Eddy Dissertation 2018

Husband Involvement during Pregnancy: A grounded theory
by
Brandon P. Eddy, M.S.
A Dissertation
In
Couple, Marriage, and Family Therapy
Submitted to the Graduate Faculty

of Texas Tech University in
Partial Fulfillment of
the Requirements for
the Degree of
DOCTOR OF PHILOSOPHY
Approved
Stephen Fife, Ph.D.

Chair of Committee
Jason Whiting, Ph.D.
Nicole Piland Springer Ph.D.
Jaclyn Cravens, Ph.D.
Mark Sheridan
Dean of the Graduate School
August, 2018
© 2018, Brandon. P. Eddy
Texas Tech University, Brandon P. Eddy, August 2018
ACKNOWLEDGMENTS
First, I wish to acknowledge my dissertation committee. To my chair, Steve,
thank you for your countless hours of guidance, support, and particularly, your
patience. To my committee members Jaclyn, Jason, and Nicole, thank you for your
mentorship and for pushing me to go further than I thought possible. Additionally I
wish to give a special thanks to my research team at UNLV: Christa Clayton, Raven
Cloud, Jessica Laam, and Lisa Toms. The four of you attended interviews,
participated in transcription, aided me in coding, and were a fantastic research team
from start to finish. Thank you.
Next I wish to acknowledge family members who have provided me support.
To my mother, who has always been my biggest fan. Behind every young child who
believes in himself is a parent who believed first. Thank you for always believing in
me. To my Grandfather, thank you for always stressing the importance of obtaining
an education. My entire academic journey started with your persistent encouragement.
Last, I wish to thank my wife, Lisa, and my children, Ryker, Hannah, and
Mason. In order to be successful in my schooling, I have had to be gone from home
quite a bit over the last 5 years. Lisa, I cannot fathom having a more loving and
supportive partner than you. This success would mean nothing without you and our
children. Thank you for supporting my dreams. It is now my turn to support you in
your dreams.
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TABLE OF CONTENTS
ACKNOWLEDGMENTS ...................................................................................... ii
ABSTRACT .............................................................................................................. v
LIST OF TABLES .................................................................................................. vi
CHAPTER I: INTRODUCTION .......................................................................... 1

Importance of the Study ................................................................................ 1
Theoretical Framework of the Study............................................................. 4
Purpose of the Dissertation ........................................................................... 4
Inquirer’s Stake ............................................................................................. 5
Introduction Summary .................................................................................. 6
CHAPTER II: LITERATURE REVIEW............................................................. 7

Family Life Cycle ......................................................................................... 7
Family Systems Theory ................................................................................ 8
Couple Relationship during Pregnancy......................................................... 9
Relational Challenges during pregnancy ...................................................... 9
Healthy Couple Relationships during Pregnancy ......................................... 13
Relationship Challenges Postpartum ............................................................ 18
Healthy Couple Relationship Postpartum ..................................................... 20
Justification for the Study ............................................................................. 25
Research Questions ....................................................................................... 26
CHAPTER III: METHODS ................................................................................... 28

Design ........................................................................................................... 28
Participants .................................................................................................... 29
Recruitment. .................................................................................................. 32
Procedures ..................................................................................................... 33
Measures. ...................................................................................................... 34
Data Collection.............................................................................................. 35
Data Analysis ................................................................................................ 36
Researcher Reflexivity and Trustworthiness ................................................ 39
CHAPTER IV: RESULTS ..................................................................................... 42

Description of the Grounded Theory ............................................................ 42
Part 1: Husband Involvement during Pregnancy .......................................... 44
Behavior 1: Helping with a Positive Attitude ............................................... 44
Behavior 2: Engaging in Daily Tasks ........................................................... 49
Behavior 3: Understanding and Empathetic Response ................................. 51
Behavior 4: Providing Intuitive Assistance................................................... 57
Behavior 5: Being Emotionally Available .................................................... 62
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Behavior 6: Responding in Significant Moments ......................................... 70

Behavior 7: Providing Continued Support .................................................... 76
Part 2: Srong Couple Relationship Postpartum............................................. 78
Inconsistent/Inattentive Husband Involvement ............................................. 85
Summary of Findings .................................................................................... 87
CHAPTER V: DISCUSSION ................................................................................ 89
Summary of Grouned Theory ....................................................................... 89
Connecting the Current Theory to Previous Research .................................. 91
Clinical Implications ..................................................................................... 97
Implications for Future Research .................................................................. 103
Limitations .................................................................................................... 105
Summary ....................................................................................................... 106
REFERENCES ........................................................................................................ 108

