Fathers of breastfed infants: postponing and types of involvement

The Role of Fathers in Promoting Exclusive Breastfeeding

The cornerstone of a newborn's nutrition is breastfeeding. Due to its well-known benefits for mothers, children, and society in the short and long term, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend it as the best way of feeding the baby during the first six months of life. The family, particularly the spouse, may significantly influence the baby's quality of nursing. On a global scale, previous studies have demonstrated that family members (such as a mother's spouse, partner, or grandmother) not only affect her choice to start and endure breastfeeding but also significantly contribute to the early postnatal period's cessation of appropriate breastfeeding. A father's knowledge and attitude are fundamental in this regard, as he has the most critical role in helping women with parenting and feeding their babies. Furthermore, because the father's role is considered important in a family, the partner's or wife's perception of the father's attitude may alter her subjective criteria about exclusive breastfeeding (EBF). Future initiatives should target new mothers and their spouses to see how they may provide the most beneficial assistance to new mothers. The main focus should be on targeting newly married couples. The father's lack of involvement may be due to the hierarchical structure of power within households. Because of this hierarchical aspect, partners or fathers may significantly influence a mother's choice to nurse their child correctly. Household chores, childcare for grown-up children, guaranteeing the well-being of their spouse, preparing meals, recognizing a newborn's hunger cues, burping, and changing the infant's diaper after feedings, all these factors indirectly support the mother in initiating and enduring the nursing of a child.

Relatively speaking? Partners' and family members' views and experiences of supporting breastfeeding: a systematic review of qualitative evidence

This review aimed to synthesize qualitative evidence of views and experiences of partners and other family members who provided breastfeeding support for a relative. The Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Maternal and Infant Care, and Web of Science were searched. Partners and other family members (e.g. grandmothers, siblings) of women in any countries were included. Included papers were critically appraised. The JBI meta-aggregative approach was used to analyze data and form synthesized findings. Seventy-six papers from 74 studies were included. Five synthesized findings were: (i) spectrum of family members' breastfeeding knowledge, experiences and roles; (ii) the complexity of infant feeding decision making; (iii) the controversy of breastfeeding in front of others; (iv) impact of breastfeeding on family; and (v) it takes more than just family members: support for family members. Partners' and family members' views and experiences of breastfeeding support reflected multi-faceted personal, social, financial, cultural, religious, emotional, psychological, and societal factors of the support they provided (or not). Healthcare professionals should engage them in breastfeeding discussions with the woman, and offer tailored and practical guidance relevant to help them to appropriately support the woman. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Fathers' Experiences and Perspectives of Breastfeeding: A Scoping Review

During the transition to parenthood, fathers may experience significant challenges, including finding a place for themselves as important participants in the context of infant breastfeeding by female partners. Although generally viewed as a healthy process and the preferred method of infant feeding, breastfeeding may result in some fathers feeling excluded, inadequate, and helpless. Breastfeeding is known to adversely affect various aspects of a father’s life, including parenting self-efficacy, quality of life (QOL), the relationship with the partner, and the perception that breastfeeding limits time available for father–infant bonding. The current scoping review explores the experiences, roles, and needs of fathers of breastfed infants by synthesizing and discussing the findings from relevant published research studies (n = 18). Recommendations, drawn from the scoping review findings, are offered to guide primary health providers and services.

Determinants of Non-paid Task Division in Gay-, Lesbian-, and Heterosexual-Parent Families With Infants Conceived Using Artificial Reproductive Techniques

Background: The division of non-paid labor in heterosexual parents in the West is usually still gender-based, with mothers taking on the majority of direct caregiving responsibilities. However, in same-sex couples, gender cannot be the deciding factor. Inspired by Feinberg’s ecological model of co-parenting, this study investigated whether infant temperament, parent factors (biological relatedness to child, psychological adjustment, parenting stress, and work status), and partner relationship quality explained how first-time gay, lesbian, and heterosexual parents divided labor (childcare and family decision-making) when their infants were 4 and 12 months old. We also tested whether family type acted as a moderator.

