The Experiences of First-Time Fathers in Perinatal Services: Present but Invisible

First-time parents' perception of midwives' and other healthcare professionals' support behaviours: A qualitative study

PROBLEM

Parents often report not being satisfied with the support received from midwives and nurses during their postpartum hospital stay.

BACKGROUND

Social support is an important protective factor during the transition to parenthood. However, little is known on how first-time parents perceived the behaviours demonstrated by healthcare professionals to support them.

OBJECTIVE

To describe social support behaviours of midwives and nurses as perceived by first-time parents during the early postpartum period.

METHODS

This qualitative study used individual semi-structured interviews to collect data. A purposeful sample of first-time parents staying on the postpartum ward of a Swiss university hospital were included. Thematic analysis was performed to identify themes and sub-themes.

FINDINGS

A total of 26 parents (15 mothers and 11 fathers) were interviewed. Parents reported behaviours perceived either as positive or negative. These behaviours were summarized into five themes: "Welcoming parents on the postpartum ward", "Establishing a partnership with parents", "Guiding parents in acquiring their new parenting role", "Caring for parent's emotions", and "Creating a peaceful environment".

DISCUSSION AND CONCLUSION

This study reported a wide variety of professional support behaviours. Behaviours promoting individualised care and related to empowering parents in their infant care were perceived as helpful by parents. Midwives and nurses should be aware of the way they provide support, as this shapes the early postpartum experience of first-time parents. Being sufficiently staffed and being well-trained, especially in providing interpersonal support, could help midwives and nurses provide better sensitive individualised care.

Elements of fatherhood involved in the gestational period: a scoping review

OBJECTIVE

To identify in the literature and summarize the elements and characteristics of fatherhood involved during pregnancy.

METHOD

Scoping review that used PRISMA-ScR guide to report this review. Searches were carried out in PubMed, CINAHL, PsycInfo, LILACS and Scopus. Google search engines and public health agency websites assisted in searches of gray literature and Rayyan in screening studies.

RESULTS

A total of 406 articles were identified, of which 16 made up the final sample. Five elements make up an involved fatherhood: feeling like a father, being a provider and protector, being a partner and participant in pregnancy, participating in prenatal appointments and feeling prepared to take care of a baby.

CONCLUSION

Fathers want to be involved in prenatal care, but feel excluded from this process. Public policies that encourage paternal involvement and healthcare professional training to better welcome and promote paternal involvement are of paramount importance.

The influence of antenatal imaging on prenatal bonding in uncomplicated pregnancies: a mixed methods analysis

BACKGROUND

Prenatal bonding describes the emotional connection expectant parents form to their unborn child. Research acknowledges the association between antenatal imaging and enhanced bonding, but the influencing factors are not well understood, particularly for fathers or when using advanced techniques like fetal magnetic resonance imaging (MRI). This study aimed to identify variables which may predict increased bonding after imaging.

METHODS

First-time expectant parents (mothers = 58, fathers = 18) completed a two-part questionnaire (QualtricsXM™) about their expectations and experiences of ultrasound (n = 64) or fetal MRI (n = 12) scans in uncomplicated pregnancies. A modified version of the Prenatal Attachment Inventory (PAI) was used to measure bonding. Qualitative data were collected through open-ended questions. Multivariate linear regression models were used to identify significant parent and imaging predictors for bonding. Qualitative content analysis of free-text responses was conducted to further understand the predictors' influences.

RESULTS

Bonding scores were significantly increased after imaging for mothers and fathers (p < 0.05). MRI-parents reported significantly higher bonding than ultrasound-parents (p = 0.02). In the first regression model of parent factors (adjusted R2 = 0.17, F = 2.88, p < 0.01), employment status (β = -0.38, p < 0.05) was a significant predictor for bonding post-imaging. The second model of imaging factors (adjusted R2 = 0.19, F = 3.85, p < 0.01) showed imaging modality (β = -0.53), imaging experience (β = 0.42) and parental excitement after the scan (β = 0.29) were significantly (p < 0.05) associated with increased bonding. Seventeen coded themes were generated from the qualitative content analysis, describing how scans offered reassurance about fetal wellbeing and the opportunity to connect with the baby through quality interactions with imaging professionals. A positive scan experience helped parents to feel excited about parenthood. Fetal MRI was considered a superior modality to ultrasound.

