Assessment of postnatal paternal–infant attachment: development of a questionnaire instrument

Mental health of parents with infants in NICU receiving cooling therapy for hypoxic-ischaemic encephalopathy

BACKGROUND

Parents cuddling their babies during intensive care to promote parent-infant bonding is usual practice in the neonatal intensive care unit (NICU). However, babies undergoing cooling therapy and intensive care are not routinely offered parent-infant cuddles due to concerns of impacting the cooling process or intensive care. We developed the CoolCuddle intervention to enable parents to cuddle babies safely during cooling therapy. We investigated whether CoolCuddle impacted parent-infant bonding and parent's mental health.

METHODS

We conducted parental interviews and compared mental health and bonding measures in two cohorts of parents; one with access to CoolCuddle and the other where CoolCuddle was not available.

RESULTS

Ten tertiary NICUs in England and Wales from 2019 to 2023 were involved and 107 families. There were high levels of post-delivery depression amongst all parents. However, at discharge mothers in the CoolCuddle group had significantly less depression, lower EPDS scores, and higher MIBS scores (consistent with better mother-infant bonding) than those where CoolCuddle was not available. All measures appeared similar when re-measured at 8 weeks. Parents reported they were not ready to access psychological support or information whilst on NICU and stressed the need of mental health support following discharge, which was not offered or available.

CONCLUSION

The CoolCuddle intervention was associated with a lower prevalence of depression and enhanced bonding scores for mothers at discharge compared to those who did not cuddle their babies. Parents highlighted increased levels of postnatal depression following the sudden and traumatic admission of their infant to NICU after birth asphyxia.

Embedding the 'CoolCuddle' intervention for infants undergoing therapeutic hypothermia for hypoxic-ischaemic encephalopathy in NICU: an evaluation using normalisation process theory

OBJECTIVES

Newborn infants exposed to lack of oxygen and blood flow to the brain around birth may develop brain dysfunction (hypoxic-ischaemic encephalopathy-HIE). These infants undergo 72 hours of cooling therapy and most are not held by their parents in the UK. We examined the implementation of 'CoolCuddle', identifying factors that impact embedding of this complex intervention in neonatal intensive care units (NICUs) across England.

DESIGN

Process evaluation and qualitative study using a standard questionnaire and interviews. Normalisation Process Theory (NPT) core constructs were used to assess relevant issues to staff embedding 'CoolCuddle', to discern change over time and different settings. Qualitative interviews provided valuable contextual exploration of implementation.

SETTING AND PARTICIPANTS

Six tertiary NICUs in England. Thirty-seven families with a newborn baby undergoing cooling therapy for HIE were recruited from September 2022 to August 2023; 17 NICU staff Normalisation MeAsure Development (NoMADs) at six NICUs over 6 months were included; 14 neonatal/research nurses from three participating NICUs were interviewed.

INTERVENTION

The family-centred intervention 'CoolCuddle' was developed to enable parents to hold their infant during cooling, without affecting the cooling therapy or intensive care.

OUTCOME MEASURES

NoMAD questionnaires at three timepoints over 6 months and NPT informed qualitative interviews.

RESULTS

NoMAD questionnaires at baseline showed more variation between units, for intervention acceptability, than those at 3 and 6 months. Qualitative data highlighted that staff understood the benefits of CoolCuddle but were apprehensive due to perceived risks involved in moving cooling babies. A rigorous standard operating procedure was flexible enough to incorporate the use of local processes and equipment and provided the relevant procedural knowledge to deliver CoolCuddle safely.

CONCLUSIONS

The CoolCuddle intervention can be implemented safely under the supervision of standard neonatal teams as part of usual practice in diverse NICU settings in England. The importance of having a rigorous standard operating procedure, which can be adapted to support local settings, is highlighted.

TRIAL REGISTRATION NUMBER

ISRCTN10018542; Results: registered on 30 August 2022.

Father-to-infant attachment and its associated factors during COVID-19 pandemic: a cross-sectional study

BACKGROUND

The attachment between father and infant is essential to a child's later development and well-being; yet, hardly any research has examined father-to-infant attachment during the outbreak of COVID-19. This study, therefore, aims to examine psychological, interpersonal, and health-related factors associated with father-to-infant attachment at 3-12 months postpartum during the pandemic.

METHOD

An online cross-sectional study was conducted between June and December 2021. A total of 775 fathers with at least one child aged 3-12 months were recruited. Participants completed measures of depression, COVID-19-related distress, relationship satisfaction, social support and other health-related factors including COVID-19 diagnosis and hospitalisation. Data on psycho-socio-demographic, obstetric, and COVID-19-related characteristics were also collected.

RESULTS

Findings demonstrated that paternal depression (β = -.33, p < .001); relationship satisfaction (β = .19, p < .001); COVID-19-related psychological distress (β = -.14, p < .001) and social support (β = .13, p < .001) had a significant effect on father-to-infant attachment. Fathers who were multiparous, had COVID-19 diagnosis, and hospitalised due to COVID-19 were more likely to report poorer father-to-infant attachment. Paternal depression was the most influential factor on father-to-infant attachment, which attenuated the strength of the relationships between marital status, prematurity, history of trauma, sleep quality, and father-to-infant attachment once included into the analyses. No significant associations between educational level, employment, socioeconomic status, delivery mode, and father-to-infant attachment were observed.

CONCLUSION

These findings highlight the critical role of paternal psychological well-being in establishing healthy father-to-infant attachment and the relevance of having satisfied interpersonal relationships in promoting this early relationship particularly during crises such as COVID-19 pandemic.

Maternal-infant and paternal-infant attachment levels after successful infertility treatment and affecting factors: A descriptive cross-sectional study

PURPOSE

This study aimed to determine the levels of maternal and paternal attachment and the factors that affect them in individuals who had a baby after infertility treatment.

METHODS

This study followed a descriptive cross-sectional design in accordance with STROBE guidelines. The research was conducted in the infertility clinic of a university hospital and included 128 participants, consisting of 64 mothers and 64 fathers. Data were collected using the 'Personal Information Form-Mother', 'Personal Information Form-Father', 'Maternal Attachment Inventory (MAI)', and 'Postnatal Paternal-Infant Attachment Questionnaire (PPAQ)'.

RESULTS

The study found that the mothers had an average MAI score of 102.35 ± 3.05, while the fathers had an average PPAQ score of 82.21 ± 4.27. A significant correlation was observed between the mothers' MAI score and the duration of their marriage. Similarly, a significant correlation was observed between the fathers' PPAQ score and the duration of their marriage, the duration of their infertility diagnosis, and the duration of their infertility treatment (p < 0.05). The correlation analysis between the MAI score and the mean score of the PPAQ's subscale of pleasure in interaction was weakly significant and positive (r = 0.26; p = 0.032). However, there was no significant relationship between the MAI score and the PPAQ score (r = 0.18; p = 0.146).

CONCLUSIONS

The study findings indicate that parents who conceive through infertility treatment exhibit high levels of attachment to their babies. Healthcare professionals should assess the attachment levels of both mothers and fathers who have undergone infertility treatment and be mindful of the factors that influence it.

Cortical volume reductions in men transitioning to first-time fatherhood reflect both parenting engagement and mental health risk

Perinatal reductions in gray matter volume have been observed in human mothers transitioning to parenthood, with preliminary evidence for similar changes in fathers. These reductions have been theorized to support adaptation to parenting, but greater investigation is needed. We scanned 38 first-time fathers during their partner's pregnancy and again after 6 months postpartum, and collected self-report data prenatally and 3, 6, and 12 months postpartum. Significant gray matter volume reductions were observed across the entire cortex but not the subcortex. Fathers who reported stronger prenatal bonding with the unborn infant, and planned to take more time off from work after birth, subsequently showed larger cortical volume decreases. Larger reductions in gray matter volume also emerged among fathers who reported stronger postpartum bonding with the infant, lower parenting stress, and more time spent with their infant. Larger volume reductions predicted more postpartum sleep problems and higher levels of postpartum depression, anxiety, and psychological distress, controlling for prenatal sleep and mental health. Volume reductions were smaller among fathers whose infants were older at the postpartum scan, indicating potential rebound. These results suggest that perinatal gray matter volume reductions might reflect not only greater parenting engagement but also increased mental health risk in new fathers.

A Concept Analysis of Paternal Bonding With Prematurely Born Infants

BACKGROUND

Maternal bonding in infancy has long been the focus of research and practice. Despite emerging evidence highlighting the importance of paternal bonding, little attention has been focused on fathers. Simultaneously, there is little clarity regarding possible differences between bonding and attachment.

PURPOSE

This article aims to clarify the concept of paternal bonding with infants born prematurely.

METHODS/SEARCH STRATEGY

Using Walker and Avant's approach to concept analysis, we selected databases and searched them for relevant studies published between 2012 and 2022. We identified 28 articles that (1) defined bonding specific to fathers of infants born prematurely, (2) were peer-reviewed, and (3) were in English. From the articles, we extracted and analyzed data specific to concept definitions, antecedents, and consequences.