Method: Participants were drawn from the new parents study. Only those who provided information about their biological relatedness to their child (N = 263 parents) were included. When infants were 4 months (T1), parents completed a password-protected online questionnaire exploring their demographic characteristics including work status and standardized online-questionnaires on task division (childcare and family decision-making), infant temperament, parental anxiety, parental depression, parental stress, and partner relationship satisfaction. When infants were 12-months-old (T2), parents provided information about task division and their biological relatedness to their children.

Results: Linear mixed models showed that no factor explained the division of family decision making at T1 and T2. For relative time spent on childcare tasks at T1, biological relatedness mattered for lesbian mothers only: biologically related mothers appeared to spend more time on childcare tasks than did non-related mothers. Results showed that, regardless of family type, parents who were not working or were working part-time at T1 performed more childcare tasks at T1. This was still true at T2. The other factors did not significantly contribute to relative time spent on childcare tasks at T2.

Conclusion: We had the opportunity to analyze the division of non-paid tasks in families where parenting was necessarily planned and in which gender could not affect that division. Although Feinberg’s model of co-parenting suggests that various factors are related to task division, we found that paid work outside the home was most important during the first year of parenthood in determining caregiving roles.

Experiences, needs, and perceptions of paternal involvement during the first year after their infants' birth: A meta-synthesis

Objectives

Fatherhood has evolved in recent decades from ‘a moral teacher’ to ‘an involved father’. However, fatherhood experiences have not been examined in detail. This meta-synthesis aimed to examine fathers’ experiences, needs, and perceptions of their involvement with their infants during the first 12 months of birth.

Method

Six electronic databases were systematically searched: PubMed, CINAHL, Embase, Scopus, PsycINFO, ProQuest (grey literature). The search resulted in 13 studies that met the inclusion criteria. Quality appraisal was conducted using the Critical Appraisal Skills Programme Checklist. All 13 studies met the appraisal criteria and were included in the meta-synthesis. The findings of the 13 studies were synthesized using the steps of Sandelowski and Barroso in conducting meta-synthesis.

Results

The 13 included studies comprised studies conducted in the West, Africa, and Asia. Fatherhood experiences differed according to different sociocultural contexts. Three themes were identified: (1) trajectory of the father-infant relationship, (2) reinforcements and hindrances to involvement, and (3) change from self-oriented to family-oriented behavior. Changes in a father’s relationship with his infant were influenced by relationships with his spouse and family members after the birth of the infant. Reinforcements, hindrances, and needs to fathers’ involvement were identified. Fathering responsibility and parenting satisfaction that developed overtime influenced a father’s behavior, changing from self-oriented to family-oriented.

Significance

This is the first meta-synthesis that examined fathers’ experiences, needs, and perceptions of their involvement with their infants during the first 12 months of birth. Multiple factors were found to influence the socially-defined fathering ideology. Cultural practices of fatherhood and fathers’ own perceptions shaped their actual fathering behaviors. The findings of this study may guide healthcare professionals as frontline personnel to understand fathers’ needs and experiences in order to promote fathers’ involvement in the early days after their infants’ birth.

'Both parents should care for babies': A cross-sectional, cross-cultural comparison of adolescents' breastfeeding intentions, and the influence of shared-parenting beliefs

BACKGROUND

Many young men and women expect to co-parent their newborn infant. This may have a positive or negative impact on decisions to breastfeed, which is an important health behaviour, influenced by cultural and psycho-social norms. We investigated the relationship between shared parenting, infant feeding beliefs and intentions in male and female (non-parent) adolescents, comparing Nordic countries (Sweden, Norway, Finland) with high breastfeeding rates with others with low rates (Scotland, USA).

METHODS

We utilised cross-sectional surveys of male and female adolescents (n = 1064, age 12-18) administered directly in schools or via the internet. We assessed attitudes to breast and formula feeding and shared parenting, using a Theory of Planned Behaviour framework, assessing beliefs, attitudes, norms and control as predictors of intention.