CONCLUSIONS

Antenatal imaging provides reassurance of fetal development which affirms parents' emotional investment in the pregnancy and supports the growing connection. Imaging professionals are uniquely positioned to provide parent-centred experiences which may enhance parental excitement and facilitate bonding.

"I always felt like I wasn't supposed to be there". An international qualitative study of fathers' engagement in family healthcare during transition to fatherhood

OBJECTIVE

Engagement of fathers in family health services confers benefits for the health and wellbeing of the whole family. The childbirth continuum is traditionally considered a feminine event, however, commensurate with the changing paradigm of gender equity in family healthcare worldwide, the role of fathers is in transformation. The aim of the study is to explore father's perceptions and experiences of healthcare engagement during pregnancy and early infant care.

DESIGN

Qualitative free-text questions were embedded in a large multi-country, cross-sectional survey, to explored fathers' attendance, participation, and experience of health care during appointments with their pregnant partner and/or baby.

SETTING AND PARTICIPANTS

Expectant and new fathers were recruited through Prolific®, an international paid online survey platform.

FINDINGS

Qualitative responses (n=889) were provided by fathers from 28 countries, with experiences of a range of contexts and models of care; 46.8% of whose partners were pregnant and 53.2% had given birth since 2020. The findings suggest that although most fathers wanted to attend and participate in maternity and early parenting-related healthcare, multiple barriers were identified at the individual father, organisational context, and societal levels. Fathers reported negative social factors such as gender bias and restrictive gender norms as barriers to their healthcare engagement. In contrast, factors that enabled fathers to overcome barriers included the fathers' feelings of confidence in their partner's autonomy and decision-making skills, trusted professional relationships with clinicians, and clinicians with good interpersonal skills.

KEY CONCLUSIONS

Multiple barriers restrict the participation of fathers in healthcare for childbearing and early parenting. Knowledge of these barriers can inform healthcare redesign to include more successful engagement strategies for fathers, to benefit fathers, mothers, and infants alike.

IMPLICATIONS FOR PRACTICE

Health professionals consulting with the mother, father and infant triad are ideally placed to address the healthcare needs of both parents. Early engagement of fathers in family health care by use of inclusive interpersonal skills and the development of a trusted relationship has potential to improve paternal mental health, and may be associated with benefits for the health, wellbeing and safety of the whole family.

"It's not just the medical aspects that are important": A qualitative exploration of first-time parents' experiences of antenatal imaging and their influence on parent-fetal bonding

INTRODUCTION

Antenatal imaging provides clinical information regarding fetal growth and development. The additional benefit afforded by imaging for expectant parents in developing an emotional connection (bond) to the unborn baby is also acknowledged. However, the relationship between imaging and bonding is not fully understood, particularly where there are differing parental and pregnancy circumstances, for example use of advanced imaging techniques or the prenatal diagnosis of a congenital fetal condition. This study aimed to explore the role of antenatal imaging in enhancing the developing parent-fetal bond in first-time parents.

METHODS

A descriptive, qualitative methodology was used. Semi-structured telephone interviews were conducted with first-time expectant parents attending a London hospital for clinical ultrasound (n = 20) or research MRI (n = 8) imaging during pregnancy. The sample included parents receiving specialist antenatal care for a diagnosed fetal cardiac condition (n = 8). Thematic analysis was conducted.

RESULTS

The analysis generated three themes: 1) Our baby, our scan too; 2) Destination parenthood; and 3) Being in the dark, then finding the light. These themes highlight the important, but transient role of antenatal imaging in enhancing parent-fetal bonding, as well as the differing care needs of expectant parents. The integral role of healthcare professionals in providing a personalised, supportive, imaging experience to facilitate bonding is also reflected.

CONCLUSION

Adopting parent-centred care approaches which involve expectant parents in fetal imaging influences bonding by helping parents to consider the reality of their impending parenthood. Knowledge acquired during scans is used to create an identity for the unborn baby, which parents can develop an emotional connection to.

IMPLICATIONS FOR PRACTICE

To optimise the potential for enhanced parent-fetal bonding, care provision in fetal imaging should be tailored to the individual needs of expectant parents.

