The Transition to Parenthood in First-Time Fathers: a Systematic Review of the Literature

The transition to parenthood in first-time fathers: a systematic review of the literature

The transition of parenthood focussing predominately on first-time Fathers accounts: A literature review.

Abstract
For a couple experiencing the birth of their first child, this period can be one of great change and unsettlement, but it is a most common example of change within a marital relationship. Several studies have proposed that couples find that the transition into parenthood the most demanding with the birth of their first child. Research indicates that it is typical for couples to experience a decline in the quality of their relationship in the early years, showing that a ‘large percentage of couples divorce or end their relationship in the first five years’ There is an abundance of research on the transitions into parenthood. However, there has been little into the experiences of the fathers. The aim of this study therefore is to evaluate the current studies that have reported the transition of parenthood from the father’s perspective and will look at emergent themes that are identified throughout.
Electronic databases such as psychINFO and psychARTICLES were searched together with journals and reference lists these were then analysed for inclusion for the review and a total of seven studies were identified. The eight qualitative studies all aimed to address first time parents and their experiences of having a child in some capacity. A theme that seemed apparent in all of the studies was that the father felt ‘side-lined’ and It was noted that parent education is aimed more at the impending mother than that of the father even though the father’s involvement is equally important.
It was shown that mental health in first-time fathers can be affected and this could therefore put their relationship and family health at risk and an awareness of this is of paramount importance among the professionals involved with first-time parents. It is imperative that the needs of the father be recognised and supported as a parent-to-be. Health professionals need to recognise fathers as valued contributors and uphold their important position

Introduction
Research indicates that it is typical for couples to experience a decline in the quality of their relationship in the early years of parent-hood. A ‘large percentage of couples divorce or end their relationship in the first five years’ (Markman & Hahlweg, 1993). Moreover, if the relationship continues, research findings propose that what materialises initially in the relationship governs the quality of the relationship in the future (Veroff et al, 2000). For a couple experiencing the birth of their first child, this period can be one of great change and unsettlement, but it is a most common example of change within a marital relationship. Several studies have proposed that couples find that the transition into parenthood the most demanding with the birth of their first child (Cowan & Cowan, 2000).
There is an abundance of research on the transitions into parenthood. However, there has been little into the experiences of the fathers. It appears that pregnancy, as opposed to the postnatal period, would appear to be the most stressful period for men undergoing the transitional stage into fatherhood (Condon, Boyce & Corkingdale, 2003). Several risk factors have been identified which include: men appear to have less of a social network of support than women and ultimately rely more so on their parents (Cronenwett & Kunst-Wilson, 1981); men seem to hold more responsibility in providing material provision for the new family, and therefore experience further work and financial pressures (Zelkowitz & Miller, 1997).
Condon et al. (1997) put forward that several men lacked the role model of a father figure, or have been brought up by fathers in times where men were far less involved in the birth and child raising. They also suggest that younger fathers-to-be have a more idealized view of the pregnancy itself, labour and actual child-raising. However, it is apparent that men are more reluctant to seek help and support with emotional problems, and therefore may result in more maladaptive approaches such as resorting to excessive alcohol consumption or riskier behaviour. In Condon et al.’s study they used a battery of self-report questionnaires using two hundred and four men who had completed all four assessments over the 23rd week of pregnancy and then at 3, 6 and 12 months postnatally. These included psychological symptom levels, lifestyle variables and relationship/sexual functioning. Results showed that it was at the pregnancy stage where men displayed the highest symptom levels which had a slight improvement at the 3 month stage, and little change after that. Lifestyle variables showed small changes over the first postnatal year; however it was the sexual functioning that appeared to decline significantly from pre-pregnancy levels which only recovered minimally by the end of the first year. This indicated that for most part, men anticipated a quick return of sexual activity to that of pre-pregnancy levels. Condon et el (2003) concluded that it was pregnancy, as opposed to the postnatal stage, that would seem to be the most stressful time for men undertaking the transition to parenthood, and that these men seemed to be ill-prepared for the effect on their lives, particularly to that of their sexual relationships with their partners.
There appears to be less support focussed purely on the father and their issues than that of the mother and their needs. The pressures new families have into the transition of parenthood and the demands of everyday life, support for both parents would be advisable as a precautionary method to advocate a healthier relationship. Therefore, this current review aims to look at contemporary studies that have reported the transition of parenthood from the father’s perspective and will look at emergent themes that are identified throughout.

