Men's psychological transition to fatherhood: an analysis of the literature, 1989-2008

A narrative review of fathers' involvement during labour and birth and their influence on decision making

OBJECTIVE

to identify and critically review the research literature that has examined fathers׳ involvement during labour and birth and their influence on decision making.

DESIGN

the review follows the approach of a narrative review. Systematic searches of electronic databases Social Services Abstract, Sociological Abstracts, ASSIA, CINAHL Medline, Cochrane library, AMED, BNI, PsycINFO, Embase, Maternity and Infant care, DH-Data and the Kings Fund Database were combined with manual searches of key journals and reference lists. Studies published between 1992 and 2013 examining fathers׳ involvement during intrapartum care were included in the review.

FINDINGS

the findings of this review suggest that fathers׳ level of involvement during labour ranges from being a witness or passive observer of labour and birth to having an active supporting and coaching role. The findings also suggest that there are a number of facilitators and barriers to fathers׳ involvement during labour and birth. There are a limited number of studies that have examined fathers׳ involvement in decision making and specifically how fathers׳ influence decision making during labour and birth.

KEY CONCLUSIONS

future research needs to address the gap in the literature regarding fathers׳ involvement and influence on decision making to help midwives and obstetricians understand the process in order enhance the transition to parenthood for women and men.

Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review

The professionalisation of doula care and research interest in this area of maternity care/support have both grown internationally in recent years highlighting important broader issues around the access, continuity and delivery of maternity care services. However, no work to date has provided a critical appraisal of the international literature on this topic. In response, this paper presents the first critical review of international empirical literature examining professional doula care for pregnant and birthing women. A database search of AMED, CINAHL, Maternity and Infant Care, and MEDLINE using the search term, "doula" was undertaken. A total of 48 papers published between 1980 and March 2013 involving trained or professional doulas were extracted. Four descriptive categories were identified from the review: 'workforce and professional issues in doula care'; 'trained or professional doula's role and skill'; 'physical outcomes of trained or professional doula care'; and 'social outcomes of trained or professional doula care'. Of the studies evaluating outcomes of doula care, there were a number with design and methodology weaknesses. The review highlights a number of gaps in the research literature including a lack of research examining doula workforce issues; focus upon the experience and perspective of significant stakeholders such as expectant fathers with regard to trained or professional doula care; clinical trials measuring both subjective experiences and physical outcomes of trained or professional doula support; synergy between the design of clinical trials research examining trained or professional doula care and the clinical reality of professional doula practice. It is imperative that key aspects of trained doula care be subject to further rigorous, empirical investigation to help establish an evidence base to guide policy and practice relating to this area of support and care for pregnant and birthing women.

Systematic and Meta-Analytic Review: Triggering Agents of Parental Perception of Child's Vulnerability in Instances of Preterm Birth

OBJECTIVE

Parental perception of a child vulnerability (PPCV) to illness, not justified by medically noticeable symptoms, is a situation well known to medical and paramedical staff. It is still disputed whether PPCV is triggered by the child's health problems or by parental emotional status. This review is aimed to clarify the etiology of PPCV in instances of preterm birth.

METHOD

PRISMA guidelines were followed. MEDLINE and Scopus indexes were searched. Of the 70 articles yielded by the search, 14 met the inclusion criteria for the systematic review, of which 10 could be included in the meta-analysis.

RESULTS

Children's physiological factors and parents' psychological factors were both found to significantly influence PPCV, in different ways, at different ages of the child.

CONCLUSION

PPCV etiology appears to mostly depend on parents' psychological factors. A better understanding of PPCV etiology could help protect children from distorted parental interaction and reduce parental demands for unnecessary medical care.

Pregnancy experiences of first-time fathers in iran: a qualitative interview study

Background:

Fatherhood, similarly to motherhood, is an important role and responsibility. For accepting this role, one needs to be well-prepared. Awareness of father’s experiences of pregnancy can help us to develop plans for the promotion of the role of fatherhood.

Objectives:

The purpose of this study was to explore how first time fathers describe their experiences of pregnancy.

Patients and Methods:

The data in this qualitative study were collected by individual open-ended interviews in five public health prenatal care clinics in Tehran, Iran, during 2010 ‒ 2011. Participants were 26 Iranian and Moslem first-time fathers living in Tehran, whose partner was in the 32th to 40th week of her normal pregnancy. Qualitative content text analysis was used for analyzing interviews.

Results:

Through analysis of fathers’ experiences of their wives’ pregnancy, four categories, as well as associated subcategories, emerged. The categories include: “Emotional responses to pregnancy, Feeling of change, Accepting the reality and satisfaction, Developing identity as a father.” These categories describe the phenomenon of “Transition to fatherhood”.

