Expectant Father Involvement in Prenatal Care: Education Needs of Fathers and Clinicians

Background: The vast majority of fathers are present at the birth of a child, and it is increasingly normative for fathers to be present for prenatal ultrasound appointments.  Fathers’ presence in prenatal care settings presents an opportunity to engage fathers in interventions aimed at improving the health and wellbeing of mothers, children, and fathers themselves.  Engaging expectant fathers along with expectant mothers in prenatal interventions targeting parenting preparation, relationship enhancement, diet and nutrition, breastfeeding, and smoking cessation increases the likelihood of positive changes on the part of mother and father that will benefit the growing family.  Yet little is known about fathers’ experiences in prenatal care settings and how to effectively engage fathers in these settings.

Methods: In this qualitative study, we use observational and interview data collected in two different health systems to examine the ways in which fathers and clinicians view their role and address their needs in prenatal care.  We observed the 20 week anatomy scan (i.e. routine prenatal ultrasound) of expectant first-time mothers accompanied by their male partner to the scan, and conducted one-on-one semi-structured interviews (approximately 30 minutes in length) with fathers-to-be immediately after the appointment.  Observations included a focus on the nature of the father’s questions and comments during the exam; his level of interest and anxiety before, during, and after; his interactions with his partner; and interactions with the sonographer. Domains addressed in interviews included father’s experience attending the ultrasound, perspective on the prenatal care his partner and he had received, his sources of support and information during pregnancy, and gaps in support and information.  Data were analyzed using an inductive approach, informed by principles of grounded theory.  An iterative process of review by multiple researchers yielded agreed upon codes for data interpretation, and two researchers independently applied codes to the data.

Results: Results suggest that fathers believe their presence in prenatal care is important both to support their partner and to learn and connect to the baby as a parent in their own right.  They see it as their role to ask questions and know what’s going on, so that they can “get it right” in their efforts to take care of mother and baby.  Clinicians vary widely in their approach to fathers, ranging from treating fathers as important participants as both partner and parent to using verbal and non-verbal communication to effectively exclude the father.  Fathers offer a range of suggestions for improving their engagement in prenatal care, and indicate willingness to engage in interventions aimed at improving health outcomes for themselves and their families.

Conclusions/Implications:  This study suggests that educating clinicians on new ways of relating to, educating, and supporting fathers has the potential to enhance father engagement and improve outcomes for fathers, mothers and children.  Further, this study suggests the timeliness of outreach efforts at the routine prenatal ultrasound, a time when fathers are likely to be present and receptive.