Scand J Caring Sci Vol. 6, No. 3 1992
Greek Fathers’ Participation in Labour and Care of the Infant Thalia G. Dragonas
ABSTRACT. Greek fathers’ (n = 157) reactions to their presence at the delivery, their expectations about the baby and their childcare practices were explored at the 4th-6th week postpartum. Only 10% of the sample attended the delivery. Their non-attendance was attributed, by the greatest number of fathers, to official hospital policy while the rest claimed it was entirely their decision. Half of the non-attenders expressed the desire to have been present while a large percentage of mothers were said to have wanted them to be present. The small number of fathers who attended the birth felt strong and satisfied. In respect to early fatherhood, three main themes were explored: reaction to fatherhood, enjoyment of the child and involvement in childcare. All three dimensions were strongly correlated. Key words: Fatherhood, presence at delivery, childcare.
INTRODUCTION
Father’s presence at delivery
Prior to 1970 very few studies had investigated the experience of men during their transition to parenthood. The few that did, focused upon psychopathological aspects rather than the more usual experiences of men at this time. The recognition that most infants form attachments to both their parents at about the same time (Abelin 1975, Lamb 1981b), the changing social and family structures, the growing number of men requesting increased participation, all have necessitated a re-evaluation of the father’s role. Cultural definitions of fatherhood are no longer clear. Do fathers have an important direct role to play during delivery and the early months of the infant’s life or is their position somewhat in the background? Women on becoming mothers have traditionally been supported by other women, whether it is their own mothers, their sisters, neighbours and midwives. Changes in the social and family structure have shifted the weight of this support to the mother’s partner and have rendered what used to be a woman’s affair, into a matter of couple negotiation.
As childbirth practices moved into the hospital, parturient women were often reported to feel lonely and to resent the isolation they have been submitted to (Riley 1968, Rich 1977). Father participation at childbirth, which seemed to be the natural way to feel the gap caused by the absence of the supporting females, is an area plagued by confusion. The medical profession, the agency which determines how childbearing should be perceived and experienced in our culture, has been ambivalent about the degree of father’s participation at the time of childbirth (Stewart 1963, Morton 1966, Philips & Anzalone 1978, Brown 1982, Gurwitt, 1989).
THALIA G. DRAGONAS, PhD. Foundation for Research in Childhood, Athens, Greece. Submitted for publication January 27, 1991, accepted September 11, 1991. Correspondence: T. G. Dragonas, The Foundation for Research in Childhood, 42 Amalias Street, Athens 10558, Greece. Scand J Caring Sci
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Mothers have been found either to disagree with the idea of including fathers at labour and birth (Mattheus 1961, Nash 1981) or to expect father’s attendance to make a “statement” about family togetherness and to establish an emphasis on sharing the event as a “couple experience” (Lewis 1986). Such expectations are certainly not easily fulfilled at a time when the couple system is undergoing radical redefinition. Yet, other studies have shown that mothers reported the birth as a “peak” experience more often (Entwisle & Doering 1981) and had shorter and more comfortable delivery, if fathers were present (Davenport-Slack & Boylan 1974, Henneborn & Cogan 1975, Anderson & Standley 1976, Wideman & Singer 1984). Fathers, from their side, with an ill-defined role are shown by some studies to be less keen than their partners to be included at the delivery (Oakley 1979, Graham & McKee 1980) but they feel guilty about staying away when they do so (Moggach 1982). Other studies of fathers who had prepared themselves with psychoprophylactic training and/or were present during labour and delivery show that they tend to see themselves in greater control and to construe their experience in positive terms (Felton & Segelman 1978, Beail 1982). Liebenberg (1973) notes that men who had a relatively negative experience during the labour and delivery-from which they were at least partially excluded-underwent considerable stress in the postpartum period. It has been argued that attendance at delivery increases the father’s bond and hence his involvement with the infant (Parke et al. 1972, Lind 1974, Klaus & Kennel1 1976, Manion 1977, Richards er al. 1977, Grossman & Vollkner 1984). However, it is unlikely that there is any simple relationship between a man’s participation in labour and delivery and subsequent fathering experience (Greenberg & Morris 1974, Fein 1974, 1976; Park & O’Leary 1976). More evidence is needed to substantiate the causal link between these correlates. Similarly, research data is required on whether fathers who attend the birth differ in any respect from those who absent themselves.
Participation in childcare The new infant has been reported to have a major influence upon men’s identity. Men shortly after delivery of the newborn have been
reported to be “engrossed” with their offspring (Greenberg & Morris 1974). This they described as a “feeling of absorption, preoccupation and interest in their infant” (p. 521). At the same time however, they have been found to experience a mixture of other extreme emotions such as anger, despair and hostility (Lewis 1986). Parenthood has been associated with a feeling of disequilibrium amongst men: many have reported to feeling odd, distant and isolated by the intensity and exlusiveness of the mother-infant “bond”. Some men experience acute worries about the child’s well-being and health (ibid). Pressure is created by their having to adapt quickly to their baby’s needs as well as to their emotional reactions. The father-infant relationship is, like every other, a reciprocal one. The infant both responds and initiates interaction, creating thus a feedback loop. The experience of the father on the part of the infant greatly depends upon the father’s own emotional response to it (Layland 1985). Although the data are neither abundant nor entirely consistent, research on fatherinfant interaction in real life situations suggests that fathers interact rather infrequently with their infants, are typically less available, on a regular basis, to the child than are mothers, and take little responsibility for infant caretaking (Kotelchuck 1972, Shereshefsky & Yarrow 1973, Ban & Lewis 1974, Parke & Sawin 1976, 1980; Richards et al. 1977, Entwisle & Doering 1981, Beail 1982, Lamb er al. 1987). Yet the results of a number of studies show that fathers may be as skillful as mothers in caretaking (Parke & Tinsley 1981, Belsky et al. 1984). The observational literature suggests that fathers involve themselves in active physical play rather than in caregiving tasks that are often viewed as routine and somewhat boring (Kotelchuck 1981, Lamb 1981a). There is evidence that there is a minimum level of paternal caretaking necessary for a father-infant relationship to exist (Kotelchuck 1981). Yet the long-term effects of father caretaking need to be explored further. Lamb & Oppenheim (1989) in a comprehensive review suggest that the degree of paternal involvement is multidetermined. Important influencing factors may be fathers’ perception of their own father, their particular sensitivity and self-confidence, the available support, especially on the part of the mother, the maternal Scand J Caring Sci
Transition to fatherhood
attitudes, the overall dynamics of the family system, the identification of fatherhood with breadwinning. All those factors, and possibly many more, need to be considered in a multivariate fashion.
