Fathers' Perceptions of the Immediate Postpartal Period

328 JOGNN Volume 33, Number 3

CLINICAL RESEARCH

Fathers’ Perceptions of the Immediate Postpartal PeriodFrancine de Montigny and Carl Lacharité

Purpose: To describe the perceptions of first-timefathers regarding critical moments of the immediatepostpartum period.

Design: Qualitative study. Setting: Data were collected through semistruc-

tured interviews with the fathers, using the critical inci-dent technique; this was done in their home, within thefirst 12 days following the birth of their child.

Participants: Sample consisted of 13 first-timefathers.

Results: A qualitative analysis allowed for theidentification of five domains, five categories, and 12subcategories of critical incidents within the first 96hours of the postpartum period. The five domains ofincidents relate to self and others: as individuals, as acouple, and as parents in relationship with the envi-ronment and with the nursing personnel. On the basisof a combined score of fathers’ presence on thematernity ward, we were able to define three sub-groups. All groups of fathers were sensitive to interac-tions with their baby and with the nurses. Highlyinvolved fathers reported not feeling supported by thehospital environment policies in regard to engaging inbehaviors that could favor their involvement with theirbaby.

Conclusions: Increased awareness of fathers’experiences during the immediate postpartum periodwill enable nurses to respond more effectively to thefathers’ needs. JOGNN, 33, 328-339; 2004. DOI:10.1177/0884217504266012

Keywords: Critical incident technique—Father—Marital interactions—Paternity—Percep-tions—Postpartum period—Qualitative—Rooming-in

Accepted: April 2003

Fathers make a unique contribution (Pruett,1998) to the development and growth of each fami-ly member. Due to this fact, health care practitionershave devised ways to foster the father’s involvementin the perinatal period, such as encouraging partici-pation in prenatal classes, birth attendance, androoming-in. Little is known, however, about the per-ceptions of fathers of the context in which father-hood evolves. The purpose of this article is toexplore the perceptions of first-time fathers of thesignificant events of the immediate postpartum period.

Background

Although parenting issues have been dealt withfor more than 50 years, early work has focusedalmost exclusively on the mother’s experiences.Studies about fathers tend to explore the pathologyof fatherhood (Freeman, 1951; Towne & Afterman,1955; Wainwright, 1966). Research on fathers’experiences with pregnancy, childbirth, and the post-partum period began to emerge in the mid-1970s(Bittman & Zalk, 1978; Fein, 1976; Parke & Sawin,1978; Wente & Crockenberg, 1976). Initial reportsdealt with topics that had been previously analyzedwhen investigating mothers, such as fathers’ transi-tion to parenthood (Fein, 1976; Henderson &Brouse, 1991). May (1982a, 1982b) yielded insighton the types and phases of involvement of the fatherduring pregnancy and on factors that foster theirreadiness to parent. Nearly 10 years later, Jordan(1990) added to our understanding of men’s experi-ences with her work on “laboring for relevance.”This work identified the essence of the father’s expe-riences, such as “grappling with the reality of preg-nancy and the child,” “struggling for recognition as

May/June 2004 JOGNN 329

a parent,” and “plugging away at the role making ofinvolved fatherhood.” More recently, Holland (1995)described fathers’ perceptions of their experiences andexpectations in their role; of their participation in childrearing, work, and family life; and of their relationshipwith their children as salient issues that influence theirpaternal conducts.

Other studies have focused on father-infant attachmentand bonding (Ferketich & Mercer, 1995; Palkovitz,1992), fathers’ sensitivity to infants (Graham, 1993),fathers’ perceptions of family dynamics (Hakulinen, Laip-pala, & Paunonen, 1998), and fathers’ attitudes towardbreastfeeding and their impact on mothers’ feeding deci-sions (Bar-Yam & Darby, 1997; Freed, Fraley, & Schan-ler, 1992, 1993). Research has rendered a better under-standing of the father’s involvement in child care,describing the father’s involvement, at times, as “partici-pation in household tasks” and at other times as “partic-ipation in child care activities” (Devault, 2000). Occa-sionally, both descriptions are used (Dubeau & Coutu,2000). Despite the ambiguity of this concept, Barclay andLupton (1999) indicate that fathers would like to be moreinvolved than they actually are, but this is difficult with-out role models as well as rules and guidelines regarding“how to father.” Generally, fathers experience difficultiesintegrating fathering-related activities into their daily lifeand work schedule (Barclay & Lupton, 1999). Devault(2000) has observed that, even when mothers are fullyemployed, caretaking tasks are not being distributedequally. Fathers admit playing with and talking to theirinfant more than assuming actual infant care, such aschanging diapers, bathing, dressing, or comforting.