RESULTS

Male and female adolescents' breastfeeding intentions varied in line with national cultural norms. Young people from Nordic countries (high breastfeeding rates) were significantly more likely to intend to breastfeed than those from Scotland or the USA (low breastfeeding rates). Positive beliefs about breastfeeding, norms and 'exposure' to breastfeeding and feeding confidence were consistently stronger in Nordic countries, whereas young people in Scotland had more positive beliefs, norms and 'exposure' to formula feeding. Differences in parenting beliefs, norms and confidence were less consistent. In logistic regression, cultural group, positive breastfeeding beliefs and exposure, norms, and shared parenting beliefs were significant predictors of breastfeeding feeding intention.

CONCLUSIONS

Positive beliefs about shared parenting and equal gender norms were related to future breastfeeding intentions for female and male adolescents. Health education programmes for young people could encourage positive breastfeeding choices by considering how this would fit with young people's ideal parenting roles, and by emphasising benefits of complementary maternal and paternal roles in breastfeeding newborn infants.

Theory-Based Design and Development of a Socially Connected, Gamified Mobile App for Men About Breastfeeding (Milk Man)

Background

Despite evidence of the benefits of breastfeeding, <15% of Australian babies are exclusively breastfed to the recommended 6 months. The support of the father is one of the most important factors in breastfeeding success, and targeting breastfeeding interventions to the father has been a successful strategy in previous research. Mobile technology offers unique opportunities to engage and reach populations to enhance health literacy and healthy behavior.

Objective

The objective of our study was to use previous research, formative evaluation, and behavior change theory to develop the first evidence-based breastfeeding app targeted at men. We designed the app to provide men with social support and information aiming to increase the support men can offer their breastfeeding partners.

Methods

We used social cognitive theory to design and develop the Milk Man app through stages of formative research, testing, and iteration. We held focus groups with new and expectant fathers (n=18), as well as health professionals (n=16), and used qualitative data to inform the design and development of the app. We tested a prototype with fathers (n=4) via a think-aloud study and the completion of the Mobile Application Rating Scale (MARS).

Results

Fathers and health professionals provided input through the focus groups that informed the app development. The think-aloud walkthroughs identified 6 areas of functionality and usability to be addressed, including the addition of a tutorial, increased size of text and icons, and greater personalization. Testers rated the app highly, and the average MARS score for the app was 4.3 out of 5.

Conclusions

To our knowledge, Milk Man is the first breastfeeding app targeted specifically at men. The development of Milk Man followed a best practice approach, including the involvement of a multidisciplinary team and grounding in behavior change theory. It tested well with end users during development. Milk Man is currently being trialed as part of the Parent Infant Feeding Initiative (ACTRN12614000605695).

'Life does not make it easy to breast-feed': using the socio-ecological framework to determine social breast-feeding obstacles in a low-income population in Tijuana, Mexico

OBJECTIVE

Breast-feeding rates reflect sociodemographic discrepancies. In Mexico, exclusive breast-feeding under 6 months of age has deteriorated among the poor, rural and indigenous populations from 1999 to 2012. Our objective of the present study was to identify the main social obstacles to breast-feeding in a low-income population in Tijuana, Mexico.

DESIGN

Qualitative study using a socio-ecological framework for data collection.

SETTING

Low-income communities in Tijuana, Mexico.

SUBJECTS

Mothers (n 66), fathers (n 11), grandparents (n 27) and key informants (n 25).

RESULTS

One hundred and twenty-nine individuals participated in the study: six focus groups (n 53) and fifty-one interviews among mothers, fathers and grandparents; and twenty-five interviews among key informants. Seven social themes were identified: (i) embarrassment to breast-feed in public; (ii) migrant experience; (iii) women's role in society; (iv) association of formula with higher social status; (v) marketing by the infant food industry; (vi) perception of a non-breast-feeding culture; and (vii) lack of breast-feeding social programmes.