A structural equation model analysis of the relationship between expectant fathers' fear of COVID-19 and their fear of childbirth: The mediating role of maternal fear of childbirth

BACKGROUND

Pregnancy and childbirth may provoke various emotional responses in expectant fathers including excessive fear of childbirth. It is not unreasonable to assume that fear of contracting the virus during the COVID-19 pandemic, may have intensified fathers' fear of childbirth. This study aims to determine the mediating role of the expectant mothers' fear of childbirth in the relationship between expectant fathers' fear of COVID-19 and their fear of childbirth.

METHODS

This cross-sectional study was conducted on 270 pregnant women and their spouses attending health centers from Aug 2021 to April 2022. Fathers' fear of childbirth scale (FFCS), Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-A), and Fear of COVID-19 Scale (FCV-19S) were used to collect data. To examine the relationships between variables and to develop the final model, we used the structural equation model (SEM).

RESULTS

The prevalence of severe fear of childbirth in fathers and their female spouses were 40.9% and 22.4%, respectively. The mean score and standard deviation of fear of childbirth in the fathers and their female spouses were 49.2 ± 17.1 and 62.5 ± 29.4, respectively. Results showed that fathers' fear of COVID-19 was directly (B = 0.44, p = 0.004) and indirectly (B = 0.13, p = 0.015) associated with fathers' fear of childbirth. Also, women's fear of childbirth was positively associated with fathers' fear of childbirth (B = 0.45, p = 0.030). In the final model, the values of χ2/df, CFI, PCFI, RMSEA, and SRMR were equal to 2.32, 0.94, 0.76, 0.07, and 0.06, respectively.

CONCLUSIONS

We found a high prevalence of severe fear of childbirth in Iranian expectant fathers which means that fathers' fear of childbirth is a national health concern that needs to be addressed. The findings of the present study indicate that mothers' fear of childbirth has a mediating role in the relationship between fathers' fear of COVID and fear of childbirth. Therefore, to alleviate fathers' fear of childbirth, interventions to reduce fathers' fear of COVID-19 and women's fear of childbirth should be developed and implemented. The impact of fathers' mental health on the fear of childbirth in expectant couples should be further investigated.

'Everything that's said comes from me': New fathers' experiences of individual conversations with the child health nurse

AIM

Swedish Child Health Services provide regular health surveillance of children 0-5 years and support to parents, with the aim to contribute to equitable child healthcare and to promote physical, emotional, and social health for children. Individual conversations with the child health nurse, including screening for postnatal depression, have been recommended and well implemented for mothers, whereas routines for a visit specifically for the nonbirthing parent vary and are not well studied. The aim of this study was therefore to explore how nonbirthing parents experienced individual conversations with their child health nurse, held 3 months after the birth of their child.

DESIGN

Qualitative interview study.

METHODS

Semistructured interviews were conducted with 16 fathers who had participated in individual conversations with a nurse at their child health centre, 3 months post-partum. Data were analysed with qualitative content analysis. The study adhered to the COREQ checklist for qualitative studies.

RESULTS

The findings are presented in three categories: 'Being invited into a supportive context', 'Talking about what was important' and 'Taking it home', each of them including three subcategories. The individual conversations, without the mother present, made the fathers feel important and allowed for a different type of content, tailored to their own needs. The conversations were validating and led to changes in daily routines with their child for some fathers.

The effect of the COVID-19 pandemic on UK parent experiences of pregnancy ultrasound scans and parent-fetal bonding: A mixed methods analysis

INTRODUCTION

Companionship in antenatal care is important for facilitating positive parental experiences. During the COVID-19 pandemic, restrictions on partner attendance at fetal ultrasound scans were introduced nationally to minimise transmission of the virus. This study aimed to explore the effect of these restrictions on maternal and paternal experiences of pregnancy scans and evaluate their potential effect on parent-fetal bonding.

METHODS

A UK-wide, anonymous cross-sectional survey was completed by new and expectant parents (n = 714) who had, or were awaiting a pregnancy scan during the COVID-19 pandemic. The CORE-10 and an adapted version of the Prenatal Attachment Inventory were used to evaluate psychological distress and prenatal bonding. Additional survey questions captured parental experiences of scans. Separate statistical and thematic analyses of the data were undertaken. A joint display matrix was used to facilitate integration of quantitative and qualitative claims to generate a comprehensive interpretation of study findings.