RESULTS

Regarding paternal bonding with infants born prematurely, our analyses of the 28 studies yielded a conceptual definition of this topic that extends beyond the commonly used definition emphasizing emotional connection. The newly formulated definition covers the cognitive, behavioral, and dynamic, as well as emotional, attributes of bonding. We identify and discuss antecedents and consequences of bonding.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Our findings led to a consistent conceptual definition of the bonding phenomenon in question. The definition should serve as a conceptual basis for future guidelines governing clinical practice and research. Through our findings, nurses can better understand and promote paternal bonding with infants born prematurely. Finally, our findings can improve researchers' exploration of this topic.

The effect of fathers' birth attendance on paternal attachment and the perception of parental role: a randomised controlled trial

BACKGROUND

Fathers' birth attendance is associated with support for mothers in infant care, positive child health outcomes, and parental well-being.

OBJECTIVE

This study was conducted in a randomised controlled experimental design to investigate the effect of fathers' birth attendance on paternal-infant attachment and the perception of parental role.

METHODOLOGY

Pregnant women during the childbirth process and their husbands were included in the study and were randomised according to fathers' birth attendance. The data were collected with the Information Form (IF), Paternal Antenatal Attachment Questionnaire (PAAQ), Self-Perception of Parental Role Scale (SPPRS), Postnatal Paternal-Infant Attachment Questionnaire (PPAQ), and Edinburgh Postnatal Depression Scale (EPDS). The IF data were obtained from women before birth, and the EPDS data were obtained from women 15 days after birth.

RESULTS

Individual characteristics of mothers and fathers in the groups, and prenatal PAAQ and SPPRS scores of the fathers were similar (p > 0.05). In the postnatal period, a significant difference was found in favour of the intervention group in the PPAQ total (p < 0.01), Patience and Tolerance (p < 0.05) and Pleasure in Interaction (p < 0.01) sub-dimensions. The within-group variation of the SPPRS scores of fathers in the intervention and control groups was analysed. The postnatal Competence (p < 0.01) and Integration (p < 0.05) sub-dimension scores statistically significantly increased in both the intervention and control groups compared to the antenatal period.

CONCLUSION

While husbands' accompanying their wives in the delivery room positively affects paternal-infant attachment, its effect on the perception of parental role is an issue that needs to be further investigated.

Skin-to-Skin Care and Spontaneous Touch by Fathers in Full-Term Infants: A Systematic Review

A series of studies have shown that mothers' early tactile behaviors have positive effects, both on full-term and preterm infants, and on mothers alike. Regarding fathers, research has focused mostly on paternal skin-to-skin care with preterm infants and has overlooked the tactile behavior effects with full-term newborns on infants' outcomes and on fathers themselves. The current systematic review considered the evidence regarding paternal tactile behaviors with full-term infants, including skin-to-skin care (SSC) and spontaneous touch (ST), during parent-infant interactions, and differentiated biophysiological, behavioral and psychological variables both in fathers and in infants. We also compared fathers' and mothers' tactile behaviors for potential differences. The few available studies suggest that paternal touch-SSC and ST-can have positive effects on fathers and infants alike. They also show that, despite some intrinsic differences, paternal touch is as pleasant as maternal touch. However, given the paucity of studies on the topic, we discuss why this field of research should be further explored.

The Effect of Kangaroo Care on Paternal Attachment: A Randomized Controlled Study

BACKGROUND

During the first interaction between the father and the infant, touch can be very important especially father-infant skin-to-skin contact. Few studies have focused on the effect of kangaroo care (KC) on paternal attachment.

PURPOSE

This randomized controlled study was conducted to determine the effect of KC on paternal attachment.

METHODS

A total of 90 fathers of healthy newborns, including 45 in the intervention group and 45 in the control group who met the inclusion criteria, were included randomly in the study. Data were collected using the Introductory Information Form at study admission and the Father-Infant Attachment Scale (FIAS) at 3 months of age. T test, Mann-Whitney U test, and Kruskal-Wallis test were used for statistical analysis.

RESULTS

The mean FIAS scores for the intervention group (I) were higher than for the control group (C) (I: 80.57 ± 13.70; C: 56.76 ± 13.23) ( P < .05). Patience and tolerance (I: 13.70 ± 1.18; C: 11.57 ± 2.30), pleasure in interaction (I: 29.50 ± 2.86; C: 17.13 ± 5.93), and love and pride (I: 37.37 ± 2.85; C: 28.06 ± 5.82) mean scores for FIAS subdimensions in the intervention group were also higher than in the control group ( P < .05).

IMPLICATIONS FOR PRACTICE AND RESEARCH

Findings of this study demonstrate that KC has the potential to increase paternal attachment. Healthcare providers should provide discharge education for fathers on KC to increase father-infant attachment. There is a need for studies with larger samples in different cultures on the factors related to parents that affect father-infant attachment and evidence-based practices that increase attachment.

Joint Developmental Trajectories of Conduct Problems and Hyperactivity/Inattention: Antecedent Risk Markers for Group Membership

This study investigated joint trajectories of conduct problems and hyperactivity/inattention from age three to nine in a cohort of 7,507 children in Ireland (50.3% males; 84.9% Irish). The parent-reported Strengths and Difficulties Questionnaire was used to collect information on conduct problems (CP) and hyperactivity/inattention (HI). Information regarding risk markers was collected when participants were nine-months-old via parent report and standardised assessments. Using a person-centred approach (i.e., group-based multi trajectory modelling), six trajectories were identified: no CP/low HI, low-stable CP/HI, low-declining CP/stable HI, desisting co-occurring CP/HI, pure-increasing HI, and high chronic co-occurring CP/HI. Specific risk markers for group membership included: male sex; birth complications; perceived difficult temperament; lower primary caregiver age and education level, and higher stress level; prenatal exposure to smoking, and indicators of lower socioeconomic status. Primary caregiver-child bonding and having siblings were protective markers against membership in elevated groups. Results suggest support for both 'pure' HI and co-occurring trajectories of CP and HI emerging in toddlerhood. However, no support was found for a 'pure' CP trajectory, which may support the suggestion that children on a persistent CP trajectory will have coexisting HI. Intervention efforts may benefit from starting early in life and targeting multiple risk markers in families with fewer resources.

Prenatal prolactin predicts postnatal parenting attitudes and brain structure remodeling in first-time fathers

Despite the important contributions that fathers make to parenting, the neurobiological underpinnings of men's adaptation to parenthood are still not well understood. The current study focuses on prolactin, a hormone that has been extensively linked with reproduction, lactation, and parental behavior in mothers. There is preliminary evidence that prolactin may also reflect the transition to sensitive fatherhood. We sampled prolactin in 91 first-time expectant fathers who participated in a laboratory visit along with their pregnant partners. Fathers' prolactin levels were correlated with their partners' prolactin levels. Men's prolactin levels during their partner's pregnancy were associated with their self-reported antenatal bonding to the unborn infant. Prenatal prolactin levels in fathers also predicted more positive attitudes toward fatherhood at three months postpartum, including lower parenting stress, greater enjoyment of the infant, and a more attunement-oriented parenting style. Within a smaller sample of 32 men who participated in MRI scanning before and after their child's birth, prenatal prolactin also predicted greater reductions in grey matter volume in the left posterior cingulate, left insula, and left nucleus accumbens. In conclusion, men's prenatal prolactin may reflect their perceptions of fatherhood and changes to their perinatal brain structure.

Collaborating to Improve Neonatal Care: ParentAl Participation on the NEonatal Ward-Study Protocol of the neoPARTNER Study

Parents are often appointed a passive role in the care for their hospitalised child. In the family-integrated care (FICare) model, parental involvement in neonatal care is emulated. Parental participation in medical rounds, or family-centred rounds (FCR), forms a key element. A paucity remains of randomised trials assessing the outcomes of FCR (embedded in FICare) in families and neonates, and outcomes on an organisational level are relatively unexplored. Likewise, biological mechanisms through which a potential effect may be exerted are lacking robust evidence. Ten level two Dutch neonatal wards are involved in this stepped-wedge cluster-randomised trial FCR (embedded in FICare) by one common implementation strategy. Parents of infants hospitalised for at least 7 days are eligible for inclusion. The primary outcome is parental stress (PSS:NICU) at discharge. Secondary outcomes include parental, neonatal, healthcare professional and organisational outcomes. Biomarkers of stress will be analysed in parent-infant dyads. With a practical approach and broad outcome set, this study aims to obtain evidence on the possible (mechanistic) effect of FCR (as part of FICare) on parents, infants, healthcare professionals and organisations. The practical approach provides (experiences of) FICare material adjusted to the Dutch setting, available for other hospitals after the study.