Nonetheless, numerous studies outline how the father’sinvolvement in child rearing benefits fathers, mothers,and infants (for example, Carpentier, 1992; Snarey,1993). It has been found that men who are more involvedin caring for their children experience greater satisfactionwithin their marriage (Cowan & Cowan, 1987) and lessanxiety (Fein, 1976). Father-infant interactions bring sup-port to mothers by relieving them of the responsibility ofassuming the entire workload related to childcare. Fur-thermore, the father’s involvement in childcare activitiesbrings a unique contribution to the child’s developmentthat cannot be neglected (Dickie, 1987). Overall, “sensi-tive parenting has a major impact on children’s cognitiveand socio-emotional development” (Broom, 1998, p. 87).

A fathers’ style and degree of involvement in child rear-ing are determined by “their perception of their role andthe degree to which they are encouraged or discouragedthrough interpersonal, intrapersonal or situational influ-ences” (Holland, 1995, p. 8). Consequently, the mother’srole as a gatekeeper or a facilitator to infant-father inter-

actions influences the father’s behaviors. McBride andRane (1997) agree that the mother’s perception of herpartner’s investments in parental, spousal, and workerroles is the best predictor of total father involvement.Fathers will exhibit less involvement if their wives fail tosupport this involvement (Pedersen, 1987). The contextu-al factors that mediate or regulate father-child interac-tions are more or less known, although according to Bar-nett and Baruch (1987), high involvement is unlikely tooccur unless there is support and approval of this behav-ior from significant others.

Various individuals are likely to influence beliefs, moti-vations, and behaviors of fathers during their transition toparenthood. Nurses are one source of influence, as theybecome significant members of the father’s environment,interacting with them from the prenatal to the postnatalperiod. As researchers and educators, we wonderedwhether fathers were sensitive to the influence of nurses’conduct during this transition phase. We were particular-ly interested in the postpartum period. Barclay and Lup-ton (1999) reported that when fathers are not involvedwith their infant early on during the postpartum period,they take longer to become close to their infant. We werecurious to discover if nurses play a determining role infathers’ postnatal involvement. We chose to investigatefathers’ perceptions of the immediate postpartum periodin the hospital and what was significant to them duringthat time. To our knowledge, this point of view had neverbeen investigated. This text will focus on describing thenature of incidents of the immediate postpartum periodthat are perceived by fathers as being significant. Theperiod referred to is the mother’s stay on the maternityward.

Objective

This qualitative study used the critical incident tech-nique to reveal 13 fathers’ perceptions of significantmoments of the immediate postpartum period (first 48 to96 hours) in hospital. These results are part of an investi-gation of both parents’ experiences (de Montigny &Lacharité, 2002, 2004). Approval of the study wasobtained from the institutional ethics committee (deMontigny, 2002). The activity under study consists of“significant moments of the immediate postpartum peri-od that are likely to influence parental adaptation of first-time fathers with a newborn infant.” As proposed byWoolsey (1986), the study’s goal is worded in familiarlanguage, because it is used as directives for fathers: Iden-tify moments experienced by fathers during the hospitalstay (after the infant’s birth) that are significant for them,either in a positive or negative fashion.


Method

The Critical Incident TechniqueBecause it allows the “lived experience” (Wilson &

Hutchinson, 1991) of fathers to unfold, the critical inci-dent technique seemed particularly appropriate to fulfilour study’s purpose. The critical incident technique stim-ulates participants to reflect analytically on a past experi-ence (Rosenal, 1995). Critical incidents are “brief butvivid descriptions of an event” (Brookfield, 1990, p. 84),therefore, interpretations of the fathers’ discourse shouldreveal the complexity of fathers’ experiences in the imme-diate postpartum period. An awareness of fathers’ per-ceptions of this particular time, the postpartum period, isnecessary to adapt nursing interventions to the needs offathers and more adequately support them during thistransition.

VariablesThe variables investigated are related to first-time

fathers’ perceptions of significant moments of the imme-diate postpartum period and how these perceptions arelikely to influence the fathers’ adaptation. Social percep-tions are defined as the fathers’ representations of othersand of their social environment, and the judgments thatthey make (Bloch et al., 1996). Significant moments of theimmediate postpartum period are defined as “observablehuman activities, that can affect a person’s adaptation ornon-adaptation” (McDonald, 1989, p. 45). Adaptation isdefined on the basis of Roy’s model, as being the processof responding positively to a changing environment (Roy,1984). The period that follows the infant’s birth until thehospital discharge from the mother-infant unit is herebydefined as the immediate postpartum period.