CONCLUSIONS

Socio-structural factors influence infant feeding practices in low-income communities in Tijuana. We hypothesize that messages emphasizing Mexican traditions along with modern healthy practices could help to re-establish and normalize a breast-feeding culture in this population. The target audience for these messages should not be limited to mothers but also include family, health-care providers, the work environment and society as a whole.

Experiences of Japanese men during the transition to fatherhood

PURPOSE

The purpose of this study was to understand the meaning of the lived experience of Japanese men during the transition to fatherhood.

DESIGN

Hermeneutic phenomenology was used. Participants were 12 Japanese men who had a first-time healthy child younger than 1 year of age, who were sought by using a purposeful sampling technique.

FINDINGS

The following six themes were identified: (1) feeling like a father; (2) realizing oneself as a husband; (3) finding the wife's pregnancy and delivery for the first time to be an impressive experience; (4) sharing time and space with one's child; (5) being aware of a change and trying to adjust to a new life; and (6) being aware of the difference between oneself and one's wife. These six themes created essence of the phenomenon of "becoming a father."

DISCUSSION

This study revealed Japanese men's own voice on becoming first-time fathers of infants.

Engaging and supporting fathers to promote breast feeding: a concept analysis

OBJECTIVE

Empirical evidence demonstrates that fathers have a strong influence on a mother's decision to initiate and continue breast feeding. However, no clear delineation of what behaviours and attributes constitute father support or differentiate it from other kinds of support is provided in the current literature. The purpose of this study was to analyse the concept of 'father support' in relation to maternity services and broader health settings, thereby clarifying meaning to enable comprehension and application in practice, education, and research.

DESIGN

A concept analysis combining the evolutionary model of concept development with the inter-related theoretical, fieldwork and analytical phases of the hybrid model of concept development.

SETTING

Children's Centres in East and West Sussex in Southern England.

PARTICIPANTS

Repeated qualitative research over two phases with 16 parents of breast fed infants through seven focus groups and five telephone interviews.

MEASUREMENTS AND FINDINGS

CINAHL, PsycINFO, AMED, MEDLINE, OVID and EMBASE databases were searched for articles published in English between 1999 and 2013 using the keywords breast feeding, father, and support. Seven same-sex focus groups and five individual interviews were also conducted over two research phases with the parents of breast fed infants to expand and exemplify, and then validate the analysis of the literature search. Five main attributes of father support in relation to breast feeding were identified: (1) knowledge about breast feeding; (2) positive attitude to breast feeding; (3) involvement in the decision-making process; (4) practical support; and (5) emotional support. Multiple antecedents and consequences to these attributes were also identified.

KEY CONCLUSION

This study has contributed to clarifying the meaning of father support in relation to breast feeding and provides an important starting point for the development of a theoretical and practical model of optimal breast feeding that takes into account father support.

IMPLICATIONS FOR PRACTICE

Identification of attributes, antecedents, and consequences of father support may assist practitioners to reflect on current working practices and service delivery models, and offer important educational opportunities for the training of student midwives and other health professionals.

Fathers' thoughts on breastfeeding and implications for a theory-based intervention

OBJECTIVE

To explore male partner's perceptions of breastfeeding to inform the development of interventions to increase their support of breastfeeding.

DESIGN

Qualitative grounded theory.

SETTING

Participants were recruited and interviewed in two Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics located Honolulu, Hawai'i.

PARTICIPANTS

Fourteen male partners of low-income pregnant women or new mothers.

METHODS

Male partner attitudes, knowledge, and feelings were collected through private interviews. Interviews were transcribed verbatim and data were analyzed using grounded theory methods.

RESULTS

All men appreciated breastfeeding's health benefits, acknowledged that it was natural, and were empathetic to the efforts of their partners. The men also discussed not being involved in the breastfeeding decision, believing formula feeding was more convenient than breastfeeding, feeling left out of the infant-feeding process, and being uncomfortable with breastfeeding in public.

