ORIGINAL ARTICLE

‘Paddling upstream’: Fathers’ involvement during pregnancy as

described by expectant fathers and mothers
Margareta Widarsson, Gabriella Engstr€
om, Tanja Tyden, Pranee Lundberg
and Lena Marmstal Hammar

Aims and objectives. To describe the perspectives of expectant mothers and

fathers on fathers’ involvement during pregnancy. What does this paper contribute
Background. Becoming a father is a major life event and paternal involvement to the wider global clinical
during pregnancy has a positive influence on the family. However, research into community?
both expectant mothers’ and fathers’ perspectives on fathers’ involvement during • Expectant mothers and fathers
pregnancy is relatively scarce. wanted the father to be more
Design. A descriptive qualitative study was used. involved during the pregnancy,
but encountered many barriers to
Methods. Thirty expectant parents (20 women and 10 men) were interviewed
such involvement. To facilitate
either as part of one of four focus groups or in an individual interview. Qualita- fathers’ involvement, healthcare
tive content analysis was performed on the interview transcripts. professionals should determine
Results. A theme of ‘Paddling upstream’ emerged as an expression of the latent expectant fathers’ specific needs
content of the interviews concerning perspectives on fathers’ involvement. Five and help them overcome barri-
sub-themes described the manifest content: trying to participate, trying to be ers.
• In promoting the progress of gen-
understanding, trying to learn, trying to be a calming influence and trying to find
der equality, we found it impor-
a balanced life. Expectant parents suggested several ways to improve fathers’ tant – from both the paternal and
involvement and to meet parents’ need for shared involvement. maternal perspectives– for the
Conclusion. Expectant mothers and fathers wanted the father to be more involved father to be involved during the
in the pregnancy. Although fathers attempted different strategies, they did not pregnancy. Shared involvement is
important for their preparation
always perceive what was expected of them and encountered many barriers as
for parenthood.
they tried to navigate through this unique experience. The best support for the • The present study is a useful
father was the mother. Expectant parents wanted their healthcare to include the description for midwives and
father more thoroughly and to focus on the whole family. other healthcare professionals of
Relevance to clinical practice. Prenatal care professionals can overcome barri- how fathers can be involved dur-
ers that prevent paternal involvement. Although fathers are not able to engage in ing pregnancy.
the pregnancy on the same level as the mother, we suggest that their specific
needs also be recognised through an increased awareness of gender norms in
healthcare.

Authors: Margareta Widarsson, MNursSci, RN, RM, Med LIC,
Doctoral Student, Centre for Clinical Research, Uppsala University,
V€astmanland County Hospital, V€aster as, Department of Public
Health and Caring Sciences, Uppsala University, Uppsala, Sweden;
Gabriella Engstr€
om, RN, PhD, Associate Professor, Christine E.
Lynn College of Nursing, Florida Atlantic University, Boca Raton,
Florida, USA; Tanja Tyden, RM, PhD, Professor, Department of
Public Health and Caring Sciences, Uppsala University, Uppsala,
Sweden; Pranee Lundberg, RN, RM, PhD, Associate Professor,
Department of Public Health and Caring Sciences, Uppsala Univer-
sity, Uppsala, Sweden; Lena Marmst al Hammar, RN, PhD, Senior
Lecturer, School of Health, Care and Social Welfare, M€alardalen
University, V€
aster
as, Sweden
Correspondence: Margareta Widarsson, Doctoral Student, Centre
for Clinical Research, V€astmanland County Hospital, S- 721 89
V€aster
as, Sweden. Telephone: +46 21 174102.
E-mail: margareta.widarsson@ltv.se