Cultural assumptions of fatherhood The concept of fatherhood is intricately connected with the prevailing cultural definitions and the patterns of social relationships associated with diverse family and community structures. Fathers’ involvement seems to vary across cultures; for example in Guatemala (Lester et al. 1974, Ross et al. 1975) and in Uganda (Ainsworth 1967) father involvement was reported to be very low, in Fiji (Katz & Konner 1981) and in Sweden (Lamb et al. 1983) men do not appear to play in a vigorous way. Rules, meaning systems and social practices which already exist in every society, shape the pattern of fathering. Transition to fatherhood signals the realignment of existing relationships and the structuring of new ones, thus providing a focus for significant social values. Parke & Anderson ( 1987) accurately describe transition to fatherhood as the articulation of individual, family and historical time, all following their own trajectory. The present paper attempts to explore Greek fathers’ reactions in respect to their presence at delivery, their expectations about the baby and their childcare practices. It is based on a larger cross-cultural longitudinal study examining transition to parenthood amongst Greek and British parents (Dragonas et al. 1988). Greek society, undergoing rapid social change, presents an interesting background for such a study. Current socioeconomic and sociocultural transformations have contributed to the disruption of traditional patterns. In the traditional context the interaction between husband and wife was the least intimate while the central family relationship was the motherson one. Womanhood was synonymous with motherhood. Roles were limited and clearly defined; ideology and norms developed slowly in accordance with the low milieu complexity. On the contrary, in the highly complex urban context, individuals have been cut off from their support group, their traditional roles are no longer operational and their communication patterns are inadequate. Whereas the closely
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knit social network was a source of support for the individual, providing a feeling of belongingness and an opportunity for growth, it is currently often transformed into a source of stress. The guiding principle of interdependence, vital for the group survival, has been transformed for the marital couple, into mere dependence both on each other and on the family of origin (Triandis et al. 1968, Vassiliou & Vassiliou 1982, Dragonas 1987). Thus, as in other urban western environments (Katz & Konner 1981), there is a relative lack of preparation of both mothers and fathers for parenthood; non-employed mothers feel isolated and are left with the impossible task on their hands, of their child’s socialization; and there is a high degree of dependency between the marital partners. The institutions of marriage and family, and the transition to parenthood, have moved from being issues negotiated on the societal level to being personal choices representing decisions at the level of the individual.
METHOD Sample and procedure Two hundred mothers were randomly selected from the Outpatient Clinic of the Elena Maternity Hospital and private obstetrical practice, both cited in Athens. The ratio of cases from private and public care was 70 : 30, representative of the obstetrical practice in the Athens area (Tzoumaka-Bakoula 1984). Fathers were recruited to the study via those mothers and were contacted at the 4th-6th week postpartum. The time chosen was considered close enough to delivery so that the fathers’ experience would still be vivid, and long enough as to provide an indication of their reaction to fatherhood. Fathers were handed a questionnaire to complete by their partners which was subsequently collected by the researcher. Seventy-nine percent ( 157) of the fathers contacted, completed the questionnaire. All fathers were married and half of them were “primiparous”. Their age ranged from 24 to 45 (Z.28.3). In terms of their education 43.5% of fathers had a higher degree, 34.5% had a six-year secondary education, 11% had a three-year secondary education and 11% had an elementary education. According to the British Registrars General’s Classification of Occupation, 1980, 44% of fathers Scand J Caring Sci
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belonged to social classes I and 11, 25% and 23% to classes 111, Manual and Non-Manual respectively, and 8% to classes IV and V. Comparison with the births in the Greek National Perinatal Survey (ibid) showed that our sample was somewhat under-representative of teenage parents and those with low levels of education.
Measures A set of questions concerning fathers’ fears during the last weeks of pregnancy, their preference for the sex of the anticipated child, their attendance or not at delivery and their reason for doing so, their expectations of and their actual ability to cope with labour were presented to fathers retrospectively at the 4th-6th week postpartum. Fathers were also asked whether they had a preference for the sex of the child. This set of questions were devised for this study. Moreover, three aspects of fatherhood were examined: (1) reaction to fatherhood, (2) participation in childcare, play and household duties and (3) enjoyment of the child. Scales were created for the present study to examine each of these. The reaction to fatherhood scale was calculated from 19 statements which explored satisfaction derived from parenthood, perceived acceptance in the home, relationship with partner since becoming a parent and confidence in parenting. Fathers indicated their reaction to each statement on a 4-point scale. Enjoyment of the child comprised seven statements concerning the father’s desire to be with the infant and the amount of time allocated and priorities set for this purpose. Father’s active involvement in childcare, play and household tasks was explored in seven statements. Testing for the homogeneity of the scaled items, the “alpha” coefficient of the reaction to fatherhood scale was u = 0.90, the enjoyment of the child scale was u = 0.83, and the involvement in childcare u = 0.73. The questionnaire was piloted in order to test for clarity and understanding. Fathers’ emotional well-being was measured using a modification of the Edinburgh Postnatal Depression Scale (EPDS) (Cox er al. 1987). The psychometric properties of the EPDS have been established only in its use with women, but validation studies with fathers are on-going in Britain (Thorpe 1990).
Statistical methods Fathers’ participation in labour and childcare was examined on the basis of the frequencies and distributions of scores of each variable. The relationship between the three aspects of fatherhood was assessed using a correlation technique. Subsequently, the method of multivariate analysis of variance (MANOVA) was used in order to examine the relative effect of father’s sociodemographic variables, age and emotional well-being on the jointly distributed variable.
