-.948]), a small for gestational age baby (AOR = .838, 95% CI [.726-.967]), and a neonatal intensive care admission (AOR = .808, 95% CI [.754-.866]). Women who were married were more likely to have a vaginal delivery (AOR = 1.144, 95% CI [1.085-1.211]) and to initiate breastfeeding (AOR = 1.601, 95% CI [1.490-1.719]). These data demonstrate that despite a normalization in society of childbearing outside of marriage, there continues to be an association of marriage with improved birth outcomes. Summary: Marriage is associated with a lower risk of preterm delivery, small for gestational age infants, and neonatal intensive care unit admission. These differences persist even after correcting for potentially confounding socioeconomic factors.

Community perspectives: An exploration of potential barriers to men's involvement in maternity care in a central Tanzanian community

Background

Male involvement in maternal health has been linked to positive health outcomes for women and children, as they control household resources and make significant decisions, which influence maternal health. Despite of the important role they have in maternal health care, their actual involvement remains low. The objective of this study was to explore community perspectives on potential barriers to men’s involvement in maternity care in central Tanzania.

Methods

Qualitative research methods were used in data collection. We conducted 32 focus group discussions (16 FGDs with men and 16 FGDs with women) and 34 in-depth interviews with community leaders, village health workers and health care providers. Interview guides were used to guide the focus group discussions and in-depth interviews. The interviews and discussions were audio recorded, transcribed and translated into English and imported into QSR NVivo 9 software for thematic analysis. Three themes emerged from the data; men’s maternity care involvement indicators, benefits of men’s involvement in maternity health care services and barriers to men’s involvement in maternity health care services.

Results

Both men and women participants acknowledged the importance of men’s involvement in maternity health care services, even though few men actually got involved. Identified benefits of men’s involvement in maternity health care services include: Learning any risk factors directly from the health care providers and getting prepared in addressing them; and reinforcing adherence to instruction received from the health care provider as family protectors and guardians. Barriers to men’s involvement in maternity health care services are systemic; starting from the family, health care and culture-specific gender norms for maternity related behaviour as well as healthcare facilities structural constrains inhibiting implementation of couple-friendly maternity health care services.

Conclusions

Men’s involvement in maternity care is influenced by culture-specific maternity-related gender norms. This situation is compounded by the conditions of deprivation that deny women access to resources with which they could find alternative support during pregnancy. Moreover, structures meant for maternal health care services lack privacy, thus inhibiting male partners’ presence in the delivery room. Intervention to increase men’s involvement in maternity care should address individual and systemic barriers to men’s involvement.

Paternal violent criminality and preterm birth: a Swedish national cohort study

Background

Fathers may affect expectant mothers’ daily living situations, which in turn might influence pregnancy outcomes. We investigated the association between paternal violent criminality and risk of preterm birth (≤36 weeks).

Methods

We conducted a register-based study with all live singleton births in the Swedish Medical Birth Register from 1992 to 2012, linked with records of paternal violent crime convictions from the National Crime Register from 1973 to 2012.

Results

Paternal violent criminality was associated with increased risk of preterm birth and lower gestational age. The association was especially pronounced among infants of reoffenders: men convicted of three or more violent crimes (adjusted odds ratio [aOR] 1.23 [95% CI 1.17, 1.29]). Maternal half sibling-comparisons, an analytic approach controlling for maternal factors stable across pregnancies, also suggested increased risk of preterm birth and lower gestational age when exposed to a violently reoffending father compared to a father without violent criminal convictions (aOR 1.30 [0.99, 1.72], adjusted mean difference − 1.07 [− 1.78, − 0.36]).

Conclusions

Persistent paternal violent criminality was associated with increased risk of preterm birth, even after controlling for maternal characteristics that did not change between pregnancies.

Men's grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model

BACKGROUND

Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men's grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men's grief, this systematic review sought to summarise and appraise the literature focusing on men's grief following pregnancy loss and neonatal loss.

METHODS

A systematic review was undertaken with searches completed across four databases (PubMed, PsycINFO, Embase, and CINAHL). These were guided by two research questions: 1) what are men's experiences of grief following pregnancy/neonatal loss; and 2) what are the predictors of men's grief following pregnancy/neonatal loss? Eligible articles were qualitative, quantitative or mixed methods empirical studies including primary data on men's grief, published between 1998 and October 2018. Eligibility for loss type included miscarriage or stillbirth (by any definition), termination of pregnancy for nonviable foetal anomaly, and neonatal death up to 28 days after a live birth.

RESULTS

A final sample of 46 articles were identified, including 26 qualitative, 19 quantitative, and one mixed methods paper. Findings indicate that men's grief experiences are highly varied, and current grief measures may not capture all of the complexities of grief for men. Qualitative studies identified that in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent needs. Men may face double-disenfranchised grief in relation to the pregnancy/neonatal loss experience.

CONCLUSION

There is a need to increase the accessibility of support services for men following pregnancy/neonatal loss, and to provide recognition and validation of their experiences of grief. Cohort studies are required among varied groups of bereaved men to confirm grief-predictor relationships, and to refine an emerging socio-ecological model of men's grief.

TRIALS REGISTRATION

PROSPERO registration number: CRD42018103981.

'The calm before the storm': A qualitative study of fathers' experiences of early labour

BACKGROUND

Early labour care presents a challenge for maternity services and is a cause of dissatisfaction for women planning birth in an obstetric or midwifery unit who may feel unsupported or unwelcome at their planned place of birth. Little is known about the perspectives of men who support their partner during early labour.