FINDINGS

When fathers did not attend the scan, feelings of excitement and satisfaction were significantly reduced (p<0.001) and feelings of anxiety increased (p<0.001) in both parents. Mothers were concerned about receiving unexpected news alone and fathers felt excluded from the scan. Mean paternal bonding (38.22, SD 10.73) was significantly lower compared to mothers (47.01, SD 7.67) although no difference was demonstrated between those who had attended the scan and those who had not. CORE-10 scores suggested low-to-mild levels of psychological distress, although the mean difference between mothers and fathers was not significant. Key themes described both parents' sense of loss for their desired pregnancy scan experience and reflected on sonographers' central role in providing parent-centred care during scans.

CONCLUSION

Restrictions on partner attendance at scans during the COVID-19 pandemic had a negative effect on parental experiences of antenatal imaging. Provision of parent-centred care, which is inclusive of partners, is essential for improved parental experiences.

Postpartum Blues in Fathers: Prevalence, Associated Factors, and Impact on Father-to-Infant Bond

In this study we explored, in men, one of the most common postpartum syndromes in women: the postpartum blues. The aims of the study were (a) to evaluate the prevalence of postpartum blues in fathers, (b) to explore the sociodemographic and perinatal factors that may be associated with its intensity, and (c) to investigate the relationship between the intensity of blues symptoms and the quality of father-to-infant bonding. Three hundred and three French-speaking fathers living in France completed a sociodemographic and obstetrical questionnaire, the Maternity Blues Questionnaire, and the Postpartum Bonding Questionnaire. The fathers were recruited from two maternity hospitals and a Child and Maternal Health Centre within 10 days of their infant's birth, or from online forums devoted to parenting. At least 17.5% of fathers experienced postpartum blues. A high level of education was associated with a higher level of postpartum blues symptoms. Dissatisfaction with the maternity care and significant father involvement during pregnancy and delivery predicted more severe postpartum blues symptoms. Symptoms of postpartum blues were positively correlated with impairment in the father-to-infant bond. This study lends support to the existence of postpartum blues among fathers and highlights its possible consequences on early father-infant relationships.

"Crying on the Bus": First Time Fathers' Experiences of Distress on Their Return to Work

There is increasing research interest in the experiences of new fathers taking paternity leave, but less insight into men's experiences of returning to work after the birth of their first baby. For many men in the UK context, this could take place immediately after the birth or after one or two weeks of paternity leave. This paper utilizes data from a UK-based study whilst also drawing on international literature and policy contexts. A constructivist grounded theory method was adopted to generate theory from the data gathered. Twelve new fathers shared their experiences in this study by participating in audio-recorded, semi-structured interviews. This paper focuses on fathers' experiences of negotiating the workplace as part of an overall theoretical framework related to broader transitions to fatherhood and sheds light on the distress, guilt and psychological challenges that the participants experienced when they initially returned to work. Whether fathers did or did not explicitly describe distress at this time, they all described a change in their worker identity, which for some participants led to uncertainty in the workplace. Men returning to work at this time in the postnatal period are vulnerable to experiencing distress. Flexibility and support in the workplace could be protective of their mental health. Finally, policy and practice developments are offered to support men's transitions to fatherhood in the workplace context.

Factors that influence the uptake of postnatal care from the perspective of fathers, partners and other family members: a qualitative evidence synthesis

BACKGROUND

Postnatal care (PNC) is a key component of maternity provision and presents opportunities for healthcare providers to optimise the health and well-being of women and newborns. However, PNC is often undervalued by parents, family members and healthcare providers. As part of a larger qualitative review exploring the factors that influence PNC uptake by relevant stakeholders, we examined a subset of studies highlighting the views of fathers, partners and family members of postpartum women.

METHODS

We undertook a qualitative evidence synthesis using a framework synthesis approach. We searched multiple databases and included studies with extractable qualitative data focusing on PNC utilisation. We identified and labelled a subset of articles reflecting the views of fathers, partners and other family members. Data abstraction and quality assessment were carried out using a bespoke data extraction form and established quality assessment tools. The framework was developed a priori based on previous research on the topic and adapted accordingly. Findings were assessed for confidence using the GRADE-CERQual approach and are presented by country income group.

