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THROUGH THE EYES OF A NEW DAD: EXPERIENCES OF FIRST-TIME FATHERS OF LATE-PRETERM INFANTS KAREN M. BENZIES

University of Calgary JOYCE MAGILL-EVANS

University of Alberta Fathers of late-preterm (34–36 weeks’ gestation) infants may experience challenges in parenting. Late-preterm infants are more irritable and less responsive in interactions. The unexpected early birth of an infant may negatively affect fathers’ cognitive and emotional experiences. The Father–Infant Interaction Program (FIIP) is a video-modeled play intervention that aims to increase fathers’ sensitivity and responsiveness to infant cues. Using data from a larger randomized controlled trial (RCT) to evaluate FIIP, the purpose of the present study was to explore the experiences of first-time fathers of late-preterm infants and their perceptions of the intervention. We conducted semistructured qualitative interviews with 85 fathers of 8-month-old infants during the outcome home visit for the RCT and thematically analyzed data. Three main themes about fathers’ experiences emerged: Fathers believed they had the “best job in the world,” yet saw fathering as the “biggest job ever.” Fathers viewed fatherhood as an opportunity for personal growth and reflected on how their lives had changed since the arrival of their infant. Fathers in the intervention and comparison groups liked the convenience of the home visits and validation of their role as a father. Fathers in the intervention group liked the tailored feedback about play.

ABSTRACT:

Los pap´as de beb´es prematuros tard´ıos (34 a 36 semanas de gestaci´on) pudieran experimentar retos en la crianza. Los beb´es prematuros tard´ıos son m´as irritables y menos sensibles en las interacciones. El inesperado temprano nacimiento de un infante pudiera afectar negativamente las experiencias cognitivas y emocionales de los pap´as. El Programa de Interacci´on entre Pap´a e Infante (FIIP) es una intervenci´on de juego v´ıdeo modelado que busca incrementar la sensibilidad y capacidad de respuesta de los pap´as a las se˜nales de los infantes. Usando datos procedentes de un ensayo controlado aleatorio (RCT) para evaluar la FIIP, el prop´osito del presente estudio fue explorar las experiencias de pap´as primerizos de beb´es prematuros tard´ıos y sus percepciones de la intervenci´on. Llevamos a cabo entrevistas cualitativas semiestructuradas con 85 pap´as de beb´es de 8 meses de edad durante la visita a casa para el resultado del RCT y analizamos los datos tem´aticamente. Tres temas principales acerca de las experiencias de los pap´as surgieron: los pap´as cre´ıan que ten´ıan el “mejor trabajo del mundo,” y aun as´ı ve´ıan la crianza en su papel de pap´a como el “trabajo m´as grande que hab´ıan tenido.” Los pap´as ve´ıan la paternidad como una oportunidad de crecimiento personal y reflexionaron sobre c´omo sus vidas hab´ıan cambiado con la llegada de sus infantes. A los pap´as en los grupos de intervenci´on y comparaci´on les gustaba la conveniencia de las visitas a casa y el que se validara su papel como pap´a. A los pap´as en el grupo de intervenci´on les gustaban los comentarios a la medida acerca del juego.

RESUMEN:

´ ´ RESUM E:

Les p`eres de b´eb´es pr´ematur´es tardifs (34 a` 36 semaines de gestation) peuvent faire l’exp´eriences de difficult´es et de d´efi avec le parentage. Les b´eb´es pr´ematur´es tardifs sont plus irritables et moins r´eactifs durant les interactions. La naissance pr´ecoce n’´etant pas attendue paut affecter de mani`ere n´egative les exp´eriences cognitives et e´ motionnelles des p`eres. Le programme d’Interaction P`ere-B´eb´e (abr´eg´e en anglais FIIP pour FatherInfant Interaction Program) est une intervention de jeu model´ee sur une vid´eo, qui a pour but d’augmenter la sensibilit´e des p`eres ainsi que leur r´eactivit´e aux signes du b´eb´e. En utilisant des donn´ees d’essai randomis´e contrˆol´e (ERC) pour e´ valuter le FIIP, le but de cette e´ tude e´ tait d’explorer les exp´eriences de p`eres (p`eres pour la premi`ere fois) de leurs b´eb´es pr´ematur´es tardifs et leurs perceptions de l’intervention. Nous avons proc´ed´e a` des entretiens semi-structur´es qualitatifs avec 85 p`eres de b´eb´es de 8 mois durant la visite a` domicile de r´esultat pour l’ERC et analys´e les donn´ees de mani`ere th´ematique. Trois th`emes principaux sur les exp´eriences des p`eres ont e´ merg´e: les p`eres pensaient qu’ils avaient “le meilleur travail au monde,” et cependant voyaient la paternit´e comme “le plus dur travail au monde”. Les p`eres percevaient la paternit´e comme une chance de s’´epanouir personnellement et ont parl´e de la fac¸on dont leur vie a chang´e depuis l’arriv´ee de leur b´eb´e. Les p`eres de l’intervention et des groupes de comparaison

