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January 2003
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A
32-year-old attorney who was an only child himself spoke of the
profoundness of watching his wife gave birth to their third child and third son:
“I marvel at how she can endure that pain and not even complain. I can’t believe
she would be willing to go through so much to have my sons. I have cut all three
of my son’s [umbilical] cords. It helps me to feel involved, to have a symbolic
role in the birth.” Becoming a father can be one of the most significant events
in a life of a man. For many fathers, the birth of a child can be a significant
emotional experience filled with mixed feelings such as excitement, fear, and
gratification. This event represents the accomplishment of a significant life
task as a man assumes a new role, with new behaviors, and the development of a
repertoire of new skills as a father.
In recent years the paternal role
during pregnancy and childbirth has been receiving increasing attention by
researchers. Despite a growing body of literature on the topic, the role of the
father in childbirth, the quality of the paternal childbirth experience, and the
benefits of a shared birth experience are only now recognized as valid and still
need further definition.
Paternal
developmental processes occurring during pregnancy are as complex as maternal
developmental processes. The father may experience mixed feelings, ranging from
ambivalence and anxiety to excitement and anticipation. Emotional responses
depend on such factors as whether the pregnancy is planned or unplanned, the
quality of the partner relationship, previous experiences with childbearing and
childrearing, paternal and maternal age, educational level, socioeconomic
status, and cultural and ethnic variables. Upon learning his wife was pregnant,
one expectant father said, “I experienced all kinds of feeling through sheer joy
and excitement to terror.” A first-time mother explained, “the ultrasound made
it very real for my husband. He hadn’t felt the baby kick, so at 22 weeks when I
had the ultrasound he said, ‘All right! We’re going to have a baby!’” Another
expectant father said, “The pregnancy became real when the belly got big.”
Some of the identified fears of expectant fathers include performance,
security, relationship, and existential fears. A father of twins expressed his
uncertainty, “It’s a lot like walking into a pitch black room and suddenly
thinking that there may not be a floor”1
In studies of family dynamics
during pregnancy, expectant mothers and fathers viewed each other as an
important source of support in making the pivotal life transition to
parenthood.2 Recent work documents the profound grief reported by expectant
fathers who experience the loss of an expected child.3 A father whose pre-term
twin daughters lived a few short hours said, “I never could have imagined the
grief and pain I felt as I held those precious little ones who were here in
mortality such a brief time. Becoming a father and losing my daughters all at
once was an overwhelming and bittersweet experience.”
Phases of paternal
involvement during pregnancy include the announcement or confirming phase in the
first trimester (producing joy or conflict); the moratorium phase in the second
trimester, which involves adjustment to the reality of the pregnancy; and the
focusing phase in the third trimester, as a man redefines himself in terms of
becoming a father.4 One husband suggested that he felt more involved and excited
when the couple was enrolled in childbirth education classes. His wife reported,
“He’s really into it!” Another expectant mother said that her husband called
their unborn child, “The angel baby.”
The expectant father may experience a
variety of stressors, including fears about his role during childbirth and his
relationship with the newborn. Barriers to the assumption of the paternal role
in 84 first-time fathers included a troubled relationship with his father, a
dysfunctional couple relationship, and other socio-cultural barriers.5 Styles of
paternal involvement during pregnancy include observer, in which the father is
passive and detached; expressive, in which the expectant father attempts to
experience the pregnancy as much as possible; and instrumental, in which the
father is the caretaker. One father’s expressive style is suggested in these
words,
My earliest memories with Trina started the day she was born. No, they
started before that. They started in the womb. I would come home and I would
say, ‘Hello,’ and she would flick and flitter in the womb. She’d start kicking.