METHODS

Opportunity sample offathers (n=12) in the UK who had been present during their partner's labour in the previous twelve months. Semi-structured interviews were audio-recorded and transcribed before thematic analysis.

RESULTS

Fathers learned about the stages of labour during antenatal education and felt well prepared for early labour but found their knowledge difficult to apply, and relied on their partners to decide when to travel to the planned place of birth. Early labour was described as the 'calm before the storm' during which they carried out practical tasks or rested to ensure they could fulfil their role when labour progressed. However, men frequently felt 'like a spare part' during the later stages of labour.

DISCUSSION

The study has implications for antenatal educators, midwives and others supporting couples during pregnancy and labour. It supports reconsideration of how information about labour progress can be most usefully conveyed to couples. Professionals could acknowledge the value of supportive tasks carried out by fathers that might otherwise be experienced as doing 'nothing'. Further research should recruit more diverse samples of men and same-sex couples. Dyadic data collection methods may be of value.

Paternal impact on the life course development of obesity and type 2 diabetes in the offspring

The aetiologies of obesity and type 2 diabetes are incredibly complex, but the potential role of paternal influences remains relatively understudied. A better understanding of paternal influences on offspring risk of obesity and type 2 diabetes could have profound implications for public health, clinical practice and society. In this review, we outline potential biological and social mechanisms through which fathers might exert an impact on the health of their offspring. We also present a systematically compiled overview of the current evidence linking paternal factors to offspring development of obesity and type 2 diabetes throughout the life course. Although evidence is accumulating to support paternal associations with offspring outcomes, more high-quality research is needed to overcome specific methodological challenges and provide stronger causal evidence.

Adult male involvement in maternity care in Enugu State, Nigeria: A cross-sectional study

INTRODUCTION

Men are the key decision makers in the family and play a crucial role in the reproductive health of partners, in Nigeria. This study assessed adult male involvement in maternity care in Enugu south local government area, Enugu State, Nigeria.

METHODS

This community-based study was conducted using a cross-sectional survey design. A total of 145 respondents were selected through multi-stage sampling and data were collected using a structured questionnaire developed by the researchers. Data generated were statistically analyzed based on the research objectives using descriptive statistics.

RESULTS

Major findings revealed that the respondents had moderate knowledge on the expected role of males in maternity care with the majority, assessed using a 4-point Likert scale, having a moderate (2.99) level of involvement in maternity care. Lack of facilities that encourage male participation in maternity care, work schedule of the male partner, and lack of knowledge on the role of the male partners during maternity care were identified as major barriers to male involvement in maternity care with means of 3.80, 3.58 and 3.48, respectively.

CONCLUSIONS

Involvement in maternity care among the respondents in this study was moderate. However, men may be restricted by some cultural beliefs such as maternity care being regarded as exclusively a woman's matter. Thus, men should be educated on the importance of their role as partners in maternity care and on the need to participate actively, regardless of existing cultural norms. Hospitals should also promote policies that encourage male presence during birth and delivery rooms need to be designed to allow bonding of partners during birth.

Reproductive justice and support for young fathers

The current article addresses the interests and contributions of fathers to child development and well-being within a reproductive and social justice framework. We present an overview of research on the role of fathers in the lives of children from the prenatal period through early childhood, with an emphasis on fathers as partners and caregivers in promoting the reproductive health and safety of women and the healthy development of young children. We explore especially the challenges of young, at-risk fathers as well as system and practice opportunities that support their contributions as partners and parents. Our goal of the article is to extend the discourse on reproductive and social justice to include the shared responsibility of all parents and facilitate circumstances whereby children experience the support needed to become nurturing caregivers for the next generation.

Protocol for a feasibility randomised trial of low-intensity interventions for antenatal depression: ADAGIO trial comparing interpersonal counselling with cognitive behavioural therapy

INTRODUCTION

One in eight women suffer from depression during pregnancy. Currently, low-intensity brief treatment based on cognitive behavioural therapy (CBT) is the only talking treatment widely available in the National Health Service (NHS) for mild and moderate depression. CBT involves identifying and changing unhelpful negative thoughts and behaviours to improve mood. Mothers in our patient advisory groups requested greater treatment choice. Interpersonal counselling (IPC) is a low-intensity version of interpersonal therapy. It may have important advantages during pregnancy over CBT because it targets relationship problems, changes in role and previous losses (eg, miscarriage). We aim to compare CBT and IPC for pregnant women with depression in a feasibility study.

METHODS AND ANALYSIS

A two-arm non-blinded randomised feasibility study of 60 women will be conducted in two UK localities. Women with depression will be identified through midwife clinics and ultrasound scanning appointments and randomised to receive six sessions of IPC or CBT. In every other way, these women will receive usual care. Women thought to have severe depression will be referred for more intensive treatment. After 12 weeks, we will measure women's mood, well-being, relationship satisfaction and use of healthcare. Women, their partners and staff providing treatments will be interviewed to understand whether IPC is an acceptable approach and whether changes should be introduced before applying to run a larger trial.Several groups of patients with depression during pregnancy have contributed to our study design. A patient advisory group will meet and advise us during the study.

ETHICS AND DISSEMINATION

Study results will inform the design of a larger multicentre randomised controlled trial (RCT). Our findings will be shared through public engagement events, papers and reports to organisations within the NHS. National Research Ethics Service Committee approved the study protocol.