We are grateful to the Alberta Centre for Child, Family and Community Research (Grants 0802INV-Benzies and 07SM-Benzies) and Alberta Innovates Health Solutions, Preterm Birth and Healthy Outcomes Team (Grant 200700595) for research funding. Lyndsey Ritz, Alberta Innovates Health Solutions, Summer Student, coded the data. Direct correspondence to: Karen M. Benzies, Professional Faculties 2222, 2500 University Drive NW, Calgary, Alberta, Canada T2N 2N4; e-mail: [email protected]. INFANT MENTAL HEALTH JOURNAL, Vol. 36(1), 78–87 (2015)  C 2014 Michigan Association for Infant Mental Health View this article online at wileyonlinelibrary.com. DOI: 10.1002/imhj.21489

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Fathers of Late-Preterm Infants



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ont aim´e l’aspect pratique des visites a` domiciles et la validation de leur rˆole de p`ere. Les p`eres dans le groupe d’intervention ont aim´e le retour d’information sur mesure a` propos du jeu. V¨ater von sp¨aten Fr¨uhgeborenen (34. bis 36. Schwangerschaftswoche) k¨onnen Herausforderungen in der Elternschaft erleben. Sp¨ate Fr¨uhgeborene sind reizbarer und weniger responsiv in Interaktionen. Die unerwartete fr¨uhe Geburt eines Kindes kann sich negativ auf das kognitive und emotionale Erleben der V¨ater auswirken. Das Vater-Kind-Interaktions-Programm (Father-Infant Interaction Program, FIIP) ist eine video-basierte Spielintervention, die darauf abzielt, das Einf¨uhlungsverm¨ogen und die Responsivit¨at der V¨ater hinsichtlich der Signale der S¨auglinge zu erh¨ohen. Es wurden Daten aus einer gr¨oßeren randomisierten Kontrollstudie (RCT) genutzt, um das FIIP zu evaluieren. Das Ziel der vorliegenden Studie war es, die Erfahrungen der Erstv¨ater von sp¨aten Fr¨uhgeborenen und ihre Wahrnehmungen hinsichtlich der Intervention zu untersuchen. Wir f¨uhrten halbstrukturierte qualitative Interviews mit 85 V¨atern von 8 Monate alten S¨auglingen w¨ahrend eines Hausbesuchs f¨ur die RCT durch und analysierten die Daten thematisch. Drei Hauptthemen u¨ ber die Erfahrungen der V¨ater entstanden: V¨ater glaubten, sie hatten den "besten Job der Welt", doch sahen die Vaterschaft als den "gr¨oßten Job u¨ berhaupt”. Die V¨ater sahen die Vaterschaft als Chance f¨ur pers¨onliches Wachstum und reflektierten dar¨uber, wie sich ihr Leben seit der Geburt ihres S¨auglings ver¨andert hatte. Den V¨atern in der Interventions- und Vergleichsgruppe gefiel die Annehmlichkeit der Hausbesuche und die Best¨atigung ihrer Rolle als Vater. Die V¨ater in der Interventionsgruppe mochten das auf sie zugeschnittene Feedback u¨ ber das Spielen.

