The Adjustment of Fathers to their First Baby: The Roles of Parenting Groups and Marital Relationship

ABSTRACT: Forty-seven first-time fathers from Lamaze classes were studied by means of self-reports of their feelings of well-being, sense of competence as parents, views of their babies’temperaments, marital relationships and social support systems. These self-reports were recorded at 2–3 months, 5–6 months and 9–10 months after childbirth. Twenty of the fathers were attending parenting groups during this period, while 27 fathers expressed interest but did not attend. Fathers participated more in baby care and felt more comfortable as parents as their babies become older, but they reported a slight decrease in marital satisfaction. Although fathers who attended parenting groups showed the same pattern of adjustment as did fathers who did not participate in the groups, they reported significantly lower feelings of relaxation and health for themselves, and more fussy moods in their babies at each of the three points during the first year. The quality of the marital relationship and attendance at parenting groups were associated with positive over-all adjustment to the baby at 9–10 months.     

Childbirth fear in Swedish fathers is associated with parental stress as well as poor physical and mental health

Objective

to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear.

Design

a longitudinal regional survey. Data were collected by three questionnaires.

Setting

three hospitals in the middle-north part of Sweden.

Participants

1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth.

Measurements

childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear).

Findings

expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2–2.8) and mental (OR 3.0; 1.8–5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4–3.0), and the forthcoming birth (OR 4.3; 2.9–6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience.

Key conclusions

expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress.

Implications for practice

this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term.     

Relationships Among Infant Sleep Patterns,Maternal Fatigue,and Development of Depressive Symptomatology

ABSTRACT: Background: Postpartum depression is a serious condition for women after childbirth. Although its etiology is unclear, one potentially important predictive variable that has received little attention is maternal sleep deprivation. The objective of this study was to examine relationships among infant sleep patterns, maternal fatigue, and the development of postpartum depression in women with no major depressive symptomatology at 1 week postpartum. Methods: As part of a population‐based postpartum depression study, 505 women who had an Edinburgh Postnatal Depression Scale (EPDS) score < 13 at 1 week postpartum completed questionnaires at 4 and 8 weeks postpartum. Results: Mothers exhibiting major depressive symptomatology (EPDS > 12) at 4 and 8 weeks were significantly more likely to report that their baby cried often, be woken up 3 times or more between 10 pm and 6 am , have received less than 6 hours of sleep in a 24‐hour period over the past week, indicate that their baby did not sleep well, and think that their baby's sleep pattern did not allow them to get a reasonable amount of sleep. Consistent with these findings, mothers with an EPDS score > 12 were significantly more likely to respond that they often felt tired. Conclusions: These results suggest that infant sleep patterns and maternal fatigue are strongly associated with a new onset of depressive symptoms in the postpartum period, and provide support for the development of postpartum depression preventive interventions designed to reduce sleep deprivation in the early weeks postpartum.     

Outcomes of Father Involvement in Pregnancy and Birth

: To test the assumption that father involvement in pregnancy and childbirth results in more positive birth and fathering experiences, 40 primiparous couples recruited from childbirth education classes and obstetricians were studied. About two weeks before their due dates each mother was asked to rate her marital closeness and her husband's interest in children. These couples were observed for one hour in mid-labor. Then mothers and fathers were interviewed about one week after the birth. Fathers who were more involved in terms of their wives’ reports of prenatal marital closeness gave generally more positive reports of the delivery and the new baby. Fathers who were involved in terms of their wives’ estimates of their interest in children were rated by observers as interacting with their wives less during labor. (BIRTH 10:1, Spring 1983)     

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.     

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.     