TRIAL REGISTRATION NUMBER

ISRCTN11513120.

Studying perceived needs for information on maternal and infant health care in the puerperium period among fathers of newborns in China

OBJECTIVE

The objective of this study is to understand the perceived needs for information on maternal and infant healthcare during the puerperium among the fathers of newborns in China, and to examine factors that are associated with the patterns of perceived needs.

DESIGN

A cross-sectional study was conducted.

METHODS

A survey was conducted in the obstetrics department of the First Affiliated Hospital of Soochow University in Suzhou, China. A total of 206 fathers of newborns were interviewed with a response rate of 98.1%. Latent class analysis (LCA) was used to identify a priori unknown patterns of perceived needs for information (knowledge/skills) on maternal and infant healthcare during the puerperium period. Chi-square tests were applied to examine factors associated with such patterns of needs.

RESULTS

The majority of the participants perceived strong needs for information on maternal and infant healthcare during the puerperium. LCA identified three latent classes on perceived needs for information on maternal healthcare among Chinese fathers of newborns: Class 1 - Low: Some Infant Health Related Needs; Class 2 - Moderate: Lower Physical Recovery Needs; and Class 3 - High: Enthusiastic Needs. Similarly, three latent classes were identified for perceived needs for information on infant health care: Class 1 - Low: Some Medical Needs; Class 2 - Moderate: Lower Breastfeeding Needs; and Class 3 - High: Enthusiastic Needs. Fathers aged 30 to 35, urban residents, and those with higher education were more likely to be in the Enthusiastic Needs groups for information needs for both maternal and infant healthcare.

CONCLUSIONS

Perceived needs for information on maternal and infant healthcare are widespread among fathers of newborns in China. Three distinct latent classes for perceived needs for information (knowledge/skills) on maternal and infant health were identified in this population. Socio-demographics, such as age, residence, and education, were significantly associated with such patterns of needs. The findings have implications for the development of interventions to improve maternal and infant healthcare in China.

Men's perception of barriers to women's use and access of skilled pregnancy care in rural Nigeria: a qualitative study

BACKGROUND

Greater paternal engagement is positively associated with improved access to and utilization of maternal services. Despite evidence that male involvement increased uptake of maternal and child services, studies show that few men are participating in MNCH programs. Community leaders have long been engaged in public health promotion in rural settings and have been shown to mobilize communities to enhance changes in cultural practices related to public health. With the ultimate goal of increasing men's involvement in maternal health, this study seeks to understand men's perceptions of community and health systems barriers to maternal access and usage of skilled care in rural Edo, Nigeria.

METHODS

This qualitative study involved the analysis of data collected from community conversations with male elders in Etsako East and Esan South East Local Government Areas of Edo State, Nigeria. Community conversations participants (n = 128) comprised of elders between the ages of 50-101. A total of 9 community conversations were conducted. Discussions were audio recorded, transcribed and imported into Atlas.ti 6.2 for content analysis.

RESULTS

Men's perceptions of barriers to maternal use of skilled care are presented in two overarching themes: community systems and health systems. Three sub themes were generated as community systems barriers to maternal healthcare use, they include: gender roles, traditional treatment and policy changes. Three sub themes emerged under health system barriers and they include: cost of health facilities, dissatisfaction with facilities and distance from facilities.

CONCLUSION

Findings suggest that community elders are not only in a good position to influence men's behavior, they are also a source of information to policy makers on strategies to overcome barriers to maternal health, especially at the community level. Furthermore, community elders need support to enact regulations that will promote men's involvement in maternal health, thereby increasing maternal use of skilled care.

Perceptions of pregnant women about prenatal care in primary health care

OBJECTIVE

To understand the perceptions of pregnant women about the care received during prenatal care, in the field of primary health care.

METHOD

Qualitative study, based on Grounded Theory. Data collection was performed from August to December 2016, through a semi-structured interview with 12 pregnant women who received prenatal care in the city of Florianópolis/SC/Brazil. Data collection and analysis were performed concomitantly. Data analysis was performed using open and axial coding.

RESULTS

Three categories were elaborated: Care before and during gestation, Participation in groups of pregnant women, and Quality care during pregnancy.

CONCLUSION

The perceptions of the pregnant women about the care received during the prenatal care is related to the care given, humanized reception, consideration of the pregnant woman's subjectivity and support in the difficult moments that make this period satisfactory.

Determinants of Men's Involvement in Maternity Care in Dodoma Region, Central Tanzania

Background

Men's involvement in maternity care is recognized as a key strategy in improving maternal health and accelerating reduction of maternal mortality. This study investigated the factors determining men's involvement in maternity care in Dodoma Region, Central Tanzania.

Methods

This cross-sectional survey used multistage sampling in four districts of Dodoma Region to select 966 married men participants aged 18 years and above. Data were collected using a structured questionnaire. Multivariate logistic regression analysis was carried out in SPSS version 21.0 to measure the determinants of men's involvement in maternity care.

Results

The study found that only 1 in 5 men were involved in maternity care of their partners. Factors found to determine men's involvement in maternity care were having >4 children (AOR=1.658, 95%CI=1.134 to 2.422), urban area of residence (AOR=0.510, 95%CI=0.354 to 0.735), waiting time >1 hour at the health care facility (AOR=0.685, 95%CI=0.479 to 0.978), limited access to information (AOR=0.491, 95%CI=0.322 to 0.747), and limited spousal communication (AOR=0.3, 95%CI=0.155 to 0.327).

