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Background Early involvement of fathers with their children has increased in recent times and this is associated with improved cognitive and socio-emotional development of children. Research in the area of father’s engagement with pregnancy and childbirth has mainly focused on white middle-class men and has been mostly qualitative in design. Thus, the aim of this study was to understand who was engaged during pregnancy and childbirth, in what way, and how paternal engagement may influence a woman’s uptake of services, her perceptions of care, and maternal outcomes. Methods This study involved secondary analysis of data on 4616 women collected in a 2010 national maternity survey of England asking about their experiences of maternity care, health and well-being up to three months after childbirth, and their partners’ engagement in pregnancy, labour and postnatally. Data were analysed using descriptive statistics, chi-square, binary logistic regression and generalised linear modelling. Results Over 80% of fathers were ‘pleased or ‘overjoyed’ in response to their partner’s pregnancy, over half were present for the pregnancy test, for one or more antenatal checks, and almost all were present for ultrasound examinations and for labour. Three-quarters of fathers took paternity leave and, during the postnatal period, most fathers helped with infant care. Paternal engagement was highest in partners of primiparous white women, those living in less deprived areas, and in those whose pregnancy was planned. Greater paternal engagement was positively associated with first contact with health professionals before 12 weeks gestation, having a dating scan, number of antenatal checks, offer and attendance at antenatal classes, and breastfeeding. Paternity leave was also strongly associated with maternal well-being at three months postpartum. Conclusions This study demonstrates the considerable sociodemographic variation in partner support and engagement. It is important that health professionals recognise that women in some sociodemographic groups may be less supported by their partner and more reliant on staff and that this may have implications for how women access care.
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R E S E A R C H A R T I C L E Open Access
Fathersengagement in pregnancy and childbirth:
evidence from a national survey
Maggie Redshaw
*
and Jane Henderson
Abstract
Background: Early involvement of fathers with their children has increased in recent times and this is associated
with improved cognitive and socio-emotional development of children. Research in the area of fathers
engagement with pregnancy and childbirth has mainly focused on white middle-class men and has been mostly
qualitative in design. Thus, the aim of this study was to understand who was engaged during pregnancy and
childbirth, in what way, and how paternal engagement may influence a womans uptake of services, her
perceptions of care, and maternal outcomes.
Methods: This study involved secondary analysis of data on 4616 women collected in a 2010 national maternity
survey of England asking about their experiences of maternity care, health and well-being up to three months after
childbirth, and their partnersengagement in pregnancy, labour and postnatally. Data were analysed using
descriptive statistics, chi-square, binary logistic regression and generalised linear modelling.
Results: Over 80% of fathers were pleased or overjoyedin response to their partners pregnancy, over half were
present for the pregnancy test, for one or more antenatal checks, and almost all were present for ultrasound
examinations and for labour. Three-quarters of fathers took paternity leave and, during the postnatal period, most
fathers helped with infant care. Paternal engagement was highest in partners of primiparous white women, those
living in less deprived areas, and in those whose pregnancy was planned. Greater paternal engagement was
positively associated with first contact with health professionals before 12 weeks gestation, having a dating scan,
number of antenatal checks, offer and attendance at antenatal classes, and breastfeeding. Paternity leave was also
strongly associated with maternal well-being at three months postpartum.
Conclusions: This study demonstrates the considerable sociodemographic variation in partner support and
engagement. It is important that health professionals recognise that women in some sociodemographic groups
may be less supported by their partner and more reliant on staff and that this may have implications for how
women access care.
Keywords: Fathers, Pregnancy, Childbirth, Paternal engagement
Background
Early involvement of fathers with their children has in-
creased in recent times [1]. Such involvement is associ-
ated with improved cognitive and socio-emotional
development of children [2,3]. Absent fathers have been
associated with poorer educational, behavioural and de-
velopmental outcomes in children with both direct ef-
fects on infant and child behaviour and indirect effects
possibly due to partner relationship problems, lack of
social support and exposure to increased levels of mater-
nal stress hormones whilst in utero [2,4]. Partner sup-
port during pregnancy may also encourage healthier
maternal behaviour, for example with regard to cigarette
smoking and alcohol consumption [2]. Research has in-
dicated that men who feel unready for fatherhood tend
to be less involved, find the transition to parenthood
more challenging, and may be less likely to be commit-
ted fathers [5].
Research in the area of fathers engagement with preg-
nancy and childbirth has mainly focused on white middle-
class men and has been mostly qualitative in design [5].
* Correspondence: maggie.redshaw@npeu.ox.ac.uk
Policy Research Unit for Maternal Health and Care, National Perinatal
Epidemiology Unit, University of Oxford, Old Road Campus, Headington,
Oxford OX3 7LF, UK
© 2013 Redshaw and Henderson; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of
the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Redshaw and Henderson BMC Pregnancy and Childbirth 2013, 13:70
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Such research as exists relating to non-white men and
those from lower socioeconomic groups suggests that they
experience lower satisfaction with the information pro-
vided and with their level of inclusion in decision-making
[6]. Research from the USA on African-American families
found higher rates of absent fathers than in other ethnic
groups, particularly in geographical areas with high un-
employment and low income [2]. Contrary to stereotype,
after adjusting for employment, it was found that black
men were more likely to be involved in housework and
childcare than other groups [2] and in this group, the
quality of the parenting was directly related to pregnancy
intentions [2].
Two UK studies from the 1990s examined the associ-
ation between socioeconomic status and degree of part-
ner support. They found that working classmen were
less likely to take time off, accompany their partner to
clinic appointments, be present in labour, or to help
postnatally [7]; and conversely, middle-classcouples
tended to be better prepared for the transition to parent-
hood, better informed and supported than working class
couples, and reported better maternal and child out-
comes [8].
Partnersmaybeparticularlyencouragedtobepresent
for some aspects of antenatal care such as ultrasound
scans and other screening tests. In one study, they
reported feeling that they were there as supporters, ra-
ther than direct participants and if a decision was ne-
cessary regarding termination of pregnancy for fetal
abnormality, men reported reacting objectively and
cognitively, without allowing themselves to become
emotionally involved [9]. In another study of parents
experience of termination for fetal abnormality, more
men than women considered that they had received ad-
equate support from their partner but men perceived
their friends and family as less supportive and, after
hospital discharge, men experienced worse emotional
well-being than women [10].
According to a study in the UK in 2000, about one
third of men attended antenatal classes with their part-
ners but found them of doubtful value, sometimes lead-
ing to unrealistic expectations [6,11,12]. However, when
there were specific antenatal groups focussing on mens
needs there were benefits in terms of reduced distress,
increased ability to cope and improved relationship with
their partner. In a study based in two urban hospitals in
the UK it was reported that although married fathers
were more likely to attend antenatal classes, those who
did attend differed little from those who did not with re-
spect to their experience of childbirth, their emotional
wellbeing postnatally or in attachment to their infant
[13]. Fathersless positive experiences of childbirth were
associated with higher depressive symptomatology at six
weeks after the birth; however, relationships with pre-
existing mental health could not be explored. Using a
behavioural style measure, a sub-group of fathers who
attended antenatal classes, but who showed a high pro-
pensity to avoid threat-relevantinformation reported a
more negative experience than a similar group not at-
tending classes.
