BIRTH 36:4 December 2009 305

Men’s Psychological Transition to Fatherhood:

An Analysis of the Literature, 1989–2008

Lucia Genesoni, BSc, and Maria Anna Tallandini, PhD

ABSTRACT: Background: The most recent review on men’s transition to fatherhood was
published in 1986. The present paper reports on how the literature has portrayed fatherhood
over the past 20 years. The aim was to investigate men’s psychological transition to fatherhood
from pregnancy of the partner through the infant’s first year of life. Methods: The PsycINFO,
PubMed, MEDLINE, Ingenta, Ovid, EMBASE, and WoS databases were accessed to conduct a
literature search on the topic. The concepts of self-image transformation, triadic relationship
development, and social environment influence were used to examine the complexity of the
fatherhood transition process. Specific focus was placed on men’s intrapsychic relational and
social dimensions. Results: Our analysis of the yielded results revealed three specific fatherhood
stages: prenatal, labor and birth, and postnatal periods. Partner pregnancy was found to be
the most demanding period in terms of psychological reorganization of the self. Labor and
birth were the most intensely emotional moments, and the postnatal period was most influenced
by environmental factors. The latter was also experienced as being the most interpersonally
and intrapersonally challenging in terms of coping with the new reality of being a father.
Conclusions: Men’s transition to fatherhood is guided by the social context in which they live
and work and by personal characteristics in interplay with the quality of the partner relationship.
Men struggle to reconcile their personal and work-related needs with those of their new families.
(BIRTH 36:4 December 2009)

Key words: fatherhood, intrapartum period, prenatal period, postnatal period, transition

Although the concept of fatherhood has been rather
widely investigated, few studies have analyzed the pro-
cess of becoming a father. American and European lit-
erature on the role of fathers (1–5) and on the effects
of father-infant interaction has extensively documented
the benefits of active paternal involvement on infant
development, and on the well-being of the fathers them-
selves (6–8).
Research has shown that, even in egalitarian couples,
the standard division of household chores still reflects
stereotypical male and female role divisions from past
generations (9). In fact, a distinctive paternal style (based
on play, recreation, and goal-oriented tasks) and a mater-
nal style (based on childcare and routine family tasks)
are robust and evident even in families with fathers
who are highly involved in childcare (10). Nonetheless,
despite variability in family parenting roles and activi-
ties due to demographic, socioeconomic, and individual
background factors, the European and North Ameri-
can literature reports a tendency for fathers to be more
involved in infant care than has been observed with
past generations (8,11). This tendency does not refer