Conclusions:

Transition to fatherhood extends beyond only moderate mental and social changes, and may be influenced by cultural background and beliefs. Therefore, caregivers should be aware of fathers' changes and needs during pregnancy, and support them while taking into consideration their culture and beliefs.

Sexuality among fathers of newborns in Jamaica

BACKGROUND

While a growing body of research has addressed pregnancy and postpartum impacts on female sexuality, relatively little work has been focused upon men. A few studies suggest that a fraction of men report decreases in libido during a partner's pregnancy and/or postpartum, with alterations in men's sexual behavior also commonly aligning with those of a partner. Here, we investigate sexuality among fathers of newborn children in Jamaica. In Jamaica, as elsewhere in the Caribbean, relationship dynamics can be fluid, contributing to variable paternal roles and care, as well as a high fraction of children born into visiting relationships in which parents live apart from each other.

METHODS

During July-September, 2011, 3410 fathers of newborns with an average age of 31 (SD = 8) years participated in the fatherhood arm of a national birth cohort study (JAKids). These fathers answered questions about sociodemographic background, relationship quality and sexuality (e.g., various components of sexual function such as sex drive and sexual satisfaction as well as number of sexual partners the previous 12 months and sexual intercourse the previous week) during a visit to a hospital or birth center within a day or two of their child being born.

RESULTS

Showed that sex drive was more variable than other components (erections, ejaculation, problem assessment) of sexual function, though sexual satisfaction was generally high. Thirty percent of men reported two or more sexual partners the previous 12 months. Nearly half of men indicated not engaging in sexual intercourse the past week. Multivariate analyses showed that relationship status was related to various aspects of men's sexuality, such as men in visiting relationships reporting more sexual partners and more openness to casual sex. Relationship quality was the most consistent predictor of men's sexuality, with men in higher quality relationships reporting higher sexual satisfaction, fewer sexual partners, and higher frequency of sex, among other findings.

CONCLUSIONS

These results provide an unusually large, quantitative look at men's sexuality during the transition to fatherhood in Jamaica, offering helpful insight to would-be parents, clinicians or others seeking to anticipate the effects of a partner's pregnancy on men's sexuality.

Releasing the flood: a qualitative case study of one high-risk father's journey through the labor unit and neonatal intensive care unit

Fatherhood is a turning point in the life of many men, but for fathers from fragile backgrounds, the birth of a premature child may be the catalyst for a fresh start. This case study details the experience of a young black man from a high-risk background during the pregnancy, birth, and hospitalization of his premature son. Fathers from backgrounds marked by violence and chaos may find the stability they crave in a hospital environment that provides comfort, familial cohesion, and an empowering sense of purpose. Fathers who lack male role models in their lives may benefit from mentoring relationships formed with male nurses in the neonatal intensive care unit. Longstanding neglected needs for available presence and guidance can be met by caring healthcare professionals who take the time to listen to these fathers and share personal experiences. While the struggle to break patterns of the past is complicated by low self-worth, healthcare providers can reinforce a sense of personal value both by providing a specific role for fathers and by engaging them in meaningful conversation. Findings provide valuable information on the lifeworld of black fathers from socially compromised urban neighborhoods and implications for healthcare practitioners working with this population.

New fatherhood and psychological distress: a longitudinal study of Australian men

Despite growing interest and concern about men's mental health during the perinatal period, we still do not know whether men are more vulnerable to mental health problems during this time. The current study is one of the first to use longitudinal, population-based data to investigate whether becoming an expectant and/or new father is associated with increases in psychological distress. We analyzed 10 waves of data collected annually (from 2001 to 2010) from the nationally representative Household, Income, and Labour Dynamics in Australia (HILDA) Survey. Over this time, 349 men were identified as new fathers (first child aged <1 year), and 224 of these men had been identified as "expectant fathers" during the previous wave. A total of 1,658 men remained "never fathers." Psychological distress was measured using the 5-item Mental Health Inventory before the partner's pregnancy, during the partner's pregnancy, and during the first year of fatherhood. Longitudinal mixed models showed no significant increase in psychological distress as a function of expectant or new fatherhood; instead, some improvement in mental health was observed. The finding suggests that expectant and new fathers are not at greater risk of poor mental health. Future epidemiologic research should continue to identify those men who are most (and least) at risk during the perinatal period in order to target resources and assistance most effectively.