It seems that almost all women in industrialised coun-
tries have their partner with them during labour and
birth [6,14]. However, there is still doubt in some quar-
ters about the appropriateness of this [15] and it is ar-
gued that the partners feelings of anxiety and tension,
especially if he is reluctant to be there, may make the
labour more difficult. In addition, a small retrospective
survey from 1988 which investigated mens experiences
as labour coaches suggested that they found it very
stressful and the demands exceeded their capabilities
[16]. However, the evidence suggests that women place a
high value on their partners presence and support in
labour, leading to reduced anxiety, less perceived pain,
greater satisfaction with the birth experience, lower rates
of postnatal depression and improved outcomes in the
child [6].
If the couple received continuous professional support,
the man was more likely to take an active role, feeling
empowered rather than helpless, leading to increased
satisfaction and greater involvement with early childcare
[5,12]. Psychological support was valued by women in
the form of emotional expressions of caring, empathy
and sympathy [5]. Some men expressed fears of seeing
their partner in pain, of not coping, fainting, panicking,
failing to respond appropriately, and of being excluded
from decision-making and being useless, especially if this
was the first time they had been involved in childbirth
or they were relatively young. Some also feared that their
partner would have a prolonged or complicated labour,
that she or the child would die or that the child would
be born handicapped [5,6]. Reporting afterwards, it
appeared that men found that the actual experience of
supporting their partner in childbirth was better than
they expected; they were less distressed and frightened,
and more excited and elated [6]. However, if a caesarean
section was required, fathers were less likely to have
been present and, using an adjective checklist [17], were
likely to describe their infants more negatively [13].
Genesoni and Tallandini [18] noted in their literature
review on fathers and the transition to parenthood that,
in a wide range of contexts, men can experience a ten-
sion between needing to be the breadwinner and also
wanting to be involved in childcare, though this is also
true for working women [1,19]. Involvement in care of
the baby during the postnatal period may be unaffected
by parity but associated with level of education, social
class and income of the father [20]. In the changing con-
text of couple relationships and the work situation for
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men and women there is little recent quantitative infor-
mation about the extent of fatherslevels of involvement
in pregnancy, childbirth and postnatally and how this
varies with sociodemographic characteristics. Thus,
among the population of recent fathers in England, the
aim was to understand who was engaged during preg-
nancy and after birth, how much were they engaged and
in what way, and how paternal engagement may influ-
ence a womans uptake of services, her perceptions of
care, and maternal outcomes, especially those associated
with health and wellbeing.
Methods
This study utilised data collected in a 2010 survey of
new mothers in England. A random sample of 10,000
women aged 16 years and over who had their baby in a
two week period in England in 2009 were selected by
the Office for National Statistics from birth registration.
Mothers whose babies had died were excluded from the
sample. Women were sent a questionnaire, invitation
letter, information leaflet and an information sheet in a
range of languages in early 2010 when the babies were
approximately 3 months of age. Using a tailored re-
minder system non-respondents were sent a reminder
letter after two weeks, a further questionnaire after four
weeks, and a last reminder letter four weeks later [14].
The survey collected data on care in the antenatal,
intrapartum and postnatal periods and how women per-
ceived their care, as well as on sociodemographic factors,
including age, parity, partnership status, age on leaving
full-time education, and an area based measure of
deprivation (Index of Multiple Deprivation (IMD)) [21].
Limited data were available on partnersage and country
of birth based on birth registration. Details were col-
lected from each mother on partner involvement in the
pregnancy, labour and postnatally, along with informa-
tion about paternity leave and partner views of staff
communication at each stage. Validated checklists were
used to collect data on worries and concerns about
labour and birth [22] and womens perceptions of care at
this time [23]. Women who were not living with their
husband or the babys father at the time of the survey
and same sex parents were excluded from the analyses.
The study involved secondary data analysis. The original
survey evaluating maternity services in England was
passed by the Trent Multi-Centre Research Ethics
Committee.
Paternal engagement scores
Two scores were constructed to estimate extent of
father engagement. Firstly, a score was constructed to
indicate the degree of father engagement prior to birth
based on fathers presence or absence at each of the fol-
lowing: pregnancy test or when pregnancy confirmed;
one or more antenatal checks; one or more ultrasound
scans; one or more antenatal education classes; and
during labour. This score also included paternal
involvement in finding information about pregnancy;
participation in decision-making about antenatal screen-
ing; making a birth plan; finding information about
labour and birth; and participation in decision-making
during labour. Thus, the overall paternal antenatal and
labour engagement score could range from 010. Sec-
ondly, a score was constructed to reflect fatherspostna-
tal engagement based on whether he was involved a
great deal(score 3), abit(score 2), rarely(score 1) or
notatall(score 0) in six activities that included chan-
ging nappies, playing with the baby and helping when
the baby cries. The postnatal engagement score could
range from 018. Because it was positively skewed, es-
pecially in primiparous women, the value of the postna-
tal engagement score was squared to normalise the
distribution.
Statistical analysis
Univariate analyses were carried out using Chi-square sta-
tistics; binary logistic regression was used to estimate the
combined effects of sociodemographic variables on fa-
thersreactions to pregnancy, presence at antenatal checks
and labour, and involvement in postnatal infant care.
Generalised linear modelling was used to determine
whether certain pre-defined sociodemographic and care
variables were associated with the paternal engagement
scores. Significance was set at p < 0.01 in the univariate
analyses due to the size of the dataset and the number of
tabulations; thereafter it was set at p < 0.05.Analyseswere
carried out using SPSSX versions 17 and 19.
Results
A total of 5333 women returned usable questionnaires, a
response rate of 55.1%. They reported on 4616 fathers
(86%) and their involvement during pregnancy, labour
and postnatally. Characteristics of women and their part-
ners are shown in Table 1. Three-quarters of fathers
(76%) were born in the UK, six percent in the rest of
Europe, and eighteen percent were from other countries.
The majority of men were in their 30s (57%), a quarter
in their 20s (26%), and 16% in their 40s; only one per-
cent of fathers were teenagers. Maternal age and pater-
nal age were highly correlated.
A comparison of respondent and non-respondent
women showed that respondents were slightly more
likely to be older, to be married, to be living in the least
deprived areas, to be white and to be born in the United
Kingdom [14]. Nevertheless of those responding, 14%
were from minority ethnic groups.
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Fathers involvement in pregnancy, childbirth and early
parenting
The extent of father involvement overall and by parity is
shown in Table 2. Most fathersinitial reaction to the
pregnancy was a positive one, with more than 80% being
pleased or overjoyed; there was no difference between
the partners of women who had previously given birth
and those for whom this was their first baby. Over half
of fathers were present for the pregnancy test or when
the pregnancy was confirmed (62%) and for one or more
antenatal checks (63%), and almost all (89%) were
present for one or more ultrasound examinations and
for labour (90%). Mothers having their first baby were
more likely to have had their partner present when the
pregnancy was confirmed, for antenatal checks, for
scans, to attend antenatal classes and be present during
labour. They were also more likely to have a partner
who accessed information about pregnancy and birth
and shared in decision-making in pregnancy and during
labour.