CONCLUSIONS

Findings suggest that an intervention to increase male partner support of breastfeeding should include multiple components to enhance knowledge, to empower men to be more engaged in the breastfeeding decision, to provide specific tips on how men can be involved in breastfeeding, and to increase comfort with breastfeeding in public. A multicomponent framework such as the social cognitive theory could be useful in guiding the development of such an intervention.

Transition to fatherhood: modeling the experience of fathers of breastfed infants

Transition to parenthood has long been examined from the angle of mothers' experience. When looked at this transition through fathers' lens, fathers' involvement and perceived parental efficacy appear to be landmarks of this experience. This article examines a model of the relationships among father involvement, perceived parental efficacy, events related to breastfeeding, support, stress, and income with a sample of 164 fathers of breastfed infants. This model highlights the direct and indirect contributions of support and stress to fathers' perceived parenting efficacy and involvement. Possible directions for nursing practice, education, and research are proposed to ease men's transition to fatherhood.

The breastfeeding team: the role of involved fathers in the breastfeeding family

Fathers influence mothers' breastfeeding decisions and experiences. Fathers' perceptions of their roles as members of the breastfeeding family are likely important components of that influence. To explore that possibility, 21 involved fathers of breastfeeding babies volunteered to be interviewed regarding their fathering breastfed babies and their roles in the breastfeeding family. Fathers identified their unique roles as team members ensuring that their babies received the benefits of breastfeeding. A primary fathering role was that of supporting breastfeeding by becoming breastfeeding savvy, by using their knowledge to encourage and assist mothers in breastfeeding, by valuing the breastfeeding mothers, and by sharing housework and child care. Fathers' nurturing roles involved fostering positive father-infant relationships in the face of limited opportunities to bond with their babies through feeding. The experiences of these fathers suggest the importance of assisting them to recognize their unique contributions to the nurture of their children as members of the breastfeeding team.

Expectant fathers' and mothers' perceptions of breastfeeding and formula feeding: a focus group study in three US cities

The objective of the current study was to better understand how pregnant women and male partners conceptualize infant feeding and support for breastfeeding. Information was collected through 18 focus group interviews in 3 major US cities. There were 121 focus group participants of varying professions and income levels. Half were African American and half were Caucasian. Pregnant women and male partners had favorable attitudes toward breastfeeding, but did not articulate specific benefits to mothers or infants. Men expressed empathy for their partners' pregnancies and deferred to their partners' feeding decisions. Both groups disapproved of breastfeeding in public. Women voiced concerns about father-infant bonding more than men did. Both groups emphasized fathers' support of the infant, but not of the mother. Educators and practitioners may wish to consider expectant couples' perceptions of breastfeeding in public, knowledge of breastfeeding laws, and expectations of father-mother and father-infant relationships in their approach to breastfeeding promotion among expectant couples.

La perception de l’identité paternelle en période postnatale selon le type de suivi prénatal

Cet article aborde la question de la place du père dans le suivi prénatal et de l’importance que celui-ci peut avoir sur les perceptions des pères en période postnatale. Le choix du professionnel de la santé dans le suivi de grossesse, à savoir médecin ou sage-femme, va ainsi au-delà du lieu d’accouchement, de la médication ou même des répercussions pour la mère; il influe également sur le développement de l’identité paternelle. Nous verrons comment les pères se perçoivent et se situent dans le cycle familial au regard du suivi prénatal dont ils ont bénéficié.

Is infant feeding pattern associated with father's quality of life?

The aim of this study was to compare the health-related quality of life of fathers under different infant feeding type scenarios. The Medical Outcomes Study 36-item Short-Form was used to measure the health-related quality of life of 1,699 fathers, and the scores were used to look for associations with different infant feeding methods. Multivariable linear regression analysis was used to explore the contribution of the other potential related factors on fathers' quality of life. After controlling for confounding factors, fathers whose infants were ever being breast-fed reported lower scores than fathers whose infants were bottle-fed. Except for the infant feeding pattern, having a job, higher family income, and being the major caregiver were positively related to the father's quality of life. Fathers may not benefit during breast-feeding process. Because fathers' involvement plays an important role in the success of breast-feeding, the development of interventions that enable fathers to support their breast-feeding partner is very important.