RESULTS AND DISCUSSION Fathers’ participation in labour When asked after delivery, 86% of fathers confessed to having been at some stage to a lesser or greater degree, concerned or anxious that their child might have physical defects. Moreover, if they had had such a child, 35% of fathers feared that they may not have wanted to keep the child. Forty percent of Greek fathers had a clear preference for the sex of the child, boys being desired more often than girls. Only 10% (16) of fathers attended the birth of their child. Of those who did not attend, 68% (87) attributed their non-attendance to the official hospital policy while 29% (37) said it was entirely their decision. Very few fathers did not attend because they were elsewhere or had other commitments. Fathers who were absent from the delivery for reasons beyond their control were asked if they would have liked to attend the birth. Sixty-four percent (67) of fathers expressed the desire to have been present. Yet 35% (40)of fathers who did not attend stated that they were absent because they could not stand the sight of blood. In spite of the infrequency with which fathers attended the birth of their child, 73% (95) of mothers were said to have wanted them to have been present versus 27% who clearly would have not wanted them in the delivery room. Reflecting the overall population norms, in response to a question on whether the father had any friends who had attended the birth of their child, the majority of fathers (59%) had no such friends. The decision on whether or not to be present at birth appears to have been taken by the Scand J Caring Sci
Transition to fatherhood
majority of fathers in early pregnancy. This makes sense since it is very often the hospital policy that deters fathers from attending labour. Over 80% of fathers claimed they had seen films, television programmes or had read a book showing details of delivery. For 15% of fathers such information had actually put them off attending the birth. Interestingly, the only factor significantly associated with attendance at birth concerned whether or not they had friends who attended the births of their own children. Fathers who had such friends were four times more likely to attend the birth of their own child than fathers who had no such friends. The large majority of fathers (80%) reported feeling either “calm” or “excited and happy” upon arrival at the hospital. In contrast to the response of mothers, feelings of being “lost and afraid” were rarely reported. The experience of being at birth was claimed by the fathers to have brought them emotionally closer to their partner and child. That it was a strong emotional experience was evidenced by the fact that 71% of fathers said either they had cried or that they had felt like crying. Fathers were asked to comment on their own expectations of and actual ability to cope with labour. The majority of fathers believed they could cope and none who attended the birth thought they could not cope. On reflection after the delivery, all fathers believed they had coped “well” or “adequately”. No fathers passed out during the birth although more than half reported feeling squeamish. Fathers were distressed at times with the pain their partners felt. They were not made to feel that they were getting in the way. Yet midwives were reported to have made “no particular effort” to make fathers feel relaxed and comfortable. This is likely to be a reflection of the midwive’s unfamiliarity with fathers’ presence in the labour ward. The vast majority of fathers (141) reported that they had been satisfied with the care they and their partner had received during labour. The last weeks of pregnancy are a time of relatively high anxiety for fathers and similar worries and concerns as the ones voiced in this study have often been mentioned in the literature (Fein 1974, Scott-Heyes 1982, Osofsky & Culp 1989). Evidence from the studies of the perinatal period suggests that rational and irra-
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tional worries about the risks of pregnancy and birth and about mother’s and baby’s well-being might be ubiquitous (Marquart 1976, McKee 1980, Lewis 1986). Men may feel helpless about, and partly responsible for, the possible dangers which both mother and child face. It seems to us, that it is the projection of those worries that make such a large number of fathers in our study claim, that they would be unable to invest emotionally in a child with physical defects. In traditional cultures there is a particular preference for male children, mainly for economic reasons. Despite the fact that these reasons are gradually disappearing, fathers seemed to have a preference for boys. It is the birth of a son that allows immediate identification by the father who projects his aspirations onto the boy infant (Benedek 1970). The number of fathers who attended the birth is very small and it is thus impossible to come up with any generalized conclusions. However, fathers in general, sound strong and satisfied. Relevant findings caution us about the sturdy and bold attitude men tend to assume both during pregnancy and labour. Lewis ( 1986) believes that men are often trapped between their identification with pregnancy and delivery on an emotional level and their public image as strong, instrumental providers on another level. For fathers the question of attendance at the delivery of their child is not an easy one since all along their partners’ pregnancy their public role is rather peripheral. It is thus not surprising that men tend to arrive in the delivery room without adequately documented reasons for their presence (Lewis 1982). Anthropological evidence on the “couvade” suggests that participation at the public “events” around this time are rich with social and symbolic consequence in terms of interpersonal relationships and by enabling one person to lay claim to another. Douglas (1975) notes that fathers claim that their presence at the birth brings them closer to their wives and the event is seen very much in terms of a demonstration of the parity between them, particularly as a result of the man’s respect for his wife’s ability to stand up to such pain and suffering. Moreover, in keeping with current ideological notions of “bonding”, many men feel that seeing their child right at the start of its life has a great influence upon the relationship. Finally, birth Scand J Caring Sci
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can be seen as a “consensus-producing statement about the essential nature of society” and “a summation of a whole community’s experience” (p. 67). Thus father’s attendance at birth is a public demonstration of his feelings for his partner and baby. The issue of including fathers at delivery is being addressed only very recently in Greece. The relevant literature from cultures that have addressed the issue long ago points out that it is still a matter of negotiation on the individual, couple and societal levels. The medical attitudes towards father attendance at delivery have not been researched in Greece. What we do know however, is that explanations for the inclusion or the exclusion of fathers, are not in any way clearly substantiated by the health care system. The hospital practice of either excluding the father altogether or of allowing him to stay during only the first stages of labour, or during the entire process of delivery, seems to be circumstantial in the various maternities. It seems to us that more crucial than whether fathers are actually present or not may be the meaning of father’s presence for all parties involved: health professionals, mother and father. Presence at birth suggests commitment to the role of the father and it cannot be overlooked that the father’s entrance into the delivery room is made at a time (individual, family and historical) when the members of the nuclear family have to face the challenge of creating, maintaining, evolving and dissolving their own autonomy.