Review methods
2.1 Search Strategy
The studies in this review were found by a comprehensive search of the following psychology databases: psychARTICLES, PsychINFO, Elsevier Science Direct, and EBSCO Electronic Journals Service. These were accessed through the University of Derby online. In addition, reference lists from the searched studies and literature reviews were inspected for additional studies.
2.1 Search Terms
A full search was conducted with the following terms: ‘First time parent*’, ‘First time father*’ ‘Transition into parent*’, together with related terms such as ‘Fathers experience*’, ‘impact of child-birth’ and ‘Relationships’, using a standardised protocol utilising Boolean commands to identify the most relevant literature, of which, 942 hits were returned and are briefly summarised in figure one.
2.1 Inclusion/Exclusion criteria
The previous search terms were used as they were all-encompassing to produce a high amount of hits in order to select appropriate articles to be included in this review. The advanced search options were used and criterion was limited to peer-reviewed articles only, book reviews were eliminated as were studies using non-human participants. In order to find the most up to date research, articles were restricted to the years 2001 to 2012.
All studies were independently evaluated and the titles and abstracts were identified from the searches conducted for their relevance to the review question. Studies included in this review needed to be of English language for ease of reading. Only parents from the ages of 18-45 were included and individual studies were included from systematic literature reviews if deemed relevant. As the Individual report that will follow this literature view is based on qualitative methods, it was decided that only qualitative studies would be used in order to compare and adopt similar strategies and themes.

Review findings
Electronic database searches of the study titles originally identified 942 possible studies that were then filtered through the search process summarised in fig.1 below.

Eight (n=8) qualitative studies in total were included in this review which are summarised in table 1 below.
Table 1: Characteristics of included studies (n=8)
Author & Date Participants and Demographics Aims/Measures Main Themes and Results