ZUSAMMENFASSUNG:

dd:ddddddlate preterm infants(dd34dd36d)ddddddddddddddddddddddddddddddd ddddddddddddddddddddddddddddddddddddddddddddddddddddddddddd ddddddddddddddddddd The Father-Infant Interaction Program (FIIP) dddddddcueddddddddddddd ddddddddddddddddddddddddddvideo-modeledddddddddddddddddddddFIIPdddddd dddddddddddddddddd(RCT) dddddddddddddddddddddddddddddddddddddd ddddddddddddddddddddddddddddd8dddddd85ddddddRCTddddddddddddddd dddddddddddddddddddd3ddddddddddddddddddddddddddddddddddddddd dfatheringdddddddddddddddddddddddddddddddfatherhooddddddddddddddddddddd dddddddddddddddddddddddddddddddddddddddddddddddddddddddddddd ddddddddddddddddddddddddddddddddddddtailoreddddddddddddd ABSTRACT:

(34 36) −(FIIP), (RCT),FIIP, ,RCT,858,, :

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* * * Fathers have an important role in nurturing their children (Carpenter, 2002). Fathers want to be involved with their infants and are eager to learn how to promote their child’s growth and development in the best possible way (Bell et al., 2007). Fathers have become increasingly involved in childcare (Harrington, Van Deusen, & Ladge, 2010; McVeigh, St John, & Cameron, 2005; O’Brien, Brandth, & Kvande, 2007) and make unique contributions to their children’s development (Cabrera, Shannon, & Tamis-

LeMonda, 2007; Lamb, 2010; Sarkadi, Kristiansson, Oberklaid, & Bremberg, 2008; Shannon, Tamis-LeMonda, London, & Cabrera, 2002). Yet, feeling left out is common for new fathers (Chin, Hall, & Daiches, 2011; Steen, Downe, Bamford, & Edozien, 2012). Fathers have described themselves as “bystanders: more detached than they expected or wanted to be” (Deave & Johnson, 2008, p. 631), highlighting the need to identify appropriate supports for new fathers, which likely differ from those that mothers may

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need (Buckelew, Pierrie, & Chabra, 2006). In addition to changing relationships within the family, early fatherhood can generate a range of cognitive and emotional experiences (Goodman, 2005). Late-preterm (34–36 weeks’ gestation) is a fairly new category (Engle, 2006) that accounts for 66% (Laughon, Reddy, Sun, & Zhang, 2010) to 74% (Davidoff et al., 2006) of all preterm infants. Late-preterm infants are at increased risk for adverse outcomes, including developmental delays (Chyi, Lee, Hintz, Gould, & Sutcliffe, 2008; Kinney, 2006; McGowan, Alderdice, Holmes, & Johnston, 2011; Samra, McGrath, & Wehbe, 2011; Teune et al., 2011). Late-preterm infants are born with an immature brain and central nervous system (Kinney, 2006). This immaturity makes late-preterm infants more challenging social partners because they send disorganized cues and are more irritable and difficult to soothe (Ludwig, 2007). Both mothers and fathers of healthy preterm infants had significantly less optimal interactions with their child at 3 and 12 months, as compared to parents of term infants (Harrison & Magill-Evans, 1996). Without intervention, parents’ interactional skills decreased over time, and fathers of preterm infants had lower scores than did their mothers (Harrison & Magill-Evans, 1996). There are many programs designed to improve the mother– infant interaction (Benzies, Magill-Evans, Hayden, & Ballantyne, 2013) and a few to support interactions between fathers and earlier preterm infants ( $40,000, Canadian) Child Gender (%male)

Two-Visit Group (n = 33) Frequency (%)

Four-Visit Group n = 18 Frequency (%)

Comparison Group n = 34 Frequency (%)

Total N = 85 Frequency (%)

25 (75.8) 20 (60.6) 32 (97.0) 31 (93.9) 19 (57.6)

14 (77.7) 16 (88.9) 16 (88.9) 18 (100) 10 (55.6)

25 (73.5) 28 (82.4) 31 (91.2) 32 (94.1) 20 (58.8)

64 (75.3) 64 (75.3) 79 (92.9) 81 (95.3) 49 (57.6)

Note. After excluding dropouts, groups remained equivalent when data were collected from the qualitative subsample. For example, the difference in proportions of fathers who were European Canadian was not statistically significant from fathers of other ethnicities, χ 2 (1, N = 85) = 14.83, p = .79.