Cognitive vulnerability to postnatal depressive symptomatology

Understanding the factors involved in the development of postpartum depressive disorders has important implications for the detection of women at risk, and the development of theory‐driven preventative treatments. In the current study, recent innovations in the assessment of idiographic cognitive functioning among adult, non‐pregnant samples were administered to a sample of healthy primiparous women to investigate their predictive utility in the onset of low mood following childbirth. Cognitive biases using autobiographical material, and the degree of self‐devaluation during brief episodes of naturally occurring low mood were assessed in 94 concurrently well women in the third trimester of their first pregnancy. The degree of depressive symptomatology at 2 and 8 weeks postpartum was assessed subsequently. Antenatal self‐devaluative tendencies and a lack of specificity in autobiographical retrieval were not associated with low mood in the initial weeks following delivery, when biological factors are believed to play an important role, but did predict depressive symptoms more distally at 8 weeks after childbirth. This relationship was demonstrated after controlling for educational level, variations in antenatal dysphoria, previous emotional difficulties, neuroticism and the woman's own experience of mothering. The theoretical and clinical implications of the findings are discussed.     

Unanticipated Cesarean Birth from the Father's Perspective

ABSTRACT: Despite the paucity of research on men's experiences of cesarean birth, fathers' attendance at cesareans has become well-established in some areas of the U.S. In this study, interviews were conducted with 46 fathers whose wives had an uncomplicated pregnancy culminating in an unanticipated cesarean birth with a healthy neonate and no major complications for mother and child. Interviews were tape recorded, transcribed and analyzed. Of these 46 fathers, 52 per cent attended the cesarean, and 48 per cent did not, primarily because hospital policy prohibited it. Fathers' predominant emotional reaction to the decision for cesarean was relief (52%); 27 per cent described their reactions as acceptance, 10 per cent expressed moderate disappointment, and 11 per cent were strongly disappointed or angry. Most negative reactions centered not on the cesarean itself, but on policies which excluded fathers from attendance arbitrarily, and on staff behaviors which reflected disregard for the fathers'need to feel included in the birth, whether they were permitted to attend the delivery or not. Seventy per cent of these fathers expressed some displeasure at physician or nurse behaviors, expressing disappointment and resentment about being excluded from discussions leading to the decision for the cesarean, having little previous contact with the obstetrician, the nursing staff failing to provide the father with adequate information and support during and immediately after the cesarean, and being denied access to the wife and infant after the cesarean for apparently arbitrary reasons.     

The implications of unfulfilled expectations and perceived pressure to attend the birth on men's stress levels following birth attendance: a longitudinal study

Men's stress and their experiences of reproduction have yet to be fully explored. This study aims to examine the subjective stress experienced by men during their partner's pregnancy, at the time of the birth and six weeks postpartum by means of a longitudinal study of 53 men's reproductive experience. Further, it aims to examine the role birth attendance, unfulfilled expectations and perceived pressure to attend the birth have on levels of stress. Men were measured on the Impact of Event Scale three times during the pregnancy, at the time of the birth and six weeks postpartum. Findings indicate that compared to non-psychiatric norms, overall levels of stress were elevated during the pregnancy, at birth and postpartum. The highest levels of stress were found at the time of the birth in the men who were in birth attendance. Stress levels were particularly high amongst men who felt they did not fulfill their role expectation, or they perceived pressure to be present at the birth. Confirming findings from phenomenological studies, there appears to be some confusion as to the nature and purpose of men's presence at childbirth. Expectant fathers may not anticipate the psychological and emotional realities of childbirth/becoming a father and there remains a possibility that raised stress following childbirth may impact on father/child bonding.     

Childbirth Education Programs: A Study of Women Participants and Non-participants

ABSTRACT: Of a random sample of 201 married postpartum women, 109 had chosen to attend childbirth education classes and 92 had not. Women who attended classes were younger, had fewer children, were married fewer years, and had had slightly more years of education than non-participants. Most frequently cited reasons for not attending childbirth classes were having already attended in a previous pregnancy, having no interest, knowing as much as is needed, having scheduling problems, and not having doctor's recommendation to attend. Results point to the need to devise a childbirth education curriculum for parents who have older children.     

