FIRST-TIME FATHERS' CHILDBIRTH EXPERIENCE

Twenty first-time fathers who had attended prenatal classes were interviewed before and after attending their wives' childbirth to determine the father's special needs at this time. The same fifty-item questionnaire was utilized in both the predelivery and the postdelivery interviews. Motivation for involvement in childbirth was explored in the predelivery interview. The most frequent motivations for involvement in childbirth were “to share the birth,” and “to enhance the couple relationship.” The responses differed little in the pre- and postdelivery interviews. In the postdelivery interview, more fathers wanted to know the baby's condition as soon as possible after birth and wanted to have the nurse at their wives' bedside as much as possible during labor. Most of the fathers had high needs for understanding, nurturance, and deference during labor. Most fathers wanted the nurses to take care of their emotional needs rather than their physical needs (hunger and rest). Assisting their wives in labor was considered to be a great achievement by the fathers. Few fathers felt overpowered or anxious about the environment of the labor suite or the birth itself. This study concluded that further research with fathers who do not attend prenatal classes was needed.     

Preparing fathers for the transition to parenthood: Recommendations for the content of antenatal education

Fathers now provide more care for their babies and children than they have in the past, and a large body of evidence supports the important role that father involvement plays in determining child and family outcomes. Fathers have also become the primary source of informal support for most mothers and it is now customary for fathers to attend antenatal education in this supporting role. However, many fathers remain unprepared for their personal transition to parenthood and this has important implications for all of the family. Antenatal education is likely to be more effective for fathers when it addresses fathers' needs but the literature is unclear about what fathers need to know. This paper presents evidence-based recommendations for core subject matter to be addressed when preparing men for the important challenges of new fatherhood.     

Fathers' Coping Style,Antenatal Preparation,and Experiences of Labor and the Postpartum

Background: In recent years the trend for fathers in Western postindustrial countries to attend childbirth has increased. This study examined the interaction between fathers' information‐seeking coping predispositions and their level of attendance at antenatal classes with respect to their experiences of attending childbirth. Associations between fathers' childbirth experiences, their relationship with their baby, and level of depressive symptomatology at 6 weeks postpartum were also examined. Methods: A quantitative methodology was employed in which 78 fathers completed several questionnaires, some within 6 days of childbirth and others at 6 weeks postpartum. Results: Fathers who were characterized as high blunters (avoiders) of threat information, from antenatal classes reported that experiencing childbirth was less fulfilling than fathers with similar coping styles who did not attend classes. Fathers' reports of fulfillment and delight while attending childbirth were negatively related to their level of depressive symptomatology at 6 weeks postpartum. Levels of distress were associated with subsequent depressive symptoms, but their effect was removed when preexisting depressive symptoms were partialled out. Fathers whose children were born by cesarean delivery used significantly more negative adjectives to describe their baby at 6 weeks postpartum compared with those born by vaginal delivery. More married fathers attended antenatal classes and reported lower levels of depressive symptomatology than unmarried fathers. Conclusions: Although fathers' attendance at antenatal classes may have positive consequences for them and their partner, for some fathers, attendance at classes may be associated with less positive reports of experiencing childbirth. The way in which men experience childbirth may have some influence on their subsequent emotional well‐being.     

Pregnancy Intentions among Expectant Adolescent Couples

Study ObjectiveTo examine the self-reported pregnancy intentions of the male partners of expectant adolescent mothers, the accuracy of adolescent mothers' perceptions of their partner's pregnancy intentions, and the concordance between young mothers' and fathers' pregnancy intentions.DesignThis cross-sectional pilot study collected interview data from expectant adolescent mothers and their male partners.SettingData were collected in participants' homes.Participants35 expectant couples were interviewed separately. Most participants were African American (89% of mothers, 74% of fathers). 69% of mothers were 17-18 years old, and half of the fathers were ≥19.Main Outcome MeasuresParents responded to survey questions adapted from the Center for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System Questionnaire.Results44% of fathers reported wanting their partner to get pregnant. Another 15% were ambivalent. A kappa statistic of 0.12 (P = .33) indicated very little “accuracy” of mothers' perceptions of their partners' pregnancy intentions. Further, there was low concordance between the pregnancy intentions of mothers and fathers. Young fathers who wanted or were ambivalent about pregnancy were significantly more likely to use no contraception or withdrawal.ConclusionFor a notable number of minority couples, adolescent mothers do not have an accurate perception of their partners' pregnancy intentions and use contraceptive methods that are not within their control. These findings indicate that teen pregnancy prevention interventions must target young males in addition to females and sexually active adolescents should be encouraged to discuss pregnancy intentions with each other.     