Men, maternity and moral residue: negotiating the moral demands of the transition to first time fatherhood

This article discusses men's transition to first time fatherhood, with a focus on the way they recognise various in-tension moral demands and negotiate an appropriate role for themselves. The findings are taken from a longitudinal study, drawing on elements of grounded theory, comprising a series of face-to-face and telephone interviews with 11 men over a 9-month period from the 12(th) week of pregnancy to 8 weeks after the birth. The analysis focuses on men's feelings and experience of exclusion and participation, and their response and reaction to that experience. The findings present two descriptive themes, 'on the inside looking in' and 'present but not participating', followed by third theme 'deference and support: a moral response' that exposes the dilemmatic nature of men's experience and explains the participants' apparent acceptance of being less involved. The discussion explores the concept of moral residue, arguing that while deference and support may be an appropriate role for fathers in the perinatal period it may also be a compromise that leads to feelings of uncertainty and frustration, which is a consequence of being in a genuinely dilemmatic situation.

Internet-based peer support for parents: a systematic integrative review

OBJECTIVES

The Internet and social media provide various possibilities for online peer support. The aim of this review was to explore Internet-based peer-support interventions and their outcomes for parents.

DESIGN

A systematic integrative review.

DATA SOURCES

The systematic search was carried out in March 2014 in PubMed, Cinahl, PsycINFO and Cochrane databases.

REVIEW METHODS

Two reviewers independently screened the titles (n=1793), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) an Internet-based community as an intervention, or at least as a component of an intervention; (2) the participants in the Internet-based community had to be mothers and/or fathers or pregnant women; (3) the parents had to interact and communicate with each other through the Internet-based community. The data was analysed using content analysis. When analysing peer-support interventions only interventions developed by researchers were included and when analysing the outcomes for the parents, studies that focused on mothers, fathers or both parents were separated.

RESULTS

In total, 38 publications met the inclusion criteria. Most of the studies focused on Internet-based peer support between mothers (n=16) or both parents (n=15) and seven focused on fathers. In 16 studies, the Internet-based interventions had been developed by researchers and 22 studies used already existing Internet peer-support groups, in which any person using the Internet could participate. For mothers, Internet-based peer support provided emotional support, information and membership in a social community. For fathers, it provided support for the transition to fatherhood, information and humorous communication. Mothers were more active users of Internet-based peer-support groups than fathers. In general, parents were satisfied with Internet-based peer support. The evidence of the effectiveness of Internet-based peer support was inconclusive but no harmful effects were reported in these reviewed studies.

CONCLUSIONS

Internet-based peer support provided informational support for parents and was accessible despite geographical distance or time constraints. Internet-based peer support is a unique form of parental support, not replacing but supplementing support offered by professionals. Experimental studies in this area are needed.

A meta-synthesis of fathers' experiences of their partner's labour and the birth of their baby

OBJECTIVE

to develop greater understanding of how expectant fathers experience their partner's labour and the subsequent birth of their baby.

DESIGN

a qualitative meta-synthesis. Data were search for in CINAHL, PubMed, Psych Info and SCOPUS.

SETTING

eight studies conducted in England, Malawi, Nepal and Sweden were included.

PARTICIPANTS

120 fathers with experiences of their partner having a spontaneous vaginal, assisted or surgical birth.

MEASUREMENTS AND FINDINGS

1st order themes were identified and subsequently grouped into seven 2nd order themes. Finally through a process of exploring patterns and connections seven 3rd order themes were developed which produced new insights into the men's experiences of labour and birth. This meta-synthesis revealed that most men wanted to be actively involved in their partner's labour, present at the birth and respected for what they could contribute. Men recognised that birth was a unique event that may be potentially challenging requiring a level of preparation. There were also men who felt pressured to attend. During the actual experience of labour men commonly expressed overwhelming feelings and inadequacy in their ability to support their partner. They particularly struggled with the 'pain' of labour. Midwives were subsequently identified as best placed to make a significant difference to how men perceived their experiences of labour and what they described as the life changing event of birth.

KEY CONCLUSIONS

the expectant fathers' birth experiences were multidimensional. Many were committed to being involved during labour and birth but often felt vulnerable. Being prepared and receiving support were essential elements of positive experience as well as contributing to their ability to adequately support the labouring woman.

IMPLICATIONS FOR PRACTICE

men's ability to actively prepare for, and be supported through, the labour and birth process influences their perceptions of the childbirth event as well as their sense of connection to their partner. Couples should be given opportunities to explore expectations and how these may influence their own construction of their role during the birth process. While the role of expectant fathers in labour and birth should be facilitated and supported arguably their wish not to participate should be afforded the same respect.