RESULTS

Regardless of study group, three main themes about fathers’ experiences emerged. Participants found fathering the “best job in the world” and the “biggest job ever,” and saw fatherhood as an opportunity for personal growth. Regarding their participation in the study, fathers liked the home visits and affirmation of their role as a father. Fathers recommended easily accessible information and resources to improve their confidence and skills as a father. Fathers’ Experiences: Best Job in the World—The Joys of Fatherhood

Fathers described fatherhood as “awesome,” “fulfilling,” “very rewarding,” “a whole lot of fun, and a lot of work,” and the “best thing ever.” Categories that contributed were spending time with the baby, watching the baby grow and learn, and being recognized by the baby. Spending time with the baby. Fathers spoke animatedly about “spending time with [the] baby.” One father stated, “[I] love when [I] can spend the whole day with the baby.” Another loved “getting on the floor and watching him play,” and yet another liked “taking [the] baby for walks in the park.” Many fathers liked “playing in the bathtub” and “putting him to bed.” One father liked that he could “teach him more now that he is older.” Spending time with the baby was a positive aspect of their experiences. Watching baby grow and learn. Most fathers expressed amazement at how quickly their babies changed, and one stated “There is something new every day.” A father was “amazed at pace of development. . . . one day she can’t and the next day she can.” Another father stated “She does things that shock and amaze me,” and “She’s an angel and its great watching her grow up.” Fathers liked to be part of their baby’s milestones, and 1 father stated that he looked “forward to each new step and each new development” and that it was exciting “to see her at different ages.” Fathers experienced wonder and joy at the opportunity to watch the child accomplish new tasks. Always excited to see Dad. Many fathers talked of being recognized and greeted by the baby at the end of the workday. One father

articulated his joy when the baby “hears the door and wants to play. . . . nothing can make [me] happier.” Another father said “Every day I get home—she just lights up to see me.” Another stated “I enjoy that he smiles at me, that I make him happy, and that he knows who I am.” Similarly, another father stated “He knows his dad—it’s so precious.” The baby’s recognition and excitement contributed to the joys of fatherhood. Fathers’ Experiences: Bigger Job Than Ever Imagined—The Challenges of Fatherhood

Fathering was a bigger job than fathers imagined and was at times “overwhelming” and “tiring.” Their experiences “started out being tough but every month gets easier and easier.” Some fathers found fathering “stressful sometimes, especially during the work week.” Specific concerns centered on keeping the baby safe, meeting developmental milestones, self-confidence in the fathering role, providing for the family, and balancing home life and work. Keeping baby safe. There were concerns about “keeping him safe from accidents” and “making sure she grows up strong.” One father was clear that his role was ensuring “baby’s overall well-being and his long term mental and physical health.” One father was worried “about someone kidnapping her.” Another stated “Stories in the news. . . . especially when they involve children . . . make [me] feel very protective.” One father asked “Where is the fine line between being overprotective and not caring?” Thus, fathers addressed the challenges of their role as supporter and protector. Lagging behind. Fathers were aware of their baby’s developmental progress. One father stated “She is not talking a lot—vocalizing; but we don’t hear specific sounds yet.” A father noted that his baby “seems to be developmentally slower than others,” and another said “She is gaining less weight than she should.” Another father sought information about his concern from the home visitor, “Some of his cousins are the same age and walking—should he be walking?” Several fathers of these late-preterm infants were keenly aware of whether their child was meeting developmental milestones. Yet, none of the fathers attributed their concerns about development delay directly to preterm birth.

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Am I able to do this? Confidence in the fathering role was an issue. One father asked “Am I doing a good job and being a good parent?” Many expressed frustration when “not knowing how to soothe her.” Other frustrations arose when fathers did not “know what the baby wants” and when the baby “doesn’t want to sleep.” They spoke about the importance of information, but were unaware of where to find it: “We don’t know where to go for information to help us be better parents.” Another father was concerned about “making sure I have all the tools necessary to meet my child’s needs.” Thus, fathers struggled with confidence and seemed to have limited knowledge of relevant information and resources. Providing for family. Some fathers had concerns about the stability of their jobs and “money concerns.” Others were concerned about life insurance and being “able to provide the opportunities to meet the baby’s needs.” The provider role was important to these fathers and was expressed in different ways. Balancing home and work. Most fathers had concerns about balancing the demands of home life and work life. One father was “not getting to spend enough time with the baby.” For most, the provider role conflicted with wanting to spend time with the baby. They would like to “spend more time with the baby, but had to work,” and noted that “finding time after working is sometimes challenging.” Fathers’ Experiences: Fatherhood as an Opportunity for Personal Growth