Women's perspectives on maternity services in Sweden: processes, problems, and solutions

Most measures of health care quality focus on medical outcomes rather than patients' assessments of quality. Drawing on data from a national survey of Swedish women, this study describes women's opinions about what is important to them during pregnancy and birth. This qualitative study is based on responses of 827 pregnant women to an open question completed in the second trimester. In total, 2061 separate statements were analyzed. Using content analysis, these statements were clustered into 4 themes: desirable characteristics of midwife, prenatal care during pregnancy, care during labor and birth, and care after birth. Within those themes, 13 categories were found. Findings suggest areas for improvement in maternity services including: the timing and length of prenatal visits, making parent education classes available to all women, prelabor visits to the maternity ward, continuous information about the progress of labor, flexibility in time of discharge, and postpartum support for families. Women also stated that characteristics of the midwife, such as being supportive, friendly, attentive, respectful, and nonjudgemental, were important. A patient-centered and individualized approach, with women and their partners as the subjects rather than the objects of care, would increase satisfaction and the overall quality of maternity services in Sweden.     

Client perspectives of midwifery care in the transition from subfertility to parenthood: a qualitative study in the Netherlands

Background: Pregnancy, childbirth and the postpartum period after fertility treatment are considered “normal” in the Netherlands, with no indication of an increased obstetric risk, and can therefore be monitored by a primary care midwife. However, there is little evidence on the experiences of couples and women who finally get pregnant after fertility treatment and a lack of training for midwives exists on this subject. The aim of this study was to map the midwifery care needs of the subfertile client with past fertility problems.

Methods: In 2011, we interviewed two couples and seven women who conceived through fertility treatment and received primary midwifery care at some point during their pregnancies. This explorative, qualitative study was based on the interpretivist/constructivist paradigm.

Results: Although the participants are not representative of all subfertile clients, the findings of our qualitative study highlight the needs of women and their partners who have become pregnant through fertility treatment including help from the primary care midwife in understanding the likely course of their pregnancy, more psychosocial support and acknowledgement of the fertility treatment history, and more consultations and frequent ultrasound scans than usual to confirm pregnancy.

Conclusions: Our study points out that the women who have become pregnant through fertility treatment and their partners communicate seemingly paradoxical prenatal care needs. It can help maternity care providers to optimally meet the care needs of subfertile clients and empower them during their transition from subfertility to parenthood.     

Impact of clinic interventions on the rate of influenza vaccination in pregnant women

OBJECTIVE: To assess the impact of interventions in a prenatal clinic on the influenza vaccination rate in pregnant women. STUDY DESIGN: This retrospective study of women receiving care in a university prenatal clinic examined the impact of several interventions to increase immunization rates implemented over 2 years. Influenza vaccination rates were assessed before and after the interventions, which included provider and staff education, stocking of the vaccine in the clinic and implementation of standing orders. RESULTS: Influenza vaccination rates in pregnant women increased from <1% to 37%. Standing orders were the most important intervention for increasing immunization rates. Patients who received care in the certified nurse midwife clinic were more likely to be vaccinated, while those who received care in a high-risk obstetric clinic were less likely. CONCLUSION: Interventions to improve influenza vaccination rates among pregnant women, particularly standing orders, are effective. These interventions should be implemented nationally in all prenatal care clinics.     

Recent Trends in Clinicians Providing Care to Pregnant Women in the United States

Introduction: Health care needs of pregnant women are met by a variety of clinicians in a changing policy and practice environment. This study documents recent trends in types of clinicians providing care to pregnant women in the United States. Methods: We used a repeat cross‐sectional design and data from the Integrated Health Interview Series (2000‐2009), a nationally representative data set, for respondents who reported being pregnant at the time of the survey (N = 3204). Using longitudinal logistic regression models, we analyzed changes over time in pregnant women's reported use of care from 1) obstetrician‐gynecologists; 2) midwives, nurse practitioners (NPs), or physician assistants (PAs); or 3) both an obstetrician‐gynecologist and a midwife, NP, or PA. Results: The percentage of pregnant women who reported seeing an obstetrician‐gynecologist (87%) remained steady from 2000 through 2009. After controlling for demographic and clinical variables, the percentage who reported receiving care from a midwife, NP, or PA increased 4% annually (yearly adjusted odds ratio [AOR] 1.04; P < .001), indicating a cumulative increase of 48% over the decade. The percentage of pregnant women who received care from both an obstetrician‐gynecologist and a midwife, NP, or PA also increased (AOR 1.027; P < .001), for a cumulative increase of 30%. Discussion: The increasing role of midwives, NPs, and PAs in the provision of maternity care suggests changes in the perinatal workforce and practice models that may promote collaborative care and quality improvement. However, better data collection is required to gather detailed information on specific provider types, these trends, and their implications.     