© 2015 John Wiley & Sons Ltd

Journal of Clinical Nursing, 24, 1059–1068, doi: 10.1111/jocn.12784 1059
M Widarsson et al.
Key words: antenatal care, content analysis, expectant fathers, expectant mothers,
involvement, prenatal care
Accepted for publication: 19 December 2014
Introduction
Becoming a father is a major life event. For some, the trans-
formative process may begin as soon as the pregnancy is
confirmed; for others, it may occur when they hold their
newborn child for the first time. This transition into father-
hood is complex and is described as a time of joy and hope
as well as of confusion and frustration (Asenhed et al.
2013). Paternal involvement during pregnancy can posi-
tively influence health outcomes for the partner, the child
and the father himself (Plantin et al. 2011), and most
fathers demand to be involved in facilitating the well-being
of their child and partner (Redshaw & Henderson 2013).
This involvement is also insisted on by expectant mothers
(Widarsson et al. 2012, Alio et al. 2013).
Background
The father wants to support his partner’s positive perinatal
experience (Fenwick et al. 2012, Alio et al. 2013), as well
as to maintain a strong family (Lindberg & Engstr€ om
2013). However, fathers sometimes fall into a secondary
role during pregnancy and may feel excluded from a largely
maternal domain following childbirth. This can be prob-
lematic for both the father and the mother (Wells et al.
2013), and a lack of effective and engaging interactions
with healthcare professionals can leave men feeling frus-
trated and distressed (Fenwick et al. 2012). There is a need
to determine why fathers feel excluded during pregnancy,
in spite of the pregnancy being about his child as well. The
development of effective intervention strategies to address
these deficiencies depends on such insight.
Women commonly spend a greater portion of time caring
for the children and family, which may reflect gendered
norms and roles in both society and families (Connell 2009).
On the other hand, there are inherent sex differences due to
the woman carrying the foetus (Bird & Rieker 1999). Social
and cultural norms, as well as policies and practices, have
changed in recent decades. This has resulted in a shift in focus
that promotes gender equality, from women’s empowerment
to the roles and responsibilities of men (WHO 2006). How-
ever, healthcare-services have difficulty increasing fathers’
involvement in educational programmes, with the result that
1060
men can be less prepared for parenting than women (WHO
2007). Official Swedish gender equality policy regards
women and men as having the same rights, obligations and
opportunities in important life domains (Nationalencyklop-
edin 2014). This development of greater equality, including
in the area of childcare, has been described as Sweden coming
close to a ‘gender revolution’, in which the differences
between fathers and mothers are gradually being reduced
(Evertsson 2014). These changes are likely facilitated by the
similar employment rates of 92% for fathers and 82% for
mothers, (Statistiska centralbyr an 2013). Sweden also has
one of the most extensive and egalitarian parental leave poli-
cies in the world (Ray et al. 2010), allowing 480 days of
leave from work per child; these days are to be used up to the
time the child is 12 years old, and may be shared between the
parents (F€ors€
akringskassan 2014).
Despite this gender equality progress, mothers report
more stress from paid work, conflicting demands and a
greater overall workload than do fathers (Berntsson et al.
2006, Strandh & Nordenmark 2006). Mothers also report
more control over household duties and total workload
than fathers, who focus mainly on their paid work and
seem fairly resistant to feelings of conflicting demands
(Berntsson et al. 2006).
The aim of maternal healthcare in Sweden is reproductive
health for both men and women, implying that maternal
healthcare provides assistance in parenting and support for
both parents along with maternal childbirth preparations
(Andersson-Ellstr€ om 2008). However, parents are dissatis-
fied with the antenatal support they receive (Edvardsson
et al. 2011), in which men do not feel involved by mid-
wives (Hildingsson & Sj€ oling 2011) and experience tradi-
tional gender roles as shortcomings in parental education
(Edvardsson et al. 2011).
Studies often focus on mothers’ and seldom on fathers’
experiences of pregnancy. The aim of this study, therefore,
was to describe the perspectives of expectant mothers and