Playing Second Fiddle Is Okay–Swedish Fathers' Experiences of Prenatal Care

Introduction: In Sweden, prospective fathers are encouraged and welcome to attend prenatal visits, and pregnant women assess their partners' involvement in prenatal care as very important. The aim of this study was to describe expectant fathers' experiences of and involvement in prenatal care in Sweden. Methods: Data were drawn from a 1‐year cohort study of 827 Swedish‐speaking fathers recruited during their partners' midpregnancy and followed up 2 months after childbirth. Results: The participants reported that the most important issues in prenatal care were the woman's physical and emotional well‐being and the support she received from her midwife. However, care was identified as deficient in nearly all aspects of information, medical care, and fathers' involvement. “Excessive” care was also reported and related to how the father was treated by the midwife, mainly in terms of attention to his emotional well‐being. Discussion: Although fathers prioritize the needs of their pregnant partners, it is important for caregivers to assess fathers' needs and incorporate a family‐oriented approach to prenatal care.     

Improving postpartum glucose monitoring in women with gestational diabetes

Objective: To improve 6-week postpartum visit attendance, glucose test ordering and test completion among postpartum patients with a history of gestational diabetes (GDM).

Methods: Pre- and post-intervention GDM women at Mount Sinai Hospital were studied via chart review. Interventions included advanced order sets for glucose monitoring at the 35-week pregnancy visit, educational modules, and nutritionist phone calls reminding patients to attend postpartum visits fasting.

Results: One hundred and seven pre-intervention and 42 post-intervention women were studied. Percentages of orders placed for postpartum testing was higher post-intervention vs. pre-intervention (57% vs. 42%, p?=?0.03). There were higher test completion rates post-intervention vs. pre-intervention (36% vs. 17%, p?=?0.01). Postpartum visit attendance rates did not vary between the groups (73% vs. 69% p?=?0.60). Six percent of patients pre-intervention fasted for postpartum visits vs. 60% post-intervention.

Conclusion: There was no observed increase in women attending their 6-week postpartum visits, yet rates of completed orders for postpartum testing, women attending visits fasting, and postpartum test completions were higher post-intervention. More research may identify the barriers to attendance at 6-week postpartum visits.     

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.     

Post partum depression and the psychosocial predictors in first-time fathers from northwestern China

Backgroundthere is growing evidence that fathers also experience post partum depression (PPD). However, paternal PPD has been less studied than maternal PPD. Very few studies have investigated PPD in first-time fathers from northwestern China.Objectivethe purpose of this study was to investigate the occurrence and predictors of depressive symptoms in first-time fathers from northwestern China.Methodsa longitudinal study was conducted involving 180 couples who were assessed at three time periods: 3 days, 2 weeks and 6 weeks after childbirth. Self-reported questionnaires including Edinburgh Postnatal Depression Scale (EPDS), Parenting Sense of Competence Scale (PSOC), and Kansas Marital Satisfaction Scale (KMSS) were administered to all participants during each time period.Findingsafter childbirth 35 (21.1%) of the fathers at 3 days, 32 (20.4%) at 2 weeks and 20 (13.6%) at 6 weeks, indicated that they suffered from PPD. Paternal parental sense of competence, paternal marital satisfaction, and maternal depressive symptoms were among the main predictors for paternal PPD.Conclusionthe study results suggest that paternal PPD is a significant public health concern. Health professionals should focus attention on the psychological health among new fathers during the postpartum period; and, the psychosocial predictors should be considered and incorporated into clinical assessment and intervention of paternal PPD.     

Association between antenatal classes attendance and perceived fear and pain during labour

ObjectivesAntenatal classes are a common method of preparation for birth with proven efficiency in improving perinatal outcomes. Yet, their impact on fear perception during labour has not been identified. The aim of the study was to analyse whether preparation for labour by means of antenatal classes attendance could be associated with decrease in level of experienced fear and pain during birth.Materials and methodsIt was a cross-sectional study of 147 women who had given vaginal births. Data was collected from mothers between 24 and 72 h postpartum. Patients answered self-reported questionnaires concerning subjective perception of birth including Delivery Fear Scale (DFS) and Numeric Rating Scale (NRS) for fear and pain assessment. The study group was divided into subgroups depending on parity and antenatal classes attendance.ResultsPatients in the primiparas subgroup who attended antenatal classes scored lower in the DFS (48.7 ± 23.5 vs. 60.2 ± 16.5, p < .03). There was no difference in the DFS score in the multiparas subgroup (p < .90). No significant differences in the NRS score depending on antenatal classes attendance in any subgroup were observed.ConclusionParticipation in antenatal classes should be advised to every pregnant primiparous woman as this type of non-invasive preparation lowers level of fear experienced during childbirth.     