Father trait anger and associations with father-infant bonding and caregiving: The mediating role of mentalizing

Trait anger reflects a tendency to feel irritation, annoyance, and rage, and involves a narrowing of cognition and attention. This narrowed scope may impact the capacity to understand the mental states of oneself and others (mentalizing), which for fathers of infants may compromise bonding and caregiving involvement. Here, we investigated the extent to which mentalizing mediated the relationship between father trait anger and both father-infant bonding and father involvement in infant caregiving. Data were from 168 fathers (M = 30.04 years of age, SD = 1.36) of 190 infants (M = 7.58 months of age, SD = 5.06) in the longitudinal Men and Parenting Pathways (MAPP) study. We assessed fathers' preconception trait anger at Wave 1 and their mentalizing 2 years later at Wave 3. At Waves 3, 4, and/or 5, we assessed father-infant bonding and father involvement in infant caregiving when men had an infant younger than 18 months of age. Associations were examined using path analysis. Poorer mentalizing fully mediated the relationship between preconception trait anger and father-infant bonding (total score), but not involvement in infant caregiving. Further, poorer mentalizing fully mediated the relationships between trait anger and each component of the father-infant bond (i.e., patience and tolerance, affection and pride, and pleasure in interactions). Findings suggest that for men high on trait anger, targeted interventions that facilitate mentalizing capacities may help to develop a foundation for a strong father-infant bond. Interventions may be offered on becoming a father (perinatal), or prior to becoming a father (preconception) to prevent future bonding problems.

Father trait anger: Associations with father–infant bonding and subsequent parenting stress

Introduction

Parent anger presents a risk to family safety and child development. Father trait anger may also compromise the early relational context of fathers and offspring, yet evidence is lacking. The aim of this study is to examine effects of father trait anger on parenting stress in the toddler years, and the mediational role of father–infant bonding.

Method

Data were from 177 Australian fathers of 205 children. Trait anger (total, angry temperament, and angry reaction), father–infant bonding subscales (patience and tolerance, affection and pride, and pleasure in interaction), and subsequent parenting stress (parental distress, difficult child, and parent–child dysfunctional interaction) were assessed. At each of the subscale levels, mediational path models examined whether father–infant bonding explained the relationship between trait anger and parenting stress. Models were presented where there was at least a small association between the mediator and both the predictor and outcome.

Results

Patience and tolerance was the only domain of father–infant bonding correlated with both trait anger and all parenting stress outcomes. Patience and tolerance partially mediated the effect of total trait anger on parental distress and fully mediated effects on difficult child and parent–child dysfunctional interaction. Patience and tolerance fully mediated relationships between angry temperament and all domains of parenting stress. Angry reactions only had a direct effect on parental distress.

Discussion

Father trait anger both directly and indirectly (through patience and tolerance in the father–infant bond) impacts their experiences of parenting stress in the toddler years. Early interventions to manage father trait anger and improve father–infant bonding may benefit fathers and children.

Development of the Paternal Brain in Humans throughout Pregnancy

Previous studies have demonstrated that paternal caregiving behaviors are reliant on neural pathways similar to those supporting maternal care. Interestingly, a greater variability exists in parental phenotypes in men than in women among individuals and mammalian species. However, less is known about when or how such variability emerges in men. We investigated the longitudinal changes in the neural, hormonal, and psychological bases of expression of paternal caregiving in humans throughout pregnancy and the first 4 months of the postnatal period. We measured oxytocin and testosterone, paternity-related psychological traits, and neural response to infant-interaction videos using fMRI in first-time fathers and childless men at three time points (early to mid-pregnancy, late pregnancy, and postnatal). We found that paternal-specific brain activity in prefrontal areas distinctly develops during middle-to-late pregnancy and is enhanced in the postnatal period. In addition, among fathers, the timing of the development of prefrontal brain activity was associated with specific parenting phenotypes.

The Effect of Antenatal Education on Expectant Fathers' Attitudes toward Breastfeeding and Attachment to the Fetus

BACKGROUND

This study explores the effect of antenatal education on fathers' attitudes toward: (i) breastfeeding and (ii) attachment to the fetus. A secondary aim is to explore the relationship of fathers' demographic and the psycho-emotional characteristics that come with breastfeeding and attachment.

METHODS

This is a longitudinal study involving a group of 216 Greek expectant fathers who participated with their partners in an antenatal educational program performed by midwives in Athens, Greece (September 2020-November 2021). The Iowa Infant Feeding Attitudes Scale (IIFAS) and Paternal Antenatal Attachment Scale (PAAS) were administered at two time points: (a) 24th-28th gestation week and (b) 34th-38th gestation week. The T-test and Univariate Analyses of Variance (ANOVA) were performed.

RESULTS

The expectant fathers' scores show that breastfeeding intention/exclusivity and prenatal attachment to the fetus were higher after their participation in the antenatal education program, but the difference was not statistically insignificant. Expectant fathers with a cohabitation agreement (p = 0.026), who felt very much supported by their partners (p = 0.001) and had no relationship difficulties with their partners (p < 0.001), as well as those who reported being very happy during pregnancy (p < 0.001), showed greater paternal antenatal attachment to the fetus.

CONCLUSIONS

Although the difference was statistically insignificant, antenatal education appears to have an impact on paternal breastfeeding attitudes and antenatal attachment to the fetus. Additionally, several paternal characteristics were associated with greater antenatal attachment. Future research should be directed toward the investigation of additional factors that impact antenatal-paternal attachment and breastfeeding attitudes so that effective education programs can be designed.

Do parental cognitions during pregnancy predict bonding after birth in a low-risk sample?

Parental bonding to their infant is important for healthy parent-infant interaction and infant development. Characteristics in the parents affect how they bond to their newborn. Parental cognitions such as repetitive negative thinking, a thinking style associated with mental health issues, and cognitive dispositions, e.g., mood-congruent attentional bias or negative implicit attitudes to infants, might affect bonding. To assess the influence of cognitive factors on bonding, 350 participants (220 pregnant women and their partners) were recruited over two years by midwives at the hospital and in the communal health care services. Participants were followed throughout the pregnancy and until the infant was seven months old as a part of the Northern Babies Longitudinal Study. Both mothers and fathers took part. First, we measured demographics, repetitive negative thinking, attentional bias, and implicit attitudes to infants during pregnancy, as predictors of bonding two months postnatally. Second, we also measured infant regulatory problems, and depressive symptoms at two months postnatally as predictors of parents' perception of infant temperament at five months. Robust regression analyses were performed to test hypotheses. Results showed that mothers and fathers differed on several variables. Parity was beneficial for bonding in mothers but not for fathers. Higher levels of mothers' repetitive negative thinking during pregnancy predicted weaker bonding, which was a non-significant trend in fathers. For fathers, higher education predicted weaker bonding, but not for mothers. Mothers' perception of their infant temperament at five months was significantly affected by bonding at two months, but for fathers, their depressive symptoms were the only significant predictor of perceived infant temperament. In conclusion, for mothers, their relationship with their infant is essential for how they experience their infant, while for fathers their own wellbeing might be the most important factor. Health care providers should screen parents' thoughts and emotions already during pregnancy to help facilitate optimal bonding.

The Current Concept of Paternal Bonding: A Systematic Scoping Review

Bonding is crucial to perinatal mental health. Despite an extensive body of literature on maternal bonding, few studies have focused on paternal bonding. This scoping review aimed to clarify the current state of the concept of paternal-infant/fetus bonding. The eligibility criteria were drawn from the population concept and context elements to answer the following questions: "what is paternal bonding?" and "what are the constructs of the concept of paternal bonding?" The review comprised 39 studies. Paternal bonding was associated with both positive and negative paternal behavior and thought and may be determined based on fathers' beliefs and rearing history. Most studies showed that father-child interaction is one of the factors promoting paternal bonding. However, fathers generally felt more distant from their babies post-delivery than mothers. Only a few studies originally defined paternal bonding; most relied on the definitions of maternal bonding. We found different descriptions lacking consensus. Few studies examined the differences between paternal and maternal bonding. No consensus exists on the concept, constructs, and assessment of paternal bonding. The causal relationship between paternal bonding and other variables is unexplored. Future studies should explore fathers' perspectives and experiences, focusing on the unknown aspects of paternal bonding identified in this review.

Paternal depression and attachment levels of first-time fathers in Turkey

PURPOSE

Paternal depression and inadequate attachment experienced in the postpartum period may be associated with future emotional and behavioural problems of children. This study aimed to investigate the paternal depression and attachment levels of first-time fathers.

DESIGN AND METHODS

The sample of this descriptive study consisted of 175 fathers with 3-6 months old babies whose wives applied to the polyclinic for check-up.

FINDINGS

When the cut-off point of the scale was evaluated at 13 and above in this study, the risk of depression was found to be 14.2%. The level of attachment decreases as fathers' risk of depression increases (p < 0.05).

PRACTICE IMPLICATIONS

There is a risk of depression in fathers in the postpartum period. The level of attachment decreases as fathers' risk of depression increases.