fathers on the involvement of fathers during pregnancy.
Methods
The study had a qualitative design, using a qualitative
latent content analysis, described by Graneheim and
© 2015 John Wiley & Sons Ltd
Journal of Clinical Nursing, 24, 1059–1068
Original article
Lundman (2004), to analyse interviews with expectant
fathers and mothers.
Participants and setting
Participants were expectant fathers and mothers recruited
(1) through an open hospital lecture describing obstetric
facilities, (2) by a midwife serving newly arrived immi-
grants, and (3) by midwives at maternity care units. Inter-
ested individuals were contacted by telephone. Thirty
expectant parents (20 women, 10 men) agreed to partici-
pate and signed informed consent forms. Twenty were first-
time parents (12 women, eight men). Participants were 21–
56 years of age (mean 30 years), all were living with their
partner and 90% had completed at least high school. Preg-
nancy duration ranged from 13–39 weeks (median
34 weeks).
Data collection
Data were collected through four focus group interviews
(FGIs) (Krueger & Casey 2000) and 12 individual inter-
views (Kvale et al. 2009), conducted by the first author
(Table 1). Swedish-speaking parents were given the
opportunity to choose between an FGI and an individual
interview; only individual interviews were available for
non-Swedish-speaking participants. Two individual inter-
views were conducted in English and two through an
interpreter. An observer assisted the FGI moderator with
field notes during the FGI and a summary afterwards. FGIs
lasted 71–109 minutes, included both first-time and
experienced parents, and were conducted at the Centre for
Clinical Research.
The 12 individual interviews were carried out at the
participant’s home or a community centre, based on the
participant’s preference. The individual interviews lasted
31–65 minutes. The opening question in each focus group
Table 1 Characteristics of participants in the four focus group
interviews and the 12 individual interviews
Focus
Number group Individual
of participants interviews interviews
Women 12 8
Men 6 4
Swedish speakers 18 8 described as struggling to achieve that involvement. He
Non-Swedish 0 4
speakers
First-time parents 13 7
Not first-time parents 5 5
© 2015 John Wiley & Sons Ltd
Journal of Clinical Nursing, 24, 1059–1068
Fathers’ involvement during pregnancy
or individual interview was ‘Please tell us about your expe-
riences becoming a father/mother’. This question was
followed up with probing questions to steer the interviews
towards the aim of our study (Polit & Beck 2008). After
the interviews the first author, the observer, or the partici-
pants made a short summary, and the participants had the
opportunity to verify the content (Krueger & Casey 2000).
Data analysis
All interviews were analysed using qualitative content
analysis according to Graneheim and Lundman (2004).
Each audiotaped interview was transcribed verbatim and
read several times to develop an overview. The analysis
process began by highlighting sentences of importance.
These sentences were first divided into meaning units. Sec-
ond, the meaning units were condensed and labelled with
short codes. Third, the codes were compared to identify
similarities and differences. Fourth, categories were devel-
oped based on the codes, which included the manifest con-
tent, or what the text communicated. Fifth, a comparison
and interpretation of the categories was undertaken, from
which the five sub-themes were developed. The sub-themes
are the underlying meanings of the categories, that is,
expressions of the latent content on an interpretative level.
Finally, the sub-themes formed one theme: (Table 2).
Ethics
The Research Ethics Committee at Uppsala approved the
study (Dnr: 247-2008).
Results
From the analysis, a theme of ‘Paddling upstream’ emerged
as a description of paternal involvement during pregnancy.
This theme was built up from five sub-themes (Fig. 1). To
maintain confidentiality, pseudonyms are used in the results
section.
Theme: ‘Paddling upstream’
This theme is a metaphor for the expectant parents’ per-
spectives on the involvement of fathers during pregnancy.
The parents wanted the father to be involved, but he was
faced many barriers, which are described in this section.
The metaphor of ‘Paddling upstream’ – trying to make
headway against the flow of a river – mirrors this struggle.
He moves forward, but has to expend a lot of energy to
1061
M Widarsson et al.