If I put my hand on my wife’s tummy when she was carrying Trina, she’d move over
to where my hand was. If I put it on the other side, she’d move to that side. I
used to sing to her. It’s always been that way and has just continued pretty
much that way. I remember one night laying with my head on my wife’s stomach and
singing a lullaby or something, I can’t remember exactly which song. She was
very active but she settled down, and then I put my hand on her stomach and she
moved my hand.6
The father
may have multiple motives for being present at the birth of his child. Pressure
from extended family, peers, the expectant mother, and health care providers can
all influence the decision to be present during the birth of a child. He may
also be motivated by a sense of responsibility to his unborn child and the
child’s mother. He may also have a desire for self-fulfillment through active
participation in the birth.7 Regardless of his motivation, the father may assume
a variety of roles during labor and birth, depending on such factors as his
personal characteristics, coping strategies, the perceived expectations of
others, professional support, the use of medical technology, and whether or not
the laboring mother has epidural analgesia/ anesthesia.8
Paternal roles
during labor and birth may include (1) coaching, leading, or directing their
partners through the childbirth experience; (2) acting as a teammate, assisting
their partners by following the directions of others; (3) choosing to be a
witness, observing the labor process and the birth of their child. Coaches seem
to have a need  for controlling themselves and the birth experience. Some wives
suggest that the assumption of the coaching role by the father was essential to
their own sense of control in a time of potential vulnerability. Teammates were
there for their presence, providing physical and emotional support as part of a
team with the health care providers being in control. Witnesses viewed
themselves as observers of the birth, offering presence but not advocacy as a
comfort to the laboring woman. Some seemed detached, but perhaps they were
coping by appearing to focus on reading or watching television.
Interactive
styles between laboring couples include:
1. The touch or physical
interactive style, which includes conversation, touching, offering comfort, and
modeling breathing and relaxation techniques.
2. The equipment or
interaction through instrumentation style, which includes attention to
electronic fetal monitoring and other medical technology.
3. The
non-interactive presence, in which the father is present but does not evidence
interaction with the laboring woman.9
Suggestions are provided by the
National Center for Fathering for the expectant father who elects to serve as
labor coach.10 Such suggestions include committing to regular practice; offering
ice chips, backrubs, and encouragement; acting as her advocate; complying with
her requests; hugging her a lot and holding her hand. Much of the research
focuses on the father’s role as a labor coach, rather than exploring the
personal needs of fathers whose wives are giving birth.
Whatever
paternal role is assumed is less important than agreement between partners on
what role is most appropriate and helpful.11 This includes following proscribed
sociocultural roles, such as those appropriate for Orthodox Jewish couples. In
such cases, fathers do not physically support their wives because of religious
prohibitions regarding touching or observing the woman when there is vaginal
bleeding or when she is immodestly exposed. In spite of not following what would
be considered typical coaching roles, Orthodox Jewish women have expressed a
strong sense of support as the expectant father prayed, read Psalms, and
consulted the rabbi. One mother described it in this way, “I give birth and my
husband helps me spiritually. He can pray for me; and that is my biggest
support.”12
Perceptions of new fathers about being present at the birth of
their baby include feeling unprepared for an unpredictable process, for the
intensity of the woman’s pain experience and behavior, and for their own
emotional responses.13 Emergent themes in first time fathers following the birth
include:
1) it’s happening; it’s beginning (often expressed at the onset of
labor); 2) more work than anticipated (often expressed during active labor as
the intensity of the experience increases); 3) increased fear and hidden fears
and emotions (often expressed during second stage labor); 4) lack of inclusion
and increased excitement (often expressed as birth approaches); 5) relief and
“we made it” (expressed at the time of birth); 6) time to get acquainted
(expressed following birth).14
Some fathers are also unprepared for the
initial sight of the newborn whose color may be purplish blue before the first
breath is taken, with a misshapen head covered with vernix.
A 30-year-old,
first-time father described his feelings when he first held his child, “It was
hard to believe we had a son, that we were co-creators of this child with our
Heavenly Father. I feel joy and happiness that I had never felt before. It is
awe-inspiring, and I feel a strong sense of responsibility, a lot less
self-centered and selfish, and more centered around this little spirit.”
Laboring for relevance was the overall theme identified in a yearlong study
of new fathers.15 Processes identified included grappling with the reality of
pregnancy and the child, struggling for recognition as a parent, and plugging
away at the role- making of involved fatherhood. Reality boosters identified
included active participation during pregnancy and birth, and infant care giving
in the early days and weeks of their infant’s life.
