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Revista chilena de pediatría

Print version ISSN 0370-4106

Rev. chil. pediatr. vol.90 no.1 Santiago  2019

http://dx.doi.org/10.32641/rchped.v90i1.821 

ARTICULO ORIGINAL

Being a first-time father. Their experiences and meanings: A Qualitative Systematic Review

Experiencias y significados de ser padre por primera vez: Una revisión sistemática cualitativa

Francisca Márquez1 

Camila Lucchini2 

María Rita Bertolozzi3 

Claudia Bustamante4 

Heather Strain5 

Claudia Alcayaga4 

Nicole Garay6 

1 Nurse Midwife, MSN, PhD, Pontificia Universidad Católica de Chile School of Nursing in Santiago, Chile.

2 Nurse Midwife, MSN, PhD ©, Pontificia Universidad Católica de Chile School of Nursing in Santiago, Chile.

3 RN, MSN, PhD, Universidade de São Paulo School of Nursing, São Paulo, Brazil.

4 Nurse Midwife, MSN, Pontificia Universidad Católica de Chile, School of Nursing in Santiago, Chile.

5 MD, Family Specialist, Ministry of Health, Chile.

6 Nurse, Master in Early Intervention Strategies in Children's Mental Health, Pontificia Universidad Católica de Chile, School of Nursing in Santiago, Chile.

Abstract:

Introduction:

Becoming a first-time father is an important change in the life of men and families. Studies on the subject show that these kinds of changes have the power to put life into perspective. Being an involved father has a deep meaning for the child and the family.

Objective:

To explore the experience of becoming a first-time father during the child first year of the life.

Subjects and Methods:

A qualitative systematic review was conducted in 2014 in three stages, based on the Joanna Briggs Institute Method for Qualitative Systematic Reviews (QSR). The stages used in this QSR were: establishing the question, determining the type of studies to be included, defining the evaluation criteria, and synthesizing the data. Papers that assessed clinical prognoses were considered such as first-time parenting experience and child care during the first year of life. Only primary qualitative studies including ethnography, phenomenology, narrative analysis, and action research were con sidered.

Results:

Three meta-syntheses were obtained from the analysis: 1) fatherhood adjustment process, 2) paternal role development, and 3) being an active father. The path towards adoption and the fulfillment of the paternal role is mediated by different processes that are consolidated during the child first year of life.

Conclusions:

The results support the idea that fathers want to be active parti cipants in the care of their children, that public policies should consider both parents equal in terms of their parenting responsibilities, and that the protection of the family and the family environment is a priority as a health promotion intervention.

Keywords: Nursing; Health Promotion; Parenting; Child Care

Resumen:

Introducción:

Ser padre por primera vez es un cambio importante en la vida del hombre y la familia. Los estudios en torno al tema demuestran que este tipo de cambios tienen la capacidad de poner la vida en perspectiva. Ser un padre participativo tiene un significado profundo para el niño/a y la familia.

Objetivo:

Explorar la experiencia de ser padre por primera vez durante el primer año de la vida del hijo/a.

Sujetos y Método:

Se realizó una revisión sistemática cualitativa en 2014 en 3 etapas, basado en el Joanna Briggs Institute Method para Revisiones Sistemáticas Cualitativas (QSR). Las etapas usadas en este QSR fueron: establecimiento de la pregunta, determinar el tipo de estudios a in cluir, definir los criterios de evaluación, y realizar la síntesis de los datos. Se consideraron manuscritos que evaluaran los pronósticos clínicos: experiencia de ser padre por primera vez y cuidados del niños durante el primer año de vida. Solo estudios cualitativos primarios incluyendo estudios de etnografía, fenomenología, análisis de narrativa e investigación de acciones fueron considerados.

Resultados:

Se obtuvieron tres meta-síntesis del análisis: 1) proceso de ajuste a la paternidad; 2) desarrollo del rol paterno y 3) ser un padre activo. El camino hacia la adopción y el cumplimiento del rol paterno está mediado por diversos procesos que durante el primer año de vida del niño/a se consolidan.

Conclu siones:

Los resultados apoyan la propuesta de que los padres desean ser protagonistas del cuidado de sus hijos/as, que las políticas públicas deben considerar a ambos padres como iguales en términos de sus responsabilidades de crianza, y que la protección de la familia y el entorno familiar es una priori dad como intervención de promoción de salud.