Lucia Genesoni is a Research Psychologist in the Department of
Psychology, University College London, and Maria Anna Tallandini
is Professor of Developmental Psychology, Department of Psychology,
University of Trieste, Italy, and Honorary Researcher, Department of
Psychology, University College London, United Kingdom.
This research was supported by BLISS–The Premature Baby Charity,
London, United Kingdom.
Address correspondence to Maria Anna Tallandini, Department of
Psychology, University College London, Gower Street, London WC1E
6BT, United Kingdom.
Accepted June 9, 2009
© 2009, Copyright the Authors
Journal compilation © 2009, Wiley Periodicals, Inc.
306
to the father often being more or equally the child’s
main caregiver, but indicates that interest in parental role
expectations in Western societies has grown over the last
three decades (10–15). The current “fatherhood culture”
has begun redefining the father role once viewed exclu-
sively in terms of breadwinner and disciplinarian, to one
of fathers also being involved in the care of children of
all ages (13,16). Although mothers are still in charge of
most daily childcare duties, the above-described changes
indicate that women, couples, families, and society at
large have been undergoing a complex re-elaboration
process with respect to male behavior and identity for
some period of time.
The aim of the present review is to illustrate research
findings on the psychological experience of becoming a
father in today’s Western societies. The topic is exam-
ined through the lens of the transition-to-fatherhood
literature published over the last 20 years. This time
frame was chosen because the two most recent exten-
sive reviews on the topic of the transition to fatherhood,
published in 1980 (17) and 1986 (18), both stated that
the family role of fathers was undergoing a transforma-
tion process, with traditional and authoritarian behaviors
being transformed into more loving, and warm attitudes
and interactive styles. The two reviews also underscore,
however, that it is not culturally acceptable for men to
be openly affectionate and that they are still expected
to assume a strong provider role—a situation that was
leading to conflict between fathers’ new behavioral ten-
dencies and societal expectations. We therefore won-
dered what the last 20 years of research conducted in
Western nations would indicate concerning the transition
to fatherhood, and whether the transformation processes
reported would be confirmed in more recent literature
pertaining to these cultural milieus.
The present review focused on the three time frames
identified by Yogman (8): the prenatal, labor and birth,
and postnatal periods, up to the infant’s first year of
life. We aimed at examining whether the characteristics
of this transition would vary in relation to these time
frames. In addition, we wanted to consider the ways in
which this process was viewed from personal, societal,
and family-related perspectives. Indeed, these were the
three main dimensions yielded by the literature search,
which appeared to play key roles in the fatherhood tran-
sition process.
Methods
The studies presented in this review were selected
through a literature search conducted by accessing
the PsycINFO, PubMed, MEDLINE, Ingenta, Ovid,
EMBASE, and WoS databases for 1989 through 2008.
BIRTH 36:4 December 2009
The search words used were transition, fatherhood, preg-
nancy, infancy, prenatal period, labor, and postnatal
period. Additional searches were then conducted based
on the references cited in the selected studies. Search
inclusion criteria were live-in fathers in a stable relation-
ship with the mothers of their children, and fathers from
Western or westernized countries (European Community,
United States, Canada, and Australia). It is generally
agreed that family structure and culturally driven aspects
are the major factors influencing the ways in which
fathers participate in the care for their children (8,19).
Search exclusion criteria were adoptive fathers, stepfa-
thers, adolescent fathers, fathers in gay relationships,
and/or fathers with high-risk children. These inclusion
and exclusion criteria were adopted to limit the number
of variables examined.
Results
Thirty-two articles were extracted based on the inclusion
and exclusion criteria. The information obtained through
the literature search is organized here into two sections.
The first section addressed the three time frames of
transition to fatherhood identified in previous analy-
ses (8): prenatal; labor and delivery; and postnatal, up
to the end of child’s first year of life. Five papers
dealt with fatherhood during the prenatal period; three
papers examined fathers during labor and delivery; and
13 papers discussed fathers’ experiences of the postna-
tal period. Eleven papers covered the entire time span,
ranging from pregnancy through the postnatal period.
The second section examined the intrapsychic, rela-
tional, and social aspects of transition to fatherhood.
In fact, three primary dimensions extracted from the
yielded articles appeared to be relevant to modifications
experienced during new fatherhood: re-elaboration of
self-image, development of a triadic mother-father-child
relationship, and influence of social environment. Six-
teen papers examined father’s self-image, 15 dealt with
triadic relationship development, and 13 at least partially
investigated social environment influences on the father-
hood process. Table 1 shows the studies examined.
Prenatal Period
Many factors come into play when couples start dis-
cussing the possibility of having a child (20), or when
the partner becomes pregnant; the literature reported con-
trasting findings on men’s experiences during this period.
On one hand, fathers viewed themselves as part of a
“laboring couple” from the very beginning of the pre-
natal period and expressed wanting to play an active
role in pregnancy-related events—for example, by being
present at medical exams and participating in childbirth
Table 1. Studies on Men’s Psychological Transition into Fatherhood

References Sample Data Collection Variables∗ Measures Results

Chandler and N = 14 Prenatal: 35–37th Expectation and experience of labor Qualitative Prenatal and postnatal: fathers at labor;
Field (21) Canada wk and birth; nonverbal behavior Unstructured ethnographic perceived themselves as being
BIRTH 36:4 December 2009

Postnatal: 4th interviews; diary; recording of merely tolerated; desired receiving

wk nonverbal behavior more information
Diemier (22) N = 83 Prenatal: first and Psychological health; coping style; Quantitative Positive impact of father-focused
USA last sessions quantity and quality of social Brief Symptoms Inventory; Coping classes on couple relationship
father- support; relationship with partner Measure Scale; Social Network
focused Support Scale; Supportive Behavior
classes Questionnaire; Conflict Tactics Scale
Ferketich and N = 147 Prenatal: 24th–34th Prenatal: feelings about pregnancy, Quantitative Prenatal: the earlier fathers felt fetal
Mercer (23) USA gestational wk fetal movements, and delivery Interview and Likert Scales; General movement, the more positive their
Postnatal: early Prenatal and postnatal: perceived Health Index; State Trait Anxiety own health perception was;
postpartum,1st, health status; psychological Inventory; Center for Epidemiologic self-esteem affected health
4th, and 8th mo well-being; family functioning; Studies Depression Scale; Sense of perception
parental competence; social support Mastery Scale; Self-Esteem
Measure; Feethman Family
Functioning Survey; Marital
Adjustment Test; Parental Sense of
Competence; Scale Life Experience
Survey; Inventory of Social Support
Behavior