Experiences of the first year as father

BACKGROUND AND AIMS

The importance of fathers' participation for development of the child and the well-being of the family is recognized from earlier research. In Sweden, legislation allows fathers to share the parental leave equally with the mother even so fathers only use a small of their paid leave. The aim of the study was to explore experiences of the first year as a father.

METHOD

A phenomenological life world approach was used. Ethical approval was obtained. Ten men, recruited by a purposive sample, were interviewed 12-14 months after the delivery of their first child. The data collection was performed during June and August 2004 in the south-west area of Sweden.

FINDINGS

The essence of the experiences of the first year as father was to place the baby in the centre without giving up one's own person. The child provided warmth and happiness in the family and men experienced a deeper relationship to their partner. The contact between father and child was facilitated by engagement and time spent alone with the child. The major constituents identified from the findings were 'To be overwhelmed', 'To master the new situation' and 'To get a new completeness in life'.

DISCUSSION AND CONCLUSION

To master fatherhood maintenance of integrity and possibility to develop an independent relationship with the child is important. Fathers are invited to participate in postnatal childbirth education but the activities address women's needs and it is doubtful if the fathers benefit from participation. Though fathers entered the delivery room some decades ago, as a support to the woman, health personnel of today must be aware of fathers' own needs and the impact gender aspects have on their professional support.

Fathers' perceptions of supportive behaviors for the provision of breast milk to premature infants

PURPOSE

To explore fathers' perceptions of behaviors used to support the provision of breast milk to hospitalized premature infants.

SUBJECTS

Sixteen English-speaking fathers who, each were at least 15 years of age, had a hospitalized premature infant between 24 and 32 weeks gestation and a partner who had decided to provide breast milk.

DESIGN

As part of a larger, exploratory study, a qualitative descriptive study was conducted to analyze fathers' perceived contributions to the process of providing breast milk.

METHODS

Fathers were interviewed with a semi-structured interview guide. All interviews were audiotaped, and verbatim transcripts were analyzed by using qualitative descriptive methods.

MAIN OUTCOME MEASURE

Supportive behaviors as identified by fathers of hospitalized premature infants.

PRINCIPAL RESULTS

Fathers described 3 types of behaviors used to support the provision of breast milk to their hospitalized premature infants: assistance with the pumping process, assumption of additional daily domestic responsibilities, and provision of moral support.

CONCLUSIONS

Results from this study suggest several significant behaviors that fathers perceived they performed to support their partners' efforts to provide breast milk to their hospitalized premature infants.

Devenir père : un portrait des premiers moments*

Problème. Les pères sont engagés, en période postnatale, dans la construction de leurs perceptions d’efficacité parentale. Pourtant, on en sait peu sur ce qui aide les pères à construire leurs perceptions d’efficacité. De même, l’apport des premiers événements de la transition à la paternité dans l’expérience paternelle est méconnu. Objectif. 1. Identifier les perceptions des pères primipares des événements critiques de la période postnatale. 2. Examiner la contribution de ces événements à la construction des perceptions d’efficacité des pères primipares. Méthode. Une étude descriptive quantitative auprès de 160 pères d’un premier enfant. Résultats. Les pères primipares ont une expérience riche et diversifiée durant les premiers moments de leur transition à la paternité. L’alliance parentale et une faible anxiété contribuent aux perceptions d’efficacité de ces pères.

Breastfeeding attitudes among counselling health professionals

AIM

The aim of the study was to develop an instrument that can be used for accurate assessment of nurses' and midwives' attitudes toward breastfeeding in a group of midwives, maternity-nursing staff and postnatal nurses experienced in breastfeeding counselling.

METHOD

An instrument based on WHO standards was developed to measure breastfeeding attitudes. In all, 168 healthcare professionals filled in the instrument. A factor analysis using maximum likelihood and varimax rotation was performed. Spearman's correlation was used to correlate factorial dimensions and self-described interest in breastfeeding.