Table 2 Content analysis of transcribed data from all interviews with 30 expectant fathers and mothers. Examples of meaning units, con-
densed meaning units, codes, categories, sub-themes and theme

Meaning unit Condensed meaning unit Code Categories Sub-themes Theme

Reducing anxiety, calming Reducing anxiety, calming down. Ease anxiety Anxiety reducer Trying to be Paddling
things down. Because in most Most things work out well. On a calming upstream
cases things work out well. the forums, they don’t say things influence
On such forums, they don’t go well for 1000 and badly for
say that things go well for one, they talk about things go
1000 and then that they go badly, or about complications.
badly for one, they talk I’m a reducer of anxiety
about the times things go
badly, or about
complications. I’m more of a
reducer of anxiety
I try to take as much I take as much responsibility as I Take practical Responsibility Trying to
responsibility as I can can concerning her career, responsibility taker find a
concerning both her career working life and social life. I balanced
and her working life, and her help her and make things easier life
social life, and as a parent, for her as much as possible. It’s
and I try to help her and always a compromise
make things easier for her as
much as possible. . . it’s
always a matter of a
compromise

Paddling upstream necessary as a source of the knowledge needed to facilitate

involvement. Difficulty being away from work or arranging
Trying to be babysitting for siblings commonly hindered participation in
understanding healthcare visits. Fathers also worried about the mother’s
Trying to
pregnancy, planned for the coming child, and were excited
participate
to reach the end of the pregnancy journey.

Trying to be a
calming influence
Trying to
learn
Trying to find a
balanced life
Figure 1 Theme and sub-themes revealed by the qualitative content
analysis of interviews with 30 expectant fathers and mothers in
Sweden.
battle against the current. The father, then, faced numerous
obstacles to being involved. He often felt that the
pregnancy was not quite real, as he could not feel the
baby’s movements or see his own body changing as the
mother was able to do. However, fathers tried to be present
in more practical ways, such as managing practical matters.
They had to try to work out what the mother wanted, as
she did not clearly express her needs. On visits to the mid-
wife, the father felt overlooked and superfluous, making
other support groups such as friends and social media
Trying to participate
The fathers wanted to participate in the pregnancy and
tried to do so in different ways. Even though the mother
was carrying the foetus, both parents described the preg-
nancy as an unreal experience, in the sense that, although
they knew there was a baby, they could not see it. This
meant that being fully involved was even more difficult for
the father. One woman described how she wished the
father would be a greater part of what was happening:
He thinks it’s a real drag, not getting to experience the pregnancy.
He thinks it’s so unfair, so he just lies there and as soon as there’s
any kicking, there he is, feeling and listening. (Marie)
One way for the father to participate was to accompany
his partner on visits to the midwife. Parents described this
as a form of support for the mother and said that the
father’s support was unique because he knew her best, but
also that the father wanted support as well. As one father
described his situation:

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1062 Journal of Clinical Nursing, 24, 1059–1068
Original article
I really want to be there [on visits to the midwife], because I want
to participate as much as I can – there’s already that distance
between [my wife] and me as the child’s parents, in that she’s the
one who’s carrying the baby. (Samuel)
Yet when the father accompanied his partner on these
visits, he did not feel welcome, since the information and
communication was directed at the mother. One mother
commented:
The midwife hardly said hello to him, and then there was just a
conversation between me and the midwife. So he wondered after-
wards, why was I there at all, the midwife treated me like air . . . it
was as if she didn’t have a single question for him, she never once
spoke to him. (Noomi)
Another way for the father to participate was during the
ultrasound examination. Even if the father was a bystander
at this exam, the parents described the ultrasound as a
turning point when the pregnancy became more real for
them both. Parents described an invisible shared bond that
joined them and strengthened their relationship. After this
experience, the father began to experience the pregnancy in
a different way and took more responsibility in prepara-
tions for the delivery, including practical measures such as
purchasing items for the child, which he had not done
before. One mother said:
It was great when he suggested things. Let’s go and buy a buggy,
and now it’s time to buy a cot, and we’re not going to be stingy
when it comes to the mattress. That’s when I begin to see that he
thinks this is very important. (Tabita)
Trying to be understanding
Fathers described how the pregnancy made their partner
more important to them and how they cared for her more
than before the pregnancy. Fathers reported trying to be
understanding by giving the woman psychological support
and taking care of household matters, which was a great
relief to the mother. Despite these efforts, fathers were not
always successful because the mother did not always
express her needs, but expected him to notice those needs.
When the father was successful in his attempt to be under-
standing and noticed his partner’s needs, she felt looked
after and happy. To the mother, this meant hope for the
future, that he would take responsibility for the family.
One mother described the father’s attempt to be under-
standing:
I ran to catch a bus, I felt it was a very stressful thing for me. When I
got home, I felt I was tired and I told him how incredibly stressed I
© 2015 John Wiley & Sons Ltd
Journal of Clinical Nursing, 24, 1059–1068
Fathers’ involvement during pregnancy
was . . . ‘But you shouldn’t be doing anything, go and lie down and
take it easy, try to unwind’ [said her husband]. (Miriam)
Despite the woman becoming more irritated due to the
pregnancy, she nevertheless experienced greater understand-
ing from the father. The father, though, did not always find
this easy to manage. Nonetheless, the mothers described the
fathers as more attentive, thoughtful and understanding,
even though the mothers themselves expressed that they did
not always deserve this. One mother explained:
My husband supports me most of all. He’s so understanding and
really incredible. For many friends, from what I’ve heard, the men
haven’t really understood why you are perhaps a bit more irritable
and that things are more difficult. (Brigit)
Fathers tried to be understanding of the mothers’ irrita-
tion or strange behaviour because it was described as some-
thing that was normal for pregnancy. The men realised that
they could not psychologically experience being pregnant,
so they simply tried to understand.
Trying to learn
Fathers wanted to prepare themselves by learning about
pregnancy, delivery and parenthood. They tried to show
their involvement by taking part in midwife visits, parent-
ing classes, father classes, and psychoprophylaxis courses.
The courses for fathers were particularly appreciated as
they provided an opportunity to converse with other
fathers. One mother said:
Perhaps it should be a bit more obligatory to have a fathers’ group
as well, where they’re on their own in some way and able to talk
about their thoughts and . . . worries. I’m sure it’s not easy for them
either to have a grumbling woman at home [laughter] . . . in that
way they could perhaps come closer and be involved in a different
way in the pregnancy. (Rebecca)
As a way to learn about pregnancy and childbirth, the
fathers spoke of their need to meet other expectant fathers
and mothers. Most appreciated parental groups that
encouraged active participation and in which the father
could gather information. An especially valuable parenting
group was the psychoprophylaxis course at which fathers
were able to gather practical knowledge in preparation for
the delivery. This provided an opportunity for the parents
to communicate about the upcoming delivery and to learn
about breathing and relaxation. Parents experienced this as
a very good way to get the father to be a part of the preg-
nancy and the preparations for the approaching delivery.
One father noted:
1063
M Widarsson et al.

If we hadn’t taken the psychoprophylaxis course, we actually pen. While the father tried to calm the mother, she
wouldn’t have known anything. I think that’s rather a pity. I have described that she did not feel confident that he himself
a pretty good idea of things, after the previous times, both the pro- would cope with the delivery. One mother reflected:
phylaxis course and the parent group, I think I’ll be well equipped.
And I don’t know, he’s like, ‘Yes, but I’m so calm’, and ‘This is
(David)
going to go well, I’ll cope with this and the delivery. It’s going to
When questions arose about pregnancy, childbirth and go really well.’ And I just picture him, you know, passing out
parenthood, the father commonly asked the mother for there. (Marie)
information first and after that would consult friends who
When fathers tried to soothe their partner by reflecting
had children. In addition, the fathers tried to learn and pre-
on what would take place at the delivery and thereafter,
pare themselves by seeking knowledge on the Internet and
mothers found this to be quite reassuring. Mothers
from books, newspapers and personal contacts. However,
described how the father took part by listening when she
fathers considered it important not to gather too much
described what made her fearful, and by being present to
information, because they did not feel they had the compe-
relieve her anxiety. Fathers, who themselves were worrying,
tence to identify which information was most relevant. One
tried not to show this to the mother, even when she was
father commented:
aware of his anxiety. As one mother said:
This inner anxiety about am I doing enough for my child, am I
It’s wonderful, especially when you have a wonderful husband who
adequately prepared, am I searching for too little information, or
helps you and gives you hope and a sense of security, who helps
too much information, is it good information, what do I think of
you to feel safe. I have to carry the child within me, but the father
all this? To sift through it all and arrive at something that suits
is around me and if he doesn’t give me enough peace, attention
me, or us. (John)
and involvement the baby will feel it. (Lisa)