Father’s participation in childcare At six weeks postpartum the majority of fathers reported some degree of active participation in childcare and household tasks. Half of our sample claimed to be daily involved in housework while 16% of the fathers stated that they never help with housework. Yet almost no fathers felt that the home is the woman’s place and they have no part in it. Ninety-two percent of fathers engaged in play with their child on a daily basis. Consistently with the existing literature, fathers seem to be much more involved in playing with the baby than actively participating in childcare such as taking the baby for a walk, bathing the baby or changing nappies. Still quite a large number of fathers, ranging from 16% to 25%, stated that they are involved in such
childcare activities. Almost half of our sample reported to be daily putting the baby to bed. Father’s enjoyment of the child was assessed by examining their desire to be with the child and the amount of time he allocated for this purpose. Sixty eight percent of fathers wished they could generally spend more time at home with the child and 92% said they enjoyed getting home from work to see their wife and child. Yet half of the fathers reported that when they get home from work, they feel too tired to take the baby and 42% find the baby hard to cope with. Still a large percentage of the fathers (60%) when they get home from work, do take the child and let their wife get on with something she wants to do. However, only 27% of fathers claimed that they were expected to do so. In response to the questions exploring reactions to fatherhood, a large number of fathers (68%) reported they felt they were making a strong bond with the baby and they were happy in the way both themselves (73%) and their partner (86%) were bringing up the baby. Only very few fathers felt they were excluded by their partner in looking after the baby (4.8%) or that their partner does not trust them to carry out such a task (4%). Four fathers reported that they were at times so stressed at home that they believed they might have a bad influence on their baby. All three scales “reaction to fatherhood”, “enjoyment of the child” and “involvement in childcare” are strongly correlated with each other (Table I), the strongest correlation coefficient being the one between “enjoyment of the child” and “involvement in childcare”. The more fathers enjoy their child the more they tend to be involved in childcare and vice versa. The MANOVA revealed that the three aspects of fatherhood are a jointly distributed variable; the Bartlett test of sphericity was highly significant ( p 0.000.
Table 11. Predictors of the jointly distributed variable reaction to fatherhood, enjoyment of child and involvement in childcare‘ Variables
B
P
Reaction to fatherhood Emotional well-being Occupation (social class)
-0.30
0.000
-0.21
0.06
Enjoyment of child Emotional well-being
-0.36
0.000
Involvement in childcare Education3 secondary education primary education
-0.21
0.09
I1 111 N.M. 111 M.
IV &
v
‘Only those variables which are significant predictors are included in the Table. *Social Class I is used as a reference. 3Higher degree is used as a reference.
Fathers who are depressed are less able to draw the real satisfactions brought by fatherhood, such as the sense of being a good father and of obtaining real pleasure from the fatherinfant interaction, the enhanced sense of personal identity and the deepening of the couple relationship. Low class fathers who are working hard and come home exhausted after a day’s manual work may well enjoy their child but they seem to be less able to participate in childcare and react postively to fatherhood. It may also be that these are fathers who come from a more traditional background whereby fathers were less involved with the day-to-day care of the infant.
CONCLUSIONS Without disregarding the ambiguities inherent within contemporary fathering roles, the vast majority of father’s responses revealed the importance fatherhood has had for them as well as a shift in parenting roles. Roles are no longer prescribed and can be viewed as a priori abstractions which can be broken as rules evolve (Jackson 1967). Roles thus become a function of the differentiation characterizing each particular relationship. In today’s society the paternal function requires new complex skills which presuppose a number of second order changes in the family system. Similarly, there is no one adequate style of adapting to fatherhood but a variety of possible models. Men’s transition to fatherhood is dependent on their having defined for themselves a role that meets their needs and those of their family (Fein 1974). Young people are facing the challenge of attaining autonomy for and through interdependence. Fathers’ responses regarding reactions to fatherhood, enjoyment of the child and involvement in childcare seem to acknowledge that male and female roles are bound to alternate depending on the situation. Today’s couple is in need of a successful negotiation of the balance between self and family, of long- and short-term complementarity, as well as of role differentiation. It is only under such assumptions that the father’s entrance in the delivery room and his involvement in childcare will become meaningful for both partners.
ACKNOWLEDGEMENTS This study was conducted as part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC) under the auspices of Scand J Caring Sci
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the World
Health
Organization, Regional
Office for Europe.
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Lester, B. M., Kotelchuck, M., Spelke, E., Sellers, J. J. & Klein, R. E. 1974. Separation protest in Guatemalan infants: Cross-cultural and cognitive findings. Developmental Psychology, 10, 79-85. Lewis, C. 1982. A feeling you can’t scratch? The effect of pregnancy and birth on married men. In Beail, N. & McGuire, J. (Eds) Fathers: Psychological perspectives. Junction Books, London. Lewis, C. 1986. Becoming a Father. Open University Press, Milton Keynes. Liebenberg, B. 1973. Expectant fathers. In Shereshefsky, P. M. & Yarrow, R. F. (Eds) Psychological Aspects of First Pregnancy and Postnatal Adaptation. Raven Press, New York. Lind, J. 1974. Observations after delivery of communications between mother-infant-father. Paper presented at the International Congress of Pediatrics, Buenos Aires. McKee, L. 1980. Fathers and childbirth: Just hold my hand. Health Visitor, 53, 368-72. Manion, J. 1977. A study of fathers and infant caretaking. Birth and the Family Journal, 4, 174-8. Marquart, R. K. 1976. Expectant fathers: What are their needs? American Journal of Maternal Child Nursing, 1, (1) 32-6. Matthews, A. E. B. 1961. Behaviour patterns in labour: A study of 776 consecutive patients. Journal of Obstetrics and Gynaecology of the Commonwealth, 63, 862-4. Moggach, D. 1982. When did you first see your baby? Sunday Times, 27 June, 34. Morton, J. H. 1966. Fathers in the delivery rooman opposition standpoint. Health Topics, 44, 103. Nash, J. 1981. Historical and social change in the perception of the role of the father. In Lamb, M. E. Ed. The Role of the Father in Child Development. Wiley, New York. Oakley, A. 1979. Becoming a Mother. Martin Robertson, Oxford. Office of Population, Censuses and Surveys (1980) Classification of Occupations. London: Her Majesty’s Stationary Office. Osofsky, H. J. & Culp, R. E. 1989. Risk factors in the transition to fatherhood. In Cath, S . H., Gurwitt, A. & Gunsberg, L. (Eds) Fathers and their Families. The Analytic Press, Hillsdale, NJ. Parke, R. D. & Anderson, E. R. 1987. Fathers and their at-risk infants: Conceptual and empirical analyses. In Berman, P. W. & Pedersen, F. A. (Eds) Men’s Transitions to Parenthood: Longitudinal Studies of Early Family Experience. Lawrence Erlbaum Associates, NJ. Parke, R. D., O’Leary, S. E. & West, S. 1972. Mother-father-newborn interaction: Effects of maternal medication, labor, and sex of infant. Paper presented at the American Psychological Association, Washington. Parke, R. D. & O’Leary, S. E. 1976. Father-motherinfant interaction in the newborn period: some