Narrative coherence across the transition to parenthood: Primiparous parents' representations of their child in relation to parental sensitivity

Narrative coherence reflects parents' ability to provide a believable, clear, relevant, and internally consistent story about their child. Parents demonstrating more narrative coherence have been theorized to show higher parental sensitivity, but this has not been examined in a normative sample, nor across the transition to parenthood, and only once in fathers. The aim of this study was to examine stability and change in narrative coherence across the transition to parenthood in mothers and fathers, as well as the relation between pre- and postnatal narrative coherence and postnatal parental sensitivity. The sample consisted of 105 primiparous expecting parents. Narrative coherence was measured at 36-weeks pregnancy and when the child was 4 months old, using the Five Minute Speech Sample procedure. Parental sensitivity was observed in three episodes. Results demonstrated that narrative coherence was moderately stable (correlations) across the transition to parenthood in fathers only. Both mothers' and fathers' narrative coherence improved over time. Furthermore, mothers and fathers were overall equally coherent, and maternal and paternal narrative coherence were positively interrelated during pregnancy only. Lastly, our findings showed weak evidence for the theorized link between narrative coherence and parental sensitivity: only postnatal narrative coherence predicted paternal sensitivity, only during free play. Our findings give new insight in the development of narrative coherence across the transition to parenthood, and how it relates to actual parenting. More research is needed to confirm our findings and further explore this topic.

A proportionate, universal parenting programme to enhance social-emotional well-being in infants and toddlers in England: the E-SEE Steps RCT

Background

Mental disorders have become a public health crisis. Early prevention is key. Parenting programmes are effective for children aged ≥ 3 years; however, there is a lack of evidence of their effectiveness for children aged ≤ 2 years.

Objectives

To establish if the model named Enhancing Social–Emotional Health and Well-being in the Early Years (E-SEE) Steps can (1) enhance child social emotional well-being and establish whether or not it is cost-effective at 20 months of age when compared with services as usual; and (2) be delivered as a proportionate universal model with fidelity.

Design

A pragmatic two-arm randomised controlled trial and economic appraisal, with an embedded process evaluation to examine the outcomes, implementation and cost-effectiveness of the intervention, and intervention uptake, compared with services as usual. The study had an external pilot phase (which was originally planned as an internal pilot).

Setting

The intervention was delivered in community settings by early years children’s services and/or public health staff in four sites.

Participants

A total of 341 parents of infants aged ≤ 8 weeks were randomised in a ratio of 5 : 1 (intervention, n = 285; control, n = 56). The target sample was 606 parents.

Intervention

Two Incredible Years® parenting programmes (i.e. infant and toddler) delivered in a proportionate universal model with three levels [one universal (book) and two targeted group-based parenting programmes].

Main outcome measures

Child social and emotional well-being (primary outcome) was assessed using the Ages and Stages Questionnaire: Social and Emotional, 2nd edition, at 2, 9 and 18 months after randomisation. Parent depression (secondary key outcome) was assessed using the Patient Health Questionnaire-9 items. Both questionnaires were eligibility screeners for targeted groups.

Results

The primary outcome analysis provided no evidence that the E-SEE Steps model was effective in enhancing child social and emotional well-being. The adjusted mean difference was 3.02 on the original Ages and Stages Questionnaire: Social and Emotional, 2nd edition, in favour of the control [95% confidence interval –0.03 to 6.08; p = 0.052; N = 321 (intervention, n = 268; control, n = 53)]. Analysis of the key secondary outcome (i.e. parent depression levels as assessed by the Patient Health Questionnaire-9 items) provided weak evidence on the Patient Health Questionnaire-9 items in favour of the intervention (adjusted mean difference –0.61, 95% confidence interval –1.34 to 0.12; p = 0.1). Other secondary outcomes did not differ between arms. The economic analysis showed that the E-SEE Steps model was associated with higher costs and was marginally more effective (0.031 quality-adjusted life-years gained from E-SEE Steps compared with SAU, 95% confidence interval –0.008 to 0.071) than services as usual, resulting in an incremental cost-effectiveness ratio of approximately £20,062 per quality-adjusted life-year compared with services as usual. Overall take-up of the targeted parenting programmes was low. Sites, although enthusiastic, identified barriers to delivering the intervention.

Limitations

The target sample size was not met and the study was not powered to explore the effectiveness of each level of intervention. Most parents in the sample were well educated and, therefore, the results are unlikely to be generalisable, particularly to those at greatest risk of poor social and emotional well-being.

Conclusions

The E-SEE Steps proportionate universal model did not enhance child social and emotional well-being, but generated non-significant improvements in parent health outcomes, resulting in considerable uncertainty around the cost-effectiveness of the intervention. The primary and key secondary outcome gave inconsistent signals. Although, with system changes, increased resources and adaptations to the intervention, the model could be implemented, evidence for positive outcomes from the E-SEE Steps model is poor.

Future work

The universal-level E-SEE Step data (i.e. the Incredible Years book) from the external pilot will be pooled with the main trial data for further exploration up to follow-up 1, which is the time point at which most change was seen.

Trial registration

This trial is registered as ISRCTN11079129.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.

Assessment of factors and father-infant attachment levels among Turkish's fathers of preterm infants

PURPOSE

Identify the factors affecting father-infant attachment among Turkishs fathers of preterm infants.

DESIGN AND METHODS

This cross-sectional study included 63 fathers of preterm infants between the ages of 6-12 months. Data were collected using the Father-Infant Descriptive Information Form and the Paternal-Infant Attachment Scale (PIAS). Descriptive statistics, independent sample t-tests, mann-whitney test, the kruskal wallis test, the tamhane test, spearman correlation analysis, and linear stepwise regression were used to evaluate the data.

RESULTS

The average PIAS scores of the fathers in the study was 62.97 ± 8.94. A statistically significant difference was found between the birth weight, clinical picture, and length of stay in the Neonatal Intensive Care Unit (NICU) and PIAS total score of preterm infants (p < 0.01). There was a significant difference between the unplanned hospitalization of the baby after discharge and the father's changing the baby's clothes and the PIAS score (p < 0.05). Birth weight and unplanned hospitalization explained 31% of PIAS total score.

CONCLUSIONS

According to the results, father-infant attachment levels of fathers of preterm infants were low. Father's involvement in changing the baby's clothes, preterm birth weight, clinical picture, and length of stay in the NICU were found to be associated with PIAS.

PRACTICAL IMPLICATIONS

It should be remembered that babies can be attached to their fathers as much as they are to their mothers. NICU nurses should initiate father-infant interaction early and ensure fathers' involvement in infant care in the NICU.

From adolescence to parenthood: a multi-decade study of preconception mental health problems and postpartum parent-infant bonds

PURPOSE

To examine associations between anxiety and depressive symptoms across adolescence and young adulthood with subsequent maternal- and paternal-infant bonding at 1 year postpartum.

METHODS

The data were from a prospective, intergenerational cohort study. Participants (381 mothers of 648 infants; 277 fathers of 421 infants) self-reported depression and anxiety at three adolescent waves (ages 13, 15 and 17 years) and three young adult waves (ages 19, 23 and 27 years). Subsequent parent-infant bonds with infants were reported at 1 year postpartum (parent age 29-35 years). Generalised estimating equations (GEE) separately assessed associations for mothers and fathers.

RESULTS

Mean postpartum bonding scores were approximately half a standard deviation lower in parents with a history of persistent adolescent and young adult depressive symptoms (maternal β_adj = - 0.45, 95% CI - 0.69, - 0.21; paternal β_adj = - 0.55, 95% CI - 0.90, 0.20) or anxiety (maternal β_adj = - 0.42, 95% CI - 0.66, - 0.18; paternal β_adj = - 0.49, 95% CI - 0.95, 0.03). Associations were still mostly evident, but attenuated after further adjustment for postpartum mental health concurrent with measurement of bonding.

CONCLUSIONS

Persistent symptoms of depression or anxiety spanning adolescence and young adulthood predict poorer emotional bonding with infants 1-year postbirth for both mothers and fathers.

US fathers' reports of bonding, infant temperament and psychosocial stress based on family sleep arrangements

Background and objectives

Evolutionary-grounded sleep research has been critical to establishing the mutual dependence of breastfeeding and nighttime sleep proximity for mothers and infants. Evolutionary perspectives on cosleeping also often emphasize the emotional motivations for and potential benefits of sleep proximity, including for parent-infant bonding. However, this potential link between infant sleep location and bonding remains understudied for both mothers and fathers. Moreover, in Euro-American contexts bedsharing has been linked to family stress and difficult child temperament, primarily via maternal reports. We know relatively little about whether paternal psychosocial dynamics differ based on family sleep arrangements, despite fathers and other kin often being present in the cosleeping environment across cultures. Here, we aim to help address some of these gaps in knowledge pertaining to fathers and family sleep arrangements.

Methodology

Drawing on a sample of Midwestern U.S. fathers (N=195), we collected sociodemographic and survey data to analyze links between infant nighttime sleep location, paternal psychosocial well-being, father-infant bonding, and infant temperament. From fathers’ reports, families were characterized as routinely solitary sleeping, bedsharing, or roomsharing (without bedsharing).

Results

We found that routinely roomsharing or bedsharing fathers, respectively, reported stronger bonding than solitary sleepers. Bedsharing fathers also reported that their infants had more negative temperaments and also tended to report greater parenting-related stress due to difficulties with their children.

Conclusions

These cross-sectional results help to highlight how a practice with deep phylogenetic and evolutionary history, such as cosleeping, can be variably expressed within communities with the potential for family-dependent benefits or strains.