Ahlborg & Stranmark, (2001) Five Swedish couples recruited from 5 different family health centres in Sweden. Mothers age ranged 20-33 mean ages 28.6 and fathers 23-37 mean age 30.4. 3 couples pregnancies were one was not and one was longed for. To describe the phenomenon of 1st time parent’s intimate relationships, mental health and the ability to support them professionally. Parents were interviewed twice, once when the baby was 6 months old and again at 18 months old. The baby was the centre of attention, split into two groups: The first category being that the baby was the focus of attention as a mutual concern which indicated a fostered relationship. Strain of parenthood in this category was mild. The second category was the baby was the focus of attention at the father’s expense. The results indicated that mental health can be affected among first-time fathers and as such this can affect the relationship and family health.
Deave, Johnson & Ingram, (2008) 24 nulliparous women were recruited from two healthcare organisations in south-west England. 20 of who had partners. Mean age of women 25.9 ranging from 18-35. The partners ranged from 19-37 mean of 27.9. Most participants were white-British with one couple being South-East Asian and three where one partner was Brazilian, Dutch or Asian. To address first time parents about the support they received during the antenatal period particularly in relation to the transition into parenthood. Interviews took place in the last trimester of pregnancy and again at 3-4 months postpartum. Types of support received and available to the women and their partners, their views on their preparation for parenthood, postnatal period and baby care and the information they received and sources of this information. Themes identified postnatally included: Issues such as support, information and preparation were again identified as were breastfeeding, and the pressure to do so, parent’s relationships and the challenges they had been, and were going through, partner’s perspective on their involvement and inclusion in the care his partner had received both antenatal and postnatal. Parents also expressed feelings such as fear, excitement and joy about becoming parents
Draper, (2002). 18 ‘novice’ and experienced fathers were recruited from antenatal classes in the North of the UK and also by means of a snowball sample. Participants were white, middle class and all were in stable relationships with their partners. To investigate men’s ‘real life’ accounts of their transition to fatherhood. Semi-structured interviews were conducted 3 times, twice antenatal and once postnatal. Desire to be ‘involved’ with their partner’s pregnancy, however difficulties emerged with engaging in its reality. The partners contributed in a range of activities which brought them closer to their partner’s pregnant body and therefore their unborn baby. Results indicated that the men’s experiences of early pregnancy were marked forcefully by their involvement in the confirmation process. The activities undertaken gave men the opportunity to help forge an involvement in the pregnancy and shape early transition to fatherhood.
Fägerskiöld, (2008). 20 first time fathers were recruited from social insurance office in southern Sweden. Participants ranged from 20-48 years old and their infants from 5-9 months old.. To explore first-time father’s experiences during early infancy of their children. Interviews were conducted in the participants own home. Changing life’ becoming a father, Alternating between work and home, changing relationship towards partner and the developing relationship with their child. It was reported that fathers appeared to be insufficiently prepared for this life-changing event, midwives at antenatal clinics focussed more on the woman and the delivery than on the man and his feeling. Although fatherhood was stated as a fantastic experience, fathers sometimes felt insignificant.
Premberg, Hellstrom & Berg, (2008). 10 first time fathers were recruited at a maternity ward in the South-West of Sweden. Fathers were aged between 25-32 . All participants were living with the mother of their child. To explore experiences of the first year as a father. Interviews were conducted 12-14 months after the delivery of their first child. To be overwhelmed, to be ruled by the baby’s needs, to mater the new situation, Adjustment to responsible fatherhood and to get a new completeness in life. Results indicated that a need for father’s involvement is worthwhile; however such childbirth education is designed more for the mother to be and excludes the father. Health personnel of today must have more awareness of the fathers own needs and the impact gender aspects have on their professional support.
Fenwick, Bayes & Johansson, (2011). 12 Australian men were recruited from a Australian teaching hospital. 3 participants were less than 30 years of age all .Five men were expecting their first baby and seven men had between 1 and 3 children. To explore and describe men’s experiences of pregnancy and childbirth expectations. Interviews were unstructured and conducted in the 2nd and 3rd trimester and again 8 weeks post birth. Six men also kept journal entries. Pregnancy news: heralds profound change, Adjusting to pregnancy and working to see things differently, Birth looming, Antenatal visits: feeling side-lined and childbirth expectations. Results indicated that adjustment to the news of the pregnancy was a unsettling time for the expectant father which increased apprehension and anxiety. Emotional work to come to terms with and accept the pregnancy was needed regardless of being a first time father or not, and quite importantly understanding mens antenatal experiences and anxieties is an important step in the development of the prevention of perinatal health complications.
Finnbogadottirm Svalenius & Persson, (2003). 7 first time fathers were recruited from antenatal clinic in Sweden. Men were aged from 28-37 the length of the present relationship was between 2 and 10 years. To describe first-time expectant fathers ' experiences of pregnancy. Interviews were conducted when their partner was in the 38th- 39th week of pregnancy. Time of transition, feelings of unreality, insufficiency and inadequacy, exclusion, reality, social changes, psychical changes, responsibility and development. Results indicated that a fathers needs during their partners pregnancy are as important as the mothers-to-be.
Premberg, Carlsson, Hellstrom et al, (2010) 10 first time fathers were recruited from two hospitals in South-West Sweden. Ages ranged from 25-43 years, all participants were living with the mother of their child. They were of different ethnic origin, mainly Swedish participants. To describe fathers’ experiences during childbirth. These were conducted 4-6 weeks after the birth. A process into the unknown, a mutually shared process for the couple, to guard and support the woman and in an exposed position with hidden strong emotions. Results suggested that in order to maintain and strengthen child-birth as a mutually shared experience, the father needs to be recognised and supported as a parent-to-be and mid-wives need to acknowledge fathers as valued participants and support their position as a father.