Trying to be a calming influence

Trying to find a balanced life
Fathers showed their involvement by trying to calm the
The fathers were described as taking part in trying to bal-
mothers’ inevitable anxieties. They described reassuring
ance their and their partner’s lives, including work, careers
their partner when something disturbed her, discussing
and leisure activities, and for some, children as well. Find-
issues with her, and giving comforting hugs when needed.
ing sufficient time for everything was described as difficult.
Fathers wanted to facilitate for the mother, be a balancing
Some situations were discussed with other parents, with a
factor when she was anxious about what might happen
goal of gaining support for the situation. Even though
during the pregnancy and delivery. This role became clear
fathers wanted to be involved in the pregnancy, and both
when it came to information on the Internet, and various
parents explained that they wanted him to take part in the
forums for chatting in which the mothers took part. The
midwife visits, the father also had to prioritise other mat-
father took part when the mother brought up something
ters. With the mother’s agreement, the father sometimes
from a forum, although he may have felt that she should
prioritised work and, in the case of experienced parents,
avoid these venues and should realise that she had limited
other children. Fathers described their involvement as doing
control over pregnancy and delivery situations. Fathers felt
what the mother said he should do; from his perspective,
that chat forums focused on complications and horror sto-
she was considered to bear the main responsibility for the
ries. One father described his role:
home and family. One father described how he took more
Reducing anxiety, calming things down. Because in most cases responsibility during the pregnancy than previously:
things work out well. On such forums, they don’t say that things
I try to take as much responsibility as I can concerning both her
go well for 1000 and then that they go badly for one, they talk
career, her working life, her social life, and as a parent, I try to
about the times things go badly, or about complications. I’m more
help her and make things easier for her as much as possible . . . it’s
of a reducer of anxiety. (Levi)
always a matter of a compromise. (Samuel)
Fathers tried to be a calming influence by reassuring and
The mothers’ description of her partner’s involvement in
encouraging mothers when they described their fears about
juggling everyday life was that they shared the workload.
the delivery. They felt she should prepare herself better by
The father’s involvement and his additional responsibilities
reading and preparing mentally for what was going to hap-
also meant that the parents had less time together, time