SampleA convenience sample of volunteer fathers was drawn

from a predominantly French-speaking urban area inWestern Quebec (estimated population of 250,000).Study participation was offered by a nurse clinician, with-in 48 hours after the birth of their first child, to all fatherswho met inclusion criteria:

• Both mother and father were first-time parents.• Father and mother lived together as a married cou-

ple or, in common-law union (Common law unionmeans that both partners are living together withoutbeing civilly or religiously married). The Quebecprovince accounts for 43% of Canada’s commonlaw marriage (Statistique Canada, 1996).

• Parents were over 19 years of age.• Parents’ mother tongue was French; if not, they

were able to speak, understand, and read French.• The infant was born after 36 weeks gestation,

weighed more than 5 pounds, and had no significant

health deficits requiring him or her to stay in theintermediate level nursery for more than 24 hours.

• Mother had no health deficits related to the birthingprocess.

• All fathers signed an informed consent.

Sequential sampling was also used, each father beinginvited to participate until new information was no longergathered. Because data saturation should be the determi-nant factor in deciding sample size (Norman, Redfern, &Tomalin, 1992), 15 fathers were approached. Thirteen(13) fathers participated, with a mean age of 30.5 years(SD = 5). The sample was 92% Caucasian. Fathers whowere living with their partner had been doing so for anaverage of 3 years (± 2.5 years). Three fathers (23; 1%)were married, and the remaining 10 fathers (76; 9%)lived in a common law union. Forty-six percent of fathers(n = 6) had completed secondary school or less. Forty-sixpercent of fathers (n = 6) had a university degree. Fifty-four percent of couples had a family income of less than$60,000, whereas 84.6% of fathers (n = 11) worked fulltime.

Appointments were made with the fathers, by tele-phone, on the third day after the mother and infant weredischarged from the hospital. Fathers were interviewed intheir own homes by a female researcher. Each man wasinterviewed for 30 to 50 minutes, within the first 12 daysafter the infant’s birth. Interviews, aiming to identify thesignificant moments of the immediate postpartum period(48 to 96 hours), were audio-recorded. Using the criticalincident technique to gather data, men were asked tothink back to the period when their partner was in thehospital, after the infant’s birth. They were asked todescribe moments that had been difficult and momentsthat had been easy for them during those first few daysfollowing the birth of their infant. To gather more infor-mation about the incidents, fathers were then asked withwhom they had shared these moments. Finally, the inter-viewer inquired about the effects, if any, these incidentshad on them at the time and the effects on them now.

Data AnalysisWith the critical incident technique, qualitative data

analysis consists of critical incidents’ identification, classi-fication, and categorization. Woolsey (1986) recommendsthree steps in this analysis: (a) defining a frame of refer-ence, (b) developing categories, and (c) establishing theirdegree of specificity. These steps are described individual-ly, integrating our own analysis process to illustrate them.

Defining a Frame of Reference

Although the critical incident technique allows for theuse of a specific predefined theoretical model to catego-rize data, a more flexible frame of reference was chosen


and defined as fathers’ perceptions of significant momentsof the immediate postpartum period that are likely toinfluence their adaptation.

Developing Categories

The primary investigator first transcribed recordeddata by hand. To ensure accuracy, audiotapes werereviewed twice while transcriptions were read. Criticalincidents were then extracted from the transcriptions, andnoted on index cards. Thematic content analysis was car-ried out, keeping in mind the objective of providing adetailed, complete, and valid description of significantmoments of the postpartum period for first-time fathers.During this initial categorization, incidents were groupedtogether, based on the similarities that could be drawnbetween them. Authors describe this phase as the “de-construction” of the information given by fathers, intosmall units, each independently meaningful (Dubouloz,1996), in this case, “incidents.”

Establishing Their Degree of Specificity

A second categorization was intended at finding differ-ences between incidents. As incidents were examined, itwas questioned whether they belonged in a given catego-ry or not. Five domains were thus identified: self andother as individual, self and other as a parent, self andother as a couple, self and other interacting with the envi-ronment, and self and other interacting with nurses, eachdomain heading one category and a total of 12 subcate-gories (Table 1). Domains are distinct from categories inthat they seem inherent to an individual’s life experience;on the other hand, categories are related more specifical-ly to the postpartum experience, which is why we choseto describe these more fully.

Incident categorization can be a controversial part ofthe critical incident technique (Stromberg & Fridlund,1999). Because data can be categorized in more than oneway, depending on the coder’s frame of reference, re-coding was used to control subjectivity. Three interviewswere selected at random, and an independent judge codedthe incidents and categories. Three experts then judged(with a 95% agreement rate) the categories, subcate-gories, and the classification of the incidents into each cat-egory. This resulted in a regrouping of the initial 85 iden-

tified incidents into 47 distinct incidents experienced byfathers (Table 1). A final step in this analysis was toattribute a positive or negative value to the incidents,based on the father’s report of the incident as having beenpositive or negative for him.