Women reported that most fathers felt midwives and
doctors communicated well with them during pregnancy
(81%), more so during labour (88%) and slightly fewer
(75%) after the birth, with little difference by parity.
While three-quarters of fathers took paternity leave
(72%), some did not take leave or were unable to do so.
Partners of first time mothers were slightly more likely
to have taken paternity leave and were more likely to
have done so for longer.
During the postnatal period, most fathers helped with
infant care, with more than three-quarters changing
nappies, bathing, helping or supporting feeding, helping
when the baby cried, playing with the baby and looking
after the baby when the mother was out or at work.
Fathers tended to help more with first babies, especially
with nappy changing, bathing and feeding. The most
common activity reported for all fathers during the post-
natal period was playing with the baby (96%). There was
no difference in fathersactivities by gender of the baby.
Paternal involvement by sociodemographic
characteristics
Some differences in key aspects of father involvement by
maternal sociodemographic variables presented by parity
are shown in Table 3. Partners of primiparous women
aged less than 25 years were significantly less enthusiastic
in reaction to the pregnancy (76% overjoyed or pleased
compared to 90% in the partners of older women); how-
ever, partners of multiparous younger women were more
likely to attend antenatal checks.
Fathers whose partners were primiparous women in
the least deprived quintiles on the IMD were signifi-
cantly more likely to be overjoyedor pleasedin reac-
tion to the pregnancy (89% compared to 85% in the
most deprived quintile), and partners of multiparous
women in the least deprived quintiles were more likely
to be present for labour. However, partnersattendance
at antenatal checks was more likely to occur in deprived
areas for multiparous women.
Partners of women of Black or Minority Ethnic (BME)
origin were significantly less likely to be present for
labour than partners of white women (81% compared to
93% in multiparous white women). In particular, part-
ners of women from Black or Black British backgrounds
were significantly less likely to be present.
The different sociodemographic variables are closely
linked so binary logistic regression was used to estimate
the combined effects on partners reaction to pregnancy,
presence at antenatal checks and labour, involvement in
obtaining information and in decision-making, and in
infant care. This showed that maternal age, IMD and
parity were all strongly associated with the variables of
interest (Table 4). Partners of multiparous women were
significantly more likely to have a negative reaction to
Table 1 Characteristics of women and their partners
n%
Parity
Primiparous 2610 50.1
Multiparous 2603 49.9
Mothers age
<25 795 15.7
25-34 2953 58.2
35+ 1326 26.1
Fathers age
<25 217 9.6
25-34 1327 58.6
35+ 721 31.8
Mothers Ethnic group
White 4405 86.0
Mixed 94 1.8
Asian or Asian British 375 7.3
Black or Black British 185 3.6
Chinese or Other 63 1.2
Index of Multiple Deprivation (quintiles)
1 (least deprived) 1040 20.1
2 1024 19.8
3 1104 21.4
4 966 18.7
5 1036 20.0
Age woman left full-time education
</= 16 years 1176 23.0
>16 years 3948 77.0
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the pregnancy, be less involved in the pregnancy, were
less likely to be present during the labour and involved
in infant care postnatally. Partners of women living in
deprived areas were more likely to have a negative reac-
tion to the pregnancy but more likely to attend antenatal
checks, less likely to be involved in obtaining informa-
tion or decision-making or be present for labour, but
more likely to be involved in infant care. Partners of
younger women were less likely to have a negative reac-
tion to the pregnancy, more likely to attend antenatal
checks, obtain information and be present for labour.
Ethnicity was only associated with presence in labour,
partners of BME women being less than half as likely to
be present compared to partners of white women (Odds
ratio 0.38, 95% confidence interval 0.28, 0.50).
Paternal engagement score
The results of the generalised linear modelling are shown
in Table 5. Paternal engagement scores were significantly
higher in partners of primiparous than multiparous women,
and in primiparous women who had received more educa-
tion or were aged 2534 years, and men born in the UK.
Engagement also tended to be higher in partners of white
women and those living in less deprived areas but these
Table 2 Fathersinvolvement in individual aspects of pregnancy, childbirth and early parenting by parity (excluding
same sex and single parents) (%)
Primiparous women Multiparous women All women
(n = 2286) (n = 2330) (n = 4616)
Pregnancy and labour
Overjoyed/pleased in reaction to pregnancy (4199) 82.4 82.6 82.5
Present for pregnancy test* (3121) 66.7 56.6 61.7
Present for 1 or more AN check* (3175) 73.3 51.5 62.5
Present for 1 or more ultrasound scan* (4588) 91.2 86.3 88.8
Present for 1 or more AN class* (1707) 59.9 7.7 34.2
Present for labour* (4657) 91.7 88.3 90.0
Not present for any of the above (125) 2.6 2.5 2.6
Information and decision-making
Involved in finding information about pregnancy* (2044) 54.5 27.0 40.9
Involved in finding information about labour/birth* (1947) 51.8 25.8 38.9
Involved in making a birth plan* (2300) 65.1 50.2 57.7
Involved in decision-making regarding AN screening* (2916) 55.9 35.7 45.8
Involved in decision-making in labour* (2769) 60.0 49.5 54.8
Not involved in any of the above* (815) 11.5 21.7 16.6
Staff Communication
Antenatally staff communication rated as good or very good* (3948) 82.6 78.7 80.7
Intrapartum staff communication rated as good or very good (4326) 87.6 88.0 87.8
Postnatally staff communication rated as good or very good (3653) 73.6 75.6 74.6
Paternity leave *
No time off (808) 24.2 30.7 27.5
Less than two weeks off (744) 13.2 17.3 15.3
Two weeks off (2142) 48.7 40.2 44.4
More than two weeks off (625) 13.9 11.8 12.8
Father involvement postnatally (a great deal/a bit) 89.5 84.3 86.9
Nappy changing* (4419)
Helping/supporting feeding* (4440) 90.1 84.5 87.3
Helping when the baby cries (4731) 93.2 92.9 93.0
Bathing the baby* (3932) 85.3 69.3 77.3
Playing with the baby (4909) 96.9 96.2 96.5
Looking after the baby when mother out/at work (4012) 81.5 76.3 78.9
* p < 0.01 AN antenatal, IP intra-partum, PN postnatal.