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1064 Journal of Clinical Nursing, 24, 1059–1068
Original article
which they missed. When they did have opportunities to
spend time together, it was impacted by her fatigue and
stress at not being able to manage life as she had before.
The parents described pressures that were sometimes trou-
blesome. Even though they realised that life would be more
difficult to manage after the birth, it was a joint decision to
have a child. The parents described how they had waited
and longed for the arrival of their child, even at the cost of
their closeness and their time together. As one mother
described:
And yet we both feel that’s a price to pay, we were prepared for
that before we decided to have children . . . That’s the way things
are, something of the purpose of life. But this real closeness, being
together, hugging one another, kissing each other, having sex or . . .
there’s much less, that has changed. (Elisabeth)
Discussion
Our theme of ‘Paddling upstream’ provides a greater under-
standing of parents’ experiences of the involvement of
fathers during pregnancy. The main finding from our analy-
sis of interviews with both expectant fathers and mothers
was that the father was expected to be involved early in the
pregnancy. Both parents described how the father tried to
live up to these expectations and that he was the best sup-
port for the mother. However, he did not always know
what to do and was dependent on the mother. As the
mother was the one carrying the child, it is natural that he
could not be as involved as she was. The parents described
the father’s involvement as a struggle, as he encountered
barriers on the pregnancy journey.
One barrier was described as a lack of support from the
prenatal care system from which the parents expected to
receive support during the pregnancy. These professionals
seemed to address the needs of the expectant mother and
the child, rather than the whole family. It is evident that
maternal services have difficulty reaching men. The WHO
(2007) suggests that health professionals should facilitate
changes that make men more active, equal and participat-
ing, leading to greater well-being for the whole family.
Society is often described as a patriarchal system, in
which men have the power and women are discredited.
Looking at the prenatal care system as a microcosm of soci-
ety, we find that it too excludes one sex, only it is an
inverted system. A gendered pattern shows that even if
fathers are invited to attend parental education and prena-
tal care visits, and they want to be involved during the
pregnancy, fathers are not as included as mothers (Fenwick
et al. 2012). We found that fathers did not always feel wel-
© 2015 John Wiley & Sons Ltd
Journal of Clinical Nursing, 24, 1059–1068
Fathers’ involvement during pregnancy
come and that they sometimes felt ignored and excluded
from antenatal care, a finding consistent with other studies
(Leite 2007, Deave et al. 2008), even though maternal
healthcare should provide support for both parents in pre-
paring for childbirth and parenting (Andersson-Ellstr€ om
2008).
The antenatal care and parental education system is often
described as a ‘matriarchy’, with predominantly female
midwives working in a traditionally female-dominated area.
Our findings reflect both gendered norms in society and
gendered roles in families, a point also made by Connell
(2009); on the other hand, there is an obvious sex differ-
ence in pregnancy, since the foetus develops within the
woman. The man’s expected participation is to support his
partner during the pregnancy, and his focus in a supporting
role is to create optimal conditions for the woman and their
child or children.
Consistent with our findings, others have reported that
parents are dissatisfied with their prenatal support (e.g. Ed-
vardsson et al. 2011). Although Sweden is a leading coun-
try for parents, and close to a ‘gender revolution’
(Evertsson 2014) with one of the most extensive and egali-
tarian parental leave policies (Ray et al. 2010), parents in
our study, as in others (Edvardsson et al. 2011, Plantin
et al. 2011), described the father as an outsider.
The father’s invisibility is noteworthy in the light of evi-
dence that active involvement by the father leads to benefi-
cial health effects for him, his partner and their child
(WHO 2007, Plantin et al. 2011). Consistent with sex dif-
ferences, this can be a result of gender roles in the family
(Connell 2009), where expectations of ‘new’ equal gender
roles are in opposition to embedded sex differences in rela-
tion to pregnancy.
Another barrier was different parent expectations. Moth-
ers expected fathers to understand their needs implicitly,
without their having to communicate them, which has also
been described during postpartum (Negron et al. 2013).
Furthermore, fathers expected the mother to have the main
responsibility for the home and family, consistent with
Connell’s (2009) finding that women possess more power
in the family. For example, in our study, in preparing for
their child, the man did what the woman told him to do
and trusted her because he felt that she had primary
responsibility. Furthermore, when the woman did not com-
municate her needs to her partner, he did not always dis-
cover them. This inadequate communication could be one
of the contributing factors to why mothers experience more
stress related to paid work, and have more control over
household duties and a higher total workload than fathers
(Berntsson et al. 2006, Strandh & Nordenmark 2006),
1065
ORIGINAL ARTICLE

‘Paddling upstream’: Fathers’ involvement during pregnancy as

described by expectant fathers and mothers
Margareta Widarsson, Gabriella Engstr€
om, Tanja Tyden, Pranee Lundberg
and Lena Marmstal Hammar