Palabras clave: Enfermería; Promoción de la salud; Paternidad; Cuidado infantil

Introduction

The way that paternity is experienced has under gone major changes over time2-4. During most of the last century, as a result of both demographic and epidemiological transitions, families have evolved from being large, extended, and matri-or-patrilocal units, towards becoming smaller, nuclear and neolocal units5. In general, in western capitalist societies, fami lies were characterized by a clear definition of parental role, where the mother assumed the role of raising chil dren and maintaining the household, whilst the father had a clear role as financial provider3,6. Progressively, fathers have assumed a more active role supporting the mother during pregnancy and childbirth7.

Evidence has shown that the inclusion of fathers in the childrearing process from pregnancy contributes to optimal child, maternal and family development; pro motes the establishment of secure attachment between the child and their main caregivers; and strengthens family bonds and the emotional satisfaction for the mother7,8. The first year of life is key in establishing effective bonding between the father and his child; du ring this period there is a process of meaningful inte raction between the two, as the child gains autonomy in his or her development.

The aim of this Qualitative Systematic Review (QSR) was to explore the experience of first time fatherhood during the first year of their child’s life. Considering the importance of the father’s presence during a child’s growth and development as well as the importance of the first year of life for the development of secure attachment, this systematic review proposed to answer the following question: How do first time fathers experience fatherhood during their child’s first year of life?

Subjects and Method

Joanna Briggs Institute (JBI) Method for QSR was used to conduct this investigation9. This form of research involves analyzing the theory, methods and fin dings of qualitative research and synthesizing new ways of understanding a phenomena10. The steps followed in this QSR were: establishing the review question, de termining the type of studies to include, designing the search strategy, defining assessment criteria, extracting data, and performing data synthesis.

The criteria for inclusion in this review were as follows: heterosexual male study participants aged 18 years or older whom had experienced becoming a father and taking care of their child, with their cou ples, during his/her first year of life. This QSR was res tricted to healthy children; therefore studies with men who shared experiences of miscarriage, child malfor mation and prematurity were not included. The study included only biological fathers whom had lived with his child during the period. There was no restriction on the ethnicity or cultural background of the parti cipants, however only studies published in English, Spanish, French and Portuguese were included in the review.

This review considered research articles and ma nuscripts that assessed the following qualitative outcomes: lived experiences of being a first time father, and caring for their child during the first year of life.

This review considered qualitative primary re search studies including designs such as: ethnography, phenomenology, grounded theory, narrative analysis and action research.

The search strategy aimed to find published and unpublished studies. A three-phase search strategy was conducted between August and September of 2014. A secondary search was conducted April 2017 to identify any new research since the original search. Phase one, supported by a specialized librarian, consisted of two steps. The first step was to identify initial key words ba sed on the research question, and the second step was to perform an initial search through a logic grid of key words from titles and abstracts found in MEDLINE and CINAHL databases.

The second phase consisted of analyzing the words contained in the titles and abstracts, and indexing the terms used to describe articles, in order to be able to develop a comprehensive and specific search strate gy for each database. Thereafter a second search was performed using all identified keywords across all databases (CINAHAL, Medline and Pubmed, PsycINFO, Lilacs, Scielo, BVS, BVS-Psi, Scopus, Cochrane Li brary, Embase and Sociological Abstracts). The key words were: fathers, caregivers, family, lived experien ces, experiences, father care and fatherhood. Finally the references list of all identified reports and articles were searched for additional studies. Studies published from 2000 to 2016, were considered for inclusion in this review. Year 2000 was chosen because this was the year that child protection was formally incorporated as a Public Health Policy in Chile. This policy recom mends the presence of the father in childcare11.

The search for unpublished studies included the Dissertation Abstracts International, the University of São Paulo Dissertations and Thesis bank, and the Pontificia Universidad Católica de Chile Dissertations and Thesis bank. The access to the grey literature was through exploration of relevant worldwide web pa ges to find technical reports from scientific research groups and working articles from research groups or committees. An initial search was performed to obtain appropriate keywords and subject listings, according to the databases to be explored. For each identified article, the references list was revised, and a manual search was performed for those references articles that do not appeared in databases.