Japanese men's success in altered fatherhood role in a foreign country

This study explores the meaning of the lived experience of childbirth and parenting of Japanese men who became fathers in a foreign country. Japanese men have been raised to maintain very strict gender roles, excluding them from sharing with their wives the experience of childbirth and the day-to-day parenting of young children. The study employed a descriptive phenomenological approach with in-depth interviews. Participants included nine Japanese men born and raised in Japan who were living in Honolulu. Three theme categories emerged from the data: "making active efforts in preparation for childbirth in a foreign country"; "challenges in pregnancy, childbirth, child care, and as husbands or partners"; and "challenges in transition to parenthood." Japanese men successfully altered their transitional and authoritarian gender role to a family orientated social structure, under the influence of Western values, when living in foreign country. By spending more time with their new family, they acknowledged the processes of becoming a father. The ability to adapt their expectations of fatherhood in line with Western values was enhanced by the support of coworkers, their mature age, rich educational background, and the personal financial resources of the male participants in the study.

Fathers' experience of childbirth when non-progressive labour occurs and augmentation is established. A qualitative study

OBJECTIVE

Augmentation with oxytocin during labour has increased in Western obstetrics over the last few decades. The aim of this study was to describe how fathers experienced childbirth when non-progressive labour occurred and augmentation was established.

METHOD

A qualitative descriptive design. Ten fathers were interviewed 4-15 weeks post partum. The interviews were semi-structured and were analyzed using Braun and Clarke's thematic analysis.

RESULTS

The analysis revealed three themes and four sub-themes. The themes were: (1) A rational approach to own role, (2) Labour and birth as uncontrollable processes and (3) Relief about the decision of augmentation. The fathers had a rational approach and felt powerless when the process of labour was uncontrollable. They felt they were not able to help their partners in pain when non-progressive labour occurred. They experienced relief when augmentation was established because of the subsequent progression of labour, and because it was then easier to find a role as a helper.

CONCLUSION

This study demonstrates that fathers feel relieved when augumentation is established. In addition, the study underlines that fathers, in order to regain control after experiencing the non-progressive labour, need directions from the midwives to carry out appropriate and usefull tasks.

Experiences of Japanese men during the transition to fatherhood

PURPOSE

The purpose of this study was to understand the meaning of the lived experience of Japanese men during the transition to fatherhood.

DESIGN

Hermeneutic phenomenology was used. Participants were 12 Japanese men who had a first-time healthy child younger than 1 year of age, who were sought by using a purposeful sampling technique.

FINDINGS

The following six themes were identified: (1) feeling like a father; (2) realizing oneself as a husband; (3) finding the wife's pregnancy and delivery for the first time to be an impressive experience; (4) sharing time and space with one's child; (5) being aware of a change and trying to adjust to a new life; and (6) being aware of the difference between oneself and one's wife. These six themes created essence of the phenomenon of "becoming a father."

DISCUSSION

This study revealed Japanese men's own voice on becoming first-time fathers of infants.

Paternal postpartum depression: what health care providers should know

Paternal postpartum depression (PPD) is a clinically significant problem for families that is currently underscreened, underdiagnosed, and undertreated. Maternal PPD is a well-known condition and has been extensively researched. In comparison, PPD in fathers and its potential effects on the family are not widely recognized. Studies have shown the importance of optimal mental health in fathers during the postpartum period. Negative effects of paternal PPD affect marital/partner relationships, infant bonding, and child development. To promote optimal health for parents and children, pediatric nurse practitioners must stay up to date on this topic. This article discusses the relationship of paternal PPD to maternal PPD; the consequences, signs, and symptoms; and the pediatric nurse practitioner's role in assessing and managing paternal PPD.

'Of course he's our child': transitions in social parenthood in donor sperm recipient families

This study examines transitions and consistencies in the views of donor sperm recipients on ‘parenthood’ and ‘family’ over time. A longitudinal qualitative study was carried out with 19 donor sperm recipients. Interviews took place during pregnancy, at birth and 1.5–2 years after birth and were analysed using a grounded theory approach. Participants intending to disclose the donor conception to their offspring (13/19) exhibited a transition from feeling anxious prior to birth to feeling more confident during the toddler stage about their parenthood. Previous anxieties about the lack of biological ties decreased as emerging social ties became more significant. Following birth, these participants (13/19) felt acknowledged by others as parents, which elicited feelings of normalization. Being able to engage in parenting and develop parental relations enhanced their confidence in their parental position. This confidence empowered donor sperm recipients to tackle future challenges and made them more convinced about their disclosure intention. Participants intending not to disclose the donor conception (6/19) reported viewing their parenthood as no different from parenthood experienced by naturally conceiving parents, no transitions were observed and insecurity about physical traits that could reveal the donor conception remained. These findings have implications for counselling throughout specific stages in parenthood.