Many fathers described fatherhood as an opportunity for personal growth through personal change and exploring how their experiences of fatherhood aligned with their expectations. Another concept that emerged was “worried about being a terrible father like mine. My dad was never around. . . . [I] want to be there for my baby when he needs me. . . .” Fathers described the transition to fatherhood as better than they expected and revealed how fatherhood made a huge difference in their lives. Better than expected. In comparing their experiences with their expectations, fatherhood was “better than I could have ever hoped it could be.” One father stated that he “enjoyed it a lot more than I thought I would.” Some participants’ experiences aligned with their expectations: “[Fatherhood] has been a lot of what I expected.” No fathers shared that their experiences were worse than expected. Huge difference in my life. Fathers reflected on the personal growth and changes that they experienced when becoming a father. One father talked about how fatherhood “changed everything including my feelings about life, the way I live my life, my expectations for the future—I am more hopeful.” Although fatherhood was a “big learning experience,” 1 participant spoke about how fatherhood “helped me to become more mature and responsible,” and

another described increased “patience” as part of the change he experienced. What Did Fathers Like/Dislike About the Study?

We asked fathers about what they liked or found interesting about the study. Fathers’ voiced concerns about being valued in their role as a father. One father stated “Originally I wanted to be in the study because I felt excluded. . . . I felt like less than a shadow in the room. . . . I wanted to get dads more noticed for their efforts. Parenting is stereotypically focused on mothers. . . . We need to change that.” Another father stated that “There is a mindset that dads don’t get involved with their babies until [age] 3 years. [We] need to change that.” In the next section, we organize the categories separately for fathers in the intervention and comparison groups, and then present the categories that overlapped both groups. Fathers in the two- and four-visit intervention groups. Fathers learned about the “importance of interaction,” and “watching the video offered the opportunity to view the interaction from a fresh perspective.” They liked “the guidance for interactions between dad and baby,” “reading the baby’s body language,” and “seeing things that you don’t usually think about.” One father liked reviewing the video recording “to see myself and how I interact and how she responds.” For another father, “The first visit was my first time alone with her, and that visit made me feel more comfortable being alone with her.” Fathers in the intervention groups learned about the importance of interaction and liked reviewing the video recording with feedback from the home visitor. Fathers in the comparison group. Fathers experienced an increased awareness of themselves and the baby. One father found that participation “initiated a conversation with my father about fathering.” Some fathers were concerned about the child’s performance during the structured play task; that the “baby would not be able to complete the task.” Despite receiving information about ageappropriate play, 1 father “had difficulty choosing an activity” for the structured play interaction (outcome for the RCT) because he was “unsure if the baby was ready to learn it.” Thus, fathers in the comparison group were more focused on their baby’s performance while fathers in the intervention group were more aware of being responsive to the baby. Categories overlapping the intervention and comparison groups. Fathers in both groups liked the one-on-one time with their child and affirmation of their fathering skills. “[It was] good to have outside confirmation that I am a good dad.” Participating in the study helped “to reflect on the joys and benefits of being a dad.” The questionnaires helped fathers to think about aspects of fatherhood that they had not previously considered. Some fathers in both groups found it difficult to be video recorded. “Playing with the baby on camera was intimidating.” “It was weird looking at myself on video.” Yet, many fathers were unconcerned about being video recorded: “Nothing about the videos was difficult.” Fathers

Infant Mental Health Journal DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.

Fathers of Late-Preterm Infants

in both groups found it challenging to keep the baby focused on the structured teaching task. Participation in the study seemed to create a cognitive space for fathers in both groups to reflect on various aspects of their role and receive affirmation of their parenting role. What Do Fathers Recommend?