Qualitative articles selected for retrieval were as sessed by two independent groups of reviewers for methodological validity prior to inclusion in the re view, using standardized critical appraisal instruments from JBI Qualitative Assessment and Review Instrument9. Any disagreements between the reviewers were resolved through discussion, or with a third reviewer. The flow of the articles selection is showed on (Figure 1).

Figure 1 Identification and selection of research articles. 

Qualitative data were extracted from articles using the JBI standardized data extraction tool9, that includes: identification of the article, description of the stu dy, author conclusions and reviewer’s comments.

The next step was to pool the textual phrases that corresponded to the qualitative research findings found in the full text articles. The analysis process in volved the synthesis of findings using the following steps: a set of statements were generated through as sembling the findings rated according to their quality, and categorizing these findings on the basis of simi larity of meanings. These categories were subjected to a meta-synthesis to produce a comprehensive set of synthesized findings that can be used as a basis for evidence-based practice.

Results

The eight reports included in the QSR were from: Sweden (2), United States (2), United Kingdom (1), Japan (1), Australia (1), and Brazil (1). Three studies were conducted using a phenomenological approach; two using a grounded theory approach; and the other three studies were conducted using a descriptive qua litative approach. A summary of the characteristics of each studies can be found in (Table 1).

Table 1 Studies included for analysis. 

This research revealed three meta-syntheses: (a)the process of adjusting to fatherhood, (b)developing the paternal role, and (c)being an active father. To repre sent the path towards fatherhood, a diagram is propo sed (Figure 2). The path that allows a man to become an active father is mediated through processes that are consolidated consecutively. It starts with the process of adjusting to fatherhood, moving towards developing the role of father, and finally a single figure arises, represented by becoming an active father.

Figure 2 Meta-syntheses Diagram. 

Meta-syntheses I: Process of adjusting to fatherhood

The man who becomes father for the first-time undergoes a process of adjustment in order to develop into his new role. At first he feels overwhelmed by the circumstances. There are many changes in the work arena, inside the partner relationship and in the household routine. Furthermore he experiences how his life changes through a complex process, sometimes disharmonic and with a burden of anxiety. Finally he adjusts to his new life situation and feelings of extreme happiness emerge. This first meta-syntheses consists of three categories:

To be overwhelmed. There is a sensation of shock as the man confronts something bigger than himself and the responsibility of meeting his child’s needs. The bir th of the baby is experienced as an overwhelming event that is hard to prepare for and it is a time that is ruled by the baby’s needs.

“Life becomes different in all ways, well it might sound clichéd; but it is really big!” p. 5812.

“A new little person who is in the centre all the time, as you have to think of him/her first. You get a little more bound, a little more stuck” p. 5812.

“That was scary, we didn’t know what to do, we were new parents.” p. 931.

Adjusting to fatherhood. During the process of transformation into fatherhood, men experience di fferent changes that made them ask themselves how they could become the best father they could be. They needed to be able to adapt their partner relationship in order to assume their new role. This is a time of op portunities and challenges where the new father has to alternate between work and home and between beco ming a father and being a partner.

“... at home waiting she has the baby, I went to the hos pital... and she was right there at the crib. This was my baby, this was my first baby... am I ready, ya know... a lot of things to think about especially after a long time being by myself ya know, now I'm having a baby. It feels kinda different... very special... kinda like having a piece of me in my hands.” p. 12513.

“Life has become somewhat divided, we don’t have as much time for each other...our little girl is in the centre of things until nine at night, then it’s our turn and when you’ve been busy all day...it’s not the same, the love is still there but it’s not the same as before...we talk about this a lot” p. 6714.

“My wife felt she needed to do something else to get new energy, so I have taken care of the child every evening this week. I think it’s worth it, to get a cheerful wife“ p. 6012. “It’s the best that’s ever happened in my life it’s hard to tell. This that we are a family, a wholeness, we belong together much more now” p. 60.

Being aware of change and trying to adjust to a new life. Fathers experience an adjustment process that so metimes produces fear, because initially, they do not know how to react to this strange new person who has entered their life. Sometimes they feel afraid because they do not want their baby’s behavior to discomfort others. This experience implies that the new father and his family have to adjust to a new life.

“Talking about meals, if at restaurants, I’m afraid that my daughter will cry to bother people, so I come to think of eating at home. I think our eating style has changed. But for me, it’s not something inconvenient, unpleasant, nor restricted. Rather, I am enjoying the time” p. 16315.