Parental perceptions and experiences after childbirth: a comparison between mothers and fathers of term and preterm infants

BACKGROUND

Parents experience a lot of positive and negative feelings and emotions after birth. The main purpose of this study was to compare perceptions and experiences of mothers and fathers with term, moderately and very preterm infants.

METHODS

We included 202 infants with both parents, divided into three groups: 1) term infants (≥ 37 weeks' gestation), 2) moderately preterm infants (≥32-<37 weeks' gestation) and 3) very preterm infants (< 32 weeks' gestation). The Clinical Interview for Parents of High-risk Infants (CLIP) was used to examine parental perceptions and experiences in eight areas: 1) Infant's current condition, 2) Course of the pregnancy, 3) Labor and delivery, 4) Relationship with infant and feelings as a parent, 5) Reactions to hospital and staff, 6) Support system, 7) Discharge and beyond, and 8) Quality of narratives during the interview.

RESULTS

The lower the gestational age of the infant, the more negative parental experiences and perceptions were on the following five areas: infant's current condition, pregnancy course, labor and delivery, relationship with the infant, and discharge and beyond. No differences were found between maternal and paternal perceptions on any of the eight CLIP areas.

CONCLUSIONS

Negative parental perceptions and experiences were mainly associated with the gestational age of the infant and not at all with the gender of the parent. These findings resulted in several recommendations to optimize care for parents after preterm birth.

Fathers sharing about early parental support in health-care - virtual discussions on an Internet forum

Becoming a father is a life changing event and this transition is associated with various emotions. Educational activities aimed at new parents are important in healthcare parental support (HCPS). HCPS has been critiqued for its predominant focus on mothers, while the needs of fathers seem to have been downplayed. As a result, fathers often turn to Internet-based forums for support. As virtual discussions and mutual support among fathers take place in cyberspace, it is important to monitor these forums to observe the ways in which the fathers discuss HCPS. The aim of this study is to explore the ways in which new fathers visiting an Internet-based forum for fathers communicated their experiences of HCPS. A netnographic method consisting of six steps was used to gather and analyse the data. The findings show that fathers shared with one another their experiences of the attitudes expressed by HCPS workers as well as their own attitudes towards HCPS. The attitudes of HCPS workers that were directed towards the fathers were perceived as highly personal and individual, while fathers described their attitudes towards the HCPS in general terms, towards HCPS as a system. Overall, the fathers described HCPS as a valuable confirmatory support that eased their worries concerning sudden infant death syndrome (SIDS), colic, weight gain, fever and teething. Although the fathers expressed gratitude towards HCPS, they also shared their negative experiences, such as feeling invisible, disregarded and insulted. In fact, the twofold attitudes that exist in the relationship between the fathers and HCPS can act as a barrier rather than being a confirmatory support. We recommend that HCPS adopts a broader approach using more targeted and strategic didactic methods for supporting fathers in the growth of their own personal awareness, as such an approach would offer a competitive and professional alternative to the support offered in informal experience-based Internet forums.

How well does the Edinburgh Postnatal Depression Scale identify depression and anxiety in fathers? A validation study in a population based Swedish sample

BACKGROUND

Fathers are increasingly involved in infant care, and depression in postnatal fathers as well as mothers may have negative effects on child development and behaviour. The EPDS has been validated to identify depression in new mothers, but few validation studies have involved fathers and there is doubt as to whether the EPDS measures the same constructs in men as in women.

SUBJECTS AND METHODS

A population-based sample of 1014 couples were sent the EPDS and the HAD-A subscale 3 months postnatally. All high-scoring fathers and a random sample of fathers scoring low were invited for a diagnostic interview to assess the presence of any depression or anxiety disorder. A factor analysis of the EPDS data was conducted for mothers and fathers.

FINDINGS

A factor analysis of the EPDS data revealed a different factor structure for fathers, implying that the scale picks up more worry, anxiety and unhappiness than depression. The EPDS yields high sensitivity and specificity, but low positive predictive value when screening for probable major depression at the optimal cut-off score of 12 or more. The accuracy of the EPDS, however, is modest for minor depression, and low for anxiety disorders. Neither the EPDS-3A score nor the HAD-A subscale reached acceptable validity in this study.

CONCLUSIONS

The EPDS seems to pick up more distress than pure depression in new fathers. It is a valid instrument for screening for probable major depression, but it is questionable if it should be used to screen for minor depression. Neither the EPDS nor the HAD-A subscale can be recommended for screening for anxiety in postnatal fathers.

LIMITATIONS

Confidence intervals around the estimates are wide and the interviewed fathers were selected preferentially.