Evolutionary-grounded cosleeping research has elucidated the intimate connections between mother-infant sleep proximity and breastfeeding. However, some Euro-American research indicates that bedsharing can coincide with family strain and stress. Here, U.S. fathers who routinely roomshared or bedshared, respectively, reported stronger bonds to their babies than solitary sleeping fathers, but bedsharing fathers also reported more negative infant temperament.

Fathers' experiences of fetal attachment: A qualitative study

Paternal-fetal attachment (PFA) is associated with the degree of emotional support offered by fathers during pregnancy and has implications for the safety and quality of a mother's labor and postnatal experiences. This study explored fathers' experiences of PFA including their understanding of the phenomenon and its manifestation. Data were collected through interviews with 10 fathers-to-be and analysis followed an interpretative phenomenological approach. Four themes emerged from the data: trigger moment; awareness of responsibility; transition to fatherhood; and emotional conflict. Most fathers experienced a trigger moment that made the reality of having a baby clear to them and which initiated or intensified feelings of attachment toward the fetus. Male family relatives, friends with children, and antenatal education groups provided support to expectant fathers. However, they felt quite lost in their role and some believed there was insufficient support for their mental health. Findings suggest that different situations can trigger the attachment process and that fathers longed to be included in perinatal care but experienced a lack of support. Raising awareness of the importance of PFA can help initiate the process in fathers and better equip them to contribute during the antenatal period and to future child development.

Physiological responses to cuddling babies with hypoxic-ischaemic encephalopathy during therapeutic hypothermia: an observational study

OBJECTIVES

To determine whether parents cuddling infants during therapeutic hypothermia (TH) would affect cooling therapy, cardiorespiratory or neurophysiological measures. The secondary aim was to explore parent-infant bonding, maternal postnatal depression and breastfeeding.

DESIGN

Prospective observational study.

SETTING

Two tertiary neonatal intensive care units (NICU).

PARTICIPANTS

Parents and their term-born infants (n=27) receiving TH and intensive care for neonatal hypoxic-ischaemic encephalopathy.

INTERVENTIONS

Cuddling up to 2 hours during TH using a standard operating procedure developed in the study (CoolCuddle).

MAIN OUTCOME MEASURES

Mean difference in temperature, cardiorespiratory and neurophysiological variables before, during and after the cuddle. Secondary outcomes were parental bonding, maternal postnatal depression and breastfeeding.

RESULTS

During 70 CoolCuddles (115 cumulative hours), there were measurable increases in rectal temperature (0.07°C (0.03 to 0.10)) and upper margin of amplitude-integrated electroencephalogram (1.80 µV (0.83 to 2.72)) and decreases in oxygen saturations (-0.57% (-1.08 to -0.05)) compared with the precuddle period. After the cuddle, there was an increase in end-tidal CO₂ (0.25 kPa (95% CI 0.14 to 0.35)) and mean blood pressure (4.09 mm Hg (95% CI 0.96 to 7.21)) compared with the precuddle period. From discharge to 8 weeks postpartum, maternal postnatal depression declined (13 (56.5%) vs 5 (23.8%), p=0.007); breastfeeding rate differed (71% vs 50%, p=0.043), but was higher than national average at discharge (70% vs 54.6%) and mother-infant bonding (median (IQR): 3 (0-6) vs 3 (1-4)) remained stable.

CONCLUSION

In this small study, CoolCuddle was associated with clinically non-significant, but measurable, changes in temperature, cardiorespiration and neurophysiology. No infant met the criteria to stop the cuddles or had any predefined adverse events. CoolCuddle may improve breastfeeding and requires investigation in different NICU settings.

Closeness with a partner and parental bond with a child during the transition to parenthood

OBJECTIVE

The aim of this longitudinal study was to examine the dyadic interdependence of the relationships between partners' perception of closeness with one another and their pre- and postnatal bonds with a child.

RESEARCH DESIGN AND PARTICIPANTS

A total of 213 first-time expectant couples participated in the study both during pregnancy (1st stage) and after the child's birth (2nd stage).

MEASUREMENTS

The participants completed the following measures: the one-item pictorial Inclusion of Other into the Self (IOS) scale and the brief maternal and paternal versions of the Antenatal Attachment Scales (MAAS/PAAS, respectively) and Postnatal Attachment Scales (MPAS/PPAS, respectively).

FINDINGS

The Actor-Partner Interdependence Models (APIM) for distinguishable dyads were performed and revealed the positive effect of parents' perceptions of closeness with their partners regarding both their own and their partners' bond with their child during pregnancy. However, after the child's birth, for both mothers and fathers, only their own perception of closeness with their partners was associated with their bond with their child. Moreover, only the actor effects of bonding with a child during pregnancy as well as the change in perception of closeness with a partner on the partner's bond with their child after birth were found (no partner effect).

KEY CONCLUSIONS

Couple attributes during the transition to parenthood should be emphasized to promote the development of parental pre- and postnatal bonds.

The Effects of the Parenting Education Performed through Whatsapp on the Level of Maternal-Paternal and Infant Attachment in Turkey

PURPOSE

This study aimed to identify the effects of parenting education with online WhatsApp messages on the level of maternal-paternal and infant attachment.

DESIGN AND METHODS

The study adopted a randomized-controlled experimental design. The sample of the study was 32 couples. The experimental group was provided with online parenting education in the WhatsApp groups. Data were collected through the Socio-Demographic Form, the Maternal Attachment Inventory, and the Paternal Postnatal Attachment Questionnaire. Data were analyzed using the Chi-square test, Wilcoxon test, Paired t-test, Independent sample t-test, Mann Whitney U test, and Wald type statistics test.

RESULTS

Intra-group comparisons showed that there was a statistical significance between the Maternal Attachment Inventory total scores (p < 0.001). There was a significant difference between group time interactions (p < 0.001), and these differences had a high effect size. When the intra-group comparisons were performed in terms of the Paternal Postnatal Attachment Questionnaire, there were significant differences between the total score differences (p = 0.001). An analysis of the group time interactions indicated no statistically significant differences (p = 0.653).

CONCLUSIONS

The results of this study showed that the parenting education intervention increased maternal attachment levels in a significant way.

Does Antenatal Education Affect Level Of Empathy And Attachment Of Fathers?

OBJECTIVE

The study aimed to determine the effects of antenatal education on the paternal bonding and empathic tendency levels of men who would become fathers for the first time.

BACKGROUND

There are a limited number of studies in the literature that have investigated the effects of antenatal education programmes on fathers.

METHODS

This prospective, controlled quasi-experimental study was conducted in a hospital in Istanbul. The men in the antenatal educational group (EG) and their wives participated in training in antenatal classes. The men in the control group (CG) came for routine prenatal follow-up examinations with their wives. The Empathic Tendency and Paternal Postnatal Attachment Scales were used to collect the data.

RESULTS

The Empathic Tendency Scale was applied before the education (1) - after the education (2) and at the 6th postpartum week (3), whilst the Paternal Postnatal Attachment Scale was used at the 6th postpartum month (4). EG had higher emphatic tendency levels in the 2nd and 3rd measurements and higher paternal bonding levels in the 4th measurement in comparison to CG (p < 0.05).

CONCLUSION

Antenatal education increased the emphatic tendency of the fathers and the effects of this education continued in the postpartum period and affected paternal bonding positively.

The effect of in-person and virtual prenatal care education of the spouses of primiparous women on the father and mother's attachment to infant: a quasi-experimental and controlled study

INTRODUCTION

Considering the important role of education in promoting parents' attachment to the infant, temporal and spatial limitations, and the need to use new educational methods for spouses' participation in childbirth preparation classes, the present study was conducted to compare the effect of in-person and virtual prenatal care education of the spouses of primiparous women on the father and mother's attachment to the infant.

METHODS

This is a quasi-experimental clinical trial that was conducted on primiparous pregnant women referring to three prenatal clinics in Tehran, Iran. Sampling was done by continuous method and pregnant women were divided into three groups of face-to-face education (n = 28), virtual education (n = 31), and control (n = 29). The content of the training program in the virtual and face-to-face groups was similar, which was presented in 4 sessions. At 18-20 weeks of gestation, demographic characteristics and pregnancy records were obtained from the samples, and 12 weeks after the delivery, maternal postnatal attachment scale, and postnatal paternal-infant attachment questionnaire were completed. Both intention-to-treat analysis and per-protocol analysis were performed.

RESULTS

There was a statistically significant difference between the two groups of in-person education and control, and also virtual education and control for both intention-to-treat and per-protocol analysis (p < 0.05). However, no statistically significant difference was found between the two groups of in-person and virtual education. Results showed a large and medium effect size between the two groups of in-person education and control, and virtual education and control in terms of father-infant attachment score, respectively. There was also no statistically significant difference between the three groups after the educational intervention in terms of the mother-infant attachment score for both intention-to-treat and per-protocol analysis.