Greenhalgh N = 78 Postnatal: 1st and Experience of childbirth; Quantitative No antenatal class influence; negative
et al (24) UK 6th wk relationship with the child; Experience of Childbirth experience of childbirth predicted
antenatal emotional well-being; coping Questionnaire fathers’ depressive symptoms
classes style Edinburgh Postnatal Depression
Scale
Miller Behavior Scale
Description of Baby Questionnaire
Donovan (25) N =6 Prenatal: 13– Social and emotional experience of Qualitative Core category: disequilibrium in the
Australia 26 wk pregnancy Open-ended interviews; group spousal relationship; ambivalence in
Postnatal: 12th wk discussion; observation the early stage; “baby is not real”;
“how should I be as a father?”;
coping with changing lifestyle and
roles
307
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Table 1. (Continued)

References Sample Data Collection Variables∗ Measures Results

Draper (26) N = 18 Prenatal: 13–26th and Experience of pregnancy, birth, and Qualitative Men felt relegated to sidelines of
UK 27–40th wk early fatherhood Ethnographic interviews pregnancy and delivery processes
Postpartum: before the
8th wk
Finnbogadottir N =7 Prenatal: 38–39 wk Psychological aspects; physical Qualitative Men expressed feelings of inadequacy
et al (27) Sweden aspects; social aspects Interview and exclusion, and request support;
transition to fatherhood is
experienced as a positive change

Gage and Kirk (28) N = 19 Prenatal: 2 meetings Knowledge of pregnancy; physical, Qualitative Fathers reported feelings of unreality
USA Postnatal: 3–6 mo emotional, and financial Semi-structured interviews about existence of child; they
first-time preparation; contact with health acknowledge importance of medical
fathers professionals staff
Jordan (29) N = 56 Prenatal: after Experience of expectant and new Qualitative Core category: elaboration of father
USA conception; after fathers Interviews role; subprocesses: struggling with
the first fetal the reality of pregnancy, requiring
movements; late of being recognized as a parent,
pregnancy engaging in father role-making
Postnatal: after birth;
at 6 wk; at 6 mo
and at 1 yr
Hallgreen N = 11 Prenatal: before Experience, expectations, and Qualitative Fathers felt unprepared with feelings
et al (30) Swedish childbirth meanings of childbirth Interviews of worry, loneliness, and
prepara- Postnatal: 1–3 wk preparation meaninglessness
tion
classes
Habib and N = 61 Postnatal: 6th mo Involvement and bonding Quantitative Paternal involvement and bonding as
Lancaster (31) Australia Time-diary interview protocol; different dimensions of fathering
Responsibility Scale; Post-natal
Bonding Scale
Strauss and N = 56 Prenatal: 26th–40th Prenatal and postnatal: ideal and Quantitative Prenatal: the self as a parent was more
Goldberg (32) USA wk possible selves; depressive The Pie† ; Center for Epidemiologic important than the self as partner
first-time Postnatal: 1 yr symptoms Studies Depression Scale; father’s and worker
fathers Postnatal: involvement and involvement with child; parental Postnatal: prenatal actual vs ideal
childrearing attitudes attitudes toward childrearing self-differed
BIRTH 36:4 December 2009
Table 1. (Continued)

References Sample Data Collection Variables∗ Measures Results

Condon N = 204 Prenatal: 23rd Psychological and health Quantitative Prenatal: the most stressful period
et al (33) Australia gestational wk well-being; couple relationship; Goldberg’s General Health Postnatal: fathers presented more
Postnatal: 3rd, 6th, quantity and quality of social Questionnaire; Mental Health Scale; negative affects, depressive and
and 12th mo support Positive and Negative Affect somatic symptoms; couple
BIRTH 36:4 December 2009

