Fathers' Engagement in Pregnancy and Childbirth

Evidence From a National Survey

Maggie Redshaw; Jane Henderson

Disclosures

BMC Pregnancy Childbirth. 2013;13(70) 

In This Article

Results

A total of 5333 women returned usable questionnaires, a response rate of 55.1%. They reported on 4616 fathers (86%) and their involvement during pregnancy, labour and postnatally. Characteristics of women and their partners are shown in Table 1. Three-quarters of fathers (76%) were born in the UK, six percent in the rest of Europe, and eighteen percent were from other countries. The majority of men were in their 30's (57%), a quarter in their 20's (26%), and 16% in their 40's; only one percent of fathers were teenagers. Maternal age and paternal age were highly correlated.

A comparison of respondent and non-respondent women showed that respondents were slightly more likely to be older, to be married, to be living in the least deprived areas, to be white and to be born in the United Kingdom.[14] Nevertheless of those responding, 14% were from minority ethnic groups.

Father's Involvement in Pregnancy, Childbirth and Early Parenting

The extent of father involvement overall and by parity is shown in Table 2. Most fathers' initial reaction to the pregnancy was a positive one, with more than 80% being 'pleased or 'overjoyed'; there was no difference between the partners of women who had previously given birth and those for whom this was their first baby. Over half of fathers were present for the pregnancy test or when the pregnancy was confirmed (62%) and for one or more antenatal checks (63%), and almost all (89%) were present for one or more ultrasound examinations and for labour (90%). Mothers having their first baby were more likely to have had their partner present when the pregnancy was confirmed, for antenatal checks, for scans, to attend antenatal classes and be present during labour. They were also more likely to have a partner who accessed information about pregnancy and birth and shared in decision-making in pregnancy and during labour.

Women reported that most fathers felt midwives and doctors communicated well with them during pregnancy (81%), more so during labour (88%) and slightly fewer (75%) after the birth, with little difference by parity.

While three-quarters of fathers took paternity leave (72%), some did not take leave or were unable to do so. Partners of first time mothers were slightly more likely to have taken paternity leave and were more likely to have done so for longer.

During the postnatal period, most fathers helped with infant care, with more than three-quarters changing nappies, bathing, helping or supporting feeding, helping when the baby cried, playing with the baby and looking after the baby when the mother was out or at work. Fathers tended to help more with first babies, especially with nappy changing, bathing and feeding. The most common activity reported for all fathers during the postnatal period was playing with the baby (96%). There was no difference in fathers' activities by gender of the baby.

Paternal Involvement by Sociodemographic Characteristics

Some differences in key aspects of father involvement by maternal sociodemographic variables presented by parity are shown in Table 3. Partners of primiparous women aged less than 25 years were significantly less enthusiastic in reaction to the pregnancy (76% overjoyed or pleased compared to 90% in the partners of older women); however, partners of multiparous younger women were more likely to attend antenatal checks.

Fathers whose partners were primiparous women in the least deprived quintiles on the IMD were significantly more likely to be 'overjoyed' or 'pleased' in reaction to the pregnancy (89% compared to 85% in the most deprived quintile), and partners of multiparous women in the least deprived quintiles were more likely to be present for labour. However, partners' attendance at antenatal checks was more likely to occur in deprived areas for multiparous women.

Partners of women of Black or Minority Ethnic (BME) origin were significantly less likely to be present for labour than partners of white women (81% compared to 93% in multiparous white women). In particular, partners of women from Black or Black British backgrounds were significantly less likely to be present.