CONCLUSION

Considering that education by both in-person and virtual methods had the same effect on improving the score of father-infant attachment, it is suggested that to increase the participation of spouses of pregnant women in the process of prenatal care, the spouses of pregnant women should have the option of virtual education in addition to in-person training.

TRIAL REGISTRATION

TCTR.ir TCTR20200515011 . Registered on May 12, 2020.

Impact of kangaroo care after caesarean section on paternal-infant attachment and involvement at 12 months: A longitudinal study in Turkey

The mother's first meeting with the baby after the caesarean section is usually delayed due to the reasons arising from the mother and the baby in Turkey. Although there are many benefits of kangaroo care (KC) intervention between the mother and the newborn, there is a limited number of studies on the KC intervention between the newborn and the father after caesarean section in international literature, and there are none in Turkey. This study was carried out to determine the effect of fathers and infants who participated in KC, immediately after birth by caesarean section, on paternal-infant attachment and the fathers' involvement in infant care in the 12th month. The study was conducted as a longitudinal study with a control group. Initially, the sample consisted of 60 fathers. However, the study was completed with 48 fathers. KC intervention was practised to the couple of the father and the infant in the experimental group, while no practice was given to the control group. Fathers in the experimental group were told that they should continue to practice KC intervention at least two times a week until their baby will be 1-year-old. The data collection forms were given to fathers face-to-face in the first interview, and then through phone calls and emails after 12 months. The status of the fathers in the experimental group fathers' involvement in infant care of the baby (p = .005) was significantly higher than the control group. The mean score for the Postnatal Paternal-Infant Attachment Questionnaire (PPAQ), in fathers who participated in KC intervention, was higher than that of fathers who did not participate in the KC intervention (p < .005). The results of this study demonstrated that the paternal-infant attachment and the fathers' participation in infant care were more positive in fathers and babies who performed the KC intervention.

Cohort profile: the Men and Parenting Pathways (MAPP) Study: a longitudinal Australian cohort study of men's mental health and well-being at the normative age for first-time fatherhood

PURPOSE

The Men and Parenting Pathways (MAPP) Study is a prospective investigation of men's mental health and well-being across the normative age for transitioning to fatherhood. This includes trajectories and outcomes for men who do and do not become fathers across five annual waves of the study.

PARTICIPANTS

Australian resident, English-speaking men aged 28-32 years at baseline were eligible. Recruitment was over a 2-year period (2015-2017) via social and traditional media and through engagement with study partners. Eight hundred and eighteen eligible men consented to participate. Of these, 664 men completed the first online survey of whom 608 consented to ongoing participation. Of the ongoing sample, 83% have participated in at least two of the first three annual online surveys.

FINDINGS TO DATE

Three waves of data collection are complete. The first longitudinal analysis of MAPP data, published in 2020, identified five profiles that characterise men's patterns of depressive symptom severity and presentations of anger. Profiles indicating pronounced anger and depressive symptoms were associated with fathers' lack of perceived social support, and problems with coparenting and bonding with infants. In a second study, MAPP data were combined with three other Australian cohorts in a meta-analysis of associations between fathers' self-reported sleep problems up to 3 years postpartum and symptoms of depression, anxiety and stress. Adjusted meta-analytic associations between paternal sleep and mental health risk ranged from 0.25 to 0.37.

FUTURE PLANS

MAPP is an ongoing cohort study. Waves 4 and 5 data will be ready for analyses at the end of 2021. Future investigations will include crossed-lagged and trajectory analyses that assess inter-relatedness and changing social networks, mental health, work and family life. A nested study of COVID-19 pandemic-related mental health and coping will add two further waves of data collection in a subsample of MAPP participants.

Design of a prospective follow-up study on early parenthood and smoking behaviour during pregnancy in Finnish primary healthcare

Aims: The primary aim of the study is to explore different factors affecting parents’ smoking behaviour, and especially how smoking may be connected with individual differences in the psychological process of becoming a parent. In the current paper, we present the study design together with basic information on the study population. Methods: The Central Satakunta Maternity and Child Health Clinic (KESALATU) Study is an ongoing prospective follow-up study in primary healthcare of the Satakunta region of southwest Finland. Families were recruited during their first maternity clinic visit between 1 September 2016 and 31 December 2019, and participation will continue until the child is 1.5 years of age. The study combines different sources and types of data: e.g. routine data obtained from primary healthcare clinic records, specific parental self-report data and data from a new exhaled carbon monoxide meter indicating maternal smoking. The data are collected using frequently repeated assessments both during pregnancy and postnatally. The methods cover the following areas of interest: family background factors (including smoking and alcohol use), self-reported parental–foetal/infant attachment and mentalization, self-reported stress, depression and quality of life. Results: 589 pregnant women and their partners were asked to participate in the study during the collection time period. The final study population consisted of 248 (42.1%) pregnant women and 160 (27.1%) partners. Conclusions: The new methods and study design have the potential to increase our understanding about the link between early parenting psychology, prenatal psychosocial risk factors and parental health behaviour.

[Questionnaires for the Assessment of Bonding During Pregnancy and after Birth (Part 3 of a series on psychological assessment during the peripartum period)]

Bonding of (expectant) parents with their child is of great importance for the psychological well-being of both the parents and the child. This is especially true if parents suffer from mental health problems like depression. Furthermore, attachment experiences during early childhood can affect both the child's mental health as well as later relationships. However, typical assessment methods like the Strange Situation Test are not very suitable in clinical practice in neonatology and obstetrics, especially since the focus here is primarily on the child's attachment behavior. In addition, bonding with the unborn child cannot be assessed in this way. Therefore, questionnaires represent a more feasible method for the assessment of parental bonding. Instruments have been developed for the time during pregnancy and after birth, but most of them were developed for women. Also, there is a need for further methodological development of these questionnaires. Cut-offs and norm values are highly relevant for clinical practice, but still need to be established in some cases. Assessment of parental bonding using questionnaires can potentially be beneficial and will most likely help to initiate timely supportive interventions.

Fathers' oxytocin responses to first holding their newborns: Interactions with testosterone reactivity to predict later parenting behavior and father-infant bonds

Little is known about human fathers' physiology near infants' births. This may represent a period during which paternal psychobiological axes are sensitive to fathers' new experiences of interacting with their newborns and that can provide insights on how individual differences in fathers' biology relate to post-partum parenting. Drawing on a sample of men in South Bend, IN (U.S.), we report results from a longitudinal study of fathers' oxytocin, cortisol, and testosterone (N = 211) responses to their first holding of their infants on the day of birth and men's reported caregiving and father-infant bonding at 2-4 months post-partum (N = 114). First-time fathers' oxytocin was higher following first holding of their newborns, compared to their pre-holding levels. Contrasting with prior results, fathers' percentage change in oxytocin did not differ based on skin-to-skin or standard holding. Drawing on psychobiological frameworks, we modeled the interactions for oxytocin reactivity with testosterone and cortisol reactivity, respectively, in predicting father-infant outcomes months later. We found significant cross-over interactions for (oxytocin × testosterone) in predicting fathers' later post-partum involvement and bonding. Specifically, we found that fathers whose testosterone declined during holding reported greater post-partum play if their oxytocin increased, compared to fathers who experienced increases in both hormones. We also observed a similar non-significant interaction for (oxytocin × cortisol) in predicting fathers' post-partum play. Fathers whose testosterone declined during holding also reported less involvement in direct caregiving and lower father-infant bonding if their oxytocin decreased but greater direct care and bonding if their testosterone increased and oxytocin decreased. The results inform our understanding of the developmental time course of men's physiological responsiveness to father-infant interaction and its relevance to later fathering behavior and family relationships.

Implementation of Virtual and Face-to-Face Childbirth Preparation Training for the Spouses of the Primiparous Women to Reduce the Fear of Childbirth, Improve the Pregnancy Experience, and Enhance Mother- and Father-Infant Attachment: Protocol for a Quasiexperimental Clinical Trial

BACKGROUND

Men have a special role to play in promoting maternal and child health during pregnancy, childbirth, and postpartum period. The health of women also requires the participation and cooperation of men. The aim of this study is to compare the effect of virtual and face-to-face childbirth preparation training for spouses of the primiparous women on the pregnancy experience, fear of childbirth (FOC), and mother- and father-infant attachment.

METHODS

The primiparous women attending the prenatal clinics of Lolagar Hospital and Azadi and Tehransar health centers of Tehran along with their husbands will be studied. The inclusion criteria for the women's husbands are the first experience of becoming a father, being at least 18 years of age, and the ability to read and write. The exclusion criteria for women's husbands are the history of physical/mental illness; being a smoker; and consuming alcohol, drugs, or psychotropic substances. The participants will be selected by the convenience sampling method and will be divided into three groups of study A, study B, and control. Spouses in study groups A and B will receive childbirth training through virtual and face-to-face methods with similar content, respectively. The control group only receives ordinary prenatal care. At the 18-20 weeks of gestation, demographic information, pregnancy experience scale (PES), and version A of Wijma delivery expectancy/experience questionnaire (WDEQ-A) will be completed. At 37-38 weeks of gestation, the PES and WDEQ-A questionnaires will be completed again and maternal postnatal attachment scale (MPAS) and postnatal paternal-infant attachment questionnaire (PPAQ) will be completed by the parents 12 weeks after the delivery. Discussion. Improving the experience of pregnancy, especially reducing the FOC and creating a positive attitude towards it, is a vital strategy to promote vaginal childbirth and reduce the number of cesarean sections requested by women. Achieving this will reduce the cost of health care and improve the quality of life during pregnancy, after childbirth, and during the growth and development of infants. Ethics and Dissemination. This research has been funded by the Iran University of Medical Sciences, approved by the Thailand Registry of Clinical Trials, and will commence in May 2020. Results will be disseminated through peer-reviewed journals and shared with the academic and medical community to pregnancy and childbirth outcomes. This trial is registered with TCTR20200515011.