Becoming a father First-time fathers' experience of labor and delivery

In this study, ethnographic interviews were used to identify first-time fathers' experiences of the birth of their first child. Fourteen fathers were interviewed, and prenatal expectations of the experience are compared with the fathers' perceptions after the birth. Although the fathers expected to be treated as part of a laboring couple, they found that they were relegated to a supporting role. Initially the fathers were confident of their ability to support their wives, but they found that labor was more work than they had anticipated. They became fearful of the outcome, but hid these fears from their partners. Later, they found that their focus moved from their wives to their babies at the time of birth. The men all completed the experience with an enhanced respect for their wives. Fathers should be included in labor management plans and need support for their role as coach, particularly when their wives experience pain. They also need to be encouraged to eat and take a break from their wives' labor when appropriate.     

Becoming a Father: First-Time Fathers' Experience of Labor and Delivery

In this study, ethnographic interviews were used to identify first-time fathers' experiences of the birth of their first child. Fourteen fathers were interviewed, and prenatal expectations of the experience are compared with the fathers' perceptions after the birth. Although the fathers expected to be treated as part of a laboring couple, they found that they were relegated to a supporting role. Initially the fathers were confident of their ability to support their wives, but they found that labor was more work than they had anticipated. They became fearful of the outcome, but hid these fears from their partners. Later, they found that their focus moved from their wives to their babies at the time of birth. The men all completed the experience with an enhanced respect for their wives. Fathers should be included in labor management plans and need support for their role as coach, particularly when their wives experience pain. They also need to be encouraged to eat and take a break from their wives' labor when appropriate.     

A Birth Education Program for Expectant Fathers in Taiwan: Effects on Their Anxiety

Background: A father who does not know how to assist the mother in relieving labor pains may experience a sense of powerlessness and anxiety. The objective of this study was to evaluate how an education program for expectant fathers who attended their partners' labor and birth affected their anxiety. Methods: In a randomized controlled trial, 87 expectant fathers who attended their pregnant partners through labor and birth at a hospital in central Taiwan were allocated by block randomization to an experimental (n = 45) and a control (n = 42) group. The men completed their basic personal information, a childbirth expectations questionnaire, and a Trait Anxiety Inventory when they were recruited. Two hours after birth of their child, all the expectant fathers completed a State of Anxiety Inventory. Results: Our results showed no statistically significant differences between the experimental and control groups of fathers in trait anxiety and their prenatal childbirth expectations. After analysis of covariance (ANCOVA) was applied to correct for education level, sources of childbirth information, attendance at Lamaze childbirth classes, and childbirth expectations at baseline, the effect of the childbirth program was significant for the postnatal level of anxiety (F = 3.38, p = 0.001). Conclusions: The study findings justify the clinical implementation of a birth education program based on the self‐efficacy theory as an effective means of reducing anxiety among expectant fathers.     

Does Team Midwife Care Increase Satisfaction with Antenatal,Intrapartum, and Postpartum Care? A Randomized Controlled Trial

Background: Although policymakers have suggested that improving continuity of midwifery can increase women's satisfaction with care in childbirth, evidence based on randomized controlled trials is lacking. New models of care, such as birth centers and team midwife care, try to increase the continuity of care and caregiver. The objective of this study was to evaluate the effect of a new team midwife care program in the standard clinic and hospital environment on satisfaction with antenatal, intrapartum, and postpartum care in low‐risk women in early pregnancy. Methods: Women at Royal Women's Hospital in Melbourne, Australia, were randomly allocated to team midwife care (n = 495) or standard care (n = 505) at booking in early pregnancy. Doctors attended most women in standard care, and continuity of the caregiver was lacking. Satisfaction was measured by means of a postal questionnaire 2 months after the birth. Results: Team midwife care was associated with increased satisfaction, and the differences between the groups were most noticeable for antenatal care, less noticeable for intrapartum care, and least noticeable for postpartum care. The study found no differences between team midwife care and standard care in medical interventions or in women's emotional well‐being 2 months after the birth. Conclusion: Conclusions about which components of team midwife care were most important to increased satisfaction with antenatal care were difficult to draw, but data suggest that satisfaction with intrapartum care was related to continuity of the caregiver.     