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Table 3 Maternal sociodemographic variables and fathersinvolvement in key aspects of pregnancy, birth and
childcare by parity, maternal and paternal age (years), black and minority ethnic group status and IMD (Index of
Multiple Deprivation) by quintile
Father overjoyed or
pleased in reaction to
pregnancy (%)
Father present for
1 or more AN
checks (%)
Father
present for
labour (%)
Father involved in accessing
information and decision-making
AN or IP (%)
Father involved a great
dealin all aspects of
baby care (%)
Primiparous:
Mothers age
<25 76.2* 81.9 96.1 88.4 38.6
25-34 88.4 78.0 97.1 92.1 40.7
35+ 89.8 74.5 95.1 90.8 42.3
Multiparous:
Mothers age
<25 78.5 64.5* 92.9 74.7 32.3
25-34 85.8 56.2 92.1 76.5 29.1
35+ 85.7 48.9 90.0 79.6 26.8
Primiparous:
Fathers age
<25 68.7* 82.4 94.9 87.2* 36.2
25-34 88.5 78.1 97.1 93.2 41.5
35+ 88.1 76.6 96.1 93.1 40.4
Multiparous:
Fathers age
<25 82.9 71.0* 95.7 77.6 32.9
25-34 85.4 56.1 91.6 81.4 30.6
35+ 85.6 51.5 90.7 80.8 26.7
Primiparous:
IMD
1 89.0* 78.2 97.5 93.0 38.2
2 90.6 77.9 97.6 89.7 43.0
3 83.4 78.3 96.7 92.1 43.0
4 84.3 77.0 96.9 89.3 39.6
5 85.3 79.3 93.9 90.8 38.3
Multiparous:
IMD
1 85.7 48.2* 94.1* 79.9 25.5
2 88.9 50.3 93.0 80.8 31.4
3 84.8 59.6 92.4 74.3 29.4
4 83.0 54.6 88.5 76.6 29.2
5 83.1 59.6 87.0 74.4 27.3
Primiparous:
White 86.2 78.4 97.2* 91.1 42.1*
BME 88.3 75.8 92.6 92.0 31.0
Multiparous:
White 85.6 53.5 93.1* 77.7 29.7*
BME 84.5 58.2 81.2 76.2 22.4
* p < 0.01 AN Antenatal, IP Intrapartum, IMD(1-least depriv ed), BME Black and Minority Ethnic group.
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differences were not statistically significant. Irrespective of
parity, where women reported that it was a planned happy
pregnancy, the fathers tended to be significantly more en-
gaged (mean partner engagement score in primiparous
women with a planned happy pregnancy 7.24 (95% confi-
dence interval 7.13, 7.35) compared to unplanned unhappy
pregnancy 6.19 (95% confidence interval 5.86, 6.53).
After adjustment for sociodemographic factors, greater
paternal engagement was positively associated with first
contact with health professionals before 12 weeks gesta-
tion, earlier booking in multiparous women, and irre-
spective of parity, having a dating scan, number of
antenatal checks and offer and attendance at antenatal
classes. In multiparous women paternal engagement was
also associated with increased number of antenatal
health problems and worries about labour. Women with
more engaged partners also used more positive adjec-
tives to describe care during labour and birth and mul-
tiparous women with more engaged partners were more
satisfied overall with their antenatal care. Other indica-
tors of perception of antenatal care were unaffected.
Certain outcomes of care were also associated with pa-
ternal engagement in pregnancy and labour. Adjusted
paternal engagement score was significantly higher in
women who delivered by forceps than women who de-
livered normally. Primiparous women who had skin-to
-skin contact with their babies soon after birth, those
who were satisfied with intrapartum care overall, and
multiparous women who felt that staff communicated
well with them in labour also reported higher levels of
paternal engagement compared with other women.
Paternal involvement after the birth was estimated using
the postnatal score (Table 6). After adjustment, where post-
natal involvement was highest, women reported signifi-
cantly better overall health at 3 months (mean engagement
score in multiparous women who were well 14.7 (95% con-
fidence interval 14.5, 14.8) compared to those who were
not well 13.6 (95% confidence interval 13.1, 14.1); primipar-
ous women reported fewer health problems at one month
and multiparous women reported fewer health problems at
each time point. Postnatal problems were also considered
in groups [24]. At one month postpartum, where paternal
involvement was higher, multiparous women were less
likely to report psychological symptoms (blues, depression,
anxiety), bodily symptoms (stress incontinence, backache,
dyspareunia), and post-traumatic stress symptoms (flash-
backs to labour or birth, sleep problems not related to the
baby, and difficulties in concentrating). Primiparous women
were more likely to have a postnatal check with their doctor
if paternal involvement was higher.
Outcomes of care and paternity leave
Paternity leave was strongly associated with well-
being at three months (Table 7). After adjustment for
sociodemographic variables and mode of delivery,
women were more likely to feel unwell at this time when
their partner had either taken no time off at all or took
more than two weeks off. Multiparous women whose
partner took no paternity leave were significantly more
likely to report depression at one month and three
months than women whose partners took the standard
two weeks leave.
Fathers involvement and infant feeding
Further analyses were conducted to assess fathersinflu-
ence on infant feeding: women were asked about infant
feeding after the birth and at the time of the survey and,
if they had breastfed, the duration of breastfeeding
(Table 8). They were also asked about breastfeeding
problems at 10 days, one month and three months. After
adjustment, women whose partners were more engaged
antenatally and in labour were more likely to breastfeed
and to breastfeed for longer, significantly so for prim-
iparous women. However, in women who were breast-
feeding, breastfeeding problems at 10 days were more
common in those whose partners were more engaged,
significantly so in multiparous women. There were no
differences at one and three months.
Discussion
This study demonstrates that the association reported in
earlier small scale studies holds up in this larger sample.
Parity, age, ethnicity and deprivation were key factors af-
fecting the fathers reaction to and degree of involvement
with the pregnancy, as well as the likelihood of him be-
ing present for the labour and helping with the baby
postnatally. In the postnatal period, partners of multipar-
ous women were less likely to be involved in childcare
than primiparous women. This is consistent with a study
from the USA [25] which reported that first time fathers
do more infant care. This is unsurprising and probably
reflects the additional childcare needed in multiparous
households. Women in lower socioeconomic groups
were also more likely to have a partner that was actively
involved in childcare, consistent with data reported in
the Millenium Cohort Study (MCS) [26]. Conversely,
partners of women from BME groups were significantly
less likely to be involved postnatally. Data from the MCS
suggest that this is particularly in Indian, Pakistani and
Bangladeshi fathers who were significantly less likely to
feed or change their babys nappy [26].
The womans reaction to the pregnancy was also
strongly associated with partner support, consistent with
earlier work in this area which stressed the importance
of partner stability, dependability and support in the
wantedness of the pregnancy [27]. After adjustment for
sociodemographic factors, greater paternal engagement
was associated with earlier first contact with a health
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professional during pregnancy, earlier timing of the
booking appointment and the woman was more likely
to have a dating scan. However, it should be borne in
mind that recall, even of such salient events, may be
compromised by time. Similarly, where paternal engage-
ment was high women were more likely to be offered
and to attend antenatal classes. This may be consequent
upon early booking as demand for classes is high and
provision inadequate in many parts of England [28].
