Preparing fathers for the transition to parenthood: Recommendations for the content of antenatal education
Introduction
Social changes, such as increasing maternal participation in paid employment and the emergence of smaller and more isolated families, have resulted in fathers playing a greater role in both partner support and in the care of their children (Pleck and Masciadrelli, 2004, ABS—Australian Bureau of Statistics, 2006). Increasing father involvement has coincided with the expansion and maturation of the literature examining fatherhood. This literature has established the important role that father involvement plays in determining maternal well-being and the quality of children's emotional and social development (Cabrera et al., 2000; Lamb, 2010, Fletcher, 2011).
However, for many fathers, the first year of parenting is marked by psychological distress, social isolation, and difficulties in the father's relationships with their partners and children (Barclay and Lupton, 1999, Buist et al., 2003). Fathers attending antenatal education classes alongside their partners may be better prepared for their role at the birth but they may feel poorly prepared for the relationship and role changes that they will confront after the birth (Fletcher et al., 2004). There are a number of reasons why antenatal preparation is likely to be less effective with fathers than it has proven to be with mothers. These include the primary focus of antenatal education on the needs of mothers; the unintended consequence of casting fathers as support persons rather than parents preparing for their personal transition to parenthood; and the uneasy relationship that men often have with health and support services (Bayley et al., 2009, MacDonald and Hastings, 2010).
Antenatal education has been associated with improved outcomes such as better use of antenatal care, reduced risk of preterm delivery, and increased initiation of breast feeding (Ickovics et al., 2007). These improved outcomes have been linked to increased maternal knowledge and competence resulting from the education and information that the mothers receive during the antenatal classes (Spinelli et al., 2003, Ickovics et al., 2007). Fathers are also likely to benefit from antenatal classes when some of the subject matter addresses factors which are directly linked to outcomes relating to father–child and father–partner relationships. A recent review concluded that mothers and fathers are more likely to have better postnatal mental health when they attend antenatal care that is delivered to couples and models shared infant care, addresses couple-relationships and sensitises men to the experiences of women (Burgess, 2011). However the literature also suggests many other issues that should also be addressed when preparing fathers for parenthood.
Practitioner reports contain a variety of topics that could be directed to fathers, including ‘providing information and education about babies and early parenting’ (Sheehy www.wch.sa.gov.au, 2006), general discussions about fatherhood such as ‘recognising fatherhood’ (Lee and Schmied, 2001), and highly specific parenting activities such as installing the car seat and packing a Dad's bag for the delivery (Kaplan, 2004). While many of the recommendations appear to be founded in the experience of the authors few are supported by evidence regarding their importance or the effectiveness of the education. Therefore, service providers have little guidance when deciding which issues to address in paternal antenatal preparation.
Dellman (2004) called for the establishment of ‘objectives to meet men's specific needs in childbirth education’ (p. 25). However, there is scant research investigating what new fathers might identify as their needs or the factors that are likely to positively or negatively influence paternal and family outcomes. This paper addresses this gap in the literature by integrating relevant research of factors that are likely to positively or negatively influence family outcomes into a set of recommendations for programme content. These recommendations are designed to guide practitioners in the development of programmes that effectively prepare fathers for the challenge and opportunities that they are likely to experience. The recommendations are also intended to stimulate discourse and further research into the development of effective paternal antenatal preparation.
The evidence demonstrating the importance of a factor for the well-being of family members and related recommendations are presented under broad conceptual domains. Research concerning the effectiveness of relevant interventions is then presented if it is available.
Section snippets
Fathers' role and relationship changes
Barclay and Lupton's (1999) exploration of the experiences of 15 men during their first 6 months of fatherhood found that fathers were not only unprepared for, but surprised by the relationship changes that occurred in the perinatal period. In other studies fathers have reported that they felt better prepared for childbirth after attending routine antenatal education but felt no better prepared for the relationship changes that occurred during their transition to fatherhood (Galloway et al.,
Recommendation 1
Preparation of fathers for the transition to parenthood should aim to prepare fathers for the relationship and role changes that they are likely to experience by providing information on what to expect and how to build and sustain a healthy parenting partnership.
Fathers and psychological distress
When fathers experience ongoing mental distress in relation to their parenting roles they are less likely to develop and maintain supportive relationships with their partners and their children. The presence of psychological distress is likely to disrupt the development of the father's attachment relationships with his child and a father with poor attachment is less likely to positively engage with the roles and responsibilities of fatherhood (Fletcher, 2011). Paternal psychiatric disorders
Recommendation 2
Preparation of parents for the transition to parenthood should aim to increase parental awareness of the increased risk that fathers face of developing mental distress and depression, the implications that this has for their family and the importance of seeking help and support if it occurs.
Recommendation 3
The antenatal preparation of fathers should aim to improve their ability to better support their partners by better preparing fathers for their personal experiences, by improving the father's understanding of what the mother is experiencing, and by providing specific training to fathers in how to be an effective support.
Understanding infant communication
A father's ability to understand infant communication plays an important role in the development of the early relationship between the father and his child (Fletcher, 2011). Warm and loving interactions that children experience, as a result of the attachment relationships that they develop with their parents, play a central role in determining children's physical, social and emotional development (Bruer, 1999, Bruer, 2008). Attachment theorists and researchers, who formerly focused almost
Recommendation 4
Antenatal education should aim to promote the development of early and strong attachments between fathers and their infants by improving the father's ability to identify and interpret infant communication.
The parenting relationship
Numerous studies have demonstrated that an effective parenting partnership, characterised by high-levels of cooperation, a lack of antagonism, general agreement on child rearing strategies, and both parents' active participation in childcare, leads to improved child and family outcomes (Feinberg, 2003, Bonds and Gondoli, 2007, Brown et al., 2010, Feinberg et al., 2010; see also McHale and Kuersten-Hogan, 2004). Parenting is more likely to be satisfying, and children are more likely to develop
Recommendation 5
Antenatal education should aim to promote the development of a strong parenting alliance by informing parents about the importance of parenting teamwork and the key features that help to build a strong parenting partnership.
Infant crying
It is important for fathers to understand why babies cry and to have strategies to employ when they are feeling overwhelmed by their infant's distress. Douglas and Hiscock (2010) summed up the importance of this issue by stating that ‘Unsettled behaviour in the first few months of life is a common clinical problem, with the associated risks of postnatal depression, premature cessation of breast feeding, long-term psychological disturbance, and child abuse’ (p. 533).
Infant crying has been
Recommendation 6
Antenatal preparation should aim to help fathers understand infant crying patterns, why babies cry and what parents and carers can do in order to avoid feeling overwhelmed by infant crying.
Conclusion
Fathers now play a much greater role in supporting their partners and caring for their children. All members of the family can expect to benefit when fathers are prepared for the challenges that they are likely to experience in their transition to parenthood. The recommendations presented in this paper provide a foundation for the development of evidence-based practice when working with fathers in antenatal education. The recommendations may also act as a guide to the important paternal factors
Conflict of interest statement
None.
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