The studies as summarised in table 1, all used qualitative methods. These approaches ranged from a phenomenological life world approach, (Premberg, Hellstrom & Berg, 2008; Premberg, Carlsson, Hellstrom et al., 2010.), descriptive phenomenological method, (Ahlborg & Stranmark, 2001), ethnographic qualitative study, (Deave, Johnson & Ingram, 2008), a longitudinal ethnographic approach, (Draper, 2002), grounded theory, (Fägerskiöld, 2008), thematic analysis, (Fenwick, Bayes & Johnson, 2011) and narrative, (Finnbogadottir, Svalenius & Persson, 2003). Five studies were carried out in Sweden, (Ahlborg & Stranmark, 2001; Fägerskiöld, 2008, Premberg et al., 2008, Finnbogadottir et al., 2003, Premberg et al., 2010) and used a total of 53 participants. Two studies used participants from the United Kingdom, (Deave et al., 2008; Draper, 2002) a total of 42 participants were included and one study used 12 male participants from Australia, (Fenwick et al., 2011). Recruitment of participants varied from health care settings, (Ahlborg & Stranmark, 2001, Deave et al., 2008) antenatal classes, (Draper, 2002; Finnbogadottir et al., 2003) a social insurance office, (Fägerskiöld, 2008) and Maternity wards in hospitals, (Fenwick et al., 2011; Premberg et al., 2010; Premberg et al., 2008).
The empirical studies all aimed to address first time parents and their experiences of having a child. Ahlborg & Stranmark (2001) looked at the parent’s intimate relationship, mental health and the ability to support them professionally. They interviewed parents when their baby was 6 months old and again at 18 months using a descriptive phenomenological method to analyse the interviews. Deave et al., (2008) addressed the support parents received during the antenatal period especially in relation to the transition into parenthood and used semi-structured interviews in the last trimester of pregnancy and 3-4 months after the baby was born, content analysis of the data was adopted. Fenwick et al., (2011) and Finnbogadottir, et al., (2003) addressed the experiences of childbirth and expectations. Fenwick et al., (2011) used unstructured interviews which were conducted in the 1st and 2nd trimester and again 8 weeks after the baby was born. Thematic analysis was used to analyse the data while Finnbogadottir, et al., (2003) conducted interviews in the 38th-39th week of pregnancy using a qualitative content analysis. Draper (2002) looked at the ‘real life’ accounts of father’s transition into fatherhood. Semi-structured interviews were used interviewing participants twice during their partner’s pregnancy and once post-natal. Interviews were analysed systematically by hand. Fägerskiöld, (2008) explored the experiences during early infancy of the children using the constant comparative method to analyse data. Premberg, et al., (2008) explored the first year as a father and interviewed participants 12-14 months after the birth of their child, data was analysed using the researchers bridled own natural attitude, theoretical knowledge preconceptions and spontaneous considerations. Lastly, Premberg et.al. (2010) described fathers’ experiences during childbirth interviewing fathers 4-6 weeks after delivery of the baby. Interviews were analysed for meaning in accordance to the phenomenological life-world approach.
A theme that seemed apparent in all of the studies was that the father felt ‘side-lined’ or excluded and the focus of the attention on the baby was at the father’s expense. Table 1 identifies the themes throughout all of the included studies as well as the quantified results. Deave (2008) reported that the women in their study felt supported particularly by family, friends and postnatal groups, however in contrast the fathers felt less supported. In general, they had less social support and felt excluded from antenatal classes and the literature that was available was very limited for the father. They found that parents had been naive to the fact that relationship changes may occur and would have liked more information regarding this, together with basics of parenting and baby care. Parents did, however, both report feelings of fear, excitement and joy about becoming parents. Further to this, the fathers in Drapers (2002) study felt quite detached from their partner’s pregnancy as they couldn’t feel the babies’ movements, etc. They recurrently spoke of their yearning to be 'involved ' yet recounted difficulty in engaging with the realism of it. Fägerskiöld (2008) found that although fathers felt great pride and happiness being a father, it was reported that they may be inadequately equipped for this life-changing event and midwives at antenatal clinics focused more on the woman and the delivery than on the father and his feelings. Premberg (2008) also noted that parent education is aimed more at the impending mother than that of the father even though the father’s involvement is equally important, a view shared with Fenwick et al. (2011), Finnbogadrottirm et al. (2003) and Premberg et al. (2010). Fenwick et al., (2011) found that adapting to the news of a pregnancy could possibly be an unnerving period for a father-to-be and a time which is frequently accompanied by increased fear and apprehension. Ahlborgs & Stranmark’s (2001) study also showed that mental health in first-time fathers can be affected and this could therefore put their relationship and family health at risk and an awareness of this is of paramount importance among the professionals involved with first-time parents. Deave et al., (2008) have indicated that numerous studies and policy documents have highlighted the scarcity of parents ' preparation for parenting and sharing this view Premberge et al., (2008) noted that although fathers are invited to participate in postnatal childbirth education the activities address women’s needs and it is doubtful the fathers benefit from such participation.
Premberge et al., (2010) stated that labour was a shared progression for the couple and although the fathers’ high involvement in labour, support from the midwife and being supportive for his partner throughout the delivery is rewarding for the couple. The actual experience of the labour, the anxiety of not knowing what is happening and the presumptions of masculine responsibilities can be hard to. Fägerskiöld, (2008) also noted that even though the relationship of the couple may change and is quite common it was not always detrimental and often united the couple with a closer relationship.