The effects of psychosocial factors on the mother's emotional well-being during early parenthood: A cross-cultural study of britain and greece

Abstract

The effect of psychosocial factors on the emotional well-being of mothers following childbirth were examined within the cultural contexts of Britain and Greece. These mothers had already completed questionnaires during pregnancy and were contacted a second time in the postpartum period. At 4–6 weeks postpartum a sample of 165 Greek mothers and 101 British mothers and their partners completed the Edinburgh Postnatal Depression Scale. The relationship between mothers' EPDS scores and measures of emotional well-being in pregnancy (CCEI), social support, life events, fathers' EPDS score, and father's perception of change in partner was examined in each culture. No difference in the distribution of EPDS scores in each culture was found. Social support and life events were found to predict postnatal depression in both cultures. Additionally, in Greece, emotional well-being in pregnancy made a separate contribution to prediction. The major difference between the two cultures was in the relationship between mothers and their partners. Greek fathers were more emotionally and physically distanced from their partners during pregnancy, birth and early parenthood and perceived their partners as being more changed by the transition to parenthood. These differences were not reflected in differences in emotional well-being possibly because they accord with social expectation in each culture.     

More than re-establishing the partner relationship: Intimate aftercare for Somali parents in diaspora

Objective

to explore the sexual relationship and couples' perceptions about intimate partner support following childbirth.

Design

a hermeneutic design using a naturalistic inquiry framework as a qualitative proxy for medical anthropology. Data were collected using a fictional and culturally-specific narrative during focus group discussions (FGDs) in early 2011. Analysis was conducted by ‘functional narrative analysis’ and interpreted for conceptual constructions. Recruitment was by snowball and purposive sampling.

Setting

a diasporic context among participants living in six urban centres across Sweden.

Participants

successful recruitment included 16 Somali-Swedish fathers and 27 mothers. Three FDGs were conducted with fathers (3–7 participants) and seven with mothers (3–6 participants).

Findings

within day 40 post partum, parents learn to rely on each other in the absence of traditional support networks. After the first 40 days, the re-introduction of sexual intimacy is likely to occur. Of the fathers experiencing postpartum sexual aversion, these seemed to experience ‘existential angst’ resulting from a combination of profound remorse over having put the partner into what they perceived as a life-threatening situation during childbirth and their perceived moral and ethical obligations to provide support in this setting. Mothers in general did not directly discuss their own sexuality. Women could imagine men's sexual aversion after witnessing childbirth. However, they seemed unaware of men's potential for angst. Mothers are situated between the loss of traditional postpartum support networks, comprised of close female kin, and their own newly-defined responsibilities in the host setting. Fathers embrace their new role. Both partners articulated the mother's new role as enhancing autonomy and independence in the host setting. However, women held mixed attitudes about fathers replacing traditional kin support.

Implications for practice

to date, late postpartum aftercare for immigrant African parents is anecdotally linked to evidence-based recommendations, which have been identified for parents who are ethnically-congruent to a western study setting. Our findings suggest that aftercare meant for Somali parents living in these settings requires an understanding of how traditional intimate support and the postpartum sexual relationship are re-negotiated in the diasporic context. This includes recognition of the father as a willing and supportive partner.     

Fathers’Birth Attendance,Early Extended Contact,and Father-Infant Interaction at Five Months Postpartum

ABSTRACT: Forty couples and their 5-month old infants were observed in their homes in a study of the relationships between fathers’birth attendance, early extended contact, and involvement with their babies at five months postpartum. Fathers who were excluded from the birth were more involved with their babies, in the presence of their wives, than were fathers who attended births. The three aspects of early extended contact that were found to be significantly associated with fathers’caregiving and social involvement at five months were time of first contact, length of first contact, and total hours fathers spent with children in the hospital. The implications for research and for policy concerning early father-infant contact are discussed.