Schedule; Self-Assessment- relationship and lifestyle tended

Irritability Scale; Hopkins to deteriorate
Symptoms Checklist; Alcohol Use
Disorders Identification Test; World
Health Quality of Life; Dyadic
Adjustment Scale; Intimate Bond
Measure; Lifestyle and Sexual
Functioning Adjustment Scale;
Social Support Questionnaire
Barclay and N = 15 Prenatal: before Expectations and experience of Qualitative Prenatal: adherence to image of
Lupton (34) Australia birth fatherhood; contribution to Semi-structured interviews “involved father”
Postnatal: 1–6 mo decision making and provision of Postnatal: fatherhood first experienced
childcare as disappointing and frustrating;
lack of father role model; difficulties
in combining father role and work
demands
Buist et al (35) N = 251 Prenatal: 26th and Psychological adjustment; couple Quantitative Prenatal: most stressful period
Australia 36th gestational relationship; gender role stress; Edinburgh Post-Natal Depression Postnatal: stress affected men’s
weeks paternal attachment Scale; Positive & Negative Affect attachment to infants
Postnatal: 1 and Scale; Beck Depression Inventory; Prenatal and postnatal: stress is
4 mo The Spanier Dyadic Adjustment associated with a decrease in couple
Scale, SF; The Intimate Bond satisfaction
Questionnaire; Masculine Gender
Role Stress Scale; Paternal
Post-natal Attachment Questionnaire
Henwood and N = 30 Prenatal: 21st–34th Expectations and experiences: ideal Qualitative Prenatal: ideal father: present,
Procter (36) UK wk father, impact of fatherhood on Administration of images with involved, nurturing, and caring;
Postnatal: 2–4 mo previous life practices pictures portraying fatherly desire for intimacy and emotional
and 4–9 mo experiences and related interviews connection with the child
Postnatal: areas of tension: providing
economical support and practical
care, autonomy; negotiating equity,
fairness and decision making with
partner
309
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Table 1. (Continued)

References Sample Data Collection Variables∗ Measures Results

Draper (37) N = 18 Prenatal: 13th–26th Experience of pregnancy Qualitative Body-mediated experiences helped
UK and 27th–40th Ethnographic interviews fathers feel closer to their partners
Postpartum: before and unborn babies
8th wk
Chapman (38) N = 20 Postnatal: 4th wk Labor roles; mutuality and Qualitative Different perspective on fathers’ role:
USA understanding in couple Observations in the labor room; coach, teammate, or witness
relationship interviews
Vehvilainen- N = 107 Postnatal: before Experience of birth Quantitative Birth: importance of being present
Julkunen and Finland baby’s discharge Original self-report questionnaire during delivery but the fathers
Liukkonen (39) from hospital requested more support
Henderson and N = 22 Postnatal: 3rd wk Experience of being a new father Qualitative Sense of not being ready for birth and
Brouse (40) Canada Interview fatherhood; feelings of exclusion,
jealousy, inadequacy; conscious
decision to take control of the
situation
St John et al (41) N = 18 Postnatal: 6 and 12 wk Experiences during perinatal period Qualitative Fathers had difficulties in: making a
Australia involving daily social and Interviews commitment and taking on
practical activities responsibility; maintaining family
integrity; balancing work- and
home-related activities
Baafi et al (42) N = 128 Postnatal: 6 wk Functional ability in: household, Quantitative No substantial changes in fathers’
Australia social and community, child Functional Status-Fathers Inventory general activities
care, personal care, occupational
activities and educational
activities
Williamson N = 128 Postnatal: 6 wk Functional status after the child’s Quantitative Sexual activity was altered by general
et al (43) Australia birth Functional Status-Fathers Inventory fatigue and disruptions caused by
baby
de Montigny and N = 13 Postnatal: 12 days Significant moments in the Qualitative Positive experiences in getting to
Lacharite (44) Canada after birth immediate postpartum period and Critical incidents technique with know their infants and in interaction
fathers’ adaptation semi-structured interviews with nurses
BIRTH 36:4 December 2009
Table 1. (Continued)
BIRTH 36:4 December 2009

References Sample Data Collection Variables∗ Measures Results

Tiller (45) N = 293 Prenatal: 3rd trimester Prenatal: planned or unplanned Quantitative No antenatal class influence on
USA Postnatal: 3rd and pregnancy; Prenatal and Adult-Adolescent Parenting preparation for a new child; fathers
12th mo postnatal: parenting attitudes; Inventory; prenatal class attendance; lack of understanding of child’s
degree of marriage satisfaction demographic interview developmental skills at 3 mo and
Postnatal: infant sleep habits; were sensitive to child needs
maternal work status, fathers’ Fathers’ marital happiness levels were
participation in housework and high during the prenatal period,
childcare; desire for another decreased at 3 mo, and
child increased at 12 mo
Hyssala N = 1,279 Prenatal: 26th– Tradition, values, and attitudes; Quantitative In rural areas traditional models of
et al (46) Finland 40th wk human and family relations; Original questionnaires fatherhood were stronger
Postnatal: birth and information and activities related In urban areas, family relations were
3 yr to maternity and babies; personal closest (nuclear families) and family
activities activities better planned
Magill-Evans N = 162 Postnatal: 5 and 8 mo Father–infant interaction; sense of Quantitative Fathers in intervention group were
et al (47) USA, competence Nursing Child Assessment Teaching more sensitive to infant cues and
Parenting Scale; Parenting Sense of increased their skills in fostering
interven- Competence infant’s cognitive growth
tion
group l
Lee and N = 165 Prenatal: 13th–27th Prenatal and postnatal marital Quantitative Marital satisfaction and degree of
Doherty (48) USA wk satisfaction; involvement with Dyadic Adjustment Scale; involvement with child are
Postnatal: 6 and their infant McBridge’s Time Diary; observation positively related
12 mo of father–infant play rated through
Parent Behavior Rating Scale
311
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Table 1. (Continued)