RESULTS

By means of factor analysis four factors were identified: the "regulating" factor focused on regulating the mothers' breastfeeding management, the "facilitating" factor focused on making it easy for mothers to manage their breastfeeding, the "disempowering" factor focused on giving advice, disregarding the needs of the mother being counselled, and the "breastfeeding antipathy" factor focused on insufficient, basic, breastfeeding knowledge and aversive reactions to breastfeeding. Midwives rated higher on the facilitating factor and breastfeeding antipathy factor and lower on the regulating factor than postnatal nurses. Breastfeeding interest was positively correlated with the facilitating factor, and negatively with the disempowering factor and the breastfeeding antipathy factor.

CONCLUSION

This instrument provides a picture of health professionals' attitudes towards breastfeeding. Four factors were identified in order of importance: regulating, facilitating, disempowering, and breastfeeding antipathy factors. Harmful attitudes were identified and suggested a need for educational programmes to help health professionals to reconcile damaging values, in order to improve breastfeeding counselling.

Meeting the Challenge of New Fatherhood During the Early Weeks

OBJECTIVE

To explore new/subsequent Australian fathers' perspectives on the experiences, processes, and life changes in the early weeks of fatherhood.

DESIGN

Interpretive study using in-depth interviews and grounded theory analysis techniques, based on a symbolic interactionist framework.

SETTING

Participants were recruited from the postnatal wards of a major public hospital, early discharge program, and early childhood centers in southeast Queensland, Australia.

PARTICIPANTS

Eighteen first-time/subsequent fathers interviewed 6 to 12 weeks after the birth.

RESULTS

Although rewarding, fathers found new or expanding fatherhood to be a significant challenge and time of change. Major themes included making a commitment, taking responsibility, negotiating responsibilities, developing and maintaining relationships, maintaining family integrity, balancing activities, and perceiving the self as father. Work had a major impact on fathers' ability to participate with their family and newborn. To manage, fathers sought to balance the demands of work and home, deal with stressors, manage their time, develop routines, and reprioritize. Fathers developed a sense of themselves as fathers over time, building confidence and deriving satisfaction from their fathering role.

CONCLUSIONS

A range of competing factors affected fathers' ability to participate in the home with their newborn in the early weeks after birth.

Becoming an Involved Father of an Infant

DATA OBJECTIVE: To describe the experience of fatherhood in the early months after the birth of an infant through a metasynthesis of relevant qualitative studies.

DATA SOURCES

Cinahl, PsychInfo, MEDLINE, and Social Work Abstracts electronic databases from 1990 through 2001 were searched using the terms qualitative, fathers, fatherhood, infants, father-infant relationship, and postpartum.

STUDY SELECTION

Ten published articles, representing seven qualitative studies, focusing on the experiences of fathers of healthy infants were reviewed. Only studies published from 1990 through 2001 were selected to reflect more recent representations of fatherhood.

DATA EXTRACTION AND SYNTHESIS

Using Noblit and Hare's metasynthesis approach, each study was carefully read, and key metaphors from each study were compared and translated by applying each of the metaphors to all the other studies. The study translations were synthesized into a whole, and the synthesis refined, leading to a description of the experience of being the father of an infant.

CONCLUSIONS

The metasynthesis revealed that fathers of infants experienced four phases, represented by the following characteristics: (a) entering with expectations and intentions, (b) confronting reality, (c) creating one's role of involved father, and (d) reaping rewards. Contextual factors that influenced the father-infant relationship were identified. Implications for theory development, research, and clinical practice are discussed.

