EXPECTANT AND NEW FATHERS’ INFORMATION AND SUPPORT NEEDS

Messages from Research

Prenatal

The benefit of traditional ante-natal classes to mothers or fathers has been hard to demonstrate (Schmied et al, 1999) and fathers express high levels of dissatisfaction with them (McElligott, 2001). In one study, one man in three wanted more information on nineteen subjects after antenatal classes were over (Singh & Newburn, 2000).

Nevertheless, fathers’ attendance is associated with greater couple inter-dependence (a marker of the quality of the couple relationship), and the men undertake more housework and are more likely to utilize support (for review, see Diemer, 1997). This last is important as expectant fathers who receive emotional support have better physical and emotional health (Jones, 1988). This very probably translates into being ‘easier to live with’, and more supportive and positive. However, even here outcomes vary according to personality and other factors.

Prenatal education specifically designed for fathers fares better:

• One study found such an intervention resulting in substantially greater likelihood of fathers’ utilizing support, undertaking housework (both before and after the birth), being more likely to ‘reason’ with their partners, and reporting better couple relationships (Diemer, 1997).

• A brief, inexpensive US prenatal intervention (consisting of one prenatal session with parents in separate gender groups focusing on psychosocial issues of first-time parenthood) was associated with mothers’ reporting greater satisfaction with the sharing of home and baby tasks post partum (Matthey et al, 2004).

• A randomized controlled trial of a prenatal intervention with low-income fathers (two sessions of factual information, practical skills training and bonding exercises) found substantially greater information-retention and parental sensitivity one month postpartum among the intervention compared with the control group (Pfannenstiel & Honig, 1995).

• A Canadian trial of antenatal classes with a special focus on changes in the marital relationship concluded that such classes may enhance marital adjustment post-birth (cited by Enkin et al, 2000, p.25).

• In the US relationship enhancement programmes developed for pre-marital education have been adapted for use in the perinatal period (Glade et al, 2005). .

The ultrasound scan is now recognised as an important plank in preparation for parenthood, and the health professionals’ manner of assisting and supporting parents at the scan is signficant. Fathers should be strongly encouraged to attend (Ekalin et al, 2004).

Postnatal

It is important to provide fathers with information and support after the birth of their children especially in high-risk families. A recent review of Shaken Baby Syndrome cases in one US jurisdiction reported 44% perpetrated by fathers and 20% by mothers’ boyfriends, in contrast to 7% perpetrated by mothers (Sinal et al, 2000).

Is fathers’ involvement with their infants affected by post natal interventions? Some early studies found that fathers who had attended baby-care courses (or who thought of themselves as more skilled) took on more care of their infants. However, other studies of short-term interventions found no influence (for review, see Lamb, 2004). Meanwhile:

• Fathers of caesarean babies usually undertake relatively high levels of infant care due to mothers’ incapacity – and Pederson et al (1980) found them still engaged in higher levels of care 5 months on.

• Myers (1982) found fathers who had been shown how to conduct standardized assessments of their newborns (the Brazelton method) becoming more knowledgeable and more involved.

• Fathers taught the skills of caring for a newborn tend to be closer to their babies at the time and also later (Nickel & Kocker, 1987; McHale & Huston, 1984).

• When fathers of four-week-old infants were given a brief training in baby massage and the Burleigh Relaxation Bath technique with a particular emphasis on the father-infant relationship they were more involved with their infants (than a comparison group of fathers) two months on. Also, their infants greeted their fathers with more eye contact, smiling, vocalising, reaching and orienting responses, and showed less avoidance behaviours (Scholz & Samuels, 1992).

• One study found 4 out of 5 fathers of six-month-olds saying they would probably have attended a ‘how to care for your baby’ session, if it had been offered in the first few weeks after the birth and as a continuation of the pre-birth training. Although when new fathers were actually offered such a session only 1 in 6 attended, the researchers felt this was a very positive result, since in that district nothing of that kind had ever been offered before (Matthey & Barnett, 1999)

Fathers of pre-term infants may have particularly high needs. These fathers reveal significantly greater stress and depression scores than fathers of full-term infants, and lower involvement rates (Rimmerman & Sheran, 2001); and, like the fathers (and mothers) of cesarian babies, use significantly more negative adjectives to describe their babies at six weeks of age (Greenhalg et al, 2000). However:

• Sullivan (1999) found that the sooner fathers held their pre-term infants the sooner they reported feelings of warmth and love for them.

• A programme comprising eight sessions shortly before discharge plus four home visits afterwards, found the fathers suffering significantly lower child-related, parent-related and total stress, twelve months on (Kaaresen et al, 2006).

And finally, the importance and value of engaging with the couple relationship is strongly indicated:

• Reduced couple satisfaction and relationship quality and increased conflict over the transition to parenthood are clear (for review, see Glade et al, 2005).