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findings, some observations and some unresolved issues. In Riegel, K. & Meacham, J. (Eds) The Developing Individual in a Changing World, Vol. 2, Social and Environmental Issues. Mouton, The Hague. Parke, R. D. & Sawin, D. B. 1976. The father’s role in infancy: A re-evaluation. The Family Coordinator, 25, 365-71. Parke, R. D. & Sawin, D. B. 1980. The family in early infancy: Social interactional and attitudinal analyses. In Pedersen, F. A. (Ed) The father-infant relationship: Observational Studies in the Family Setting. Praeger, New York. Parke, R. D. & Tinsley, B. R. 1981. The father’s role in infancy: Determinants of involvement in caregiving and play. In Lamb, M. E. (Ed) The Role of the Father in Child Development. Wiley, New York. Philips, C. R. & Anzalone, J. T. 1978. Fathering: Participation in Labour and Birth. C. V. Mosby, St Louis. Richards, M., Dunn, J. & Antonis, B. 1977. Caretaking in the first year of life: The role of fathers and mothers’ social isolation. Child Care, Health and Development, 3, 23-36. Rich, A. 1977. Of Woman Born. Virago, London. Riley, M. 1968. Brought to Bed. Virago, London. Ross, G., Kagan, J., Zelazo, P. & Kotelchuck, M. 1975. Separation protest in infants in home and laboratory. Developmental Psychology, 11, 256-7. Scott-Heyes, G. 1982. The experience of perinatal paternity and its relation to attitudes, to pregnancy and childbirth. In Beail, N. & McGuire, J. Eds. Fathers: Psychological Perspectives. Junction Books, London. Shereshefsky, P. & Yarrow, L. 1973. Psychological Aspects of a First Pregnancy and Early Post Natal Adaptation. Raven Press, New York. Stewart, R. H. 1963. Natural childbirth, father participation, rooming-in or what have you. Medical Times, 91, 11. Thorpe, K. J. 1990. A validity study of postal administration of the EDPS for detection of depression among parent groups outside the postpartum. Fifth International Conference of the Marce Society: Child Bearing and Mental Health, 4-7 September. Triandis, H., Vassiliou, V. & Nassiakou, M. 1968. Three cross-cultural studies of subjective culture. Journal of Personality and Social Psychology, 8, (4) 21 -42. Tzoumaka-Bakoula, C. 1984. Panhellenic Perinatal Survey. First Paediatric Clinic of the Athens University, Athens (In Greek). Vassiliou, G. & Vassiliou, V. 1982. Promoting psychosocial functioning and preventing malfuntioning. Pediatrician, 11, (1 -2) 90-8. Wideman, M. V. & Singer, J. E. 1984. The role of psychological mechanisms in preparation for childbirth. American Psychologist, 39, (12) 1357-71. Scand J Caring Sci
Greek Fathers’ Participation in Labour and Care of the Infant Thalia G. Dragonas
ABSTRACT. Greek fathers’ (n = 157) reactions to their presence at the delivery, their expectations about the baby and their childcare practices were explored at the 4th-6th week postpartum. Only 10% of the sample attended the delivery. Their non-attendance was attributed, by the greatest number of fathers, to official hospital policy while the rest claimed it was entirely their decision. Half of the non-attenders expressed the desire to have been present while a large percentage of mothers were said to have wanted them to be present. The small number of fathers who attended the birth felt strong and satisfied. In respect to early fatherhood, three main themes were explored: reaction to fatherhood, enjoyment of the child and involvement in childcare. All three dimensions were strongly correlated. Key words: Fatherhood, presence at delivery, childcare.
INTRODUCTION
Father’s presence at delivery
Prior to 1970 very few studies had investigated the experience of men during their transition to parenthood. The few that did, focused upon psychopathological aspects rather than the more usual experiences of men at this time. The recognition that most infants form attachments to both their parents at about the same time (Abelin 1975, Lamb 1981b), the changing social and family structures, the growing number of men requesting increased participation, all have necessitated a re-evaluation of the father’s role. Cultural definitions of fatherhood are no longer clear. Do fathers have an important direct role to play during delivery and the early months of the infant’s life or is their position somewhat in the background? Women on becoming mothers have traditionally been supported by other women, whether it is their own mothers, their sisters, neighbours and midwives. Changes in the social and family structure have shifted the weight of this support to the mother’s partner and have rendered what used to be a woman’s affair, into a matter of couple negotiation.
As childbirth practices moved into the hospital, parturient women were often reported to feel lonely and to resent the isolation they have been submitted to (Riley 1968, Rich 1977). Father participation at childbirth, which seemed to be the natural way to feel the gap caused by the absence of the supporting females, is an area plagued by confusion. The medical profession, the agency which determines how childbearing should be perceived and experienced in our culture, has been ambivalent about the degree of father’s participation at the time of childbirth (Stewart 1963, Morton 1966, Philips & Anzalone 1978, Brown 1982, Gurwitt, 1989).
THALIA G. DRAGONAS, PhD. Foundation for Research in Childhood, Athens, Greece. Submitted for publication January 27, 1991, accepted September 11, 1991. Correspondence: T. G. Dragonas, The Foundation for Research in Childhood, 42 Amalias Street, Athens 10558, Greece. Scand J Caring Sci
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Mothers have been found either to disagree with the idea of including fathers at labour and birth (Mattheus 1961, Nash 1981) or to expect father’s attendance to make a “statement” about family togetherness and to establish an emphasis on sharing the event as a “couple experience” (Lewis 1986). Such expectations are certainly not easily fulfilled at a time when the couple system is undergoing radical redefinition. Yet, other studies have shown that mothers reported the birth as a “peak” experience more often (Entwisle & Doering 1981) and had shorter and more comfortable delivery, if fathers were present (Davenport-Slack & Boylan 1974, Henneborn & Cogan 1975, Anderson & Standley 1976, Wideman & Singer 1984). Fathers, from their side, with an ill-defined role are shown by some studies to be less keen than their partners to be included at the delivery (Oakley 1979, Graham & McKee 1980) but they feel guilty about staying away when they do so (Moggach 1982). Other studies of fathers who had prepared themselves with psychoprophylactic training and/or were present during labour and delivery show that they tend to see themselves in greater control and to construe their experience in positive terms (Felton & Segelman 1978, Beail 1982). Liebenberg (1973) notes that men who had a relatively negative experience during the labour and delivery-from which they were at least partially excluded-underwent considerable stress in the postpartum period. It has been argued that attendance at delivery increases the father’s bond and hence his involvement with the infant (Parke et al. 1972, Lind 1974, Klaus & Kennel1 1976, Manion 1977, Richards er al. 1977, Grossman & Vollkner 1984). However, it is unlikely that there is any simple relationship between a man’s participation in labour and delivery and subsequent fathering experience (Greenberg & Morris 1974, Fein 1974, 1976; Park & O’Leary 1976). More evidence is needed to substantiate the causal link between these correlates. Similarly, research data is required on whether fathers who attend the birth differ in any respect from those who absent themselves.