Conclusions

Long waiting time to receive the service and limited access to information regarding men's involvement are associated with low men's involvement in maternity care. Male friendly maternity care should recognize men's preferences on timely access to services and provide them with relevant information on their roles in maternity care. Spousal communication is important; mothers must be empowered with relevant information to communicate to their male partners regarding fertility preferences and maternity care in general.

Fathers' Paternity Leave-Taking and Children's Perceptions of Father-Child Relationships in the United States

Paternity leave-taking is believed to benefit children by encouraging father-child bonding after a birth and enabling commitments to fathers' engagement. Yet, no known U.S. studies have directly focused on the associations between paternity leave-taking and children's reports of father-child relationships. Understanding the potential consequences of paternity leave-taking in the United States is particularly important given the lack of a national paid parental leave policy. The present study uses five waves of data on 1,319 families, largely socioeconomically disadvantaged, from the Fragile Families and Child Wellbeing Study to analyze the associations between paternity leave-taking and 9-year-old children's reports of their father-child relationships. We also assess the extent to which these associations are mediated by fathers' engagement, co-parenting quality, parental relationship satisfaction, and fathers' identities. Results indicate that leave-taking, and particularly 2 weeks or more of leave, is positively associated with children's perceptions of fathers' involvement, father-child closeness, and father-child communication. The associations are explained, at least in part, by fathers' engagement, parental relationship satisfaction, and father identities. Overall, results highlight the linked lives of fathers and their children, and they suggest that increased attention on improving opportunities for parental leave in the United States may help to strengthen families by nurturing higher quality father-child relationships.

Engaging Fathers in Early Obesity Prevention During the First 1,000 Days: Policy, Systems, and Environmental Change Strategies

OBJECTIVE

Fathers are critical stakeholders in childhood obesity prevention but are difficult to engage. This review presents a new approach to engaging fathers in obesity prevention during the first 1,000 days.

METHODS

The review focuses on five existing health and social service programs, including prenatal care, pediatric care, the Special Supplemental Nutrition Program for Women, Infants, and Children, home visiting, and Early Head Start. For each program, the obesity prevention services provided, evidence of father engagement, and barriers thereto are outlined. Subsequently, policy, systems, and environmental strategies are outlined to address the noted barriers and promote father engagement.

RESULTS

Although the programs hold great promise in bringing obesity prevention services to fathers, barriers to their engagement are present in the inner (e.g., limited hours of operation, lack of father-specific materials and programming) and outer (e.g., lack of model programs, best practice models, and consistent funding) settings of programs. Policy, systems, and environmental strategies to increase father engagement focus on earmarked funding, changes to national practice guidelines and practitioner training requirements, and the establishment of father-engagement performance metrics.

CONCLUSIONS

Increasing father involvement in the specified programs will likely increase their engagement in early obesity prevention in an efficient and sustainable manner.

Psychological distress and resilience of mothers and fathers with respect to the neurobehavioral performance of small-for-gestational-age newborns

Background

The existence of psychological distress (PD) during pregnancy is well established. Nevertheless, few studies have analyzed the PD and resilience of mothers and fathers during high-risk pregnancy. This study analyzes the differences between parents’ PD and resilience and the relation between them and the neurobehavioral performance of their SGA newborns.

Methods

This prospective study compares two groups of parents and newborns: case group (52 parents and 26 SGA fetuses) and comparison group (68 parents and 34 appropriate-for-gestational-age, AGA, fetuses). In each group, the parents were evaluated during the last trimester of pregnancy, to obtain standardized measures of depression, stress, anxiety, and resilience. At 40 ± 1 weeks corrected gestational age, psychologists evaluated the state of neonatal neuromaturity achieved.

Results

Multivariate analysis of variance showed, in gender comparisons, that mothers obtained higher scores than fathers for psychological distress but lower ones for resilience. Similar differences were obtained in the comparison of parents’ distress to intrauterine growth by SGA vs. AGA newborns. Mothers of SGA newborns were more distressed than the other groups. However, there were no differences between the fathers of SGA vs. AGA newborns. Regarding neurobehavioral performance, the profiles of SGA newborns reflected a lower degree of maturity than those of AGA newborns. Hierarchical regression analyses showed that high stress and low resilience among mothers partially predict low neurobehavioral performance in SGA newborns.

Conclusions

These findings indicate that mothers of SGA newborns may need psychological support to relieve stress and improve their resilience. Furthermore, attention should be paid to the neurobehavioral performance of their babies in case early attention is needed.

The Efficacy of Father Attachment Education on the Severity of Domestic Violence in Primegravida Women

Purpose: In addition to physical and psychological tension imposed on women through pregnancy, the stress of the spouses' violence can cause harmful effects on both the fetus and mother. In Iran, there are limited data on this subject. Thus, learning attachment skills may be effective in reducing adaptation and domestic violence. This study aimed to investigate the efficacy of paternal attachment on the severity of domestic violence in primgravida women.

Methods: This quasi-experiment research was conducted on 150 pregnant women who were eligible and selected through simple convenience sampling. In the intervention group, four 90-minute training sessions were designed on father attachment, while the control group received routine prenatal care. A violence questionnaire was completed both before and after the intervention (36-38 weeks of pregnancy) in both case and control groups. Data analysis was done in SPSS software, using paired t-test and independent t-test.