Information–Seeking and its Predictors in Low-Income Pregnant Women

This study examined information‐seeking and its predictors (information needs and barriers) in low‐income pregnant women. Eighty‐four pregnant women from a prenatal clinic were interviewed using three scales that measured the frequency of information‐seeking from eight different sources, information needs for 20 pregnancy health topics, and 15 barriers to seeking information, respectively. Most women were black, unmarried, between 20 and 29 years of age, high school educated or less, multigravidas, and in their third trimester of pregnancy. Information needs and barriers were significant predictors of information‐seeking. Together, they explained 26% of the variance in the seeking outcome. High information needs and low barriers predicted more frequent information‐seeking. First pregnancy and asthma during pregnancy were significant covariates for information‐seeking. Information needs and barriers are related to information‐seeking among low‐income pregnant women. To facilitate pregnant women's information‐seeking, health care providers may assess a woman's need for information and barriers that the woman experiences when seeking information, and factors such as first pregnancy and asthma.     

Perinatal Outcomes and Satisfaction with Care in Women with High Body Mass Index

Introduction: The majority of studies on pregnant women with high body mass index (BMI) have focused on medical complications and birth outcome, rather than these women's encounters with health care providers. The aims were to identify the proportion of pregnant women with high BMIs (≥30); compare maternal characteristics and pregnancy and birth outcomes; and assess the experiences of prenatal, intrapartum, and postnatal care in women with high (≥30) and lower (<30) BMIs. Methods: Data were collected through questionnaires and antenatal records from 919 women recruited in mid‐pregnancy at 3 hospitals in the north of Sweden, with a follow‐up questionnaire 2 months after birth. Results: The prevalence of obesity was 15.2%. Women with high BMIs were more often aged 35 years or older and less likely to have a university education. They had more negative attitudes regarding being pregnant and reported more childbirth fear compared to women with lower BMIs, but they did not differ in regard to their feelings about the approaching birth or the first weeks with the newborn. They reported more pregnancy complications and had less continuity of caregiver. High BMI was associated with labor induction and emergency cesarean birth. No differences were found in birth complications; birth experience; or satisfaction with prenatal, intrapartum, or postnatal care. Discussion: The findings reveal that women who are obese have more complicated pregnancies and births but are generally satisfied with the care they receive. There are some differences in the way they experience care. Health care providers have a delicate task to provide sufficient information about health risks while still offering respect, encouragement, and support.     

Interactions Between Adolescent Fathers and Health Care Professionals During Pregnancy, Labor, and Early Postpartum

Objective: To examine interactions between adolescent fathers and health care professionals from the perspectives of the families of the adolescent fathers during pregnancy and early postpartum.
Design: Content analysis methods were used to analyze data from the prenatal and 1 month data points of a larger longitudinal qualitative case study design examining paternal involvement. A purposive sample of 25 sets of unmarried, low-income Black adolescent fathers, adolescent mothers, and at least one of each of their parents were individually interviewed at 1, 6, 12, 18, and 24 months after birth using a semistructured interview guide.
Setting: Approximately 90% of participants were interviewed in their homes.
Participants: Annual household incomes were between $0 to $28K ( M =$14,661). The 111 participants included 25 sets of adolescent parents, 50 grandmothers, and 11 grandfathers. Approximately 75% of the adolescent fathers were 17 to 19 years of age.
Results: Supportive (information, emotional, and material support), distancing, and neutralizing interactions between health care professionals and adolescent fathers were identified.
Conclusions: Although most interactions were perceived as supportive, distancing, and neutralizing interactions could potentially have negative long-term effects for these vulnerable families and contribute to disparities in health care. Nurses may be important resources for these new fathers.     