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

Background

Early involvement of fathers with their children has increased in recent times and this is associated with improved cognitive and socio-emotional development of children. Research in the area of father’s engagement with pregnancy and childbirth has mainly focused on white middle-class men and has been mostly qualitative in design. Thus, the aim of this study was to understand who was engaged during pregnancy and childbirth, in what way, and how paternal engagement may influence a woman’s uptake of services, her perceptions of care, and maternal outcomes.

Methods

This study involved secondary analysis of data on 4616 women collected in a 2010 national maternity survey of England asking about their experiences of maternity care, health and well-being up to three months after childbirth, and their partners’ engagement in pregnancy, labour and postnatally. Data were analysed using descriptive statistics, chi-square, binary logistic regression and generalised linear modelling.

Results

Over 80% of fathers were ‘pleased or ‘overjoyed’ in response to their partner’s pregnancy, over half were present for the pregnancy test, for one or more antenatal checks, and almost all were present for ultrasound examinations and for labour. Three-quarters of fathers took paternity leave and, during the postnatal period, most fathers helped with infant care. Paternal engagement was highest in partners of primiparous white women, those living in less deprived areas, and in those whose pregnancy was planned. Greater paternal engagement was positively associated with first contact with health professionals before 12 weeks gestation, having a dating scan, number of antenatal checks, offer and attendance at antenatal classes, and breastfeeding. Paternity leave was also strongly associated with maternal well-being at three months postpartum.

Conclusions

This study demonstrates the considerable sociodemographic variation in partner support and engagement. It is important that health professionals recognise that women in some sociodemographic groups may be less supported by their partner and more reliant on staff and that this may have implications for how women access care.

Exploring Professional Support Offered by Midwives during Labour: An Observation and Interview Study

Support in labour has an impact on the childbirth experience as well as on childbirth outcomes. Both social and professional support is needed. The aim of this study was to explore professional support offered by midwives during labour in relation to the supportive needs of the childbearing woman and her partner. The study used a qualitative, inductive design using triangulation, with observation followed by interviews. Seven midwives were observed when caring for seven women/couples in labour. After the observations, individual interviews with midwives, women, and their partners were conducted. Data were analysed using hermeneutical text interpretation. The results are presented with three themes. (1) Support as a professional task seems unclear and less well defined than medical controls. (2) Midwives and parents express somewhat different supportive ideas about how to create a sense of security. (3) Partner and midwife interact in support of the childbearing woman. The main interpretation shows that midwives' supportive role during labour could be understood as them mainly adopting the "with institution" ideology in contrast to the "with woman" ideology. This may increase the risk of childbearing women and their partners perceiving lack of support during labour. There is a need to increase efficiency by providing support for professionals to adopt the "with woman" ideology.

Fathers online: learning about fatherhood through the internet

In the transition to fatherhood, men face numerous challenges. Opportunities to learn new practices and gain support are limited, although the provisions of father-specific spaces such as fathers' antenatal classes or "responsible fathering" programs are important advances. This article explores how men use the social space of a father-specific Internet chat room to learn about fathering. Messages to an Australian-hosted, father-specific chat room (for fathers of infants or young children) were examined, and three overlapping themes illustrated men's perceptions of their transition to fatherhood. The themes concerned recognition of and response to a lack of social space, services, and support for new fathers. The implications for fathers' perinatal education are discussed.

Involving fathers in prevention of mother to child transmission initiatives--what the evidence suggests

Introduction

The current UNAIDS goal towards virtual ending or elimination of infants acquiring HIV by 2015 is perhaps the most achievable goal to date. Yet, models show that delivery of antiretroviral compounds alone will not suffice to achieve this goal, and a broader community-based approach to pregnancy, families and HIV is needed. Such an approach would highlight the important role of men in reproduction. Although early studies have shown it is cost-effective to include males, very few interventions have proceeded to involve men.

Methods

This review utilized systematic review techniques to explore the literature on effective interventions for the inclusion of men in the prevention of HIV to infants. A key word search of literature sources generated 248 studies for hand sorting and interrogation. Of these, 13 were found to contain some information on involvement of males in some form of provision. Data were abstracted from these and form the basis of this review.