Father's Bonding With an Infant Born Prematurely: A Qualitative Meta-synthesis

There is no current theory that explains the process of a fathers' bonding with their infants born prematurely. Through meta-synthesis of 19 qualitative studies, we developed a conceptual framework to illustrate how fathers perceive the relationship with their premature infant formed over the first 18 months of life. It details the contextual factors that contribute to that process. Findings reveal a complex process comprised of five stages, derived from five core themes and related subthemes. Fathers progress through five sequential stages to establish their role as fathers and form emotional connections with their child. Stages include: (a) feeling alien and lacking emotional connection to the infant, (b) caregiving engagement and claiming the role as a father, (c) claiming the infant as their own, (d) adjusting to having the infant home, and (5) normalizing family life. This conceptual framework can inform future research and clinical interventions designed to foster father-infant bonding.

Pre-natal Attachment and Parent-To-Infant Attachment: A Systematic Review

During the perinatal period, the establishment of the attachment relationship with the fetus and subsequently with the real child is crucial for the parents' and the child's well-being. Coherently with the assumption that the attachment relationship starts to develop during pregnancy, this systematic review aims to analyze and systematize studies focused on the association between pre-natal attachment and parent-to-infant attachment, in order to clarify the emerging results and provide useful information for clinical purposes. Nineteen studies were included. Sixteen researches identified a positive relationship between pre-natal attachment and parent-to-infant attachment, and three articles highlighted a negative association between antenatal attachment and post-partum bonding disorders. These results were found both in women and men, in normative and at-risk pregnancies, adopting different assessment approaches (i.e., self-report measures, observations, and projective measures). However, only small or moderate associations were found. Future studies are needed to further confirm these findings across different populations (e.g., male samples, non-normative samples or samples in disadvantaged conditions) and with different methodological approaches (e.g., observational measures). Moreover, studies would be needed in order to clarify mechanisms through which pre-natal attachment influences parent-to-infant attachment, as well as protective and risk factors which intervene between these two variables.

A longitudinal investigation of young mothers' prenatal attachment, depressive symptoms, and early parenting behaviour

Objectives: This study explores whether young, low-income mothers' prenatal attachment to their infants is related to attachment and parenting behaviour postnatally.Background: A small literature has documented continuity in maternal attachment from pregnancy to postpartum and shown that early maternal attachment is associated with positive parenting behaviour. Less is known about whether prenatal attachment has a unique impact on parenting behaviour, or if it is primarily a step in the development of postnatal attachment, which in turn influences parenting. Additionally, it is unclear whether associations between attachment and early parenting might be attributable to other factors such as depressive symptoms.Method: This longitudinal study followed young primiparous mothers from pregnancy through 3-weeks postnatal. 240 ethnically/racially diverse low-income American women reported their attachment-related thoughts and feelings and their depressive symptoms during pregnancy and postnatally. At 3 weeks postpartum, mothers were observed interacting with their infant.Results: There was stability in attachment and depressive symptoms from pregnancy to postpartum. In multivariate path models, prenatal attachment was directly associated with two types of parenting behaviour: positive engagement and encouragement of learning, even when accounting for depressive symptoms and postnatal attachment. There was an indirect effect of prenatal attachment on sensitivity through postnatal attachment.Conclusion: The foundation of a mother's emotional connection to her infant begins before birth. Parenting support programmes for young mothers should begin during pregnancy. Supporting the establishment of positive prenatal attachment may also have a positive influence on later parenting behaviour among mothers, including mothers experiencing depressive symptoms.

The Applicability and Performance of Tools Used to Assess the Father-Offspring Relationship in Relation to Parental Psychopathology and Offspring Outcomes

Introduction: Father-infant interactions are important for optimal offspring outcomes. Moreover, paternal perinatal psychopathology is associated with psychological and developmental disturbances in the offspring, and this risk may increase when both parents are unwell. While, the father-offspring relationship is a plausible mechanism of risk transmission, there is presently no "gold standard" tool for assessing the father-offspring relationship. Therefore, we systematically searched and reviewed the application and performance of tools used to assess the father-offspring relationship from pregnancy to 24-months postnatal. Methods: Four electronic databases (including MEDLINE, PsycINFO, Maternity and Infant Care Database, and CINAHL) were searched. Selected articles included evidence of father-offspring relationship assessment in relation to parental perinatal psychopathology and/or offspring outcomes. Data was extracted and synthesized according to the following: (i) evidence supporting the performance of tools in terms of their psychometric properties when applied in the context of fathers, (ii) tool specific characteristics, and (iii) study specific methodological aspects in which the tool was embedded. Results: Of the 30,500 records eligible for screening, 38 unique tools used to assess the father-offspring relationship were identified, from 61 studies. Ten tools were employed in the context of paternal psychopathology, three in the context of maternal psychopathology, and seven in the context of both maternal and paternal psychopathology, while nine tools were applied in the context of offspring outcomes only. The remaining nine tools were used in the context of both parental psychopathology (i.e., paternal, and/or maternal psychopathology) and offspring outcomes. Evidence supporting the psychometric robustness of the extracted observational, self-report and interview-based tools was generally limited. Most tools were originally developed in maternal samples-with few tools demonstrating evidence of content validation specific to fathers. Furthermore, various elements influencing tool performance were recognized-including variation in tool characteristics (e.g., relationship dimensions assessed, assessment mode, and scoring formats) and study specific methodological aspects, (e.g., setting and study design, sample characteristics, timing and nature of parental psychopathology, and offspring outcomes). Conclusion: Given the strengths and limitations of each mode of assessment, future studies may benefit from a multimethod approach to assessing the father-offspring relationship, which may provide a more accurate assessment than one method alone.

Associations of Partnership Quality and Father-to-Child Attachment During the Peripartum Period. A Prospective-Longitudinal Study in Expectant Fathers

Background: During the transition to parenthood, a complex network of relationships unfolds between father, mother and the child. Expectant parents begin bonding with their unborn child, with this antenatal process supposedly being predictive for later postnatal attachment and child mental health. At the same time, couples may experience a change in partnership quality. While the majority of previous studies focused on associations between psychopathology, partnership quality and attachment from the perspective of mothers, the changes in partnership quality and attachment from the perspective of fathers has gained far less attention. Methods: Data were derived from the Maternal Anxiety and it's Relation to Infants' Development (MARI) study. N = 109 expectant fathers were recruited during mid-pregnancy (22 to 26 week of gestation). Lifetime anxiety and depressive disorders (DSM-IV) were assessed with a standardized diagnostic interview (CIDI). Paternal partnership characteristics and father-to-child attachments were assessed using standardized questionnaires at the second trimester, 10 days after delivery and 4 months after delivery in N = 76 fathers. Analyses were based on bivariate, robust and multivariate regression analyses. Results: Fathers did not report an overall decrease in partnership quality during the peripartum period. However, fathers with comorbid anxiety and depressive disorders reported lower partnership satisfaction at postpartum, as compared to unaffected fathers. Fathers with pure depressive disorders reported lower intensity of antenatal attachment. Paternal antenatal partnership quality was positively associated with antenatal father-to-child attachment. Furthermore, antenatal father-to-child attachment, as well as ante- and postnatal partnership quality in fathers, were positively related to postnatal father-to-child attachment. Conclusions: Antenatal father-to-child-attachment and paternal partnership quality appear to be promising targets for the prevention of postnatal attachment problems in fathers. The associations between partnership quality and attachment to the child further support an interpersonal approach in perinatal research, treatment and intervention, and may also feed into awareness programs that encourage expectant fathers to actively engage in relationships as early as during pregnancy-both with the mother and the unborn child.

Profiles of Depressive Symptoms and Anger in Men: Associations With Postpartum Family Functioning

Background: Evidence suggests that men commonly experience depression as feelings of anger; yet, research has not investigated what this means for the manifestation of depressive symptoms in the early years of fatherhood and for key indicators of family functioning. Methods: Using data from a longitudinal cohort study of men at the normative age for entering fatherhood (28-32 years), we conducted latent class analyses to identify patterns of depressive symptoms and 3 sub-types of state anger (feeling; verbal; physical). We then assessed whether class membership was associated with paternity status (n = 535). In a subsample of fathers of infants aged up to 18 months (n = 162), we prospectively assessed associations with paternal-infant bonding, co-parenting, perceived social support, paternal involvement in childcare and alcohol use up to 2 years later. Results: Five classes emerged that differentiated men by anger and depressive symptom severity and by the degree to which men endorsed the feeling of wanting to express anger physically. Compared to the reference class with minimal symptoms, fathers had a higher probability of being in either the mild or most severe symptom classes. Men in symptomatic classes were at higher risk of lower levels of social support, co-parenting problems, and paternal-infant bonds. Class membership was not associated with alcohol use or paternal involvement in childcare. Conclusions: Our results reveal patterns of co-existing symptoms of depression and anger in fathers of infants that will be relevant to men's own need for support, their family safety, partner mental health and child developmental outcomes.