Hispanic Women's Perceptions of Patient‐Centeredness During Prenatal Care: A Mixed‐Method Studya

ABSTRACT: Background: Assessing the quality of prenatal care received by Hispanic women is particularly important, given the rapidly growing Hispanic population in the United States. The purpose of this study was threefold: to assess the prevalence of Hispanic mothers who perceived their prenatal care to be patient‐centered, to determine whether Hispanic mothers were less likely to perceive their prenatal care to be patient‐centered than non‐Hispanic mothers, and to better understand Hispanic women's perceptions of the patient‐centeredness of their prenatal care. Methods: Semistructured interviews were conducted with a proportionate, stratified random sample of 359 women initiating prenatal care in their first trimester and 68 women initiating prenatal care in their third trimester who delivered at 10 Palm Beach County, Florida, maternity hospitals between May and December 2003. Interviews assessed three aspects of patient‐centered prenatal care using quantitative and qualitative methods. Results: Hispanic mothers were less likely than non‐Hispanic mothers to perceive that doctors and nurses treated them with respect during their prenatal care appointments (adjusted OR, 0.29; 95% CI, 0.10–0.86), and to perceive that office staff treated them with respect during their prenatal care appointments (adjusted OR, 0.29; 95% CI, 0.12–0.73). Hispanic mothers were more likely to experience language or communication problems than non‐Hispanic mothers (adjusted OR, 3.30; 95% CI, 1.40–7.76). Qualitative analyses found that lack of patient‐centered care limited Hispanic mothers’ ability to understand information given during prenatal visits, ability to ask questions about their prenatal care, and desire to return for subsequent appointments. Conclusions: Hispanic women could benefit from prenatal care that is more culturally and linguistically competent as well as care that is responsive to the group's cultural norms. One recommendation is the use of group prenatal care, which encourages groups of women with similar gestational ages to articulate and discuss cultural norms and attitudes about pregnancy during structured prenatal care sessions. (BIRTH 32:4 December 2005)     

Group Prenatal Care for Women Receiving Medication‐Assisted Treatment for Opioid Use Disorder in Pregnancy: An Interprofessional Approach

Opioid use disorder among pregnant women is common and rapidly increasing nationwide. Group prenatal care is an innovative alternative to individual care for pregnant women and has been shown to improve women's and health care providers’ satisfaction and adherence to care. We describe a novel group prenatal care program colocated in an opioid treatment program that integrates prenatal care, substance use disorder counseling, and medication‐assisted treatment. Our interprofessional model draws on the unique contributions of physicians, midwives, nurses, and mental health professionals to address the complex needs of pregnant women with opioid use disorder. Participants reported increased trust and engagement with health care providers and peers, improved prenatal care and birth experience, and increased resilience for relapse prevention. Group prenatal care is an accepted and promising model for women with opioid use disorder in pregnancy and has the potential to improve outcomes for women and newborns.     

Fathers matter

Becoming a father, especially for the first time, can present changes in men's identity and in the relationship with their partner. Affinity within the family and participation in the whole process of pregnancy, childbirth and the postnatal period are important for fathers' sense of postnatal security. The fathers want to be already prepared before birth for the early postnatal period. Willingness to participate and take responsibility from the first day of pregnancy is important for his own sake and also for the sake of the mother's and child's wellbeing. Affinity within the family can be strengthened by midwives' empowerment and the father's interaction with the midwife. Midwives should invite fathers to participate in maternity care rather than only 'permit' participation. To enable future development of postnatal care, a specific instrument called Parents'postnatal sense of security (PPSS) has been developed in Sweden. The PPSS can be used to evaluate antenatal and postnatal care and exists in one version for fathers and one for mothers.     

Women's Satisfaction with Their Involvement in Health Care Decisions During a High‐Risk Pregnancy

ABSTRACT: Background: Increasingly, women seek involvement in decisions about their health care. The purpose of this study was to examine women's experience of, and satisfaction with, their involvement in health care decisions during a high‐risk pregnancy. Methods: Forty‐seven women with hypertension or threatened preterm delivery (including multiple births) were interviewed after the birth of their child. They received prenatal care at home from nurses in a community program or were hospitalized. The in‐depth interviews were audiotaped and transcribed; data were analyzed using constant comparative methods. Results: Women identified an increased feeling of responsibility for the health of their baby and themselves, but differed in choosing active or passive involvement in health care decisions. Women who wanted active involvement achieved it through one of three processes: struggling for, negotiating, or being encouraged. Women who wanted passive involvement and women facing health crises used the process of trusting in the expertise of nurses and physicians. Women were satisfied if the care from health care professionals was congruent with how they wanted to be involved in decision‐making. Conclusions: Although most women want to be actively involved in health decision‐making during a high‐risk pregnancy, some prefer a passive role. The setting of prenatal care, community‐based or in‐hospital, was less important than the ability of nurses and physicians to support the woman in her preferred role in decision‐making. (BIRTH 30:2 June 2003)