RESULTS

Of 12 678 papers identified from the original search, 109 were tagged as 'family members views' and, of these, 30 were eligible for this review. Twenty-nine incorporated fathers' views, 7 included the views of grandmothers or mothers-in-law, 4 incorporated other family member views and 1 included comothers. Four themes emerged: access and availability; adapting to fatherhood; sociocultural influences and experiences of care. These findings highlight the significant role played by fathers and family members on the uptake of PNC by women as well as the distinct concerns and needs of fathers during the early postnatal period.

CONCLUSION

To optimise access to postnatal care, health providers should adopt a more inclusive approach incorporating flexible contact opportunities, the availability of more 'family-friendly' information and access to psychosocial support services for both parents.

Paternal Perinatal Experiences during the COVID-19 Pandemic: A Framework Analysis of the Reddit Forum Predaddit

During the COVID-19 pandemic, new parents were disproportionately affected by public health restrictions changing service accessibility and increasing stressors. However, minimal research has examined pandemic-related stressors and experiences of perinatal fathers in naturalistic anonymous settings. An important and novel way parents seek connection and information is through online forums, which increased during COVID-19. The current study qualitatively analyzed the experiences of perinatal fathers from September to December 2020 through the Framework Analytic Approach to identify unmet support needs during COVID-19 using the online forum predaddit on reddit. Five main themes in the thematic framework included forum use, COVID-19, psychosocial distress, family functioning, and child health and development, each with related subthemes. Findings highlight the utility of predaddit as a source of information for, and interactions of, fathers to inform mental health services. Overall, fathers used the forum to engage with other fathers during a time of social isolation and for support during the transition to parenthood. This manuscript highlights the unmet support needs of fathers during the perinatal period and the importance of including fathers in perinatal care, implementing routine perinatal mood screening for both parents, and developing programs to support fathers during this transition to promote family wellbeing.

Exploring the Needs and Expectations of Expectant and New Parents for an mHealth Application to Support the First 1000 Days of Life: Steps toward a Co-Design Approach

To improve maternal and child health, it is essential to adhere to health-promoting and preventive measures. However, reliable information as well as effective tools are not easy to identify in this field. Our cross-sectional study investigated the needs and expectations of expectant and new mothers and fathers as potential primary users of a hypothetical application supporting the first 1000 days of life. Between May and August 2022, we recruited expectant and new parents by administering an 83-item 5-point Likert scale questionnaire related to the content, functionalities, and technical features of the hypothetical app. We stratified responses using sociodemographic characteristics and then performed ward hierarchical clustering. The 94 women and 69 men involved in our study generally agreed with the proposed content, but expressed low interest in certain app functionalities or features, including those related to the interaction mechanism and interactivity. Women were generally more demanding than men. Our findings, resulting from the engagement of end-users, may be useful for designers and technology providers to implement mHealth solutions that, in addition to conveying reliable information, are tailored to the needs and preferences of end-users in the first 1000 days of life.

Parents' experiences with public health nursing during the postnatal period: A reflective lifeworld research study

AIM

To describe mothers' and fathers' experiences with public health nursing and child and family health centre services in the postnatal period, both as a couple and as individuals.

METHOD

A phenomenological reflective lifeworld research approach with a descriptive design was chosen. A purposive sample of 10 mothers and 10 fathers were interviewed twice, 1-2 and 6-8 weeks postpartum, using joint and individual interviews. By focusing on being open and flexible, the data were analyzed to elucidate a meaningful structure of the phenomenon.

RESULTS

The findings revealed that parents' experiences with public health nurse (PHN) and Child and Family Health Centre (CFHC) services in the postnatal period are characterised by a longing to be seen and confirmed both as unique individuals and as a family by the PHN. Although an increased need for both lay and professional care is prominent during the postnatal period, the parents drew a varied picture of their experiences demonstrating that the CFHC services are focussing almost exclusively on mother and child.