Results

Thirteen fathers identified 289 incidents, with a rangeof 7 to 46 incidents each, which accounted for 47% of the610 incidents reported by both parents; 39% of theseincidents were positive (n = 107), whereas 60.9% (n =176) were negative, meaning that fathers stated that theseincidents had a positive or negative impact on them.

Descriptions of Domains, Categories,Subcategories, and Incidents

Results of this critical incident analysis include adescription of each domain, category, and subcategory,illustrated by fathers’ words.

Self and Other as Individual: Coming to Terms With the Physical and EmotionalChanges During the Postpartum Period

Five incidents related to fathers’ adaptation to theintense changes inherent to the postpartum period werereported in this category, which was filled with negativeexperiences for fathers. Being exhausted is the most sig-nificant event of the postpartum period, as reported by69% of fathers.

“The first night after the birth, it was time I lie down,I was so tired. I wasn’t worried, just exhausted,” saidPeter, while Brian shared, “Taking care of my wife, andthen the baby, I became so tired.”

Self and Other as a Parent: Coping With Parental Demands

This category is divided into three subcategories:knowing, taking care, and feeding their infant, which areall related to parents’ adaptation to their new role.Although fathers report a number of negative incidents inthis category, it contains the largest proportion of positiveincidents (53%). Knowing their infant and taking care oftheir infant are mostly positive experiences for fathers.Brian and Phil shared how holding and comforting theirinfant, giving the infant bath and changing diapers, feed-ing their infant, and rooming in with their infant were sig-nificant incidents for them:

I will always remember those first few days, that first

1. All names have been changed.

Following the birth of their child, first-timefathers experience critical moments during

the immediate postpartum period.


diaper, that first bottle, that first bath, the first time Iheld her after the birth, those are all events that stoodout positively for me. . . . For the first bath, nursesexplained to me how to do, but when I gave it to her, Iwas alone. I was hot all over. She was moving so much.But everything went fine . . . every time I gave her abath, it became easier. I feel closer to my baby, becauseof these experiences. The first time, I was afraid to

break her. Now, whether she cries or not, I feel confi-dent to hold her. It took my stress away, to practice inhospital (Brian).Family life started in hospital, this is where ties tight-ened. Rooming in was very important to me. We hadhim with us for three days and three nights. We wokeup with him in the room. When there was a problem[baby crying], nurses were always there to explain and

TABLE 1Postpartum Incidents Identified by First-Time Fathers

Incidents Related to Coming to Terms With PostpartumChanges

1. Seeing his spouse experience postpartum pain 2. Being exhausted 3. Witnessing his spouse experience a complication related

to birthing4. Witnessing spouse’s postpartum blues 5. Experiencing worries about spouse’s health

Incidents Related to Coping With Parental Demands

Knowing their infant 6. Holding the infant 7. Rooming-in with the infant 8. Consoling the infant 9. Identifying the infant’s reactions 10. Feeling in-love with the infant 11. Experiencing an unusual event with the infant 12. Being worried about the infant’s health

Taking care of the infant 13. Giving the infant a bath 14. Changing diapers 15. Cleaning the umbilicus

Feeding their infant 16. Feeding the infant with a bottle or a glass 17. Feeding the infant by breast 18. Postponing breastfeeding 19. Adapting to breastfeeding in neonatology 20. Positioning the infant at the breast21. Coping with breastfeeding difficulties related to the

infant22. Coping with breastfeeding difficulties related to mother 23. Feeling emotions toward breastfeeding 24. Recognizing signs of the infant’s satisfaction 25. Using breastfeeding aids26. Deciding to cease breastfeeding

Incidents Related to Maintaining Conjugal Functioning

Communicating and sharing emotions 27. Sharing needs, preoccupations, and worries with

spouseResponding emotionally

28. Being supported by spouse 29. Experiencing a loss of intimacy with spouse 30. Giving feedback to spouse

Solving problems 31. Taking decisions as a couple and as parents

Incidents Related to Coming to Terms With EnvironmentalDemands

Knowing hospital routines 32. Being informed of hospital routines

Coping with hospital routines 33. Having specific hours for services 34. Being cared for by different nurses daily 35. Establishing an adequate time for visits 36. Coming to terms with nursery routines 37. Coming to terms with neonatal unit routines

Coming to terms with loss of control over time 38. Being under the impression of waiting 39. Being under the impression of having no respite

Incidents Related to Exchanging Information With Nurses

Obtaining a response from nurses 40. Obtaining a response from nurses in regard to father’s

emotional and physical needs 41. Obtaining a response from nurses in regard to mother’s

emotional and physical needs Giving/receiving information from nurses

42. Sharing needs, preoccupations, and worries with nurses 43. Obtaining appropriate information from nurses

promptly44. Learning that hospital discharge is postponed 45. Receiving contradictory information from nurses

Being praised by nurses 46. Being complimented by nurses 47. Being humiliated by nurses


help us find solutions (Phil).

