Men often struggle with the transition to fatherhood amid a lack of information and emotional support targeted to their needs, suggests a review of the available qualitative evidence, published in the open access journal BMJ Open.
Greater focus is needed in clinical practice, antenatal services, and research on men's unique experiences of the perinatal period, which encompasses pregnancy and the first 12 months after the birth, say the researchers.
Pregnancy and childbirth can be an anxious time for new parents, and the transition to fatherhood—defined as physical, psychological, and social changes in the lives of fathers from as early as conception to after the birth—can be a stressful and isolating experience, demanding significant lifestyle changes for them, point out the researchers.
They therefore wanted to explore how first time and experienced fathers find the transition to fatherhood, and how well supported they feel during the perinatal period, focusing on the concerns and challenges that may affect their mental health and wellbeing.
They scanned research databases for relevant qualitative studies, and included 37 out of an initial haul of 2475. These were carried out in: the UK (11); Europe (9); Australia (7); Asia (6); North America (2); and the Middle East (2).
Most of the studies variously included in-depth interviews, focus groups, and phone calls (646 fathers) or online surveys (1005 fathers). Thirty focused on fathers' mental health and wellbeing during the transition to fatherhood; the remainder explored their experiences of antenatal classes, interventional support, and helplines during the perinatal period.
The researchers also involved two first time and two experienced fathers from different ethnic, social, and economic backgrounds, to help them tease out the principal themes from the studies.
Synthesis of the findings showed that some fathers had a positive experience with no mental health repercussions, but most faced challenges throughout the perinatal period, which had a detrimental impact on their overall mental health and wellbeing.
Four principal themes emerged from the findings: the changed relationship with their partner; confusion over their identity as provider or protector and what their in-laws and society expected of them; feeling left out and unvalued, including by healthcare staff; and struggles with masculine ideals of fatherhood.
Fathers said they often felt ill prepared for the exhaustion and new responsibilities prompted by the arrival of a new baby, which left little time for intimacy and quality time with their partners and that this strained the relationship.
They often felt excluded from the mother-child relationship, an exclusion which started during the pregnancy when they felt like bystanders because of the unique physical experiences their partners were going through, all of which undermined their confidence in their ability to parent.
They didn't feel there was enough tailored information or antenatal classes that addressed their needs during the transition to fatherhood. Involving them in the content of parental information and educating them about what to expect during the antenatal period just wasn't considered important, they said.
In nearly half of the included studies, fathers particularly felt that they needed to be better informed on parenting in general, but especially breastfeeding issues and practical advice on what to do when things went wrong so that they could better support their partners.
Fathers in 26 of the studies said they were physically and emotionally tested to breaking point, at times, experiencing bouts of exhaustion and postnatal depression symptoms. But they felt unable to reach out for help, on the grounds that they weren't supposed to be the ones finding new parenthood difficult and that they felt they should have been able to cope.
But in any case, even when they recognised they didn't need to go it alone, they didn't feel there was any specific emotional/mental health support available for them, or anywhere they could turn for help.
The researchers acknowledge that most (29) of the included studies were from westernised cultures, limiting global perspectives and cultural comparisons. And most of the participants were White British and highly educated, so limiting the generalisability of the findings. Further research on fatherhood is needed to address these and other gaps, they suggest.
But in the meantime, the researchers recommend that clinical guidelines should be developed for paternal perinatal mental health support and management, drawing on the best available evidence. Health practitioners should also ensure adequate time is allocated to acknowledge fathers' wellbeing during perinatal appointments, they suggest.
They conclude: "By addressing fathers' wellbeing concerns and challenges during the transition to fatherhood through the development of clinical guidelines on the management of paternal perinatal mental health, as well as effective practitioner/organisational engagement and inclusion of fathers, may assist in removing stigma and gender expectations that society still follows."
They add: "It is clear that fathers require equal emotional and practical support to mothers during this period, and therefore it is important that future tailored support is provided and that fathers are not considered a 'forgotten entity', [so] creating a more positive transition and parenting experience."