Fathers wanted interventions that developed their knowledge, skill, and confidence and that were tailored to meet a variety of needs. A program that builds knowledge, skill, and confidence. Fathers in the intervention and comparison groups wanted an intervention with ongoing access to information with “more suggestions or links to resources for further learning.” They wanted a program that builds skills and confidence. One father in the intervention group found the “comments during first visit about how she learns and different ways to play very helpful . . . [and I] carried those through into ongoing learning and playing opportunities.” Fathers were able to transfer their learning to other contexts. Thus, a program that builds knowledge, skill, and confidence should provide ongoing access to information and resources as well as validation of the role of fatherhood and individual fathering abilities. Tailored convenient programming. Fathers in all groups found the visits “very convenient with you coming to the home.” Fathers in the four-visit intervention group suggested another visit at 12 months. In terms of timing, fathers supported 4 months as the right time to start a program for fathers. Some fathers wanted the intervention to continue: “A full year of visits would be great . . . like having a teacher come once a month to help guide.” Fathers in the comparison group wanted more frequent visits, with 1 father stating, “better to come more often . . . babies grow so fast . . . [You] need to come every month,” although the “number of visits depends upon the needs of the dad.” Participants suggested that “some fathers will need more visits than others so [the program] needs to be flexible.” One father in the comparison group thought a program would be most helpful to fathers “who are less in tune with being a dad or who are afraid of fatherhood or who need help or reassurance about daddy skills.” Another father in the comparison group suggested having “a group visit with babies the same age range . . . then we could compare our babies to see how they were doing.” Fathers liked having a healthcare professional as the home visitor; 1 father “found comfort in knowing he could ask questions regarding the baby.” Another father suggested a “male home visitor for [a] better relationship.” Thus, fathers’ recommendations about an ideal program varied, which reinforces the idea of program components tailored to the needs of the father and the family. DISCUSSION

Our qualitative study provides insights into fathers’ experiences of parenting a late-preterm infant and recommendations for supportive interventions. To our knowledge, this is the first study that gives voice to the experiences of these fathers and their recommendations



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for interventions. In the present study, fathers expressed positive experiences associated with spending time with their baby, watching the baby grow and learn, and being recognized by the baby. This finding is similar to that of Deave and Johnson (2008), who identified amazement and love as the positive cognitive and emotional responses during the transition to fatherhood. However, in a meta-synthesis of fathers’ experiences that included the Deave and Johnson study, Chin et al. (2011) identified emotional responses during pregnancy and up to 2 years’ postbirth that were more negative than positive. These negative emotions (detachment, surprise, and confusion) were aligned with the challenging aspects of the transition to fatherhood identified by Deave and Johnson. In contrast, Svensson, Barclay, and Cooke (2006) reported rapidly changing emotions up to 8 weeks’ postbirth that ranged from joy, to anxiety, to uncertainty; somewhat like riding a “roller coaster” (p. 22). The contrasting positive and negative experiences may be related to the phases in the new parenting role. In a grounded theory study of first-time mother–father–infant triads, Bell et al. (2007) described three phases during the transition to parenting. At 1 week’ postbirth, the family was an “undifferentiated family unit” (p. 187), with individual members learning how to interact in new ways. By 6 weeks, mother–infant and father–infant dyadic interactions were paramount, and maternal perceptions of weakness in the father–infant relationship were related to less paternal involvement in the care of the infant. Stronger parent–infant relationships created tension in the couple relationship and disruptions in family cohesiveness. By 16 weeks, the time when the current study began, the family unit was more integrated with defined role boundaries for the mother and father in relationship to their infant. These phases are consistent with “relational synchrony” described by Palkovitz (2007). However, fathers in the Palkovitz study believed they needed to work harder than did mothers on developing a relationship with their infant. In addition, the more positive experiences of fathers of late-preterm infants in the present study may be related to their participation in the FIIP. All fathers in the present study received home visits to collect data, which may have served to value and affirm their role as a father, regardless of whether the father received the self-modeled video-interaction guidance and feedback intervention. The construction of gendered roles in the family may affect how fathers operationalize their fathering role. Given that most fathers feel more confident with play, they distinguished their role from mothers as play partner for the infant (Lamb & Tamis-LeMonda, 2004). While fathers may want to be involved with their infants, they may inadvertently adopt roles as helpers that remain unchallenged by mothers who inadvertently reinforce traditional role boundaries (Petrassi, 2012). This may be especially true in the case of very preterm children who remain in the hospital for long periods when fathers must return to work and mothers remain at the infant’s bedside (Arockiasamy, Holsti, & Albersheim, 2008; Deeney, Lohan, Parkes, & Spence, 2009; Helth & Jarden, 2013). Steen et al. (2012) conducted a meta-synthesis of fathers’ encounters with pregnancy and postpartum care where men found themselves in an “interstitial, undefined space” (p. 430) that