Feeding their infant contains both the greater number ofincidents of the “coping with parental demands” catego-ry and the greater number of negative incidents. Of theseincidents, 28.9% are related to emotions felt towardbreastfeeding. As Kevin reported: “Breastfeeding waswhat I found most difficult. I didn’t know how to help, Ifelt useless.” “At times, my wife had difficulty breastfeed-ing, it made me so anxious. I just wanted the baby todrink well,” added Nicholas.

Self and Other as a Couple: Maintaining Conjugal Functioning

Maintaining conjugal functioning divides into threesubcategories: responding emotionally, emotion sharing,and problem solving and communicating (Table 1). Oneincident that stands out in the first subcategory is relatedto fathers’ experiencing a loss of intimacy with theirspouse as Max confided:

During the hospital stay, we would take time to betogether just the two of us, but the feeling of closenesswas different, as if I could only see my baby’s motherin her and not my spouse. It was more difficultbetween us, more tense, the whole situation was moretense than easy.

Half the incidents mentioned under “communicating andemotion sharing” are about sharing needs, preoccupa-tions, and worries with spouse, and consists of positiveevents for fathers. As stated by Jake:

I talked with Roxanne, I was learning with her, so Iasked her my questions [about infant care].

Self and Other Interacting With the Environment: Coming to Terms With Environmental Demands

This category also branches into three subcategories:knowing hospital routines, coping with hospital routines,and coming to terms with loss of control over time. Sev-eral interesting data emerge from the analysis of this cat-egory’s incidents, which are highly negative for fathers. Tobe informed of hospital routines represents half the inci-dents described by fathers, all of which are negative.Kevin testified in this sense:

I was filling out forms on breastfeeding, nobody hadexplained them, yet I made some sense of them.Despite that, they kept changing the time she shouldbreastfeed, and nobody explained why.

Steven confirmed: “Father’s rooming-in is allowed, but itdoesn’t seem supported. I was never informed if I couldshower. I didn’t dare ask. I had to go home to shower.”

Fathers named five incidents (incidents #33, #34, #35,#36, and #39, Table 1) in this category, which seemed spe-cific to their experience, because mothers did not mentionthem. Establishing an adequate time for visits posed aproblem for fathers, such as Max:

I wanted to see my friends; I wanted them to see thebaby and my spouse. But it was difficult to determinea good time for a visit. During a feeding, it’s not a goodtime. After a feeding is not a good time also because weneed a rest. And then nurses had work to do. It neverseemed to be a good time.

Being unable to find a respite is another recurrent themein fathers’ experience:

It was one feeding after another; I was under theimpression of having no respite. I knew it would be likethat, but I still found it difficult (Steven).

Self and Other Interacting With Nurses:Exchanging Information With Nurses

Interestingly, although the critical incident interviewdid not encourage stories of interactions with a specificcategory of personnel, only nurses are mentioned as hav-ing been part of significant incidents with fathers duringthe postpartum period. Unfortunately, fathers’ experi-ences with nurses tend to be more negative (63%) thanpositive (36.9%). Giving and receiving information inregard to mothers’ and infant’s health, breastfeeding,infant care, and hospital discharge was generally difficultfor these fathers, as can be sensed in Kevin’s words:

The father wants to know what is happening. At onepoint, it took me two days to obtain results from ablood test done on the baby. Another time, theybrought our infant to the intermediate care unit with-out any explanation. If something is wrong, theyshould tell us without our having to push for the infor-mation. How do we feel as fathers, when they tell us:“We have to keep the infant,” without giving reasons?The father needs to know.”

Receiving contradictory information from nurses wasexpressed in this way:

“Information given by nurses is often different fromone nurse to the next, sometimes even contradictory,”reported Danny. “One would tell us to wash the infantlike this, we would do so, and then another one wouldsay no, not like this. We didn’t know which one to lis-ten to,” added Tim.


Although fathers’ perceptions of the way nurses meetmothers’ needs is generally positive (87.5%), they aremore negative (80%) on how nurses respond to their ownneeds as fathers.

It was important to me that all the involvement I hadhad during pregnancy, childbirth and now, after, berecognized by someone else than my spouse. I wantedothers to be able to recognize my involvement, by sim-ply talking to me, by including me in conversations. Iwasn’t excluded by nurses, they didn’t ask me to leavethe room, but it was a nonverbal exclusion, by the waytheir body was . . . they never asked me how I felt as adad (Peter).