Results: According to the results of an independent t-test, there was no significant difference in psychological violence, physical violence, and economic violence. However, there was a significant change in social violence, sexual violence, and overall violence score.

Conclusion: Training the fathers on behavior of domestic violence and its skills leads to reduced social and sexual violence. Therefore, it seems necessary to include education for the fathers in prenatal care.

Paternal Perinatal Mental Health: At-Risk Fathers’ Perceptions of Help-Seeking and Screening

Given the prevalence of paternal perinatal mental health concerns, researchers have suggested introducing routine screening. However, little is known about the acceptability of perinatal screening measures in male populations. Furthermore, the need for screening is influenced by men’s perinatal help-seeking behaviors. A thematic analysis of interview data from nine men at risk of paternal perinatal depression and/or anxiety investigated both acceptability of screening and help-seeking behaviors. Themes indicate that routine screening is desired, but acceptability is influenced by perceptions of its intention and possible outcomes. Findings also suggest that barriers to men’s perinatal help-seeking are likely to be minimized by increased awareness and normalization. Future research and clinical practice should account for complexities raised by men’s perceptions of health care services.

What he knows about her and how it affects her? Husband's knowledge of pregnancy complications and maternal health care utilization among tribal population in Maharashtra, India

Background

Husbands’ knowledge and awareness of pregnancy complications have a positive impact on their wives’ utilization of maternal health care services. In this study, we examined whether husbands’ knowledge and awareness of pregnancy complications can serve as determinants of maternal health service utilization among wives from the tribal population.

Methods

This cross-sectional study was conducted in the rural Gadchrioli district of Maharashtra, India, during November 2014–March 2015. This study included a representative population-based sample of 385 men whose wives had given birth in last 2 years at the age of 15–49 years. A multistage sampling strategy was adopted to select the respondents. Univariate, bivariate, and binary logistic regression analyses were applied to examine the association between men’s knowledge and maternal health service utilization.

Results

The result revealed that an increase in husbands’ education level increased the wives’ utilization of antenatal (ANC) care services. The type of tribe also contributed to significant differences in ANC utilization (OR: 2.64; 95% CI: 0.847–8.24). Regarding standard of living, husbands who were poor were 22% less likely than husbands in the rich category to report the utilization of ANC by their wives. Men with partial or complete knowledge of pregnancy, childbirth, and postpartum complications were more likely to utilize all maternal health services by their wives.

Conclusions

The wives are of men who aware of complications during pregnancy and childbirth are more likely to use maternal health services. Therefore, educating and empowering men about pregnancy complications will contribute to the reduction in maternal and neonatal deaths.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2214-x) contains supplementary material, which is available to authorized users.

Barriers to men's participation in perinatal care: a qualitative study in Iran

BACKGROUND

The role of men's participation in prenatal, delivery and postpartum care is very important, well defined and cannot be over emphasized. Very few studies exist about men's role in promoting the health of the mother and barriers to their participation in perinatal care in Iran; hence, the present study was conducted to determine the barriers to men's participation in perinatal care.

METHODS

The present qualitative study was carried out on 45 participants who were selected employing purposeful sampling technique. Data were collected through in-depth semi-structured interviews, focused group discussions and field notes. Data were analyzed using conventional content analysis.

RESULTS

After data analysis, four main categories extracted were: "cultural barriers", "personal and interpersonal barriers", "health system-related barriers" and "socio-economic barriers".

CONCLUSION

The results of this study, by presenting the barriers to and challenges for men's participation in perinatal care, could be helpful in designing culture-based strategies to overcome these barriers and improve men's participation.

The role of male partner in utilization of maternal health care services in Ethiopia: a community-based couple study

BACKGROUND

Ethiopia has recorded substantial progress in maternal health recently. However, poor utilization of maternal health care services is challenging further improvement. Although male partners are decision-makers in households, the impact of their involvement on maternal health care services has not been well studied. Thus, the objective of this study was to examine the association between male partners' involvement in maternal health care on utilization of maternal health care services.

METHODS

A community-based cross-sectional study was conducted on male/female couples with a baby less than 6 months old (N = 210) in Addis Ababa, Ethiopia. The main independent variable of the study was male partners' involvement in maternal health care. Two structured questionnaires were used to collect the data from men and women. Bivariate and multivariate logistic regression models were used to examine the relationship between the dependent and independent variables.

RESULTS

Mean age in years was 28.7 (SD = 5.4) for women and 36.2 (SD = 8.8) for men. Half of the men (51.4%) have accompanied their partner to antenatal care (ANC) at least once. However, only 23.1% of them have physically entered the ANC room together. Overall involvement of male partners was poor in 34.8% of the couples (involved in two or fewer activities). After controlling for other covariates, the odds of having 1st ANC visit within the first trimester of pregnancy and skilled delivery attendant at birth were higher in women whose male partners took time to know what happened during ANC visits (AOR = 1.93; 95%CI = 1.04-3.60; AOR = 2.93; 95%CI = 1.24-5.6.90, respectively). Similarly, the odds of having at least one ANC visit, first ANC visit within twelve weeks, HIV testing, skilled birth attendant, and birth in a health facility were higher in couples with higher overall male partner involvement.

CONCLUSION

The study demonstrated significant associations between male partners' involvement in maternal health care and utilization of some maternal health care services by female partners.