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generated feelings of uncertainty, exclusion, and fearfulness. Similarly, findings from Sweden (Hildingsson & Sjoling, 2011) have suggested that fathers feel like “strange visitors in the women’s world” (p. 265). Fathers in an Australian study by Rowe, Holton, and Fisher (2012) reported similar feelings of exclusion, with the father viewed as a helper to the mother rather than as a parent during the early postpartum period. In a Scottish study of first-time fathers, support was perceived as what was given to the mother and not to themselves (Bradley, Boath, & Mackenzie, 2004). These feelings of detachment and discontent during a life-changing transition may be problematic, given fathers’ desires to be more involved with their young children and the perceived value of their contributions to child development (Goodman, 2005). In contrast, relatively few fathers in the current study expressed feelings of being left out. Given that fathers were offered an intervention specifically for them, it may be that an acknowledgment of fathering was implicit within this study. In the present study, fathers’ views about elements of fathering that contributed to their joy in fatherhood included spending time with the baby, the wonder of watching him or her grow and learn, and being recognized by the baby when he comes home after work. Similar to the theme of “reaping rewards” in Goodman’s (2005, p. 194) meta-synthesis, the fathers in the current study wanted to be more involved with their infant because they found the role rewarding. These rewards, such as being recognized by the baby, contributed to fathers’ desires to spend more time with baby and be able to watch in wonder at how quickly the child was changing. Typically, time with the baby was constrained by the provider role, and fathers commented on the challenges of balancing time at home and work. Fathers have expressed inadequacy as a result of having to return to work, a sense of guilt for not being at home with mom and baby, and for returning home when the child is already asleep (Jackson, Ternestedt, & Schollin, 2003). Several of these fathers (Jackson et al., 2003) reported being less involved than they wanted, a sentiment that was echoed by fathers in the current study. This speaks to the desire of fathers to have paternal leave and greater flexibility at work—an option that is afforded to many women who return to the workforce after childbirth. Having a preterm baby—the lack of preparedness for baby and the unknown developmental outcomes—can be very stressful for both mother and father. Stress can interfere with the parent– child relationship and create behavioral issues in the child several years later (Ramchandani et al., 2012). Reducing stress through interventions geared specifically toward the needs of fathers of preterm children could help to reduce adverse child developmental outcomes by increasing sensitivity to their child’s cues. Fathers who participated in a home intervention study aimed at interpreting and acting upon early preterm infant cues showed decreased stress levels; furthermore, the more visits the fathers participated in, the greater the stress reduction (Kaaresen, Ronning, Ulvund, & Dahl, 2006). Those families who participated in the intervention showed similar stress levels to those of the full-term control families at 12 months (Kaaresen et al., 2006). In this study, fathers in the

intervention group stated that they liked learning about their babies’ cues and the importance of interaction. For some fathers in the present study, their participation provided them with time to reflect and increase awareness of their own fathering. How men parent is contingent on their experiences of being parented, their perceptions of the fathering role, and how they perceive themselves in that role (Nicholson, Howard, & Borkowski, 2008). Similarly, Chin et al. (2011) reported that fathers matured and developed personally in their new fathering role. Part of this change was the increased awareness of self as father and the importance of the fathering role to the development of his child, specifically in the role of provider (Chin et al., 2011). Fathers’ comments about the importance of the fathering role were reported in a Swedish study (Fagerskiold, 2008) in which they described their changing life as “enormous, much bigger than you could imagine” (p. 66). First-time fathers who were able to incorporate their child into their existing life seemed to be least disrupted by the change of bringing a baby into the family (Bradley et al., 2004). A novel finding in the present study was fathers’ concerns about keeping their infant safe and secure. In part, their concern was related to preventing injury and managing child illness. The other contributing factor was security of the child, specifically related to the very rare instance of abduction. With increasing emphasis of protecting privacy, we noticed greater difficulty in recruiting families for a study that included home visits because many families preferred not to have any unnecessary people in their homes. While fathers in the present study did not comment specifically on their infant being late-preterm, they expressed concerns about how their child was developing relative to other children the same age. They were interested in information and advice that will help build and strengthen their skill and confidence as a father (Rowe et al., 2012). Fathers recommended that they wanted information that was accessible and tailored to meet their needs. In another study of Web-based information for fathers during the antenatal period, the most popular information was related to father– infant interaction (baby games and father–infant bonding), with information about breast-feeding and sex of least interest (Fletcher, Vimpani, Russell, & Keatinge, 2008). While Web-based learning is popular, both mothers and fathers prefer experiential learning (Svensson et al., 2006), as offered in the current study. In a small study (N = 23) of Australian fathers who were the predominant users of an Internet chat room, posts suggested the need for groups for fathers only, information about skills, and an opportunity to seek opinions about social issues (StGeorge & Fletcher, 2011). In a population sample of fathers of infants up to age 1 year, Tiller (1995) found that the greatest need for information about child development and parenting was at age 3 months. Although fathers in the present study suggested that age 4 months was an appropriate time to begin an educational intervention targeting father–infant interactions, the provision of information at an earlier age may have been a useful adjunct to the intervention. This study is limited by the inclusion of a convenience sample of cohabiting fathers who were mostly highly educated and