• Issues that may not be significant for couples who never have children may become significant once a baby is born: this has been shown to be the case with family-of-origin experiences and with conflicts that arise when partners have different approaches to parenting (Cowan, 1988; Lane et al, 1988).

REFERENCES

Cowan, P.A. (1988b). Becoming a father: a time of change, an opportunity for development. In P. Bronstein & C.P. Cowan (eds.), Fatherhood Today: Men’s changing Role in the Family. New York: Wiley.

Diemer, G. (1997). Expectant fathers: influence of perinatal education on coping, stress, and spousal relations. Research in Nursing and Health, 20, 281-293.

Ekalin, M., Crang-Svalenius, E., Dykes, A.K. (2004). A qualitative study of mothers’ and fathers’ experiences of routine ultrasound examination in Sweden. Midwifery, 20(4), 335-344.

Enkin, M.W., Kierse, M.J.N.C., Neilson, J., Crowther, C., Duley, L., Hodnett, E. et al (2000). A Guide to Effective Care In Pregnancy and Childbirth,(3rd ed.). Oxford: Oxford University Press.

Glade, A.C., Bean, R.A., & Vira, R. (2005). A prime time for marital/relational interventions: a review of the transition to parenthood literature with treatment recommendations. The American Journal of Family Therapy, 33, 319-336.

Greenhalgh, R., Slade, P., & Spiby, H. (2000). Fathers’ coping style, antenatal preparation, and experiences of labour and postpartum. Birth-Issues In Perinatal Care, 27(3), 177-184.

Jones, L.C. (1988). Support systems. In F.H. Nichols & S.S. Humenick (eds.), Childbirth Education: Practice, Research and Theory. Philadelphia: Saunders.

Kaaresen, P. I., Ronning, J. A., Ulvund, S. E., & Dahl, L. B. (2006). A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. Pediatrics, 118(1), 366-367.

Lamb, M.E. (ed.) (2004). The Role of the Father in Child Development (4th ed.). Hoboken NJ: John Wiley & Sons.

Lane, A.R., Wilcoxon, S.A., & Cecil, J.H. (1988). Family-of-origin experiences and the transition to parenthood: considerations for marital and family therapists. Family Therapy, 15(1), 23-29.

McElligott, M. (2001). Antenatal information wanted by first-time fathers. British Journal of Midwifery, 9(9).

McHale, S.M., & Huston, T.l. (1984). Men and women as parents: sex role orientations, employment, and parental roles with infants. Child Development, 55, 1349-1361.

Matthey, S., & Barnett, B. (1999). Parent infant classes in the early postpartum period: need and participation by fathers and mothers. Infant Mental Health Journal, 20, 278-290.

Matthey, S., Kavanagh, D. J., Howie, P., Barnett, B., & Charles, M. (2004). Prevention of postnatal distress or depression: an evaluation of an intervention at preparation for parenthood classes. Journal of Affective Disorders, 79(1-3), 113-26.

Myers, B.J. (1982). Early intervention using Brazelton training with middle-class mothers and fathers of newborns. Child Development, 53, 462-471.

Nickel, H., & Kocher, N. (1987). West Germany and the German speaking countries. In M.E.Lamb (ed.), The Father’s Role: Cross-Cultural Comparisons. Hillsdale, NJ: Lawrence Erlbaum.

Pederson, F., Zazlow, M.T., Cain, R.L. & Anderson, B.J. (1980). Caesarian birth: the importance of a family perspective. Paper presented at the International Conference on Infant Studies (April).

Pfannenstiel, A.E., & Honig, A.S. (1995). Effects of a prenatal ‘Information and insights about infants’ program on the knowledge base of first-time low-education fathers one month postnatally. Early Child Development and Care, 111, 87-105.

Rimmerman, A., & Sheran, H. (2001). The transition of Israeli men to fatherhood: a comparison between new fathers of pre-term/full-term infants. Child & Family Social Work, 6(3), 261-267.

Schmied, V., Myors, K., & Wills, J. (1999). Visions’ of Parenthood: innovation in the presentation of childbirth and parenting education. St. George’s Hospital, Sydney: Family Health Research Unit.

Scholz, K., & Samuels, A. (1992). Neonatal bathing and massage intervention with fathers, behavioural effects 12 weeks after birth of the first baby: the Sunraysia Australia Intervention Project. International Journal of Behavioral Development, 5(1), 67-81.

Sinal, S.H., Petree, A.R., Herman-Giddens, M., Rogers, M.K., Enand, C., & DuRant, R.H. (2000). Is race or ethnicity a predictive factor in shaken baby syndrome? Child Abuse & Neglect, 25(9), 1241-1246.

Singh, D., & Newburn, M. (2000). Becoming a father: Men’s access to information and support about pregnancy, birth and life with a new baby. London: National Childbirth Trust & Fathers Direct.

Sullivan, J.R. (1999). Development of father-infant attachment in fathers of preterm infants. Neonatal Network, 18(7), 33-39.