Pregnant Women's Perspectives on Paternal Involvement in Prenatal Care: Implications for Efforts to Engage Expectant Fathers

Background: Supportive paternal involvement during pregnancy can positively impact maternal and child outcomes. Paternal participation in prenatal care is increasing, and attendance at prenatal ultrasound examinations is rapidly becoming a norm. Yet little research exists to understand how mothers experience paternal involvement in prenatal care and their preferences for paternal involvement. Better understanding of pregnant women’s perspectives on paternal involvement is a necessary precursor to developing appropriate policies and interventions to support paternal involvement during pregnancy. In this qualitative study, we examine pregnant women’s perspectives on paternal involvement in prenatal care and identify implications for efforts to engage expectant fathers.

Methods: We interviewed twenty-two women expecting their first child, recruited through a university health system, immediately after a routine prenatal ultrasound examination approximately midway through pregnancy. Interviews addressed when and how fathers had participated in prenatal care, how mothers experienced paternal involvement in prenatal care, their perceptions of care providers’ treatment of fathers, and their preferences for paternal involvement. Interviews were recorded, transcribed, and coded in an iterative process informed by principles of grounded theory. The research team developed and reached consensus on codes for data interpretation, created a codebook, and then two researchers independently coded each transcript, using NVivo 11.

Results: Nearly all of the women reported that their baby’s father had participated in prenatal care to some degree, ranging from attendance at visits considered “important” (e.g., ultrasounds) to attendance at every appointment. Women’s experience of this involvement varied, with many describing it as both an important act of support for the mother and part of assuming the role of father. Most participants saw great value in paternal involvement, as an opportunity for fathers to learn how to support a healthy pregnancy, learn about and bond with their developing baby, and share joy and/or worries with mothers. Some participants considered paternal involvement simply appropriate, and not something that should be treated as optional or laudatory. Participants generally felt that fathers were made to feel welcome, and wished that providers would be inclusive of fathers from considering both parents in scheduling to addressing themselves to and inviting questions from both parents-to-be during appointments. An important caveat to the general wish for paternal involvement is the understanding of one mother in the sample that her abusive former partner’s involvement would be harmful.

Conclusions: Results of this study suggest that many expectant mothers want fathers to be involved alongside them in prenatal care. As increasing numbers of fathers participate, prenatal care appointments may be an ideal time to reach out to men and provide information and services that can support their positive involvement in the pregnancy, support for mothers, and preparation to parent. Results of this study can be used to inform prenatal care that is supportive of partner involvement, but still centered on the needs and preferences of pregnant women. Critically, results suggest that paternal involvement is not always advisable. Prenatal care provides an important opportunity to screen for and identify intimate partner violence and provide counsel and assistance.