Results

Background descriptive studies painted a picture of low male involvement, poor male inclusion and barriers to engagement at all stages. Yet, pregnancy intentions among men affected by HIV are high and the importance of fathers to family functioning – from relationships, through conception, pregnancy and parenting – is well established. Search strategies for interventions for males in HIV and pregnancy were used to generate studies of sufficient quality to inform strategies on the future of male involvement. Of the 317,434 papers on pregnancy and HIV, only 4178 included the term male (paternal or father). When these were restricted to intervention studies, only 248 remained for hand sorting, generating 13 studies of relevance for data extraction. The results show that all these interventions were concentrated around male partner HIV testing. In general, male partner testing was low and was amenable to change by offering voluntary counselling and testing (VCT) information, providing couple-based testing facilities and encouraging male attendance. All interventions used indirect approaches to men via their pregnant spouse. Non-health facility (clinic or hospital)-based provision (such as testing facilities in the community in bars and churches) were more effective than healthcare facilities in attracting male participation.

Conclusions

In conclusion, the review showed that approaches to men are limited to HIV testing with little innovative planning and provision for male treatment and care. As such, initiatives run the risk of alienating rather than including males. Direct approaches and the provision of male-specific facilities and benefits should be explored.

Transition to fatherhood: modeling the experience of fathers of breastfed infants

Transition to parenthood has long been examined from the angle of mothers' experience. When looked at this transition through fathers' lens, fathers' involvement and perceived parental efficacy appear to be landmarks of this experience. This article examines a model of the relationships among father involvement, perceived parental efficacy, events related to breastfeeding, support, stress, and income with a sample of 164 fathers of breastfed infants. This model highlights the direct and indirect contributions of support and stress to fathers' perceived parenting efficacy and involvement. Possible directions for nursing practice, education, and research are proposed to ease men's transition to fatherhood.

Father for the first time--development and validation of a questionnaire to assess fathers' experiences of first childbirth (FTFQ)

BACKGROUND

A father's experience of the birth of his first child is important not only for his birth-giving partner but also for the father himself, his relationship with the mother and the newborn. No validated questionnaire assessing first-time fathers' experiences during childbirth is currently available. Hence, the aim of this study was to develop and validate an instrument to assess first-time fathers' experiences of childbirth.

METHOD

Domains and items were initially derived from interviews with first-time fathers, and supplemented by a literature search and a focus group interview with midwives. The comprehensibility, comprehension and relevance of the items were evaluated by four paternity research experts and a preliminary questionnaire was pilot tested in eight first-time fathers. A revised questionnaire was completed by 200 first-time fathers (response rate = 81%) Exploratory factor analysis using principal component analysis with varimax rotation was performed and multitrait scaling analysis was used to test scaling assumptions. External validity was assessed by means of known-groups analysis.

RESULTS

Factor analysis yielded four factors comprising 22 items and accounting 48% of the variance. The domains found were Worry, Information, Emotional support and Acceptance. Multitrait analysis confirmed the convergent and discriminant validity of the domains; however, Cronbach's alpha did not meet conventional reliability standards in two domains. The questionnaire was sensitive to differences between groups of fathers hypothesized to differ on important socio demographic or clinical variables.

CONCLUSIONS

The questionnaire adequately measures important dimensions of first-time fathers' childbirth experience and may be used to assess aspects of fathers' experiences during childbirth. To obtain the FTFQ and permission for its use, please contact the corresponding author.

Experiences of community health nurses regarding father participation in child health care

Traditionally child health care (CHC) has been an arena where mothers and nurses meet, but in recent years fathers are entering CHC with increasing frequency. The aim of this study was to describe nurses' experiences of fathers' participation in CHC. Nine Swedish nurses working in CHC were interviewed and asked to give a description of their experiences from meetings with fathers in CHC. Phenomenology according to Giorgi was used for the analysis and the essence of the findings was that father participation was seen from the perspective of mother participation and was constantly compared to mother participation in CHC. The essence is explicated in the following themes: participation through activities; equal participation although diverse; influence of structures in society; and strengthening participation. Clinical implications include the need for creating a separate identity in CHC for fathers and more communication directed at fathers.

Fathers' birth experience in relation to midwifery care

The aim was to identify the proportion of fathers having a positive experience of a normal birth and to explore factors related to midwifery care that were associated with a positive experience.

BACKGROUND

Research has mainly focused on the father's supportive role during childbirth rather than his personal experiences of birth.

METHODS

595 new fathers living in a northern part of Sweden, whose partner had a normal birth, were included in the study. Data was collected by questionnaires. Odds Ratios with 95% confidence interval and logistic regression analysis were used.

RESULTS

The majority of fathers (82%) reported a positive birth experience. The strongest factors associated with a positive birth experience were midwife support (OR 4.0; 95 CI 2.0-8.1), the midwife's ongoing presence in the delivery room (OR 2.0; 1.1-3.9), and information about the progress of labour (OR 3.1; 1.6-5.8).

CONCLUSION

Most fathers had a positive birth experience. Midwifery support, the midwife's presence and sufficient information about the progress of labour are important aspects in a father's positive birth experience. The role of the midwife during birth is important to the father, and his individual needs should be considered in order to enhance a positive birth experience.