References Sample Data Collection Variables∗ Measures Results

McVeigh N = 128 Postnatal: 6 wk Functional ability in: household, Quantitative Fathers’ participation in childcare and
et al (49) Australia social and community, child Inventory of Functional household responsibilities did not
care, personal care, occupational Status-Fathers increase; participation in social
activities and educational activities and in functioning at work
activities was positively related to satisfaction
with fatherhood
Walker N = 87 Postnatal: not Life style; stress; physical Quantitative Postnatal: healthier lifestyle was
et al (50) USA specified symptoms; parenting confidence; Healthy Lifestyle; Perceived Stress related to: lower perceived stress,
social desirability Scale; Physical Symptom Checklist; greater parenting confidence, and
Maternal Self-Confidence Scale fewer health symptoms
Modified for Fathers; Social
Desirability Scale Short-form
Hudson N = 34 Postnatal: 8 wk Satisfaction with the Network; Quantitative Internet-based social support improves
et al (51) USA Fathers’ Internet self-efficacy; parenting Infant Care Survey; What Being a self-efficacy and parenting
Network satisfaction Parent of a New Baby is Like satisfaction
(Questionnaire); telephone
interviews
Fägerskiöld (52) N = 20 Postnatal: 6 mo Father’s expectations Qualitative Fathers wanted to share infant care
Sweden Semi-structured interview and request support from nurses
Nugent (54) N = 48 Postnatal: 1st–3rd Postnatal: experience of pregnancy, Quantitative: Neonatal Behavioral Fathers had high degree of
Ireland days of life labor, and delivery; perceptions Assessment Scale; Father Caretaking involvement in childcare, which
of their role as fathers; attitudes Inventory; Bayley Mental and remained stable over the first year
toward own children; lifestyle Motor Scale of Infant Development and had an effect on infant
changes; nature of interaction Qualitative cognitive skills at 1 yr
with the child; infant’s Interview High degree of marital satisfaction
development and caretaking was linked to paternal adaptation
skills
∗ All variables refer to fathers-to-be or fathers, unless otherwise specified.
† The Pie (32) is an instrument created to capture and measure the psychological sense of self in men.
BIRTH 36:4 December 2009
BIRTH 36:4 December 2009
classes (21–24). Yet, despite this relatively new tendency
for men to be involved in the prenatal process, they fre-
quently experienced ambivalent feelings during the early
stages of their partners’ pregnancies (21,25–30).
In fact, the literature revealed three main areas of
difficulty for men during the prenatal period. The first
concerned feelings of unreality, arising out of the lack
of tangible evidence of the existence of their unborn
child (25,28), and the desire to develop an emotional
bond with the child (28). The second problem area for
fathers pertained to the couple relationship, that is, a
perceived disequilibrium in the relationship with their
partner, involving a divergence between male and female
expectations about the relationship and the experience of
discrepant needs (25). The third difficulty was linked to
the formation of a parental identity, which requires a
core identity shift from the role of partner to that of par-
ent (31,32). For instance, Habib and Lancaster (31) doc-
umented the ways in which fatherhood status emerged in
the first trimester of the partner’s pregnancy. In this early
stage, fathers reflected on the type of father they would
like to be and identified their role in multidimensional
terms, ranging from playmate and coach, to provider of
emotional support, to caregiver for their future infants.
These authors found a direct relationship between impor-
tance attributed to father status by expectant first-time
fathers and both intensity of preoccupation with the fetus
and quality of bonding with the unborn child (31).
Although we had expected childbirth to be the most
stressful time for men, the studies we examined indicated
pregnancy as being the most stressful period (30,33–35).
This finding could be because men must undergo psycho-
logical reorganization during this time (33) when they
may also be aiming to adhere to a father image based
on close involvement with family and childcare—an
image for which they never inherited a role model (36).
Only four papers had analyzed supportive experiences
for fathers-to-be during this period, such as being present
during ultrasound scans of the fetus (37), viewing fetal
movements (23,26), and participating in fatherhood dis-
cussion groups (22).
Labor and Birth Period
The biological transition to fatherhood occurs during the
labor process (26). Although standard hospital practice
over the last 30 years has been to admit and even encour-
age fathers to be present at their partners’ labor, the
presence of fathers in delivery rooms seems both vari-
able and limited (20).
Seven studies documented fathers’ experiences dur-
ing labor and delivery, finding that fathers frequently
felt helpless, useless, and anxious during the labor pro-
cess (21,24,29,30,38,39). In fact, fathers usually reported
313
that they had not expected labor to be so demand-
ing (21,30), and had felt mostly out of place, vul-
nerable, unprepared, and in need of psychological
support (26,39,40). Many fathers reported wanting to
participate in their partners’ labor and delivery, but also
wanting to flee at the same time (26,30). Only one study
investigated the effect of fathers’ presence in the delivery
room on subsequent transition to fatherhood: Green-