With respect to perceptions of care, although women
were asked throughout the survey whether they felt they
were treated with respect and kindness and spoken to so
that they could understand, treated as an individual, had
confidence in the staff, and overall satisfaction, the only
Table 4 Sociodemographic factors associated with father
involvement in pregnancy and labour: binary logistic
regression
Factors associated with father having a negative reaction to
pregnancy
Parity Odds ratio (95% CI)
Primiparous reference group
Multiparous 1.23 (1.03, 1.46)*
Index of multiple deprivation (Quintile, 1- least deprived)
1 reference group*
2 0.79 (0.60, 1.05)
3 1.25 (0.97, 1.60)
4 1.27 (0.97, 1.66)
5 1.14 (0.86, 1.50)
Womans age
<25 years reference group
25-34 years 0.49 (0.39, 0.61)*
35+ years 0.48 (0.37, 0.63)*
Factors associated with father being present for 1 or more
antenatal checks
Parity Odds ratio (95% CI)
Primiparous reference group
Multiparous 0.35 (0.31, 0.41)*
Index of multiple deprivation (Quintile, 1- least deprived)
1 reference group
2 1.04 (0.86, 1.26)
3 1.28 (1.05, 1.56)*
4 1.08 (0.88, 1.33)
5 1.27 (1.03, 1.58)*
Womans age
<25 years reference group
25-34 years 0.79 (0.63, 0.98)*
35+ years 0.62 (0.49, 0.79)*
Factors associated with father being present for labour
Parity Odds ratio (95% CI)
Primiparous reference group
Multiparous 0.40 (0.30, 0.53)*
Ethnicity
White reference group
Black and Minority Ethnic 0.38 (0.28, 0.50)*
Index of multiple deprivation (Quintile, 1- least
deprived)
1 reference group*
2 0.87 (0.57, 1.34)
3 0.79 (0.52, 1.20)
4 0.64 (0.42, 0.97)*
5 0.52 (0.34, 0.78)*
Table 4 Sociodemographic factors associated with father
involvement in pregnancy and labour: binary logistic
regression (Continued)
Womans age
<25 years reference group*
25-34 years 1.05 (0.68, 1.63)
35+ years 0.66 (0.41, 1.04)
Factors associated with father not being at all involved in
obtaining information and decision-making
Parity Odds ratio (95% CI)
Primiparous reference group
Multiparous 3.11 (2.54, 3.80)*
Index of multiple deprivation (Quintile, 1- least
deprived)
1 reference group
2 1.17 (0.87, 1.56)
3 1.44 (1.09, 1.91)*
4 1.36 (1.01, 1.83)*
5 1.44 (1.07, 1.95)*
Womans age
<25 years reference group
25-34 years 0.76 (0.57, 1.01)
35+ years 0.69 (0.50, 0.94)*
Factors associated with father being involved in infant care
Parity Odds ratio (95% CI)
Primiparous reference group
Multiparous 0.79 (0.68, 0.92)*
Index of multiple deprivation (Quintile, 1- least
deprived)
1 reference group
2 1.11 (0.87, 1.41)
3 1.14 (0.90, 1.45)
4 1.35 (1.06, 1.73)*
5 1.56 (1.22, 2.00)*
* p < 0.05 Adjusted for maternal age, ethnicity, parity and Index of
Multiple Deprivation.
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Table 5 Mean partner engagement score (95% confidence interval) by a) socio-demographic factors and parity, and
other factors during b) antenatal, c) intrapartum and d) postnatal periods
Primiparous women Multiparous women
Mean (95% CI) Adjusted*pMean (95% CI) Adjusted*p
a) Sociodemographic factors
Mothers ethnicity
White 7.13 (7.03, 7.24) 4.93 (4.83, 5.02)
BME 6.83 (6.50, 7.16) 0.93 4.83 (4.51, 5.14) 0.74
Index of multiple deprivation (quintile)
1 7.30 (7.09, 7.52) 4.92 (4.74, 5.10)
2 7.12 (6.90, 7.33) 4.96 (4.76, 5.16)
3 7.18 (6.97, 7.39) 4.99 (4.77, 5.20)
4 7.03 (6.80, 7.26) 4.88 (4.64, 5.12)
5 6.82 (6.57, 7.08) 0.16 4.78 (4.54, 5.02) 0.42
Mother left full time education aged
<16 yrs 6.77 (6.52, 7.03) 4.93 (4.79, 5.13)
>/= 16 yrs 7.17 (7.06, 7.28) 0.01 4.91 (4.80, 5.01) 0.92
Age group (mothers)
<25 yrs 6.72 (6.48, 6.96) 5.33 (4.92, 5.73)
25-34 yrs 7.21 (7.09, 7.33) 4.94 (4.81, 5.06)
35+ yrs 7.09 (6.86, 7.33) 0.00 4.79 (4.64, 4.94) 0.01
Fathers country of birth
UK 7.24 (7.13, 7.35) 4.94 (4.83, 5.04)
Europe 6.01 (5.60, 6.42) 5.02 (4.52, 5.53)
Rest of the world 6.78 (6.45, 7.11) 0.00 4.75 (4.45, 5.05) 0.48
Pregnancy planning
Planned and happy pregnancy 7.24 (7.13, 7.35) 4.97 (4.87, 5.08)
Unplanned but happy 6.77 (6.44, 7.11) 4.68 (4.34, 5.02)
Unplanned and unhappy 6.19 (5.86, 6.53) 0.00 4.60 (4.30, 4.89) 0.02
b) Antenatal care factors
Booking appointment
Before 10 weeks 7.23 (7.11, 7.35) 5.06 (4.93, 5.19)
Booking at/after 10 weeks 6.89 (6.70, 7.08) 0.33 4.69 (4.54, 4.84) 0.00
Gestation when healthcare professional 1
st
seen
<12 weeks 7.17 (7.07, 7.28) 4.95 (4.85, 5.05)
12+ weeks 6.22 (5.79, 6.65) 0.01 4.58 (4.27, 4.89) 0.01
Number of antenatal checks
0-5 6.60 (6.31, 6.89) 4.57 (4.36, 4.78)
6-8 7.14 (6.97, 7.31) 4.76 (4.60, 4.92)
9-10 7.07 (6.86, 7.27) 5.10 (4.88, 5.32)
11 or more 7.29 (7.12, 7.45) 0.05 5.22 (5.04, 5.41) 0.00
Dating scan done 7.13 (7.03, 7.23) 4.95 (4.84, 5.05)
No dating scan 6.73 (6.37, 7.09) 0.05 4.62 (4.32, 4.92) 0.02
Antenatal classes
Offered 7.20 (7.10, 7.30) 5.03 (4.89, 5.16)
Not offered 6.27 (5.96, 6.58) 0.01 4.79 (4.66, 4.92) 0.02
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Table 5 Mean partner engagement score (95% confidence interval) by a) socio-demographic factors and parity, and
other factors during b) antenatal, c) intrapartum and d) postnatal periods (Continued)
Attended 7.48 (7.36, 7.60) 5.72 (5.39, 6.06)
Not attended 6.53 (6.36, 6.70) 0.00 4.85 (4.72, 4.96) 0.00
Number of antenatal health problems
0,1 7.02 (6.86, 7.18) 4.75 (4.59, 4.91)
2,3 7.21 (7.05, 7.36) 4.84 (4.69, 4.98)
4+ 7.01 (6.79, 7.22 0.18 5.14 (4.96, 5.32) 0.01
Worries about labour
low 7.21 (6.93, 7.48) 4.70 (4.54, 4.87)
low-medium 7.08 (6.86, 7.30) 5.00 (4.83, 5.18)
medium-high 7.24 (7.07, 7.41) 4.90 (4.70, 5.09)
high 6.92 (6.74, 7.09) 0.16 5.07 (4.84, 5.30) 0.02
Overall satisfaction with antenatal care
Satisfied or very satisfied 7.14 (7.04, 7.24) 4.96 (4.86, 5.06)
Neither satisfied nor dissatisfied 6.82 (6.41, 7.25) 4.50 (4.18, 4.82)
Dissatisfied or very dissatisfied 6.70 (6.25, 7.13) 0.16 4.66 (4.22, 5.11) 0.01
c) Intrapartum factors