“The first one [infant] changes your whole lifestyle, becau se although you are married you have nothing to worry about, no responsibility. Then all of a sudden up comes the handbrake. You now have responsibility.” p. 18316.

Meta-syntheses II: Developing the paternal role

First time father, experience a new stage in which he exercises a new paternal role. At the same time he needs to separate this new role from his own identity. Furthermore, he needs to assume the roles of provider and father. This second meta-synthesis contains three categories:

Wanting to be the person that he used to be. The new father struggles to maintain his identity as a man in a relationship as well as a father and he believe that his partner should also express their needs. He expresses the need to remain the same person he was before the child’s birth. Adjustments are made to his routine, for example, in relation to hobbies.

“If I would rather go fishing it’s no problem, my wife stays at home and takes care of the child. But it’s the same if she wants to go. It’s important to continue to be your self and not just be a parent. To remain being the person you are and not sacrificing, of course if you have to but not if it’s not necessary. Then it’s easier to be happy to remain being the person you are” p.5912.

“My hobby is expensive and the income decreases quite a lot, so you have to cut down on everything, all expen ses. You have a little girl to care for. So that’s it, you have to provide and see to her best interest first” p. 5912.

A new role as provider. New fathers face responsibi lities attributed by society as the role of provider and protector, living this experience like a journey.

“I gotta actually make something of my life first so I can support him... I don’t want my son to ever think that things aren’t good enough.” p.14613.

“I think it comes from myself making sure that I’m trying to make sure that I provide what I have to [for the family] as well. I suppose it [the provider role] does come from society, but there’s only one of us earning the money too, so we’ve got to make sure it all goes right” p. 18416.

Feeling like a father. At this stage the challenge is to feel like a father and develop the sensitivity, patience and maturity that is required.

“I don’t feel myself as a father, or how should I put it . . . I don’t feel it consciously. It was not like going up stairs and at a certain point, “I’m a father from today!” Such a feeling didn’t come to me. It was more like going up a slope” p. 16215.

“I’ve been much more sensitive, I care more about others. Earlier a sad film never affected me, but now I really feel the sadness, especially if there are children involved” p. 5912 ).

“One day I was like... I want to do it today...all the stuff... and when he look at you... and you have him... you feel like a father, a real father, it feels good. He is the best thing in the world” p. 831 ).

Meta-syntheses III: Being an active father

First-time father after the process of adjustment and discovering what kind of father he wants to be starts to practice this new role and develops an accep tance for the tasks that are required. He also establis hes a special connection with his child, discovering the unique relationship between them. This third meta syntheses consists of three categories:

Assuming a new role. To take on a new role is perceived as a task that needs to be carried out actively. Fathers need to feel a sense of utility, agency and con trol to be able to move into fatherhood.

“All of a sudden I have got a task, I have got a role. So I have gone from being the passenger or just fetching and carrying and I can’t really do much more than do the jobs in the house, I have now got a role. I can take her off Clare, I can wander off, I can do the dad thing... I feel like I have been sat on the subs bench an I am now playing the game” p. 2117.

A journey of connection and transcendence. In the process of connecting with his child, a father disco vers their needs and envisages himself as transcending through his child. They feel the need to be a real pre sence in the life of their child.

“I consider it like I live forever because he has my last name and he’s gonna pass on my last name and they will keep on passing on my last name. I don’t want to be forgotten, I want my name to go on forever.” p. 14313.

“I try to be his friend; I always try to make him smile, that he always notices my presence, that he watches me” p. 25618.

A unique relationship with the child. New fathers discover the special and unique relationship they built with their child; they recognize that this new relation ship is an essential relationship that prevents them being kept outside of family relations. The need to change the daily routines brings out new sensations and feelings. The first few months are not easy mainly because of the crying; but over time the child starts to communicate in new ways, such as gestures and smi les, and a parent-child relationship seems to emerge. In this way the father becomes a witness to his child's behavior and development.

“To be on parental leave, this time on your own with the child, you can make up things to do, things you don’t usually have time to do. To take a walk, go to the children’s zoo and look at the goats, it is a special quality to be alone with the child” p.6012.

“Nine months ago, it was like she suddenly started to cry. It was like an alien, or maybe a strange creature. But she started to show some gestures, or smiling, or show va rious expressions. I thought it was a change” p. 16315.