At least two decades of research document that paternal involvement
during childbirth may serve to facilitate the childbirth process emotionally and
physically, enhance both maternal and paternal feelings of self worth,
strengthen the couple relationship, and facilitate paternal-infant attachment.16
As expressed by one first-time mother, “I felt a very strong closeness to my
husband because I feel the baby is a part of him and a part of me. Especially
that he looks so much like [his father]. I can’t even explain it. It’s like
someone took a string and tied both of us together. I felt like a unita
little family.”17
The father who is present during labor and birth and is
actively involved in physical and emotional care giving activities offers a
quality of care that is different than that of professionals.18 The father
brings to the childbirth experience his presence, knowledge, and understanding
of the laboring woman; love for the mother and his child; and a sense of
advocacy coupled with a desire for the woman to have a positive birth
experience. One woman spoke of the importance of her husband’s presence: “My
husband was a real support from the start till the end. Just being supportive
and being a comfort, that’s the best I could have asked for. You see another
part of your husband that you didn’t know existed before, a caring part.”19
When women were asked about who was most helpful to them while giving birth,
the majority indicated that it was their partner, coupled with professional
support.20 Mothers described the birth experience as enjoyable when the father
actively participated with them in an intimate and pivotal family experience.
The mutual benefits for both the childbearing woman and the father of her
baby are illustrated in Figure 1. As the couple shares the experience of
childbirth, the woman has the sense of that “someone cares,” which contributes
to a feeling of well-being. The father has a sense of competency and
contributing to the experience as he offers support and presence. The maternal
and paternal roles are shared and attained, the birth experience is integrated
into the framework of the marriage. All of these circumstances contribute to a
strengthened and enhanced couple relationship.
One father spoke about the
enhancement of his love for his wife as they became parents for the first time,
“I couldn’t believe Jeni’s strength in giving birth. I was so proud of her. She
was beautiful when I first met her.… She was beautiful the day we were married.
But she was the most beautiful when she was breastfeeding my son wearing a gray
flannel shirt and no makeup.”
As the father progresses with the childbearing
woman through pregnancy and birth, he begins to take on the paternal role. One
father described his this way:
The moment that I really knew that I was a dad was the day after he
was born. In the morning, Jeni went to take a shower and Joshua started getting
a little fussy. So the nurse showed me how I could use my pinky finger as
pacifier. So I cleaned my hands, and I sat down. And I put my little pinky in
his mouth, and he started sucking on it, and then he looked right into my eyes.
And so, I guess this was my moment of fatherhood. And I knew that Josh was truly
my son and I was his dad.
Fathers may also have a profound emotional and spiritual experience at
birth. One father expressed with tears in his eyes what becoming a father meant:
“It was as though a door opened to a room in my mind, in my heart, that I never
knew existed, and I felt emotions of such sweetness and strength that I was
overwhelmed. I have been ecstatic, absolutely joy-filled, since the moment I
laid my eyes on that little baby.”21 Another father spoke of his feelings of
pride and the desire to be the protector:
It’s hard to believe that you can have so much love for this
itty-bitty thing. But I really love this little baby. The sense of
responsibility is overwhelming. Now what I do affects this little guy. I want to
be the best father I can be.
In
the work of the authors, when new mothers were interviewed about the meaning of
their birth experience, fathers who were present were also eager to talk about
birth from their perspective. Fathers do appreciate being asked about their
birth experience.22 Another father said:
Man, she was brave! I never knew how strong my wife is, you know? I
just always thought of her as being delicate and beautiful, and man, she was so
strong, and so beautiful, it made me dizzy to watch her. I loved being a part of
it! What a high!.23
Both professional and lay literature demonstrates an increasing focus on
perceptions of the paternal birth experience24 and ways to enhance the quality
of paternal birth experiences.25 Childbirth education classes should foster
dialogue between partners about what childbirth and parenting roles they are
mutually comfortable with. The expectant couple can explore how to make the
childbirth experience and parenting the child theirs instead of hers alone. It
has been suggested that expectant parents should actively negotiate sharing
childcare and household labor responsibilities prior to the birth of their
child.