Type of delivery
Spontaneous vaginal birth 7.03 (6.90, 7.17) 4.87 (4.76, 4.98)
Forceps 7.25 (6.98, 7.52) 5.70 (4.98, 6.43)
Ventouse 7.18 (6.87, 7.49) 5.46 (4.82, 6.09)
Caesarean section 7.14 (6.94, 7.33) 0.03 4.92 (4.72, 5.11) 0.04
Number of positive adjectives describing staff in labour and birth
0-3 6.58 (6.38, 6.77) 4.64 (4.45, 4.82)
4-5 7.06 (6.89, 7.23) 4.80 (4.64, 4.96)
6+ 7.48 (7.34, 7.63) 0.00 5.18 (5.03, 5.33) 0.00
After birth, had skin-to-skin contact with baby
Yes 7.19 (7.08, 7.30) 4.92 (4.82, 5.02)
No, not offered 6.85 (6.53, 7.16) 5.02 (4.63, 5.42)
No, not well enough 6.76 (6.37, 7.15) 4.92 (4.44, 5.39)
No, not wanted 5.87 (4.77, 6.97) 0.02 4.63 (3.98, 5.27) 0.72
Staff communication in labour
Very/fairly well 7.14 (7.03, 7.24) 4.93 (4.83, 5.03)
Not very/at all well 6.60 (6.23, 6.98) 0.30 4.63 (4.28, 4.98) 0.05
Overall satisfaction with intrapartum care
Satisfied or very satisfied 7.16 (7.05, 7.26) 4.94 (4.84, 5.04)
Neither satisfied nor dissatisfied 6.85 (6.40, 7.30) 4.53 (4.10, 4.96)
Dissatisfied or very dissatisfied 6.54 (6.15, 6.94) 0.03 4.88 (4.50, 5.26) 0.08
*Adjusted for maternal age, ethnicity, IMD, age left full-time education, and fathers country of birth.
Other variables entered in analysis but not significant in either primiparous or multiparous women: staff spoke so woman could understand, were kind and
respectful antenatally, woman stayed in hospital overnight antenatally; number of negative adjectives applied to staff in labour, treated as an individual, staff
spoke so woman could understand, were kind and respectful in intrapartum period, induction of labour, duration of labour, able to move around in labour, type
of caesarean section, held/breastfed soon after birth, had confidence in staff intrapartum, left alone in labour or soon after the birth when it was worrying, how
woman felt in first few days after the birth.
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measure that was significantly associated with pater-
nal engagement was the positive subscale of the adjec-
tive checklist used to describe the staff in labour and
delivery.
Women who reported greater partner involvement
antenatally also reported more antenatal problems and
worries about labour. This may reflect the increased
support that may be required in circumstances where a
woman is anxious or unwell.
Outcomes of care varied only slightly by paternal en-
gagement after adjustment for sociodemographic factors.
Paternal engagement was significantly higher in women
who had a forceps delivery compared to women who
had a normal delivery. These women also had longer la-
bours and were more likely to have been induced. It is
possible that fathers who were more supportive and en-
gaged were particularly distressed at seeing their partner
in pain and exhausted, possibly prompting earlier inter-
vention than men who were less engaged with the
process. It is possible that they also felt more em-
powered to intervene on their partners behalf. This is
supported by an Italian study, examining fathersexperi-
ence during labour where their partner had an epidural.
They found that, where an epidural was used, men felt
significantly more helpful and involved and experienced
less stress and anxiety [29]. Postnatal health, particularly
in multiparous women, tended to be better in women
whose partner was more involved at this stage. At three
months women were significantly more likely to report
feeling physically very well or quite wellwhere their
Table 6 Paternal involvement after birth using postnatal paternal engagement score (95% confidence interval) and
maternal problems by parity
Primiparous women Multiparous women
Mean (95% CI) Adjusted* pMean (95% CI) Adjusted* p
How woman felt at time of survey
very/quite well 16.0 (15.9, 16.1) 14.7 (14.5, 14.8)
not very well/ill 15.3 (14.8, 15.8) 0.00 13.6 (13.1, 14.1) 0.00
Number of postnatal problems at 10 days
0,1 15.9 (15.7, 16.2) 14.6 (14.3, 14.8)
2,3 16.1 (15.9, 16.3) 14.8 (14.5, 15.0)
4+ 15.9 (15.7, 16.1) 0.50 14.2 (13.8, 14.6) 0.04
Number of postnatal problems at 1 month
0 16.1 (15.8, 16.3) 14.8 (14.6, 15.1)
1 16.0 (15.8, 16.3) 14.6 (14.3, 15.0)
2+ 15.9 (15.7, 16.0) 0.05 14.2 (13.9, 14.4) 0.00
Number of postnatal problems at 3 months
0 15.9 (15.8, 16.1) 14.7 (14.5, 14.9)
1+ 16.0 (15.8, 16.2) 0.99 14.3 (14.0, 14.5) 0.01
Postnatal psychological problems at 1 month
yes 15.9 (15.7, 16.2) 14.1 (13.7, 14.4)
no 16.0 (15.8, 16.1) 0.68 14.7 (14.5, 14.8) 0.00
Postnatal PTSD type symptoms at 1 month
yes 15.9 (15.7, 16.1) 14.1 (13.7, 14.4)
no 16.0 (15.8, 16.1) 0.21 14.7 (14.5, 14.8) 0.01
Postnatal bodily problems at 1 month
yes 15.9 (15.7, 16.1) 14.3 (14.1, 14.6)
no 16.0 (15.9, 16.2) 0.14 14.7 (14.5, 14.8) 0.02
Postnatal check
Check carried out 16.0 (15.9, 16.1) 14.6 (14.4, 14.7)
Check not carried out 15.5 (15.2, 15.9) 0.03 14.4 (14.0, 14.8) 0.39
PTSD Post Traumatic Stress Disorder.
*Adjusted for maternal age, ethnicity, IMD, age left full-time education, and fathers country of birth.
Other variables entered in analysis but not significant in either primiparous or multiparous women: visited at home by midwife, number of different midwives
who visited, would have liked to see midwife more/less frequently at home, met midwife before, confidence in staff postnatally, choice about where to access
care, groups of postnatal problems at 10 days and 3 months.
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partner was more involved. Similarly, they had fewer
postnatal problems and were more likely to have a post-
natal check. These findings conflict with data from the
MCS which found that fathersinvolvement in childcare
was not associated with mothershigher satisfaction or
reduced depression [26]. However, these analyses related
to children at 9 months at which point circumstances
may be different.