halgh et al. (24) reported that fathers who expressed
high levels of fulfillment and delight with their expe-
rience of the delivery process subsequently reported few
depressive symptoms. Moreover, fathers with a vaginally
born infant described their infants with more positive
attributes than fathers whose infants had been delivered
by cesarean section.
Postnatal Period
The baby’s homecoming marks the beginning of a
man’s integration into fatherhood from a social per-
spective. After childbirth, fathers can feel torn between
the way their lives used to be and what they view as
a new phase in their existence (37). This conflict is
reflected in the difficulties they encounter in reconcil-
ing the desire to be participating fathers with the need
to provide for their families (34,36,41). The most fre-
quently reported problems in this initial period were:
frustration at not being able to be more involved in
the homecoming process and not having enough time
to establish intimate contact with their babies (34); dete-
rioration of lifestyle and sexual relationships with part-
ners (42,43); restricted sense of freedom with respect
to free time previously enjoyed (33,35); perceptions of
not being as skilled in infant care as their partners
were (29,35,40,44); and a need to learn more about their
infants’ characteristics (45). These difficulties are exac-
erbated by a need to create a new caregiving model
for themselves—one that differs significantly from the
model provided by their own fathers and is based on their
own abilities and wishes (34,46). This intergenerational
conflict influenced men’s adjustment to fatherhood and
their self-perceptions before and after their babies were
born (32,33).
Studies have reported that one way fathers cope with
this initial phase is to “take control” of the new situ-
ation by acquiring the new skills to care for the baby,
such as recognizing the baby’s needs, feeding him or
her, learning to change diapers, etc. (29,40,41,44). The
importance of infant-care skill acquisition was demon-
strated by a recent study, which showed the positive
influence of a father-centered education program on the
development of fatherhood identity (47). The education
program consisted of a self-modeling, father-infant inter-
action procedure based on external feedback. The fathers
314
were videotaped interacting with their infants, and were
subsequently given advice on how to recognize their
infants’ signals and how to respond to them. Partici-
pating fathers welcomed this opportunity and enhanced
their abilities to foster their infants’ cognitive growth
and their sensitivity to infant cues. Other factors shown
to play a major positive role include positive partner
relationship in the prenatal period (48) and in the post-
natal period (35), quality of functioning at work (49),
good quality of life (50), and availability of social sup-
port (51,52).
Self-image, Relational, and Social Dimensions
The processes involved in men’s transition to fatherhood
revealed three primary dimensions in the developmen-
tal processes that are required of men during this life
phase: changes in self-image, transformation of the part-
ner dyadic relationship into a triadic relationship, and
modifications in social environment.
Self-image
During the prenatal period, men gradually realize the
lifestyle changes they are facing. However, the fact
that they cannot experience the physical aspect of preg-
nancy allows them to delay the identity transformation
process (23,25,26). The main difficulties they encounter
during this time are linked to diminished indepen-
dence. Moreover, they are forced by the events to
learn a new approach to life, so as to deal with a
new sense of feeling powerless—of not having control
over the situation—and to accept that they are enter-
ing a new phase of their lives (25,27). The conflicting
mental states produced by these components are fre-
quently expressed through moodiness, irritability, anx-
iety (33), frustration (26,27), and a negative perception
of self (23). Participation in labor and delivery is an
important factor for men in learning to cope with this
transition (39), because the process is accompanied not
only by the previously cited feelings of helplessness
and other factors but also by a sense of pleasure and
pride (21,30,39).
The role that fathers assume during delivery is typ-
ically influenced by the characteristics of the couple
relationship, such as degree of understanding and reci-
procity. This process, in turn, is the result of a com-
plex constellation of the man’s personality, the couple’s
expectations of the experience of labor, and cultural
factors (38). It is therefore impossible to draw general
conclusions on the matter; this ambiguity is reflected
in the literature, which reports conflicting results. For
instance, Greenhalgh et al. (24) found that fathers who
did not have a positive experience of their partner’s labor
BIRTH 36:4 December 2009
can later suffer from symptoms of depression, whereas
Ferketich and Mercer (23) did not observe this type of
negative influence. The latter authors found unexpected
results when investigating the men’s health status from
pregnancy through postpartum; that is, less positive feel-
ings about labor and delivery were associated with a
better perception of their own health status. The authors
accounted for this unexpected direction of the findings
in terms of degree of identification with their partners.
Specifically, men who experienced this identification
process also tended to consider their own health prob-