Aims and objectives. To describe the perspectives of expectant mothers and

fathers on fathers’ involvement during pregnancy. What does this paper contribute
Background. Becoming a father is a major life event and paternal involvement to the wider global clinical
during pregnancy has a positive influence on the family. However, research into community?
both expectant mothers’ and fathers’ perspectives on fathers’ involvement during • Expectant mothers and fathers
pregnancy is relatively scarce. wanted the father to be more
Design. A descriptive qualitative study was used. involved during the pregnancy,
but encountered many barriers to
Methods. Thirty expectant parents (20 women and 10 men) were interviewed
such involvement. To facilitate
either as part of one of four focus groups or in an individual interview. Qualita- fathers’ involvement, healthcare
tive content analysis was performed on the interview transcripts. professionals should determine
Results. A theme of ‘Paddling upstream’ emerged as an expression of the latent expectant fathers’ specific needs
content of the interviews concerning perspectives on fathers’ involvement. Five and help them overcome barri-
sub-themes described the manifest content: trying to participate, trying to be ers.
• In promoting the progress of gen-
understanding, trying to learn, trying to be a calming influence and trying to find
der equality, we found it impor-
a balanced life. Expectant parents suggested several ways to improve fathers’ tant – from both the paternal and
involvement and to meet parents’ need for shared involvement. maternal perspectives– for the
Conclusion. Expectant mothers and fathers wanted the father to be more involved father to be involved during the
in the pregnancy. Although fathers attempted different strategies, they did not pregnancy. Shared involvement is
important for their preparation
always perceive what was expected of them and encountered many barriers as
for parenthood.
they tried to navigate through this unique experience. The best support for the • The present study is a useful
father was the mother. Expectant parents wanted their healthcare to include the description for midwives and
father more thoroughly and to focus on the whole family. other healthcare professionals of
Relevance to clinical practice. Prenatal care professionals can overcome barri- how fathers can be involved dur-
ers that prevent paternal involvement. Although fathers are not able to engage in ing pregnancy.
the pregnancy on the same level as the mother, we suggest that their specific
needs also be recognised through an increased awareness of gender norms in
healthcare.

Authors: Margareta Widarsson, MNursSci, RN, RM, Med LIC,
Doctoral Student, Centre for Clinical Research, Uppsala University,
V€astmanland County Hospital, V€aster as, Department of Public
Health and Caring Sciences, Uppsala University, Uppsala, Sweden;
Gabriella Engstr€
om, RN, PhD, Associate Professor, Christine E.
Lynn College of Nursing, Florida Atlantic University, Boca Raton,
Florida, USA; Tanja Tyden, RM, PhD, Professor, Department of
Public Health and Caring Sciences, Uppsala University, Uppsala,
Sweden; Pranee Lundberg, RN, RM, PhD, Associate Professor,
Department of Public Health and Caring Sciences, Uppsala Univer-
sity, Uppsala, Sweden; Lena Marmst al Hammar, RN, PhD, Senior
Lecturer, School of Health, Care and Social Welfare, M€alardalen
University, V€
aster
as, Sweden
Correspondence: Margareta Widarsson, Doctoral Student, Centre
for Clinical Research, V€astmanland County Hospital, S- 721 89
V€aster
as, Sweden. Telephone: +46 21 174102.
E-mail: margareta.widarsson@ltv.se

© 2015 John Wiley & Sons Ltd

Journal of Clinical Nursing, 24, 1059–1068, doi: 10.1111/jocn.12784 1059
Original article Fathers’ involvement during pregnancy

Conclusion
Acknowledgements
The expectant mothers and fathers wanted the father to be
We thank all the participating expectant mothers and
more involved during the pregnancy and he tried to be so
fathers.
in different ways. He did not always perceive what was
expected of him by the mother or the community and
encountered many barriers around which he tried to navi- Disclosure
gate. The best support for the father was the mother. Both
The authors have confirmed that all authors meet the IC-
parents wanted their care providers to be more inclusive of
MJE criteria for authorship credit (www.icmje.org/ethi-
the father and to consider the man an asset in their efforts
cal_1author.html), as follows: (1) substantial contributions
to serve the whole family.
to conception and design of, or acquisition of data or
analysis and interpretation of data; (2) drafting the article
Relevance to clinical practice or revising it critically for important intellectual content;
and (3) final approval of the version to be published.
This study will be useful for midwives and other healthcare
professionals seeking to integrate the father throughout
pregnancy and childbirth, with benefits for the future child Conflicts of interest
and family. In their support, professionals can overcome
The authors have no conflict of interest to declare.
barriers that prevent the expectant father’s involvement and
make the pregnancy a more real experience. Even though
fathers are not able to engage fully due to biological limita- Funding
tions, we suggest that the expectant father’s specific needs
The study was supported by grants from the County Coun-
should be included through an increased awareness of
cil of V€
astmanland, Sweden.
gender norms.

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Journal of Clinical Nursing, 24, 1059–1068