Typology of Fathers’ Experience

After gaining awareness of fathers’ experiences of thepostpartum period, we wondered if there was a pattern tothese experiences. Further data analysis was done to ver-ify if fathers’ experiences varied according to theirinvolvement in the postpartum period. The purpose ofthis analysis was to identify what incidents fathers weresensitive to, related to their postpartum involvement.Postpartum involvement was defined on the basis of twocriteria: (a) fathers’ perceptions of themselves as beingpresent in the postpartum period (“I was absent,” “I wasfairly present,” “I was very involved”) and (b) fathers’report of the frequency and the duration of their visits on

TABLE 2Fathers’ Experience of the Postpartum Period According to Involvement

Length Hours Number of Group Age of Stay on Unit Incidents Categories Reported Experience Profile

Less involved X = 27 X = 2,3 days X = 7.8 hrs X = 12,8 50% reported no 78% of incidentsfathers (n = 4) incidents regarding relate to interactions

physical and emotional with the infant andpostpartum changes nurses75% reported no 47% of incidentsincidents with their relate to the infant.spouse Knowing the infant

accounts for 42% of the incidents in this category

Moderately X = 33.3 X = 2,5 days X = 19 hrs X = 19 25% reported no 77% of incidentsinvolved incidents regarding relate to interactionsfathers (n = 4) physical and emotional with nurses (39%)

postpartum changes, and the infant (38%).relationship with their Feeding the infantspouse and with the accounts for 40%environment of the incidents in

this category. Incidents reported increase to 87% when interactions with their spouse are taken into account.

Highly X = 31 X = 3,6 days X = 88 hrs X = 32 20% reported no 65% of incidentsinvolved incidents with their relate to interactionsfathers (n = 5) spouse. with nurses and theCaesarean: 60% infant.

Knowing the infant accounts for 43% of the incidents in this category, whereas feeding the infant accounts for 45%. Numbers increase to 82% when inter-actions with the environment areincluded.


the postpartum unit, as recorded by an instrument devel-oped by de Montigny (2000). These answers were con-verted into a score of the number of hours spent on theunit. The analysis of the data on the basis of these two cri-

teria allowed three groups of fathers to emerge: lessinvolved fathers, moderately involved fathers, and highlyinvolved fathers. Characteristics of each group aredescribed in Table 2.

Less Involved FathersThese fathers (n = 4) spent an average of 7.8 hours on

the unit during the postpartum period, with duration ofvisits varying from less than 1 hour to less than 8 hours aday. These fathers spontaneously described themselves ashaving been absent during postpartum period, explainingthat they had no paternity leave, had to finish the infant’sroom, or had been sick. The average number of incidentsreported by this group of fathers is 12.8. These fathershighlighted numerous incidents related to getting to knowtheir infant and close to none related to their spouse.

Moderately Involved FathersModerately involved fathers (n = 4) spent an average of

19 hours on the unit, with duration of visits varying from4 to 20 hours each. The average number of incidentsreported by these fathers is 19. Moderately involvedfathers are older and more educated than less involvedand highly involved fathers (Table 2), 75% of them hold-ing a university degree. They also reported a greater per-centage of negative incidents (63.3%) than the fathers inthe other categories (respectively, 55% for less involvedfathers and 58.5% for highly involved fathers). Feedingtheir infant was the highpoint of their postpartum experi-ence.

Highly Involved FathersHighly involved fathers (n = 5) reported an average of

32 incidents and were more likely to be rooming-in, aver-aging 88 hours on the unit during the postpartum stay.These fathers’ wives stayed longer in hospital comparedto less involved fathers and moderately involved fathers(see Table 2) and were more likely to have had a cesarean

section. Highly involved fathers were more likely toreport positive interactions with their infant and theirwife than moderately involved fathers and less involvedfathers. What characterized these fathers is that they wereconcerned about both knowing and feeding their infant,and about their interactions with their environment.

Limits

There are two limiting elements in this study. First, theretrospective interview method depends on individuals’memory and their ability to remember specific eventsrelating to the desired theme (Care, 1996). To minimizethis effect, we proceeded to collect data as soon as possi-ble, following hospital discharge (X = 7-8 days afterbirth). Another limit pertains to all fathers being recruit-ed from the same hospital, thus exposed to the same kindof environment.

Discussion

When this study was begun, it was wondered howfathers perceived the immediate postpartum period andthe nursing interventions in hospital. Because their view-point is different from the mothers’, it was assumed thatfathers’ experience of the immediate postpartum periodwould also be different. The analysis allowed the researchteam to develop an understanding of the paternal experi-ence of the postpartum period, its similarities and differ-ences with mothers’ experience, and most important, itsuniqueness.

The first element that stands out is that fathers’ expe-rience and report a variety of incidents that are critical tothem during this transition phase. Some groups of fathersseem to be particularly touched by this period of life. Forexample, fathers with a short marital history are moreeloquent, reporting numerous events. We can hypothesizethat these fathers are more affected because they havefewer shared experiences with their partner in their shortlife together as a couple, making the postpartum period amore special time.