Paternity leave had a similar effect in that, after adjust-
ment, women whose partners had taken no paternity
leave were more likely to report feeling unwell or ill at
three months, and multiparous women reported much
higher rates of depression at one and three months (46%
and 44% respectively of those whose partners had taken
no leave). However, partners of women who were unwell
or ill at this point were also more likely to have a partner
who took more than two weeks off, perhaps reflecting
the fact that these women would have needed more
help. The difference by parity in fathers postnatal in-
volvement may, as speculated by Hosking et al. [30], be
due to men taking a greater role in care of older chil-
dren. Paternity leave was highly correlated with the post-
natal engagement score which is consistent with MCS
data indicating that men who took more leave tended to
be more involved in nappy changing, feeding and getting
up in the night [31]. Breastfeeding in the first few days
and at three months was also positively associated with
paternal engagement, particularly in primiparous women.
This is consistent with other research in this area
which has found that where fathers are more involved
Table 7 Outcomes of care by paternity leave and by parity (%), and binary logistic regression adjusting for
sociodemographic variables and mode of delivery
Paternity leave
None 1-9 working days 2 weeks More than
(n = 1257) (n = 702) (n = 2041) 2 weeks (n = 589)
How woman felt physically at 3 months
Primiparous women**
Very/quite well 23.6 13.7 49.5 13.2
Not well/ill 29.3 8.6 41.4 20.7
OR (95% CI) of being not well/ill 1 (ref) 0.50 (0.27, 0.90)* 0.67 (0.46, 0.97)* 1.31 (0.84, 2.04)
Multiparous women**
Very/quite well 29.4 17.8 40.9 11.9
Not well/ill 39.5 14.1 35.1 11.2
OR (95% CI) of being not well/ill 1 (ref) 0.65 (0.43, 0.97)* 0.66 (0.49, 0.90)* 0.70 (0.45, 1.10)
Depression at 1 month
Primiparous women
Yes 27.7 7.8 47.0 17.5
No 23.9 13.6 48.9 13.6
OR (95% CI) of depression 1 (ref) 0.53 (0.28, .01) 0.87 (0.58, 1.29) 1.15 (0.70, 1.91)
Multiparous women **
Yes 46.0 15.1 28.8 10.1
No 29.8 17.4 40.9 11.9
OR (95% CI) of depression 1 (ref) 0.61 (0.36, 1.02) 0.47 (0.31, 0.72)** 0.55 (0.30, 1.03)
Depression at 3 months
Primiparous women
Yes 26.8 7.0 49.3 16.9
No 24.1 13.4 48.7 13.8
OR (95% CI) of depression 1 (ref) 0.50 (0.18, 1.37) 0.97 (0.54, 1.74) 1.20 (0.57, 2.55)
Multiparous women **
Yes 44.0 15.5 25.0 15.5
No 30.2 17.4 40.7 11.7
OR (95% CI) of depression 1 (ref) 0.61 (0.31, 1.17) 0.42 (0.24, 0.74)** 0.85 (0.43, 1.68)
* p < 0.05 **p 0.01.
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breastfeeding rates are higher [32]. However, another
small study suggested that bottle feeding allowed men the
time to develop their relationship with their babies and
was encouraged by some women [33]. In multiparous
women who were breastfeeding at 10 days, breastfeeding
problems were more common in women whose partners
were more engaged. This could be interpreted as women
who receive support and encouragement from their part-
ner persevering with breastfeeding, even when it is more
difficult or problems arise. Also, multiparous women may
be more aware than primiparous women that 10 days is
still early for lactation to be well-established.
Other outcomes that were examined but which were
not significantly associated with paternal engagement
after adjustment were: womens physical health in the
first few days and most of the individual postnatal health
problems which included fatigue, backache and stress in-
continence as well as anxiety and depression.
Limitations to this study include the response rate of
55.1%. There was under-reporting from women who
were young, single, from a BME group and those living
in deprived areas. Nevertheless, the sample size of 5332,
86% of whom provided information about their partner,
is considerable. A further limitation of this type of sur-
vey is its cross-sectional nature. It is therefore not pos-
sible to ascribe causality to the associations reported.
Although some men may have completed the section
relating to fathers themselves, the majority were prob-
ably completed by women on their partners behalf.
They may not accurately reflect fathersviews or degree
of involvement and may be completed such as to
present their partner in a particular way. However, data
reported in the MCS suggest that the correlation be-
tween mothersand fathersreported amount of domes-
tic work undertaken by men was high, although fathers
over-report and mothers under-report mens involve-
ment [26]. Similarly, the sociodemographic characteris-
tics were predominantly those of the woman reflecting
her pattern of parity, deprivation and ethnicity rather
than her partners, although where both parentsages
and country of birth were available, these were highly
correlated. The partner engagement scores were based
on what may be considered fairly crude markers for
partner involvement and recall over the duration of
pregnancy and the postnatal period which may have led
to inaccuracy. Moreover, many men may be unable to
be present at the various checks, scans and classes ante-
natally but still be very supportive of their partner.
Similarly, in this study women who were not living with
their babys father were excluded although it is acknowl-
edged that non-resident fathers are generally still in-
volved with their children to a certain extent [19].
Table 8 Mean partner engagement score (95% confidence interval) and associated infant feeding patterns and
breastfeeding problems, by parity
Primiparous women Multiparous women
Mean (95% CI) Adjusted* pMean (95% CI) Adjusted* p
Tried to breastfeed at least once 7.18 (7.08, 7.29) 4.95 (4.85, 5.06)
Never tried to breastfeed 6.36 (6.05, 6.66) 0.00 4.75 (4.53, 4.97) 0.05
Infant feeding in first few days
Breastfeeding only 7.25 (7.13, 7.38) 4.95 (4.84, 5.06)
Breast and formula 6.98 (6.76, 7.20) 4.91 (4.63, 5.20)
Formula only 6.61 (6.35, 6.86) 0.00 4.76 (4.56, 4.97) 0.10
Infant feeding at 3 months
Formula 6.89 (6.75, 7.03) 4.84 (4.71, 4.97)
Breastfeeding 7.42 (7.25, 7.58) 4.97 (4.81, 5.13)
Both formula and breast 7.06 (6.82, 7.30) 4.95 (4.70, 5.21)
Other 7.67 (5.85, 9.38) 0.00 5.00 (2.68, 7.32) 0.31
Breastfeeding duration
didnt breastfeed 6.44 (6.17, 6.70) 4.82 (4.61, 5.03)
1-20 days 7.12 (6.88, 7.36) 4.82 (4.58, 5.06)
21-98 days 6.99 (6.76, 7.22) 4.90 (4.67, 5.13)
still breastfeeding 7.30 (7.16, 7.43) 0.00 4.96 (4.83, 5.10) 0.25
Of those women breastfeeding: Breastfeeding problems at 10 days
Yes 7.22 (7.06, 7.38) 5.11 (4.91, 5.31)
No 7.20 (7.03, 7.37) 0.86 4.85 (4.71, 4.99) 0.03
*Adjusted for maternal ethnicity, age, IMD. age on leaving full-time education, and fathers country of birth.