Infant Mental Health Journal DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.

Fathers of Late-Preterm Infants

employed. Our findings may not be transferrable to settings without national healthcare insurance and to other populations of fathers, including adolescent fathers, those with less education and income, and nonresident fathers. Note that home visits in the intervention and comparison groups were different, and feedback from fathers in the different groups may or may not mean the same thing. For the purposes of understanding fathers’ perceptions of the intervention, greater attention should be focused on the feedback from fathers in the two intervention groups. Future research should include a comparison of the differences in how fathers of full-term, late-preterm, and early preterm infants gain knowledge, skill, and confidence in parenting. More evidence is needed to clarify the format to deliver educational interventions for fathers (e.g., Webbased, face-to-face, self-modeled video with feedback). Finally, future research needs to examine whether fathers prefer to receive information and support individually or as a couple. Implications for Practice

Practitioners caring for families with infants need to recognize the profound impact of the transition to fatherhood in the same way that we have long recognized the transition to motherhood (Barclay, Everitt, Rogan, Schmied, & Wyllie, 1997; Rogan, Shmied, Barclay, Everitt, & Wyllie, 1997; Rubin, 1984). It is important that practitioners acknowledge the joys of a first-time father and address their concerns. Fathers have negative perceptions of help-seeking (Devault, Gaudet, Bolte, & St-Denis, 2005). This places additional onus on practitioners to invite fathers to be involved (Fagerskiold, 2006; Hildingsson & Sjoling, 2011) and advise them about fathers’ groups and other sources of personal support for fathers (Hildingsson & Sjoling, 2011), in addition to education that includes discussions of gendered roles in parenting and how these influence parenting choices (Cowdery & KnudsonMartin, 2005). Practitioners may wish to target interventions for fathers in environments where they are already present, such as the workplace (Devault et al., 2005). These elements should be considered in conjunction with the suggestion from 1 father in this study to have male “health care providers” provide information to fathers. Timing of interventions also is important, as suggested by participants in this study, where 4 months was an appropriate start time, and monthly visits were appreciated due to the rapid changes in young children. Fathers recommended tailored, father-oriented programs that incorporate individualized advice and guidance from a professional. REFERENCES Arockiasamy, V., Holsti, L., & Albersheim, S. (2008). Fathers’ experiences in the neonatal intensive care unit: A search for control. Pediatrics, 121(2), e215–e222. doi:10.1542/peds.2007-1005 Barclay, L., Everitt, L., Rogan, F., Schmied, V., & Wyllie, A. (1997). Becoming a mother—An analysis of women’s experience of early motherhood. Journal of Advanced Nursing, 25(4), 719–728. doi:10.1046/j.1365-2648.1997.t01-1-1997025719.x



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Infant Mental Health Journal DOI 10.1002/imhj. Published on behalf of the Michigan Association for Infant Mental Health.

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Through the eyes of a new dad: experiences of first-time fathers of late-preterm infants.

Fathers of late-preterm (34-36 weeks' gestation) infants may experience challenges in parenting. Late-preterm infants are more irritable and less resp...
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