Being a dad to a child with Down's syndrome: Overcoming the challenges to adjustment

Background

Historically, research exploring the impact of having a child with an Intellectual Disability (ID), has focussed exclusively on mothers. The present study aimed to investigate fathers’ experiences of parenting a child with Down's syndrome (DS), their contributions, influences on family functioning and inclusion in their child's support provision.

Method

Semi‐structured interviews were conducted with 15 fathers. Interviews were analysed using Grounded Theory (GT).

Results

Fathers’ adjustment appeared to be on a fluid trajectory with three key categories influencing this: “Accommodating the Child,” “Adapting the Parental/Spousal Role” and “Adapting Society.”

Conclusions

The accounts uncovered fathers’ adjustment trajectory to parenting a child with DS, concluding that despite practical and emotional challenges, fathers employed strategies to achieve positive adjustment. Fathers identified the need for services to recognize their role and involve them in their child's support provision. Implications for clinical practice and future research are discussed.

Exploring antenatal education content for couples in Blantyre, Malawi

BACKGROUND

Despite advocating for male involvement in antenatal education, there is unmet need for antenatal education information for expectant couples. The objective of this study was to gain a deeper understanding of the education content for couples during antenatal education sessions in Malawi. This is needed for the development of a tailor-made curriculum for couple antenatal education in the country, later to be tested for acceptability, feasibility and effectiveness.

METHODS

An exploratory cross sectional descriptive study using a qualitative approach was conducted in semi-urban areas of Blantyre District in Malawi from February to August 2016. We conducted four focus group discussions (FGDs) among men and women independently. We also conducted one focus group discussion with nurses/ midwives, 13 key informant interviews whose participants were drawn from both health-related and non-health related institutions; 10 in-depth interviews with couples and 10 separate in-depth interviews with men who had attended antenatal clinics before with their spouses. All the interviews were audiotaped, transcribed verbatim and translated from Chichewa, the local language, into English. We managed data with NVivo 10.0 and used the thematic content approach as a guide for analysis.

RESULTS

We identified one overarching theme: couple antenatal education information needs. The theme had three subthemes which were identified based on the three domains of the maternity cycle which are pregnancy, labour and delivery and postpartum period. Preferred topics were; description of pregnancy, care of pregnant women, role of men during perinatal period, family life birth preparedness and complication readiness plan, coitus during pregnancy and after delivery, childbirth and baby care.

CONCLUSION

Antenatal education is a potential platform to disseminate information and discuss with male partners the childbearing period and early parenting. Hence, if both men and women were to participate in antenatal education, their information needs should be prioritized. Men and women had similar choices of topics to be taught during couple antenatal education, with some minor variations.

Male involvement in the maternal health care system: implication towards decreasing the high burden of maternal mortality

Background

One of the essential components of antenatal care (ANC) is birth preparedness and complication readiness (BP/CR). Strengthening BP/CR measures is one of the principal strategies to reduce maternal mortality and morbidity. The current study aimed at determining the level of men’s knowledge about obstetric danger signs, and their involvement in BP/CR among community of Northwest Ethiopia.

Method

A cross-sectional community based survey was conducted in Northwest Ethiopia from May 2016 to July 2016. Data was analyzed by the Statistical Package for the Social Sciences software Version 21.0 for Windows. Participants’ socio-demographic characteristics, knowledge of obstetric danger signs, and level of involvement in BP/CR were described using frequencies and percentages. Bivariate and multivariable logistic regressions were employed to explore the associated factors and P-value of 0.05 was used as a cut-off point to declare significant association.

Result

From 856 men who were invited for the study, 824 men agreed for the interview giving a response rate of 96.2%. Half of the men stated one danger sign that may occur during pregnancy 407(49.4%); one third during delivery 271(32.9%); and 213(25.8%) during postpartum period. Among all participants, 256(31.1%) had not made any preparations; 363(44.1%) made one step; 116(14.1%) made two steps; 82(9.9%) made three steps; 5(0.6%) made four steps; 2(0.24%) made five steps; and no one made all the birth preparation steps during the birth of their last child. BP/CR was significantly association with knowledge of at least one danger sign during pregnancy (AOR = 3.3, 95% CI: 3.1, 3.9); during delivery (AOR = 2.2, 95% CI: 1.1, 2.8); and post partum period (AOR = 1.8, 95% CI: 1.1, 2.4). Furthermore, BP/CR was found to be positively associated with being married, completing college education, escorting wife to antenatal care, and urban residence.

Conclusions

Men’s level of knowledge about obstetric danger signs, and their involvement in BP/CR was found to be very poor. Considering the importance of male involvement in the maternal health care, it is recommended to advocate policies and strategies that can improve awareness of men and enhance their engagement in the maternal care.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2139-9) contains supplementary material, which is available to authorized users.

Mothers' experience of maternity and neonatal care when babies die: A quantitative study

BACKGROUND

The death of a newborn baby is devastating. While clinical issues may be a primary concern, interpersonal aspects can impact significantly. Mothers in this situation are not easy to access for research and little quantitative evidence is available. In this study we aimed to describe their experience of care, emphasising associations with infant gestational age.

METHODS

Secondary analysis of population-based survey data collected through the Office for National Statistics following neonatal death in England in 2012-13. Women were asked about clinical events and care during pregnancy, labour and birth, when the baby died, postnatally and in the neonatal unit.