Incorporation of family life education into current childbirth
education courses may be an effective intervention to enrich the family
perspective. Such work is currently in process through the implementation of
“Marriage Moments” as part of childbirth education classes in Utah Valley. 26
Facilitating assumption of the paternal role is helpful. One father wrote of
his initial experiences with his child:
Seeing him [my son Scott], I took his hand in mine and was able to
accompany him into the nursery. Later, I awoke to a nurse smiling as she stood
above my chair. It had been six hours since I had taken him into the nursery,
and I was still holding his hand.
While each father’s experience will vary somewhat, the opportunity to
participate in the birth of his childand to then share his perspectives of
his experiences during pregnancy, childbirth, and the transition to
fatherhoodwill help a man integrate these experiences into the framework of
his life. In addition, efforts to understand the father’s role in childbirth,
those factors that affect the quality of the father’s experience, and the
benefits of a shared birth experience will undoubtedly foster positive outcomes
for the childbearing family. 
Lynn Clark Callister, RN, PhD, is a professor in the College of
Nursing at Brigham Young University; Geraldine Matsumura, RN, PhD, is an
associate professor in the College of Nursing at BYU; Katri
Vehvilainnen-Julkunen, CNM, PhD, is chair of the Department of Nursing
Science at the University of Kuopio, Kuopio, Finland.
References
1 J.L. Shapiro, When Men Are Pregnant (San Luis Obispo
Calif.: Impact Publishers, 1987): 13.
2 G.A. Diemer, “Expectant fathers:
Influence of perinatal education on stress, coping, and spousal relations.”
Research in Nursing and Health, 20 (1997): 281-93.
3 J. Kavanaugh, “Parents’
experience surrounding the death of a newborn whose birth is at the margin of
viability” Journal of Obstetric, Gynecologic, and Neonatal Nursing, 26 no. 1
(1997): 43-51; B. O’Neill, “A father’s grief: Dealing with stillbirth.” Nursing
Forum, 33 no.4 (1998): 33-37; M. Samuelson, I. Radestad, and K. Segesten, “A
waste of life: Fathers’ experience of losing a child before birth” Birth, 28 no.
2 (2001): 124-28. C. Wallerstedt, and P. Higgins,“Facilitating perinatal
grieving between the mother and the father” Journal of Obstetric, Gynecologic,
and Neonatal Nursing, 25 (1996): 389-94; N.J. Worth, “Becoming a father to a
stillborn child” Clinical Nursing Research, 6 no. 1 (1997): 71-89.
4 J.
Draper, “‘It’s the first scientific evidence’: Men’s experience of pregnancy
confirmation.” Journal of Advanced Nursing, 39 no. 6 (2002): 507.
5 P.L.
Jordan, “Barriers to paternal involvement in childbearing and parenting” Podium
presentation (Western Institute of Nursing Research Annual conference, Portland,
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6 http://fatherwork.byu.edu/birth Retrieved 8 Nov. 2002
7
R. Greenhalgh, P. Slade, and H. Spiby, “Fathers’ coping style, antenatal
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8 L.L. Chapman, “Expectant fathers and labor epidurals” MCN: The
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10
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15 P.L. Jordan, “Laboring for relevance:
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16
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17
L.C. Callister, The meaning of the childbirth experience to the Mormon woman.
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18 M. Enkin, M.J.M.C
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19 Bondas, 1984
20 L.C. Callister,
ibid., 4.
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22 S.L. Diamond, Hard Labor (New York: Tom
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23 K. Vehvilainen-Julkunen, and A. Liukkonen,
ibid.
24 Diamond, ibid.
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perceive men as fathers” International Journal of Nursing Studies, 17 (2000):
199-205; K. Vehvilainen-Julkunen and A. Liukkoen, ibid.
26 P.L. Jordan, “The
art of fathering” First Time Dad (Summer 2000): 7.
27 McVeigh, Baafi, and
Williamson (1992)
28 A. Hawkins, G. Christiaens, “The Marriage of family
life education and community health education: Strengthening marriages during
the transition to parenthood” Study in process (Provo, Utah: Brigham Young
University Center for Studies of the Family, 2000).
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