Discussion and conclusions
In conclusion it is apparent from the studies reviewed that the first time father felt side-lined when he would have liked to continue with the involvement in the pregnancy and birth. The lack of involvement in the birth of the baby culminated in the father feeling the birthing process forced the partnership apart temporarily (Condon et al, 2011). Although pregnancy has been cited as causing more stress and concerns for the first time father than the actual birth, Cowan & Cowan (2000) proposed that the transition into parenthood for first time parents creates most demands.
The transition from being a couple to being parents and part of a family is a demanding and exasperating period sometimes resulting in the deterioration of the relationship ultimately concluding in separation or divorce (Markham & Hahlweg, 1993). The initial period of adjustment is crucial as this dictates the way the relationship is conducted in the future which may be the converse of deterioration, strengthening the couple’s relationship (Veroff et al, 2000).
Several studies have identified causal factors for the trepidation concerning the first time father becoming a responsible parent. These include: male social networks generally being on a smaller scale than that of females; more reliance on parents; pressures of providing for the family; several men lacked a role model or father figure during their informative years therefore felt less equipped to become a father themselves (Condon et al, 1997). One significant feature identified was the reluctance of males to enquire about advice and support with emotional issues, this may result in maladaptive coping behaviours such as excessive use of alcohol (Condon et al, 1997).
It would appear that the involvement of the father in the birth has not progressed all that much since the days when fathers sat in a waiting room to hear when their baby had been born. Although fathers are now allowed into the delivery room their role is very restricted to wiping their partner’s brow and holding their hand through contractions although some maternity units do allow the father to cut the baby’s cord but this is dependent on the hospital and not offered as standard. Draper (2002) states the fathers’ desires to be involved in the pregnancy and birth are often not realized. From taking part in ante-natal classes to the actual birth, the father to be is allocated a small supporting role for the expectant mother.
Mental health issues can affect both new parents yet the literature and focus of midwives, health visitors and GPs is on the mother and baby (Fagerskiold, 2008). Health professionals consider the mother most vulnerable to alterations to mental health due to hormonal changes etc. and it is generally accepted that a new mother may experience the ‘baby blues’ after giving birth. This is monitored in an attempt to discourage the onset of post-natal depression.
As most of the activities and literature are steered by the needs of mother and baby, the father may feel excluded from the whole process. The lack of attention to issues concerning the father, especially with regard to mental health deterioration or affectation, should be addressed by health professionals so as to make the transition easier and more comfortable for the family (Ahlborg & Stranmark, 2001).
The lack of education and scarcity of preparation for first time parenthood has been highlighted by policies and numerous studies. Most information was aimed at the mother and growth of the baby. Warnings of possible difficulties are discussed and regular visits to the midwife give the mother-to-be a chance to allay fears. There is no equivalent information source for the father and as fear and apprehension have been identified (Fenwick et al, 2011) there would appear to be a need for this.
Consequently in order to continue and strengthen childbirth as a mutually shared experience for the couple, it is imperative that the needs of the father be recognised and supported as a parent-to-be. Health professionals need to recognise fathers as valued contributors and uphold their important position. Further research is advised in the relationship between first time parents and health professionals. Studies reviewed indicated significant negative affect of the lack of interaction between first time fathers and health professionals. It may be beneficial to train health care professionals and first time fathers together. This would resolve the rejection felt by the fathers and enable health professional to identify issues affecting the relationship during pregnancy, birth and beyond.