The different sociodemographic variables are closely linked so binary logistic regression was used to estimate the combined effects on partner's reaction to pregnancy, presence at antenatal checks and labour, involvement in obtaining information and in decision-making, and in infant care. This showed that maternal age, IMD and parity were all strongly associated with the variables of interest (Table 4). Partners of multiparous women were significantly more likely to have a negative reaction to the pregnancy, be less involved in the pregnancy, were less likely to be present during the labour and involved in infant care postnatally. Partners of women living in deprived areas were more likely to have a negative reaction to the pregnancy but more likely to attend antenatal checks, less likely to be involved in obtaining information or decision-making or be present for labour, but more likely to be involved in infant care. Partners of younger women were less likely to have a negative reaction to the pregnancy, more likely to attend antenatal checks, obtain information and be present for labour. Ethnicity was only associated with presence in labour, partners of BME women being less than half as likely to be present compared to partners of white women (Odds ratio 0.38, 95% confidence interval 0.28, 0.50).

Paternal Engagement Score

The results of the generalised linear modelling are shown in Table 5. Paternal engagement scores were significantly higher in partners of primiparous than multiparous women, and in primiparous women who had received more education or were aged 25–34 years, and men born in the UK. Engagement also tended to be higher in partners of white women and those living in less deprived areas but these differences were not statistically significant. Irrespective of parity, where women reported that it was a planned happy pregnancy, the fathers tended to be significantly more engaged (mean partner engagement score in primiparous women with a planned happy pregnancy 7.24 (95% confidence interval 7.13, 7.35) compared to unplanned unhappy pregnancy 6.19 (95% confidence interval 5.86, 6.53).

After adjustment for sociodemographic factors, greater paternal engagement was positively associated with first contact with health professionals before 12 weeks gestation, earlier booking in multiparous women, and irrespective of parity, having a dating scan, number of antenatal checks and offer and attendance at antenatal classes. In multiparous women paternal engagement was also associated with increased number of antenatal health problems and worries about labour. Women with more engaged partners also used more positive adjectives to describe care during labour and birth and multiparous women with more engaged partners were more satisfied overall with their antenatal care. Other indicators of perception of antenatal care were unaffected.

Certain outcomes of care were also associated with paternal engagement in pregnancy and labour. Adjusted paternal engagement score was significantly higher in women who delivered by forceps than women who delivered normally. Primiparous women who had skin-to-skin contact with their babies soon after birth, those who were satisfied with intrapartum care overall, and multiparous women who felt that staff communicated well with them in labour also reported higher levels of paternal engagement compared with other women.

Paternal involvement after the birth was estimated using the postnatal score (Table 6). After adjustment, where postnatal involvement was highest, women reported significantly better overall health at 3 months (mean engagement score in multiparous women who were well 14.7 (95% confidence interval 14.5, 14.8) compared to those who were not well 13.6 (95% confidence interval 13.1, 14.1); primiparous women reported fewer health problems at one month and multiparous women reported fewer health problems at each time point. Postnatal problems were also considered in groups.[24] At one month postpartum, where paternal involvement was higher, multiparous women were less likely to report psychological symptoms ('blues', depression, anxiety), bodily symptoms (stress incontinence, backache, dyspareunia), and post-traumatic stress symptoms (flash-backs to labour or birth, sleep problems not related to the baby, and difficulties in concentrating). Primiparous women were more likely to have a postnatal check with their doctor if paternal involvement was higher.

Outcomes of Care and Paternity Leave

Paternity leave was strongly associated with well-being at three months (Table 7). After adjustment for sociodemographic variables and mode of delivery, women were more likely to feel unwell at this time when their partner had either taken no time off at all or took more than two weeks off. Multiparous women whose partner took no paternity leave were significantly more likely to report depression at one month and three months than women whose partners took the standard two weeks leave.

Father's Involvement and Infant Feeding

Further analyses were conducted to assess fathers' influence on infant feeding: women were asked about infant feeding after the birth and at the time of the survey and, if they had breastfed, the duration of breastfeeding (Table 8). They were also asked about breastfeeding problems at 10 days, one month and three months. After adjustment, women whose partners were more engaged antenatally and in labour were more likely to breastfeed and to breastfeed for longer, significantly so for primiparous women. However, in women who were breastfeeding, breastfeeding problems at 10 days were more common in those whose partners were more engaged, significantly so in multiparous women. There were no differences at one and three months.

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