Participation in childcare The new infant has been reported to have a major influence upon men’s identity. Men shortly after delivery of the newborn have been
reported to be “engrossed” with their offspring (Greenberg & Morris 1974). This they described as a “feeling of absorption, preoccupation and interest in their infant” (p. 521). At the same time however, they have been found to experience a mixture of other extreme emotions such as anger, despair and hostility (Lewis 1986). Parenthood has been associated with a feeling of disequilibrium amongst men: many have reported to feeling odd, distant and isolated by the intensity and exlusiveness of the mother-infant “bond”. Some men experience acute worries about the child’s well-being and health (ibid). Pressure is created by their having to adapt quickly to their baby’s needs as well as to their emotional reactions. The father-infant relationship is, like every other, a reciprocal one. The infant both responds and initiates interaction, creating thus a feedback loop. The experience of the father on the part of the infant greatly depends upon the father’s own emotional response to it (Layland 1985). Although the data are neither abundant nor entirely consistent, research on fatherinfant interaction in real life situations suggests that fathers interact rather infrequently with their infants, are typically less available, on a regular basis, to the child than are mothers, and take little responsibility for infant caretaking (Kotelchuck 1972, Shereshefsky & Yarrow 1973, Ban & Lewis 1974, Parke & Sawin 1976, 1980; Richards et al. 1977, Entwisle & Doering 1981, Beail 1982, Lamb er al. 1987). Yet the results of a number of studies show that fathers may be as skillful as mothers in caretaking (Parke & Tinsley 1981, Belsky et al. 1984). The observational literature suggests that fathers involve themselves in active physical play rather than in caregiving tasks that are often viewed as routine and somewhat boring (Kotelchuck 1981, Lamb 1981a). There is evidence that there is a minimum level of paternal caretaking necessary for a father-infant relationship to exist (Kotelchuck 1981). Yet the long-term effects of father caretaking need to be explored further. Lamb & Oppenheim (1989) in a comprehensive review suggest that the degree of paternal involvement is multidetermined. Important influencing factors may be fathers’ perception of their own father, their particular sensitivity and self-confidence, the available support, especially on the part of the mother, the maternal Scand J Caring Sci
Transition to fatherhood
attitudes, the overall dynamics of the family system, the identification of fatherhood with breadwinning. All those factors, and possibly many more, need to be considered in a multivariate fashion.
Cultural assumptions of fatherhood The concept of fatherhood is intricately connected with the prevailing cultural definitions and the patterns of social relationships associated with diverse family and community structures. Fathers’ involvement seems to vary across cultures; for example in Guatemala (Lester et al. 1974, Ross et al. 1975) and in Uganda (Ainsworth 1967) father involvement was reported to be very low, in Fiji (Katz & Konner 1981) and in Sweden (Lamb et al. 1983) men do not appear to play in a vigorous way. Rules, meaning systems and social practices which already exist in every society, shape the pattern of fathering. Transition to fatherhood signals the realignment of existing relationships and the structuring of new ones, thus providing a focus for significant social values. Parke & Anderson ( 1987) accurately describe transition to fatherhood as the articulation of individual, family and historical time, all following their own trajectory. The present paper attempts to explore Greek fathers’ reactions in respect to their presence at delivery, their expectations about the baby and their childcare practices. It is based on a larger cross-cultural longitudinal study examining transition to parenthood amongst Greek and British parents (Dragonas et al. 1988). Greek society, undergoing rapid social change, presents an interesting background for such a study. Current socioeconomic and sociocultural transformations have contributed to the disruption of traditional patterns. In the traditional context the interaction between husband and wife was the least intimate while the central family relationship was the motherson one. Womanhood was synonymous with motherhood. Roles were limited and clearly defined; ideology and norms developed slowly in accordance with the low milieu complexity. On the contrary, in the highly complex urban context, individuals have been cut off from their support group, their traditional roles are no longer operational and their communication patterns are inadequate. Whereas the closely
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knit social network was a source of support for the individual, providing a feeling of belongingness and an opportunity for growth, it is currently often transformed into a source of stress. The guiding principle of interdependence, vital for the group survival, has been transformed for the marital couple, into mere dependence both on each other and on the family of origin (Triandis et al. 1968, Vassiliou & Vassiliou 1982, Dragonas 1987). Thus, as in other urban western environments (Katz & Konner 1981), there is a relative lack of preparation of both mothers and fathers for parenthood; non-employed mothers feel isolated and are left with the impossible task on their hands, of their child’s socialization; and there is a high degree of dependency between the marital partners. The institutions of marriage and family, and the transition to parenthood, have moved from being issues negotiated on the societal level to being personal choices representing decisions at the level of the individual.
METHOD Sample and procedure Two hundred mothers were randomly selected from the Outpatient Clinic of the Elena Maternity Hospital and private obstetrical practice, both cited in Athens. The ratio of cases from private and public care was 70 : 30, representative of the obstetrical practice in the Athens area (Tzoumaka-Bakoula 1984). Fathers were recruited to the study via those mothers and were contacted at the 4th-6th week postpartum. The time chosen was considered close enough to delivery so that the fathers’ experience would still be vivid, and long enough as to provide an indication of their reaction to fatherhood. Fathers were handed a questionnaire to complete by their partners which was subsequently collected by the researcher. Seventy-nine percent ( 157) of the fathers contacted, completed the questionnaire. All fathers were married and half of them were “primiparous”. Their age ranged from 24 to 45 (Z.28.3). In terms of their education 43.5% of fathers had a higher degree, 34.5% had a six-year secondary education, 11% had a three-year secondary education and 11% had an elementary education. According to the British Registrars General’s Classification of Occupation, 1980, 44% of fathers Scand J Caring Sci
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belonged to social classes I and 11, 25% and 23% to classes 111, Manual and Non-Manual respectively, and 8% to classes IV and V. Comparison with the births in the Greek National Perinatal Survey (ibid) showed that our sample was somewhat under-representative of teenage parents and those with low levels of education.