Discussion

Men who become fathers for the first time are pro tagonists in a process that leads them to experience different emotions. The process of first time fatherhood produces a radical change in their lives. As they face the challenges imposed by their new role, they see the need to change and learn. Through this process they live the experience of integration of their new role until they eventually become actives fathers19-24.

In the literature review men express the need to be part of the process of parenting, playing an active role and not remaining as a mere spectator. It is neces sary to find ways to support their needs and recognize them as an important part of parenting1. One possible orientation to find ways to support the needs of fathers and recognize them as key actors in the process is to analyze these results from a gender perspective. This perspective shows that the exercise of child rearing in western societies still assigned to the female role as something that is born and found in the collective cons ciousness of mothers and fathers(8>25).

International studies have described ways men ex perience becoming a father for the first-time, and this allowed for the identification of three meta-syntheses on the experience and meaning of this phenome non, based on eight studies of similar quality and rigor1,12-15,17,18,26. No other QSR of first time fatherhood was found during this review.

Conclusion

The results of this QSR may lay the groundwork for considering men in the reproductive stage from an inclusive perspective, making an impact on the welfare and self efficacy of new fathers and as well an improved development and welfare of his children and partner. The health system needs to demonstrate the capacity to involve fathers as active participants in the childrea ring process, by developing spaces to facilitate their active participation in childcare, including fathers in the childbirth process across both public and private health sectors. The health system should consider the importance of both parents and their complementary roles in promoting their child's development.

Men becoming fathers for the first time have multi ple life roles to reconcile such as their family life, work life and their social life. However, often public policies and working conditions do not recognize this process. Therefore there is a need for strengthening public po licies directed towards family wellbeing. Based on the notion that parenthood is a social process that equates men and women with the same degree of responsibility, currently there seems to be a lack of programs and policies designed to facilitate and protect family life, including policies to promote paternal participation during childbirth, paternal postnatal leave, and per mission for fathers to leave work to be at home with their sick child or attend child health checkups. This QSR confirms that becoming a father is a process that should be considered in all its dimensions.

The results of this review has important implica tions for families who are at the parenting stage of fa mily life cycle, since they contributes to highlight each one of its members (father, mother and child) as part of a complex system. This also has implications for fa mily nursing and other health professionals’ practice, since it contributes to the visibility of a fundamental participant, the father, in the process of raising chil dren. Health care professionals and nurses could in clude fathers in different activities that allow him to be part of the process e.g. ask fathers to prepare his child for physical exams, involve the father in health care decisions, and ask father information about the child temper behavior.

A limitation of this study is the lack of available qualitative studies about first-time fatherhood. Specifically many of the studies that focus on this topic did not report the key elements necessary to meet the inclusion criteria for this current study. Another limi tation was the language restriction for the selections of the articles, something that affected the breadth of cultural backgrounds of the fathers whom participated in the studies reported in this review.

This QSR demonstrate that there is little qualitative research about first time fatherhood, however the sig nificance of their lived experiences are relevant for the implementation of childrearing programs including both mothers and fathers. Although the articles inclu ded in this SR do not refer to sociohistorical contexts, in which the participants developed their experience of parenting, it is necessary to incorporate these aspects into future paternity studies. Thus, the importance of additional research studying fatherhood in different settings is recommended.

Ethical responsibilities

Human Beings and animals protection: Disclosure the authors state that the procedures were followed according to the Declaration of Helsinki and the World Me dical Association regarding human experimentation developed for the medical community.

Data confidentiality: The authors state that they have followed the protocols of their Center and Local regulations on the publication of patient data.

Conflicts of Interest: Authors declare no conflict of interest regarding the present study.

Acknowledgement:

The authors would like to thank Melissa A. Suther land (U.S. Fulbright Scholar-Chile) Associate Profes sor at the William F. Connell School of Nursing Boston College, for her assistance with manuscript edits and publishing suggestions.

The authors would like to thank Gloria Rojas, Librarian of San Joaquín Campus Library, Pontifi cia Universidad Católica de Chile. For developed the search strategy.

Financial Disclosure:

The authors received financial support for the re search from the National Committee of Science and Te chnology (CONICYT) of Chile, through the National Fund of Research in Health (FONIS) N° SA13I20218.

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Received: July 20, 2018; Accepted: September 26, 2018

Correspondencia: Camila Lucchini. E-mail: clucchin@uc.cl.

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