Fathers Faring Poorly

Fathers of young children may face health challenges. In this article, the authors sought to characterize health-related challenges among fathers of young children (aged 4 years or younger) through the use of an Internet survey. Questions covered an unusually large battery of outcomes related to men’s health, including general health, affect, and sexual function. A total of 126 adult fathers provided usable data. The most notable findings were that scores on the General Health Questionnaire, Kessler Psychological Distress Scale, and negative affect indicated poor general health and high levels of distress and negative affect compared with normative data. Relationship satisfaction, sexual desire, and sexual activity were similar to normative data, although sexual enjoyment with and without a partner were lower among fathers participating in this study. Some variables were associated with each other (e.g., relationship satisfaction and affect) but most were not. This study also indicates that fathers can be successfully recruited through Internet-based survey research.

First-time fathers' experiences of childbirth--a phenomenological study

OBJECTIVE

To describe fathers' experiences during childbirth.

DESIGN

Qualitative method with phenomenological lifeworld approach. A re-enactment interview method, with open-ended questions analysed with a phenomenological method, was used.

PARTICIPANTS AND SETTING

10 First-time fathers from two hospitals were interviewed four to six weeks after childbirth in Southwest Sweden during the autumn of 2008.

FINDINGS

The essential meaning of first-time fathers' lived experience of childbirth was described as an interwoven process pendulating between euphoria and agony. The four themes constituting the essence was: 'a process into the unknown', 'a mutually shared experience', 'to guard and support the woman' and 'in an exposed position with hidden strong emotions'.

KEY CONCLUSIONS

Childbirth was experienced as a mutually shared process for the couple. The fathers' high involvement in childbirth, in cooperation with the midwife, and being engaged in support and care for his partner in her suffering is fulfilling for both partners, although the experience of the woman's pain, fear of the unknown and the gendered preconceptions of masculine hegemony can be difficult to bear for the father-to-be.

IMPLICATIONS FOR PRACTICE

In order to maintain and strengthen childbirth as a mutually shared experience for the couple, the father needs to be recognised and supported as a parent-to-be. Midwives have to acknowledge fathers as valued participants and support their significant position.

L’expérience paternelle entourant la naissance sous l’angle du discours social

Dans ce texte, j’aborde la question de l’expérience du père lors de la période entourant la naissance d’un enfant de manière à introduire les quatre articles faisant partie de ce dossier. Dans un premier temps, une mise en contexte sociohistorique est proposée. Cela permettra d’abord de situer les préoccupations actuelles à propos des pères, de l’identité paternelle et de l’engagement paternel et ensuite de montrer que ces préoccupations sont directement liées aux transformations récentes de la famille et des identités au sein des sociétés occidentales. Dans un deuxième temps, l’idée que les pères, tout autant que les mères, vivent une expérience personnelle lors de la période entourant la naissance de leur enfant sera présentée de façon à mettre en relief ses origines (d’où vient cette idée que les pères ont une expérience de cette transition à la paternité?) ainsi que la forme de discours social qui y est rattaché (comment parle-t-on de cette expérience paternelle?) en particulier à l’intérieur des contextes professionnels et institutionnels qui servent à procurer des soins et des services périnataux. Le texte se termine par une brève description du contenu des quatre articles.

A birth education program for expectant fathers in Taiwan: effects on their anxiety

BACKGROUND

A father who does not know how to assist the mother in relieving labor pains may experience a sense of powerlessness and anxiety. The objective of this study was to evaluate how an education program for expectant fathers who attended their partners' labor and birth affected their anxiety.

METHODS

In a randomized controlled trial, 87 expectant fathers who attended their pregnant partners through labor and birth at a hospital in central Taiwan were allocated by block randomization to an experimental (n = 45) and a control (n = 42) group. The men completed their basic personal information, a childbirth expectations questionnaire, and a Trait Anxiety Inventory when they were recruited. Two hours after birth of their child, all the expectant fathers completed a State of Anxiety Inventory.

RESULTS

Our results showed no statistically significant differences between the experimental and control groups of fathers in trait anxiety and their prenatal childbirth expectations. After analysis of covariance (ANCOVA) was applied to correct for education level, sources of childbirth information, attendance at Lamaze childbirth classes, and childbirth expectations at baseline, the effect of the childbirth program was significant for the postnatal level of anxiety (F = 3.38, p = 0.001).

CONCLUSIONS

The study findings justify the clinical implementation of a birth education program based on the self-efficacy theory as an effective means of reducing anxiety among expectant fathers.