Fathers who spend more time on the maternity wardduring the postpartum period report more incidents thatare significant for them, which could be expected. Inter-estingly, we note that fathers whose wives stay longer inhospital tend to room-in more. Also to be noted is thatwhen mothers have a cesarean birth, fathers are morelikely to room-in, thus be more involved in infant care.This is congruent with fathers’ socialization, leading themto mobilize their resources in front of a problem. Ourfindings are supported by Fox (1989), who states that acesarean birth might provide more opportunities forfathers to care for their child, thus reinforcing their feel-ing of competence in caring for their infant. Yet we can’thelp but question what accommodations the hospital

Fathers who room-in are more highly involvedand report a more intense experience of the

postpartum period than fatherswho spend less than 6 hours a day on the maternity ward.


environment can provide to fathers so as to favor theirinvolvement in the case of vaginal births, where relativelyfew problems are encountered.

There is still, according to Holland (1995), a belief thatmen are reluctant fathers. Fathers in this research hold adifferent opinion, expressing their motivation to beinvolved and their desire to see this involvement recog-nized by health professionals, especially nurses. Fathersoften feel that society does not recognize their role, whichis frequently being relegated as a support or a breadwin-ner (Jordan, 1990). As shared by a dad in Jordan’s study,“the pervasive message is that the father’s role is to sup-port . . . the new mother” (Jordan, 1990, p. 14). Thefathers in our study deplored not being addressed by nurs-es. They stated that although hospital policies supportfathers’ involvement, in actual fact, access to informationand comfort measures is difficult. One can conclude thatbecause learning infant care skills is a crucial factor inbecoming closer to their child, fathers need conditionsthat promote paternal involvement on the postpartumunit.

What emerges from this study’s results is that, whatev-er the degree of paternal involvement, fathers’ interac-tions with their infant and with nurses are cited by allgroups as significant moments of the postpartum period.In this sense, the typology of fathers’ experience providesuseful information to nurses, orienting them to fathers’preoccupations, whether they room-in or spend relativelylittle time on the unit. However, although “knowing theirinfant” and “taking care of their infant” were regularlymentioned as positive paternal experiences, no fathers inthis study mentioned identifying infant cues as a signifi-cant event. We can wonder if perhaps they were unable todo so, which would indicate learning needs. Feeding theirinfant, especially the breastfeeding experience, was astressful event for fathers in this study. In previous stud-ies, fathers often reported feeling excluded from themother-child unit (Barclay & Lupton, 1999). As Jimremarked: “It is hard to become totally involved whenyou can’t feed him, and this, apart from sleeping, is whathe is predominantly doing” (Barclay & Lupton, 1999, p.1017). This was also reported by some fathers in thisstudy; Dennis, owning up to not feeling very importantfor his daughter yet expressed some hope when he stated“It will come.”

One last result needs to be commented on. Indeed, 5out of 13 fathers (39%, Table 2) reported no significant

event relating to their spouse in the postpartum period.Because it is a well-known fact that a spouse is a father’smain source of support (Dulac, 1997), we are concernedabout this information, as it seems to illustrate that somecouples become isolated from each other during this period.

Implications for Practice, Education, and Research

Implications for PracticePregnancy and childbirth are periods where individuals

can grow as they attempt to reorganize their life. For thecouple, this period is a “critical developmental touchpoint” (Belsky, 1994; Pruett, 1998) where nurses can andshould grasp every opportunity to support fathers andmothers in their transition. Gottman (1991) holds theopinion that when individuals reorganize their life, theyare more open to interventions. Interventions should beintended for both partners (Tomlinson, 1996) becausefavoring only one, traditionally the mother, tends toincrease her developing expertise, which subsequentlytends to increase parental conflict (Lamb, 2001). Severalauthors have recommended the adoption of couple cen-tered interventions (Cowan & Cowan, 2000; de Mon-tigny, 1988, 1991; de Montigny & Dumas, 1993). Con-sidering that few incidents relating to significantinteractions with the spouse were mentioned, we suggestthat nurses act as catalysts to foster interactions betweenboth partners. From the prenatal to the postnatal period,nurses can encourage the couple in terms of mutual rein-forcement of insight and skills; mutual support, whichentails exploring how each partner wants to be supportedand by whom; mutual expressions of emotions, beliefs,worries, and questions; and mutual tasks distribution andproblem-solving skills.

Interventions that influence sensitivity to infant cuesand ability to respond to infant needs are required. Thiscan take the form of interventions aiming to increaseparent-child interactions, as described by Bryan (2000).Nurses can also support the interpretation of infant cuesand encourage the parent to adopt an attitude of discov-ery toward the infant (Rustia & Abbott, 1990).