lems less relevant. This account underscores the complex
link between intrapsychic processes and the relational
aspects associated with the birth of a child.
After birth, new fathers faced the difficult task of
putting their own fatherhood image (about which they
had fantasized during the pregnancy period) into prac-
tice (31,32,34,36). Fathers who managed to construct a
positive, relatively conflict-free father self-image expe-
rienced a motivational force for greater involvement
with their infants (32). If their self-image, however, still
involved many conflicting elements, they found it dif-
ficult to deal with the demands of their new role and
easily experienced feelings of exclusion (29,32). In fact,
after birth their partners and babies received most of the
attention from the social surroundings (25).
Triadic Relationship Development
During the first months of their partners’ pregnancy,
men can have trouble imagining what a relation-
ship with a child will be like and can struggle to
psychologically acknowledge the baby’s existence in
the absence of noticeable changes in their partner’s
body (25,28,29,37,40). This situation is reflected in their
difficulties in developing an emotional bond with the
baby during this time (25). Women can also experience
a similar sense of unreality in the early days of preg-
nancy, when evidence of new life in the womb is not yet
tangible (53). After the third month, pregnancy is charac-
terized by more evident physical changes in the woman,
and this period is when a solid couple relationship can
facilitate the father-to-be’s access to the physical aspects
of pregnancy (23,29,35,37,54). From this stage onward,
however, the couple relationship begins to be psycholog-
ically overshadowed by the presence of a third develop-
ing human being, and this process gradually transforms
the dual relationship in a triadic one. The importance
of men’s relationships with their partners is even more
evident during the postnatal period. Women, who are
usually their babies’ main caregivers, can directly influ-
ence paternal identity and co-parenting relationships (55)
by facilitating fathers’ access to their babies (29,48).
BIRTH 36:4 December 2009
The general findings of our literature analysis point
to the key role of female partners in helping men con-
struct the triadic relationship and the importance of good
couple attunement before pregnancy as predictors of a
fulfilling sense of fatherhood (48).
The Social Environment
The transition from being merely a partner to being a
father propels men to reorganize their lifestyles (albeit
somewhat reluctantly) (28,40). During the prenatal and
the childbirth periods, the social environment can play
a key support role by meeting the needs of fathers-
to-be, for example, by providing prenatal classes for
fathers (22) and by training medical staff about fathers’
needs during the labor process (28,44). During this
period, moreover, men are frequently active in physi-
cally preparing their environment (e.g., by decorating
the nursery) to welcome the child by creating a suitable
“nest” (28).
The postnatal period is characterized in part by a
man’s integration of his new social status as a father
with consequent social adjustments. During the early part
of this period, men frequently find it difficult to rene-
gotiate the division of labor of household chores (54)
and tend to lament the lack, or impossibility, of obtain-
ing the social support they need, such as work sched-
ule flexibility (25,33,41). Many men find the fact that
they must dedicate less time and focus to their careers
during this period to be highly challenging, and they
worry about the possibility of a consequent decline in
their social status. Indeed, the data demonstrate that not
only men’s work and social activities tend to remain
unchanged during the postnatal period (42,49) but also
their satisfaction as fathers is positively related to suc-
cessful work performance and involvement in social
activities (49). They therefore tend to not change their
habits, and end up providing little support to their new
families in terms of practical help (42,49). The provision
of social support, however, in the form of fatherhood
discussion groups (51) and information on infant devel-
opment (47,52) can be an important factor during this
life phase (51,52) in helping men build good relation-
ships with their children (47).
Discussion
The purpose of this review was to illustrate the psy-
chological reactions that men in Western societies
currently experience when becoming fathers. Our lit-
erature analysis confirmed the earlier documented find-
ings of fathers’ gradual and conflict-ridden shift from
traditional and authoritarian behaviors to more openly
affectionate and warm roles. The recent literature more
315
frequently described men’s willingness to break away
from the paternal role model of previous generations.
Yet, the literature did not examine the degree to which,
or the frequency with which, fathers actually managed
to put this intention into practice.
In contrast with the previously reported data, how-
ever, it now appears that fathers generally perceive that
they are expected to assume the twin responsibilities of
providing economical and emotional support for their
family. Two factors appear to play a crucial role in oblig-
ing men to be active childcare participants. The first is
the current prevalence of families who are geographi-
cally isolated from the rest of their extended families.
The second is the growing percentage of postpartum