CONCLUSION

A public health nurse can contribute to strengthen parenthood and promote the family's health when the focus is on the new baby. Being cared for while learning to care for the baby is pivotal in a phase that involves both joy and vulnerability. This study adds knowledge concerning the importance of both parents being seen and confirmed by the PHN as unique individuals and a family unit in the postnatal period.

Peripartum Cardiomyopathy and Spouses' Experiences of Persistent Uncertainty

PURPOSE

The purpose of this study was to explore the experiences of spouses whose wives had peripartum cardiomyopathy (PPCM).

DESIGN METHODS

Participants were recruited for this phenomenological study through online sites Facebook and SavetheMommies. Fifteen men from four countries participated through semistructured phone interviews conducted between October 2019 and August 2020. Data were analyzed using a modified version of the constant comparison method.

RESULTS

The overarching theme of spouses' experiences was Living with the 'what ifs' of persistent uncertainty. Four main themes were: Feeling the shock, Facing the challenge, Figuring out a new normal, and Finding meaning. Spouses had to deal with the fear of their wives' heart failure relapse or death, changed marital and parental roles, and unclear expectations of the future.

CLINICAL IMPLICATIONS

PPCM is a rare complication of pregnancy with uncertain implications for the future that can have a profound impact on the woman's spouse and family. Our findings should alert nurses and other health care professionals to the need for emotional, spiritual, and informational support of spouses or partners of women who have PPCM. Nurses should include spouses and partners in care and communication to make sure they are as informed as possible, have their questions and concerns addressed as needed, and receive adequate follow-up support.

Social support needs of first-time parents in the early-postpartum period: A qualitative study

Background

The early postpartum period is a critical time for first-time parents as they adapt to their new role. Perceived lack of social support is a risk factor for developing mental health problems. Insufficient or inappropriate professional support for both parents has been reported by many studies. Social support that appropriately meets parents' needs is an important protective factor for parents' wellbeing; however, little is known about the social support needs of both first-time parents.

Aims and objectives

To describe both first-time parents' formal social support needs in the early postpartum period.

Method

Individual semi-structured interviews were conducted with first-time parents recruited on the postpartum ward of a Swiss university hospital. Thematic analysis was used to identify themes and sub-themes.

Results

Fifteen mothers and eleven fathers were interviewed. Twelve themes were identified. Mothers' themes were "experiencing postpartum changes," "creation of a family unit," "self-esteem," "emotional needs," "difficulty in communicating their needs," and "the postpartum stay." Fathers' themes were "to be included in care procedures on the postpartum ward," "to be reassured," "to anticipate their postpartum stay" and "to consider their need as non-priority." Parental shared needs were: "to care for their newborn," and "returning home."

Conclusion

Mothers' and fathers' needs differed. Mothers needed more emotional support than fathers and fathers considered themselves as the main support for their partner. Fathers wanted to be integrated in the care of their newborn.

Parent and Peer Attachments in Adolescence and Paternal Postpartum Mental Health: Findings From the ATP Generation 3 Study

Background: When adolescent boys experience close, secure relationships with their parents and peers, the implications are potentially far reaching, including lower levels of mental health problems in adolescence and young adulthood. Here we use rare prospective intergenerational data to extend our understanding of the impact of adolescent attachments on subsequent postpartum mental health problems in early fatherhood.

Methods: At age 17–18 years, we used an abbreviated Inventory of Parent and Peer Attachment to assess trust, communication, and alienation reported by 270 male participants in their relationships with mothers, fathers, and peers. More than a decade later, we assessed the adult males, now fathers, at 12 months postpartum (N = 409 infant offspring) for symptoms of depression, anxiety, and stress. Logistic regression was used to examine the extent to which attachment dimensions predicted paternal postpartum mental health, adjusting for potential confounding, and with assessment for interactions between parent and peer attachments.

Results: Trust in mothers and peers, and good communication with fathers during adolescence, were associated with 5 to 7 percentage point reductions in postpartum mental health symptoms in early fatherhood. Weak evidence of parent-peer interactions suggested secure attachments with either parent or peer may compensate for an insecure attachment with the other.

Conclusions: Our results suggest that fostering trust and communication in relationships that adolescent boys have with parents and peers may have substantial effects on rates of paternal postpartum mental health problems. The protective benefits may be preventative in intergenerational cycles of risk for mental health problems.