Individual father-centered interventions need not beexcluded. They can include an acknowledgment offathers’ experience, the offer of various forms of support,and a reinforcement of fathers’ beliefs in their strengthsand capacities. Considering that fathers’ support is animportant dimension in the persistence with breastfeeding(Dumas & Lepage, 1999), nurses need to anticipatefathers’ worries and offer congruent information regular-ly. It has been known for quite some time that fathers’participation in childcare is greatly augmented by infor-

Nurses can make a difference through betterknowledge of the fathers’ experiences.

mation (Dulac, 1998; Geifer & Nelson, 1981; Wanders-man, 1980).

Implications for EducationA recent study conducted by Ménard (1999) with a

Quebec nursing population reveals that nurses do not per-ceive the benefits for fathers to be involved with theirchild. For these professionals, the father’s involvementenhances first and foremost the well-being of the motherand the child, offering support for the former and attach-ment ties for the latter. Perinatal nursing competenciesdrawn from AWHONN’s Family Centered Standards forPerinatal Nursing (1999) specifically state that “perinatalnurses should seek out opportunities to promote confi-dence in the woman and her family by assessing and rein-forcing their abilities to care for their newborn while rec-ognizing their particular vulnerability during the earlypostpartum period.” This, however, doesn’t seem totranslate into actual nursing care. It appears that theimportance of fathers’ involvement for themselves has yetto be grasped by health professionals. The latest researchfindings on fathers’ involvement, impeding and contribut-ing factors, and implications for nursing interventions areusually integrated in perinatal nursing curricula and in in-service continuing education programs. We suggest thatthe critical incidents reported by fathers in this study beadded to this content to underline the significance of thepostpartum period for first-time fathers.

Implications for ResearchFathers are “active, purposeful parts of an integrated

complex and dynamic person-environment system”(Magnusson & Stattin, 1998, p. 685) for whom interac-tions with significant others as well as the context inwhich these interactions take place are likely to be salientissues in the developmental outcomes observed (Bronfen-brenner & Ceci, 1994). Fathers in this study testified howsignificant were the interactions with nurses, with theirpartner, and with the environment in their adaptation tothe immediate postpartum period. This seems to call forfurther investigation of the impact of these interactionsand this context on fathers’ development of “self as afather.” One crucial dimension of this developmentalphase is the construction of self-efficacy beliefs in regardto the parenting role (Zahr, 1991). In this line of thought,it seems called for to include fathers in the exploration ofthe impact of the postpartum context and interactionswith significant others (nurses and partners) on both par-ents’ perceptions of parental efficacy. It is important toinvestigate these themes because if helping practices andpostpartum context end up being predictors of perceivedparental efficacy, this will guide future political and pro-fessional practices.

Conclusion

The culture of fatherhood has been known to changemore rapidly than practice (LaRossa, 1988). This studyraises questions on how the modern hospital environmenthas been able to develop father-friendly practices and atti-tudes. These fathers’ testimonies emphasize the fact thatthere seems to coexist more than one form of fathering,characterized by a diversity of behaviors and styles ofinvolvement. For all fathers involved, interactions withtheir babies and with nurses are significant aspects oftheir postpartum experience. Nurses are in a crucial posi-tion to support fathers in a way that fathers feel goodabout themselves, their abilities, and their infant. Thisenhances their motivation to interact with and care fortheir infant (Bandura, 1996; Bryan, 2000). Interventionsthat increase mutual conjugal support offer an economi-cal way of enhancing family health (Bryan, 2000),because professional help cannot replace the day-to-daysupport that mothers and fathers provide for each other.

Acknowledgments

This research was funded by a doctoral grant from theSCHRC (Social Sciences and Humanities Research Coun-cil of Canada). We would like to thank Ms. NoëllaTremblay-Carreau, Ms. Françoise Courville, and Ms.Linda Bell, who have gracefully judged this research’sdomains, categories, and incidents, and Ms. Marlise Vlas-blom and Ms. Nicole Duquet for the revision of the Eng-lish version of this text.

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Francine de Montigny, RN, BScN, MScN, PhD, is director ofthe Department of Nursing at the University of Québec inOutaovais.

Carl Lacharité, PhD, is a professor & director at the ResearchGroup in Child and Family Development in the Department ofPsychology, Université du Québec à Trois-Rivières, Québec,Canada.

Address for correspondence: Francine de Montigny, M.Sc.N.,Ph.D., Director of Nursing, Department of Nursing, Universitédu Québec en Outaouais, C.P. 1250, Succ. Hull, Gatineau,J8X-3X7, P.Q.Canada; E-mail: [email protected].

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Fathers' Perceptions of the Immediate Postpartal Period