women returning to work earlier than had occurred in
previous decades. Our review revealed, however, that
men tend to experience great difficulty in reconciling
their personal needs and expectations with those of their
new families (34,36,41). In fact, men’s work and social
activities tend to remain unchanged during the postnatal
period (42,49), and mothers remain in charge of most
daily childcare duties.
Men’s parental role identity and their partners’ beliefs
about fathering are apparently the two main factors that
contribute to variability in the transition to fatherhood.
In fact, a man’s experience as a father has been shown to
be the result of his own personal characteristics interwo-
ven with the quality of the relationship he has with his
partner, which in turn, is the result of a complex con-
stellation of personal endowment, such as personality,
knowledge, ability, attitudes, and cultural factors (38).
Distinctive psychological processes can be observed in
the three time frames examined in this transitional phase.
The prenatal period consists of a phase of psychologi-
cal reorganization based on the emergence of fatherhood
status. This process requires gradual integration of part-
ner and father roles. The few studies that have investi-
gated fatherhood during the labor and birth phases define
them as being the most intense emotional events during
the transition to fatherhood. These studies also describe
labor and birth as involving highly mixed feelings for
fathers, which range from helplessness and anxiety to
pleasure and pride. During the postnatal period, men
find themselves struggling to balance personal and work
needs with the new demands of father status and their
new self-image. An element emerging as being common
to all three periods is the importance of the quality of a
man’s relationship with his partner.
The complexities of the transitional process involved
in forging a fatherhood identity can be viewed as the
result of transformations occurring simultaneously at
three different levels: readjustment to a new self-image,
formation of a triadic family relationship, and adaptation
to a new position in the social context.
316
This topic has not received homogeneous focus in
all Western societies. For instance, most studies on this
topic have been conducted by American and Australian
researchers (Table 1), who may be more aware of its
importance than those from other countries. We were
nonetheless unable to identify common patterns of data
interpretations due to cultural differences. Given the
great variability in the study design, the findings reported
here cannot be considered conclusive.
Future research should focus on disentangling the
influence of single psychological (e.g., father personality
characteristics, quality of interaction), social (e.g., eco-
nomic level, family composition, living circumstances),
and cultural variables on the transition to fatherhood.
Rigorous investigation on the topic of new fatherhood
should therefore avoid examining isolated variables, but
should take all components of this complex process into
account.
Implications for Clinical Practice
The literature acknowledges the importance of active
paternal involvement (6–8) on child development. These
findings can be of great value for gynecologists, pedia-
tricians, obstetricians, midwives, and nurses working in
neonatal care by suggesting ways to reach out to, and
assist, fathers-to-be. Medical and nursing staff working
in collaboration with psychologists and sociologists can
play a key role in supporting men’s transition to father-
hood by keeping fathers informed about birth and post-
partum routines, infant medical conditions, and infant
development. They can also contribute by creating “par-
ticipative space” for new fathers during both the preg-
nancy and the postpartum periods. This activity can be
achieved, for example, by helping fathers take on their
new role by supporting and promoting their degree of
involvement in the process. They can also be encour-
aged to actively participate in caring for, and maintaining
contact with, their babies. More broadly, fathers should
also have access to services provided to mothers; gender-
specific services for motherhood and those for father-
hood should also be provided.
Conclusions
Although the topic of transition to fatherhood has
received little empirical attention, our findings from the
literature search only partially supported the originally
hypothesized direction of this role change. A much more
pressing topic appears to be that of men’s struggle in
reconciling their personal and work-related needs with
those of their new families. Men frequently withdraw
from this conflicting situation into their traditional role
BIRTH 36:4 December 2009
and do not attempt to change their habits; therefore, they
end up providing little support to their new families in
terms of practical help.
The characteristics of this transition differed for each
of the three time frames examined. Pregnancy is seen
as the most demanding period in terms of psycho-
logical reorganization of self. Labor and birth are the
most highly emotional moments. The postnatal period
is the most interpersonally and intrapersonally challeng-
ing time, in which fathers must “juggle” their newly
assumed father role and their families’ relational and
emotional demands with persisting societal and econom-
ical pressures.
Acknowledgments
We thank Melinda Tucker for her careful correction of
the English text.
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