RESULTS

249 mothers returned completed questionnaires (30% response rate), 50% of births were at 28 weeks' gestation or less and 66% had babies admitted for neonatal care. 24% of women were left alone and worried during labour and 18% after birth. Only 49% felt sufficiently involved in decision-making at this time. Postnatally only 53% were cared for away from other mothers and babies, 47% could not have their partner stay with them, and 55% were not located close to their baby. Mothers of term babies were significantly less likely to report confidence in staff, feeling listened to and having concerns taken seriously during labour, and postnatally many felt insufficiently informed about their baby's condition, and that neonatal staff were not always aware of parental needs. However, most mothers (84%) were satisfied with neonatal care.

CONCLUSIONS

There is room for improvement if women whose babies die in the neonatal period are to receive the care and support they need. Women who have a baby admitted to a neonatal unit should be cared for nearby, with room for their partner and with greater involvement in decision-making, particularly where withdrawal of life support is considered.

Men's Confrontation with Pregnancy from Women's Point of View: an Ethno Phenomenological Approach

Introduction: In providing pregnancy services, particular attention is given to the mother and her infant and comparatively less consideration is paid to men’s role. This study aimed to explore how Iranian men are confronted with pregnancy from pregnant women’s point of view.

Methods: This study was conducted, using an ethno-phenomenological approach. 25 Pregnant women were recruited via purposeful sampling from health centers, hospitals, and private obstetric clinics in Mashhad, Iran. In-depth semi-structured interviews (n=25), vignettes, (n=13) as well as observation were used for data collection. The data were organized with MAXQDA software version 10 and analyzed, using van Manen descriptive- interpretive phenomenological approach.

Results: The main theme which emerged was: "adaptation, skillfulness and self-actualization of man in confrontation with pregnancy". This was derived from two themes: 1) "spouse's emotional engagement" subthemes spouse’s emotional confrontation with pregnancy occurrence, man's sentimentality following being an expectant father, husband`s confrontation with wife's motherhood, man's emotional excitement, seeing the symptoms of fetal survival, husband's gender orientation and 2)"Concentration, vigilance and active efforts of spouse during pregnancy" subthemes managing wife towards successful pregnancy, efforts to acquire paternal skills and pregnancy as an issue to expand spouse's mental horizons.

Conclusion: Besides an overwhelming sense of emotion, men tend to be supportive in managing successful pregnancy. As an opportunity window pregnancy seems to develop thinking, vision and horizons of life among men and increases their responsibility. By promoting male participation in pregnancy, important steps could be taken to improve maternal and infant health using spouses` support approach.

Childbirth experiences and their derived meaning: a qualitative study among postnatal mothers in Mbale regional referral hospital, Uganda

BACKGROUND

Evidence shows that negative childbirth experiences may lead to undesirable effects including failure to breastfeed, reduced love for the baby, emotional upsets, post-traumatic disorders and depression among mothers. Understanding childbirth experiences and their meaning could be important in planning individualized care for mothers. The purpose of this study was to explore childbirth experiences and their meaning among postnatal mothers.

METHODS

A phenomenological qualitative study was conducted at Mbale Regional Referral Hospital among 25 postnatal mothers within two months after birth using semi-structured interviews and focus group discussions and data was thematically analyzed.

RESULTS

The severity, duration and patterns of labour pains were a major concern by almost all women. Women had divergent feelings of yes and no need of biomedical pain relief administration during childbirth. Mothers were socially orientated to regard labour pains as a normal phenomenon regardless of their nature. The health providers' attitudes, care and support gave positive and negative birth experiences. The Physical and psychosocial support provided comfort, consolation and encouragement to the mothers while inappropriate care, poor communication and compromised privacy contributed to the mothers' negative childbirth experiences. The type of birth affected the interpretations of the birth experiences. Women who gave birth vaginally, thought they were strong and brave, determined and self-confident; and were respected by members of their communities. On the contrary, the women who gave birth by operation were culturally considered bewitched, weak and failures.

CONCLUSION

Childbirth experiences were unique; elicited unique feelings, responses and challenges to individual mothers. The findings may be useful in designing interventions that focus on individualized care to meet individual needs and expectations of mothers during childbirth.

'Unless you come with your partner you will be sent back home': strategies used to promote male involvement in antenatal care in Southern Tanzania

Background: Male involvement in pregnancy and childbirth has been shown to improve maternal and child health. Many countries have used different strategies to promote participation of men in antenatal care services. While many strategies have been employed to promote male participation in antenatal care, few have been evaluated to provide much-needed lessons to support wider adoption.

Objective: This study aimed at describing strategies that were used by health providers and the community to promote male participation in antenatal care services and challenges associated with the implementation of these interventions in Southern Tanzania.

Methods: We used qualitative data and analytical methods to answer the research questions. The study relied on semi-structured interviews with health providers, men and women, village and community leaders and traditional birth attendants. Data were analysed using a thematic approach.

Results: The findings of this study revealed that different strategies were employed by health providers and the community in promoting participation of men in antenatal care services. These strategies included: health providers denying services to women attending antenatal care without their partners, fast-tracking service to men attending antenatal care with their partners, and providing education and community sensitisation. The implementation of these strategies was reported to have both positive and unintended consequences.