References for Studies Reviewed.
Ahlborg, T., & Strandmark, M., (2001). The baby was the focus of attention first-time parents ' experiences of their intimate relationship. Scandinavian Journal Caring Science. 15:318-325
Deave, T., Johnson, D., & Ingram, J. (2008). Transition to parenthood: the needs of parents in pregnancy and early parenthood. BMC Pregnancy and Childbirth, 8:30
Draper, Janet (2002). ’It’s the first scientific evidence’: Men’s experience of pregnancy confirmation -some findings from a longitudinal ethnographic study of transition to fatherhood. Journal of Advanced Nursing, 39:6, 563–570.
Fägerskiöld, A. (2008). A change in life as experienced by first-time fathers. Scandinavian Journal Caring Science. 22:64-71.
Fenwick, J., Bayes, S., & Johanansoon, M., (2012). A qualitative investigation into the pregnancy experiences and childbirth expectations of Australian fathers-to-be. Sexual & Reproductive Healthcare 3:3-9.
Finnbogadottir, H., Svalenius, E.C.,& Persson, E.K., (2003). Expectant first-time father’s experiences of pregnancy. Midwifery. 19:96-105.
Premberg, A., Carlsson, G., Hellstrom, A.L., & Berg, M. (2011). First-time fathers experiences of childbirth-A Phenomenoloical study. Midwifery. 27:848-853.
Premberg, A., Hellstrom, A.L., & Berg,M., (2008). Experiences of the first year as father. Scandinavian Journal Caring Science. 22:56-63.

Other References
Condon, J.T., Boyce P., & Corkingdale, C.J. (2003). The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood. Australian and New Zealand Journal of Psychiatry, 38,56–64.
Condon J, Corkindale CJ. (1997). The correlates of antenatal attachment in pregnant women. British Journal of Medical Psychology, 70, 359–372.
Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: The big life change in couples. Mahwah, NJ: Erlbaum.
Cronenwett, L. R., & Kunst Wilson, W. (1981). Stress, social support, and the transition to fatherhood. Nursing Research, 30, 196-201.
Markman, H. & Hahlweg, K. (1993) The prediction and prevention of marital distress: an international perspective. Clinical Psychology Review, 13, 29-43.
Veroff, J., Young, A. & Coon, H. (2000) The Early Years of Marriage in R. Milardo & S. Duck,
(eds) Families as Relationships. Chichester: Wiley.
Zelkowitz, P.,& Milet, T.H. (1997). Postpartum psychiatric disorders: their relationship to psychological adjustment and marital satisfaction in the spouses. Journal of Abnormal Psychology, 105(2), 281-5.

References: Condon, J.T., Boyce P., & Corkingdale, C.J. (2003). The First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood. Australian and New Zealand Journal of Psychiatry, 38,56–64. Condon J, Corkindale CJ. (1997). The correlates of antenatal attachment in pregnant women. British Journal of Medical Psychology, 70, 359–372. Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: The big life change in couples. Mahwah, NJ: Erlbaum. Cronenwett, L. R., & Kunst Wilson, W. (1981). Stress, social support, and the transition to fatherhood. Nursing Research, 30, 196-201. Markman, H. & Hahlweg, K. (1993) The prediction and prevention of marital distress: an international perspective. Clinical Psychology Review, 13, 29-43. Veroff, J., Young, A. & Coon, H. (2000) The Early Years of Marriage in R. Milardo & S. Duck, (eds) Families as Relationships. Chichester: Wiley. Zelkowitz, P.,& Milet, T.H. (1997). Postpartum psychiatric disorders: their relationship to psychological adjustment and marital satisfaction in the spouses. Journal of Abnormal Psychology, 105(2), 281-5.