Measures A set of questions concerning fathers’ fears during the last weeks of pregnancy, their preference for the sex of the anticipated child, their attendance or not at delivery and their reason for doing so, their expectations of and their actual ability to cope with labour were presented to fathers retrospectively at the 4th-6th week postpartum. Fathers were also asked whether they had a preference for the sex of the child. This set of questions were devised for this study. Moreover, three aspects of fatherhood were examined: (1) reaction to fatherhood, (2) participation in childcare, play and household duties and (3) enjoyment of the child. Scales were created for the present study to examine each of these. The reaction to fatherhood scale was calculated from 19 statements which explored satisfaction derived from parenthood, perceived acceptance in the home, relationship with partner since becoming a parent and confidence in parenting. Fathers indicated their reaction to each statement on a 4-point scale. Enjoyment of the child comprised seven statements concerning the father’s desire to be with the infant and the amount of time allocated and priorities set for this purpose. Father’s active involvement in childcare, play and household tasks was explored in seven statements. Testing for the homogeneity of the scaled items, the “alpha” coefficient of the reaction to fatherhood scale was u = 0.90, the enjoyment of the child scale was u = 0.83, and the involvement in childcare u = 0.73. The questionnaire was piloted in order to test for clarity and understanding. Fathers’ emotional well-being was measured using a modification of the Edinburgh Postnatal Depression Scale (EPDS) (Cox er al. 1987). The psychometric properties of the EPDS have been established only in its use with women, but validation studies with fathers are on-going in Britain (Thorpe 1990).
Statistical methods Fathers’ participation in labour and childcare was examined on the basis of the frequencies and distributions of scores of each variable. The relationship between the three aspects of fatherhood was assessed using a correlation technique. Subsequently, the method of multivariate analysis of variance (MANOVA) was used in order to examine the relative effect of father’s sociodemographic variables, age and emotional well-being on the jointly distributed variable.
RESULTS AND DISCUSSION Fathers’ participation in labour When asked after delivery, 86% of fathers confessed to having been at some stage to a lesser or greater degree, concerned or anxious that their child might have physical defects. Moreover, if they had had such a child, 35% of fathers feared that they may not have wanted to keep the child. Forty percent of Greek fathers had a clear preference for the sex of the child, boys being desired more often than girls. Only 10% (16) of fathers attended the birth of their child. Of those who did not attend, 68% (87) attributed their non-attendance to the official hospital policy while 29% (37) said it was entirely their decision. Very few fathers did not attend because they were elsewhere or had other commitments. Fathers who were absent from the delivery for reasons beyond their control were asked if they would have liked to attend the birth. Sixty-four percent (67) of fathers expressed the desire to have been present. Yet 35% (40)of fathers who did not attend stated that they were absent because they could not stand the sight of blood. In spite of the infrequency with which fathers attended the birth of their child, 73% (95) of mothers were said to have wanted them to have been present versus 27% who clearly would have not wanted them in the delivery room. Reflecting the overall population norms, in response to a question on whether the father had any friends who had attended the birth of their child, the majority of fathers (59%) had no such friends. The decision on whether or not to be present at birth appears to have been taken by the Scand J Caring Sci
Transition to fatherhood
majority of fathers in early pregnancy. This makes sense since it is very often the hospital policy that deters fathers from attending labour. Over 80% of fathers claimed they had seen films, television programmes or had read a book showing details of delivery. For 15% of fathers such information had actually put them off attending the birth. Interestingly, the only factor significantly associated with attendance at birth concerned whether or not they had friends who attended the births of their own children. Fathers who had such friends were four times more likely to attend the birth of their own child than fathers who had no such friends. The large majority of fathers (80%) reported feeling either “calm” or “excited and happy” upon arrival at the hospital. In contrast to the response of mothers, feelings of being “lost and afraid” were rarely reported. The experience of being at birth was claimed by the fathers to have brought them emotionally closer to their partner and child. That it was a strong emotional experience was evidenced by the fact that 71% of fathers said either they had cried or that they had felt like crying. Fathers were asked to comment on their own expectations of and actual ability to cope with labour. The majority of fathers believed they could cope and none who attended the birth thought they could not cope. On reflection after the delivery, all fathers believed they had coped “well” or “adequately”. No fathers passed out during the birth although more than half reported feeling squeamish. Fathers were distressed at times with the pain their partners felt. They were not made to feel that they were getting in the way. Yet midwives were reported to have made “no particular effort” to make fathers feel relaxed and comfortable. This is likely to be a reflection of the midwive’s unfamiliarity with fathers’ presence in the labour ward. The vast majority of fathers (141) reported that they had been satisfied with the care they and their partner had received during labour. The last weeks of pregnancy are a time of relatively high anxiety for fathers and similar worries and concerns as the ones voiced in this study have often been mentioned in the literature (Fein 1974, Scott-Heyes 1982, Osofsky & Culp 1989). Evidence from the studies of the perinatal period suggests that rational and irra-
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tional worries about the risks of pregnancy and birth and about mother’s and baby’s well-being might be ubiquitous (Marquart 1976, McKee 1980, Lewis 1986). Men may feel helpless about, and partly responsible for, the possible dangers which both mother and child face. It seems to us, that it is the projection of those worries that make such a large number of fathers in our study claim, that they would be unable to invest emotionally in a child with physical defects. In traditional cultures there is a particular preference for male children, mainly for economic reasons. Despite the fact that these reasons are gradually disappearing, fathers seemed to have a preference for boys. It is the birth of a son that allows immediate identification by the father who projects his aspirations onto the boy infant (Benedek 1970). The number of fathers who attended the birth is very small and it is thus impossible to come up with any generalized conclusions. However, fathers in general, sound strong and satisfied. Relevant findings caution us about the sturdy and bold attitude men tend to assume both during pregnancy and labour. Lewis ( 1986) believes that men are often trapped between their identification with pregnancy and delivery on an emotional level and their public image as strong, instrumental providers on another level. For fathers the question of attendance at the delivery of their child is not an easy one since all along their partners’ pregnancy their public role is rather peripheral. It is thus not surprising that men tend to arrive in the delivery room without adequately documented reasons for their presence (Lewis 1982). Anthropological evidence on the “couvade” suggests that participation at the public “events” around this time are rich with social and symbolic consequence in terms of interpersonal relationships and by enabling one person to lay claim to another. Douglas (1975) notes that fathers claim that their presence at the birth brings them closer to their wives and the event is seen very much in terms of a demonstration of the parity between them, particularly as a result of the man’s respect for his wife’s ability to stand up to such pain and suffering. Moreover, in keeping with current ideological notions of “bonding”, many men feel that seeing their child right at the start of its life has a great influence upon the relationship. Finally, birth Scand J Caring Sci