Measuring bonding or attachment in the parent-infant-relationship: A systematic review of parent-report assessment measures, their psychometric properties and clinical utility

BACKGROUND

Meaningful, valid and reliable self-report measures can facilitate the identification of important parent-infant-relationship factors, relevant intervention development and subsequent evaluation in community and clinical contexts. We aimed at identifying all available parent-report measures of the parent-infant-relationship or bond and to appraise their psychometric and clinimetric properties.

METHOD

A systematic review (PROSPERO: CRD42017078512) was conducted using the, 2018 COSMIN criteria. Eight electronic databases were searched. Papers describing the development of self-report measures of the parent-infant-bond, attachment or relationship from pregnancy until two years postpartum or the assessment of their psychometric properties were included.

RESULTS

Sixty-five articles evaluating 17 original measures and 13 modified versions were identified and reviewed. The studies' methodological quality (risk of bias) varied between 'very good' and 'inadequate' depending on the measurement property assessed; however, scale development studies were mostly of 'inadequate' quality. Although most measures had good clinical utility, the psychometric evaluation of their properties was largely poor. The original or modified versions of the Postpartum Bonding Questionnaire collectively received the strongest psychometric evaluation ratings with high quality of evidence.

CONCLUSIONS

This novel review revealed that only a few antenatal and postnatal measures demonstrated adequate psychometric properties. Further studies are needed to determine the most robust perinatal measures for researchers and clinicians.

Neural Responses to Infant Emotions and Emotional Self-Awareness in Mothers and Fathers during Pregnancy

Neuroscientific research has largely investigated the neurobiological correlates of maternal and (to a much lesser extent) paternal responsiveness in the post-partum period. In contrast, much less is known about the neural processing of infant emotions during pregnancy. Twenty mothers and 19 fathers were recruited independently during the third trimester of pregnancy. High-density electroencephalography (hdEEG) was recorded while expectant parents passively viewed images representing distressed, ambiguous, happy, and neutral faces of unknown infants. Correlational analyses were performed to detect a link between neural responses to infant facial expressions and emotional self-awareness. In response to infant emotions, mothers and fathers showed similar cerebral activity in regions involved in high-order socio-affective processes. Mothers and fathers also showed different brain activity in premotor regions implicated in high-order motor control, in occipital regions involved in visuo-spatial information processing and visual mental imagery, as well as in inferior parietal regions involved in attention allocation. Low emotional self-awareness negatively correlated with activity in parietal regions subserving empathy in mothers, while it positively correlated with activity in temporal and occipital areas implicated in mentalizing and visual mental imagery in fathers. This study may enlarge knowledge on the neural response to infant emotions during pregnancy.

Systematic Review: Feasibility, Reliability, and Validity of Maternal/Caregiver Attachment and Bonding Screening Tools for Clinical Use

INTRODUCTION

Infant-caregiver attachment is crucial for an infant's immediate and long-term social-emotional development and health. Despite advocacy by the National Institute of Children's Health Quality for infant social-emotional development screening, there is a lack of identified tools for use in primary care. Therefore, we conducted a systematic review to identify caretaker-infant attachment self-report screening tools that would be feasible, reliable, and valid for use in primary care.

METHOD

A systematic search identified 340 abstracts/articles, which were screened using inclusion and exclusion criteria. Twelve articles and six self-report attachment tools were examined for reliability, validity, and feasibility characteristics.

RESULTS

Six caregiver-infant attachment self-report tools were identified. Establishment of feasibility, reliability, and validity are in the early stages.

DISCUSSION

Potential infant-caretaker attachment screening tools were identified for use in primary care practices. Suggestions for research and practice include informal screening, additional psychometric testing, and development of policies supporting implementation of screening.

First-Time Grandparents' Role Satisfaction and Its Determinants

This article focuses on satisfaction with the grandparent role at 1 and 2 years after the transition to grandparenthood. Three hundred and eighteen grandparents (male and female) were initially recruited and required to complete a well-validated self-report measure of grandparent satisfaction, together with self-report questionnaires assessing a range of characteristics which might predict role satisfaction. The main finding was that grandparent-grandchild attachment (bonding) was the most powerful predictor. Some predictors (e.g., generativity) appeared to have a direct effect on satisfaction, whereas the effect of others (e.g., grandchild temperament) appeared to be mediated via the grandparent-grandchild attachment relationship. Role satisfaction, aside from its probable relevance to grandparent wellbeing, is also likely to be of relevance to grandparents' willingness to provide childcare. The latter, besides impacting on well-being of both grandparents and parents, also powerfully influences workforce economics.

Infants Autonomic Cardio- Respiratory Responses to Nurturing Stroking Touch Delivered by the Mother or the Father

The building of physiological self-regulation during bonding is a crucial developmental process based on early cardio-respiratory maturation. The mother’s role as a facilitator of this physiological maturation has been evidenced and recognized in many respects. Research in fathers, however, remains sparse which may be due to the belief that bonding is a physiological behavior reserved for a mother’s maternal instinct. In the current study we compared the impact of paternal and maternal nurturing stroking touch on infants’ physiological self-regulation in terms of respiratory sinus arrhythmia (RSA). We compared the impact of a 3-min stroking period (STROKING) with a pre-baseline (PRE-STROKING) and post-baseline (POST-STROKING) of 25 mothers and 25 fathers (unrelated to one another) on their infants, aged 4–16 weeks. We registered infant electrocardiogram (ECG) and respiration to calculate infant RR-interval (RRI), respiration rate (fR) and (respiratory corrected) RSA (RSAcorr). Based on video-recordings, we analyzed the stroking speed. Infants’ RSAcorr significantly increased during and after stroking, no matter whether touch was delivered by fathers or mothers. This effect was mediated by both heart rate (HR) and respiration. However, respiratory mediation occurred later when delivered by fathers than by mothers. Both mothers’ and fathers’ stroking speed occurred within the optimal stimulation range of c-tactile (CT) afferents, a particular class of cutaneous unmyelinated, low-threshold mechano-sensitive nerves hypothesized to be involved in inter-personal bonding. The discussion builds on the idea to mitigate fathers’ doubts about their paternal capabilities and proposes a research agenda regarding the further examination of the role of nurturing touch and its underlying mechanisms within the development of infants’ physiological self-regulation. Finally, the importance of respiratory measurements in infant physiological research is emphasized.

Early father-infant skin-to-skin contact and its effect on the neurodevelopmental outcomes of moderately preterm infants in China: study protocol for a randomized controlled trial

BACKGROUND

Skin-to-skin contact (SSC) is an evidence-based intervention that benefits low birth weight /preterm infants. However, China's health institutional policy inhibits parents from visiting their baby in the neonatal intensive care unit (NICU). In addition, the Chinese traditional postpartum behavioral practice of confining women to home raises barriers to mother-infant contact. Thus, to shorten the duration of parent-infant separation, father-infant SSC is considered a possible alternative. This study determines whether it is safe to perform father-infant SSC in the NICU and investigates how paternal SSC affects outcomes compared with traditional care (TC) for moderately preterm infants.

METHODS/DESIGN

A randomized controlled trial will be used to investigate the effects of paternal-infant SSC in NICU wards in China. Preterm infants born at a gestational age in the range of 320-346 weeks with a birth weight > 1500 g will be eligible. A simple random sampling method will be used to allocate infants to the SSC group (n = 25) or the TC group (n = 25). After medical stability, infants in the SSC group will be provided SSC by fathers for one hour every day until discharged from hospital. The primary outcome is neurodevelopmental measures, specifically salivary cortisol and Premature Infant Pain Profile (PIPP) during hospitalization. At 40 weeks of corrected age, infants will be assessed using the Infant Neurological International Battery (INFANIB) and neuroimaging. Secondary outcomes include infants' physiological stability during SSC and throughout hospitalization and state observation at discharge. The fathers' mental health will be assessed with the State-Trait Anxiety Inventory (STAI) 1 day to 3 days after the infant's admission to the NICU and at discharge. Father-infant attachment will be evaluated at 4 and 6 months after the infants' discharge, measured by the Paternal Postnatal Attachment Scale (PPAS). Statistical analyses will be conducted using a two-sided significance level of 0.05.

DISCUSSION

The effects of paternal-infant SSC on moderately preterm infants will be assessed. The data gathered in this study may have important implications for medical practice and policy in the NICU regarding the care methods of premature infants in China.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-IOR-1701274 . Registered on 20 September 2017. Retrospectively registered.