The family management of breastfeeding low birth weight infants

Human milk plays a vital role in the health and development of low birth weight (LBW) infants, yet the initiation and duration rates of breastfeeding in this population are far below those of term infants. Families play an important role in the breastfeeding experience and therefore may contribute to the overall success or lack thereof of the experience. This qualitative study used naturalistic inquiry to describe the family management styles of 13 breastfeeding families of LBW infants. The family management style conceptual framework guided this inquiry, with management styles emerging from the families' definition of the experience and their management behaviors within their unique sociocultural context. These families described facilitating, maintaining, and obstructing family management styles. Through the identification of distinct management styles, interventions may be developed that will assist these families to achieve their breastfeeding goals.

Ways of being a father: how first-time fathers and public health nurses perceive men as fathers

The purpose of this paper is to describe the different ways of being a father identified in a sample of Finnish men. The data consisted of 71 interviews with fathers and 175 essays written by public health nurses. The fathers and public health nurses described different ways of being a father: bystander, supporter of spouse, partner, and head of the family. The spouse, relatives and maternity health care workers could encourage the father to choose a specific way to be a father, or discourage them from adopting a specific way. The information obtained in this study will be helpful in supporting the different kinds of fathers and their individual needs in family nursing.

Characteristics and treatment of women with antenatal and postpartum depression

OBJECTIVE

Investigations of the efficacy of treatment for non-psychotic pregnancy-related mood disorders are scarce. Thus, a prospective, longitudinal study of six months duration, involving ninety-six index cases and forty-five healthy women as a reference group, was implemented to determine the response of mood, parenting stress and dyadic adjustment to an eclectic management.

METHOD

In this naturalistic study, the index cases were offered treatment consistent with their symptoms, context, and level of compliance. All women received individual psychotherapy combining strategies from Interpersonal and Cognitive Behavioral Psychotherapy and/or Marital Interventions and Pharmacology. Rating scales (Dyadic Adjustment Scale, Hamilton Rating Scale for Depression, Edinburgh Postnatal Depression Scale, Child Stress Inventory) scored monthly, were used to measure the response to treatment over time.

RESULTS

Depressive symptoms are generally alleviated by the second to third month of treatment. Dyadic discord accentuated by traditional sex role expectations and child care stress exacerbated by low self-esteem persisted throughout the trial at levels significantly different from the untreated reference group.

CONCLUSIONS

Short-term interventions are cost-effective for the relief of mood disorders. However, creative solutions, during an era of economic restraints, are required to extend treatment sufficiently to address couple conflicts and facilitate the transition to parenthood for index cases.

Fathers' experiences of childbirth

OBJECTIVE

To describe how fathers who are present during childbirth experience the event, what they feel during childbirth and how they understand the meaning of childbirth.

DESIGN

Survey using questionnaire.

SETTING

Maternity unit in Finland.

PARTICIPANTS

A non-random sample of fathers (n = 137) who were present at the birth of their baby at one university hospital in Finland. The response rate was 81% (n = 107).

MEASUREMENTS AND FINDINGS

Young fathers and those expecting their first baby reported feeling uncomfortable during delivery more frequently than others. Almost all said that they had plenty of good experiences, younger fathers more so than older fathers. The fathers expressed their confidence in the staff and described the environment at the hospital as pleasant. They said their presence at delivery was important for their growth into fatherhood. The best experience was the moment that the baby entered the world. The hardest things were the pain experienced by their partner and being unable to help. Most of the fathers were very pleased with current midwifery practices followed in childbirth, however, it was felt that more attention ought to be paid to pain relief and to supporting and providing guidance to the father during delivery.

IMPLICATIONS FOR PRACTICE

The work of midwives should be planned so that fathers can feel secure and comfortable. Further studies are needed into the ability of midwives to support fathers in their fatherhood.

Fathers and breastfeeding: a review of the literature

Research on breastfeeding support has consistently identified fathers as an important source of support in the decision to breastfeed and in its implementation. The literature indicates that fathers influence four aspects in particular: the breastfeeding decision, assistance at first feeding, duration of breastfeeding, and risk factors for bottle feeding. Research which focuses on fathers has added to our understanding of their attitudes, knowledge, and coping techniques regarding breastfeeding. This paper reviews the research findings in each of these areas, and offers suggestions for further research.