Conclusions: This study concludes that despite the importance of male involvement in pregnancy and childbirth-related services, the use and promotion of the male escort policy should not inadvertently affect access to antenatal care services by pregnant women. In addition, programmes aiming for men’s involvement should be implemented in ways that respect, promote and facilitate women’s choices and autonomy and ensure their safety. Furthermore, there is a need for sensitisation of health providers and policymakers on what works best for involving men in pregnancy and childbirth.

Experiences of Greek women of water immersion during normal labour and birth. A qualitative study

INTRODUCTION

There is scarce information on water births in Greece, as few women labour and give birth in water. The Greek public health system does not provide water immersion as a birthing option, and so women can only experience this option in private healthcare settings. The aim of this study was to explore the key concepts and themes identified from an analysis of the experiences of women who laboured and gave birth immersed in water.

METHODS

This was a qualitative study involving twelve women who used water immersion during labour, of which nine had also a water birth. Individual interviews were conducted and their content was analysed using thematic analysis.

RESULTS

Three main themes were identified: Water use as a natural way of birth, Mixed messages from the healthcare professionals, and Partner's supportive role during water birth. All women reported a positive birth experience and water immersion helped them cope with the pain of labour. They felt greatly empowered following birth and this contributed to successful breastfeeding for more than one year, in the majority of cases. They reported difficulties in finding healthcare professionals that were in support of their choices. The women felt highly supported by the partner's role.

CONCLUSIONS

Labouring and giving birth immersed in water was met with great satisfaction by all women. The findings of this study have added to the current body of midwifery knowledge on how water immersion can improve a woman's experience and so support a normal birth outcome.

Development of a conceptual framework that identifies factors and challenges impacting perinatal fathers

BACKGROUND

A father's ability to cope with fatherhood in the perinatal period has received limited attention in the literature. Recent studies have shown that both mothers and fathers are challenged by the demands of parenthood.

AIMS

The challenges experienced by fathers during the perinatal period are explored and specific risk factors are identified. The aim of this paper was to develop a framework embedding the identified risk factors into a theoretical model that could be applied in predicting paternal emotional well-being.

METHODS

This literature review consulted English peer-reviewed papers as far back as 1990. Databases, including PubMed, CINAHL, SCOPUS, PsycINFO, EBSCO, and ProQuest Dissertations and Theses were examined.

RESULTS

The results of the literature review depicted a number of factors that could be aggregated into four clusters, including vulnerability factors, precipitating factors, coping style, and socio-cultural factors.

LIMITATION

The literature review was limited as it only examined English based peer-reviewed articles.

CONCLUSION

The suggested model is based on various theoretical concepts and empirical findings. The application of this model could assist clinicians in the identification of at-risk perinatal fathers and target interventions to specific challenges experienced by perinatal fathers.

Informational interventions on paternal outcomes during the perinatal period: A systematic review

PROBLEM

The perinatal period is a stressful transition for new parents.

BACKGROUND

Various forms of educational interventions are available and are found to be efficacious in improving maternal and child outcomes. Such interventions for fathers were scarce and western-centric. Fathers should be educated as they have an impact on maternal and child outcomes.

AIM

This review aims to evaluate the efficacy of quantitatively-studied informational support-focused interventions for fathers using paternal outcomes only.

METHODS

The search was carried out in six databases: Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, Embase, Psychological Information Database, and MedNar. Cochrane Collaboration's tools were used to assess the eligibility of the studies.

FINDINGS

A total of 17 studies with 18 interventions were identified and included in the narrative synthesis. Most interventions were delivered to the Western population during the antenatal or postpartum period. The method of delivery for these interventions was mainly face-to-face, with inconclusive findings on various paternal psychosocial outcomes.

DISCUSSION

Limited father-inclusive interventions were available. Technology-based longitudinal studies with interventions carried out across the perinatal period with longer follow-up periods were recommended for interventions providing informational support for fathers. Future studies can also examine paternal physical health and behavioural outcomes. Interventions in culturally-diverse populations should be designed and tested for their efficacies as fathers have different informational needs, especially in Asia.

CONCLUSION

Informational interventions for fathers were found to be lacking and recommendations for future studies on educational interventions for fathers were discussed.

Husband's involvement with mother's awareness and knowledge of newborn danger signs in facility-based childbirth settings: a cross-sectional study from rural Bangladesh

Objective

The aim of this study was to examine the association between husband involvement and maternal awareness and knowledge of newborn danger signs. This cross-sectional study was conducted in three rural hospitals of Bangladesh among the recently delivered women (RDW).

Results

RDW were interviewed to determine their knowledge and understanding of seven key neonatal danger signs. About 51.4% of the respondents were able to identify at least one danger sign. ‘Fever’ was the most correctly identified (43.7%), and hypothermia was the least (26.1%) identified danger sign. The factors associated with RDW possessing knowledge of at least one neonatal danger sign were: secondary education (COR: 1.3, 95% CI 1.1–1.6), increased ANC visits (COR: 1.2, 95% CI 1.1–1.3), previous history of facility delivery (COR: 1.3, 95% CI 1.1–1.4), and husband involvement in the mother’s facility delivery (COR: 1.3, 95% CI 1.1–1.5). RDW were more likely to recall at least one newborn danger sign (AOR: 1.2, 95% CI 1.1–1.4) when the husband was actively involved in his wife’s antenatal, delivery and postnatal care. In conclusion, this study found that husband involvement was significantly associated with the maternal knowledge related to identification of neonatal danger signs.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3386-6) contains supplementary material, which is available to authorized users.