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can be seen as a “consensus-producing statement about the essential nature of society” and “a summation of a whole community’s experience” (p. 67). Thus father’s attendance at birth is a public demonstration of his feelings for his partner and baby. The issue of including fathers at delivery is being addressed only very recently in Greece. The relevant literature from cultures that have addressed the issue long ago points out that it is still a matter of negotiation on the individual, couple and societal levels. The medical attitudes towards father attendance at delivery have not been researched in Greece. What we do know however, is that explanations for the inclusion or the exclusion of fathers, are not in any way clearly substantiated by the health care system. The hospital practice of either excluding the father altogether or of allowing him to stay during only the first stages of labour, or during the entire process of delivery, seems to be circumstantial in the various maternities. It seems to us that more crucial than whether fathers are actually present or not may be the meaning of father’s presence for all parties involved: health professionals, mother and father. Presence at birth suggests commitment to the role of the father and it cannot be overlooked that the father’s entrance into the delivery room is made at a time (individual, family and historical) when the members of the nuclear family have to face the challenge of creating, maintaining, evolving and dissolving their own autonomy.
Father’s participation in childcare At six weeks postpartum the majority of fathers reported some degree of active participation in childcare and household tasks. Half of our sample claimed to be daily involved in housework while 16% of the fathers stated that they never help with housework. Yet almost no fathers felt that the home is the woman’s place and they have no part in it. Ninety-two percent of fathers engaged in play with their child on a daily basis. Consistently with the existing literature, fathers seem to be much more involved in playing with the baby than actively participating in childcare such as taking the baby for a walk, bathing the baby or changing nappies. Still quite a large number of fathers, ranging from 16% to 25%, stated that they are involved in such
childcare activities. Almost half of our sample reported to be daily putting the baby to bed. Father’s enjoyment of the child was assessed by examining their desire to be with the child and the amount of time he allocated for this purpose. Sixty eight percent of fathers wished they could generally spend more time at home with the child and 92% said they enjoyed getting home from work to see their wife and child. Yet half of the fathers reported that when they get home from work, they feel too tired to take the baby and 42% find the baby hard to cope with. Still a large percentage of the fathers (60%) when they get home from work, do take the child and let their wife get on with something she wants to do. However, only 27% of fathers claimed that they were expected to do so. In response to the questions exploring reactions to fatherhood, a large number of fathers (68%) reported they felt they were making a strong bond with the baby and they were happy in the way both themselves (73%) and their partner (86%) were bringing up the baby. Only very few fathers felt they were excluded by their partner in looking after the baby (4.8%) or that their partner does not trust them to carry out such a task (4%). Four fathers reported that they were at times so stressed at home that they believed they might have a bad influence on their baby. All three scales “reaction to fatherhood”, “enjoyment of the child” and “involvement in childcare” are strongly correlated with each other (Table I), the strongest correlation coefficient being the one between “enjoyment of the child” and “involvement in childcare”. The more fathers enjoy their child the more they tend to be involved in childcare and vice versa. The MANOVA revealed that the three aspects of fatherhood are a jointly distributed variable; the Bartlett test of sphericity was highly significant ( p 0.000.
Table 11. Predictors of the jointly distributed variable reaction to fatherhood, enjoyment of child and involvement in childcare‘ Variables
B
P
Reaction to fatherhood Emotional well-being Occupation (social class)
-0.30
0.000
-0.21
0.06
Enjoyment of child Emotional well-being
-0.36
0.000
Involvement in childcare Education3 secondary education primary education
-0.21
0.09
I1 111 N.M. 111 M.
IV &
v
‘Only those variables which are significant predictors are included in the Table. *Social Class I is used as a reference. 3Higher degree is used as a reference.
Fathers who are depressed are less able to draw the real satisfactions brought by fatherhood, such as the sense of being a good father and of obtaining real pleasure from the fatherinfant interaction, the enhanced sense of personal identity and the deepening of the couple relationship. Low class fathers who are working hard and come home exhausted after a day’s manual work may well enjoy their child but they seem to be less able to participate in childcare and react postively to fatherhood. It may also be that these are fathers who come from a more traditional background whereby fathers were less involved with the day-to-day care of the infant.
CONCLUSIONS Without disregarding the ambiguities inherent within contemporary fathering roles, the vast majority of father’s responses revealed the importance fatherhood has had for them as well as a shift in parenting roles. Roles are no longer prescribed and can be viewed as a priori abstractions which can be broken as rules evolve (Jackson 1967). Roles thus become a function of the differentiation characterizing each particular relationship. In today’s society the paternal function requires new complex skills which presuppose a number of second order changes in the family system. Similarly, there is no one adequate style of adapting to fatherhood but a variety of possible models. Men’s transition to fatherhood is dependent on their having defined for themselves a role that meets their needs and those of their family (Fein 1974). Young people are facing the challenge of attaining autonomy for and through interdependence. Fathers’ responses regarding reactions to fatherhood, enjoyment of the child and involvement in childcare seem to acknowledge that male and female roles are bound to alternate depending on the situation. Today’s couple is in need of a successful negotiation of the balance between self and family, of long- and short-term complementarity, as well as of role differentiation. It is only under such assumptions that the father’s entrance in the delivery room and his involvement in childcare will become meaningful for both partners.
ACKNOWLEDGEMENTS This study was conducted as part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC) under the auspices of Scand J Caring Sci
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the World
Health
Organization, Regional
Office for Europe.
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