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This study therefore strengthens the literature on
father involvement with pregnancy and childbirth which
is mainly qualitative and has largely focused on white,
middle class men or relatively small scale quantitative
studies. The pronounced effect of parity is previously
unreported except in a limited manner [25] and al-
though not unexpected, this powerfully reflects the life
changing nature of the birth of the first child and the
transition to parenthood with a new role and identity
[34,35], compared to the situation with the birth of sec-
ond and subsequent children. The cultural differences
associated with ethnicity, particularly in the delivery
room are also consistent with the literature in this area
[36-38] as are the variations by womensageanddegree
of deprivation [7].
Implications for practice principally lie in the import-
ance of health professionals recognising that women in
some sociodemographic groups may be less supported
by their partner and more reliant on staff. They may
book later in pregnancy and, as a consequence, miss the
window of opportunity for dating scans and other
screening tests. They may also miss out on antenatal
classes which may leave them even more unsupported in
the postnatal period. Nevertheless, the vast majority of
fathers are reportedly pleased or overjoyed in reaction to
the pregnancy, and involved antenatally, in labour and
postnatally. While women and their babies are the main
focus of care it seems that there is room for yet greater
engagement with fathers. Health professionals can have
an active role in supporting and facilitating this by en-
couraging fathers to attend appointments and classes
with their partners and, where possible, to direct some
parts of antenatal education specifically at fathers.
Conclusion
From the womens point of view the majority of recent
fathers are clearly actively engaged in pregnancy, child-
birth and afterwards. The positive association with
women themselves accessing maternity care during
pregnancy and postnatally and with outcomes including
breastfeeding, reinforce a position that values fathers
and their important role in supporting women at this
critical time in the lives of their partners and children.
Most fathers were very positive about their partners
pregnancy; almost all were present for pregnancy ultra-
sound examinations and for labour. Three-quarters of
fathers took paternity leave and, during the postnatal
period, most fathers helped with infant care. Greater pa-
ternal engagement was positively associated with timing
of first contact with health professionals, having a dating
scan, number of antenatal checks, offer and attendance
at antenatal classes, and breastfeeding. Paternity leave
was also strongly associated with maternal well-being at
three months postpartum.
This study demonstrates the considerable sociode-
mographic variation in partner support and engagement
in the processes associated with pregnancy care, labour
and birth and in the early days of parenting and caring
for a young baby at home. It is important that health
professionals recognise that women in some sociode-
mographic groups may be less supported by their part-
ner and more reliant on staff providing maternity
services and support and that this impacts on womens
needs and how and when they access care.
Competing interests
The authors declare that they have no competing interests.
Authorscontributions
MR was responsible for designing the survey, oversaw the management and
coordination and helped to draft the manuscript. JH conducted the analysis
and drafted the manuscript. Both authors read and approved the final
manuscript.
Acknowledgements
This paper reports on an independent study which is funded by the Policy
Research Program in the Department of Health. The views expressed are not
necessarily those of the Department of Health. The original survey was
funded by the Department of Health (London, United Kingdom).
Received: 13 December 2012 Accepted: 6 March 2013
Published: 20 March 2013
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doi:10.1186/1471-2393-13-70
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... Despite the aspects highlighted, it is evident that male partner involvement in maternal health has significantly contributed to improved utilization of institutional delivery [6]. Additionally, other benefits of involving men in maternity care have increased access to antenatal visits hence increased the likelihood of access to skilled birth attendants, family planning, and addressing gender-based barriers to access to maternal health [7][8][9]. ...
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Book
This book documents the early lives of almost 19,000 children born in the UK at the start of the 21st century, and their families. It is the first time that analysis of data from the hugely important Millennium Cohort Study, a longitudinal study following the progress of the children and their families, has been drawn together in a single volume. The unrivalled data is examined here to address important policy and scientific issues. The book is also the first in a series of publications that will report on the children’s lives at different stages of their development. The fascinating range of findings presented here is strengthened by comparison with data on earlier generations. This has enabled the authors to assess the impact of a wide range of policies on the life courses of a new generation, including policies on child health, parenting, childcare and social exclusion. Babies of the new millennium (title tbc) is the product of an exciting collaboration from experts across a wide range of health and social science fields. The result is a unique and authoritative analysis of family life and early childhood in the UK that cuts across old disciplinary boundaries. It is essential reading for academics, students and researchers in the health and social sciences. It will also be a useful resource for policy makers and practitioners who are interested in childhood, child development, child poverty, child health, childcare and family policy.
Chapter
The Millennium Cohort Study (MCS) provides data from mothers and fathers about their involvement with their new baby and in family life, uniquely, for a very large sample of UK fathers. This chapter first examines the effect of the baby. It looks on an under-researched group — fathers — as they appear in the existing literature, followed by a report on the division of domestic work between mothers and fathers. The discussion then presents what the survey finds about fathers' involvement with the cohort child, irrespective of whether they are living in the same home. It also reviews parenting beliefs and attitudes as well as the overlaps in mothers' and fathers' views about parenting, and some of the mothers' feelings about having a new baby.
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Using data from the first wave of the Millennium Cohort Study, covering a large birth cohort of children in the UK at age 8 to 12 months, this paper examines the effects of leave-taking and work hours on fathers' involvement in four specific types of activities: being the main caregiver; changing diapers; feeding the baby; and getting up during the night. We also investigate the effects of policies on fathers' leave-taking and work hours. We find that taking leave and working shorter hours are related to fathers being more involved with the baby, and that policies affect both these aspects of fathers' employment behaviour. Thus, we conclude that policies that provide parental leave or shorter work hours could increase fathers' involvement with their young children.
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This paper is concerned with themes taken from two different areas of sociological theory and investigation. The first relates to work on social class and social relationships and networks, within which a central issue has been the extent to which interpersonal ties are differentiated by occupationally-based class groups in modern society. The second area of work lies within the sociology of health and illness, and concerns the question of the health-promoting potential of social support. The paper draws on data from a study of a social support intervention in pregnancy involving 507 pregnant women in the Midlands and the South of England, and considers to what extent family, friendship and neighbourhood ties exhibit different patterns by occupational and other measures of class. The study findings suggest that working class women are not more closely involved with their relatives and are more isolated in terms of friends than middle class women; male domestic support is also less common in working class households. These patterns are discussed as part of the context within which services for the promotion of maternal and infant health are provided in modern industrial societies.
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Interviews with 59 1st-time mothers-to-be (aged 16–38 yrs) toward the end of their pregnancies and again after the birth of their babies, assessed the significance of social inputs (e.g., age and social class) and social mediators for the women's satisfaction with the quality of their birth experience. Measures of preparation for childbirth, satisfaction with information, social support, expected pain, and health locus of control were taken at Time 1, while measures of preparation for childbirth, social support, reported pain, symptoms of stress, reports of the baby's behavior, and satisfaction with the birth experience were taken at Time 2. Results highlight the ways that social class affect both social support and information; working-class women felt less satisfied with the birth experience. There were no age differences noted for preparation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)