APPENDICES ......................................................................................................... 118
A. LETTER OF IRB APPROVAL ........................................................................ 118
B. INFORMED CONSENT ................................................................................... 120
C. GROUNDED THEORY INTERVIEW GUIDES ........................................... 122
D. DEMOGRAPHIC QUESTIONNAIRE............................................................ 125
E. RECRUITMENT FLYER ................................................................................. 127
F. SAMPLE MEMOS ............................................................................................. 128
iv
ABSTRACT
The transition to parenthood is among the most difficult challenges couples will face
in their relationship. As couples make this transition they develop new roles, which
can be confusing to define and often creates tension. Relational difficulties during
pregnancy often impact the couple relationship postpartum. Although many couples
experience this life cycle change, there is relatively little literature on how couples
navigate the transition. Hence, the purpose of this grounded theory qualitative study
was to build a theory describing how husband involvement during pregnancy impacts
the couple relationship postpartum. The overarching research question was how does
husband involvement during pregnancy impact the couple relationship postpartum?
11 couples were interviewed regarding husband involvement during the couple’s most
recent pregnancy. The findings of the study indicate that proactive husband
involvement during pregnancy helps to strengthen the couple relationship postpartum.
Proactive husband involvement consists of 7 behaviors: helping with a positive
attitude, engaging in daily tasks, understanding and empathetic response, providing
intuitive assistant, being emotionally available, and continued support. Husbands who
engaged in proactive husband involvement found the couple relationship strengthened
postpartum. Husbands who did not engage in proactive involvement did not see their
relationship strengthened.
Keywords: Proactive Husband Involvement, Pregnancy, Transition to Parenthood,
Family Life Cycle
v
LIST OF TABLES
2.1. Individual Characteristics Demographics Table .............................................. 31

2.2. Couple Characteristics Demographics Table ................................................... 32
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CHAPTER I
INTRODUCTION
Importance of the Study
The transition to parenthood presents a significant life change for couples and is a
time that couples will face many difficulties (Kluwer & Johnson, 2007). Couples making
this transition experience changes in their relationship and in the structure of their family
(Cox, Paley, Payne, & Burchinal, 1999; Minuchin & Fishman, 1981). Many couples
experience joy and happiness during this transition; however, couples also experience
increased stress, decreased intimacy, increased anxiety, and the development of new roles
within the family system (Fillo, Simpson, Rholes, & Kohn, 2015; Cowan & Cowan,
2000). Additionally, couples typically see a decrease in marital satisfaction during the
transition to parenthood, even among couples who have high marital satisfaction
(Lawrence, Rothman, Cobb, Rothman, & Bradbury, 2008; Belsky & Pensky, 1988;
Belsky, Lang, & Rovine, 1985).
Family researchers have discovered that many couples lack the knowledge about
how to effectively navigate the transition to parenthood, leaving many parents feeling
unprepared to make the change (Deave, Johnson, & Ingram, 2008). Furthermore, many
fathers report feeling unsure about how to provide support to their spouse during
pregnancy (Deave et al., 2008). Among the protective factors for couples making the
transition to pregnancy is prenatal planning and a stable relationship before pregnancy.
Couples who engage in prenatal planning and have higher marital satisfaction during
1
pregnancy have been found to have healthier relationships postpartum (Lawrence,
Rothman, Cobb, Rothman, & Bradbury, 2008). Additionally, women are more likely to
receive prenatal care and less likely to smoke while pregnant when their partner is
involved in pregnancy (Martin, McNamara, Milot, Halle, & Hair, 2007), providing
evidence that husband involvement during pregnancy can promote better health outcomes
for families.
Studies have shown a positive relationship between marital quality and secure
attachment, suggesting that secure attachment with one’s spouse generally leads to higher
levels of marital satisfaction (Banse, 2004). With knowledge that higher marital
satisfaction during pregnancy generally leads to a decrease in marital difficulties after
pregnancy, and knowing that secure attachment is positively associated with marital
satisfaction, it could prove beneficial to examine how husband involvement during
pregnancy positively or negatively impacts the couple relationship.
Although there is evidence that paternal involvement during pregnancy is
beneficial to maternal health, there is no research that investigates the process through
which husband involvement during pregnancy can help strengthen couple relationships
following the birth of a child. The purpose of this study was to investigate how husband
involvement during pregnancy contributes to stronger couple relationship postpartum.
This qualitative study addressed a critical gap in the research literature on how couples
can strengthen their relationship during pregnancy, as well as after the birth of a child.
There is a wealth of information on how pregnancy negatively impacts the couple
2
relationship, but little research on how partner involvement affects the couple relationship
and how relationships can be strengthened during this period. The aim of this study was
to build a theory of how husband involvement during pregnancy affects couple
relationship postpartum. To date, no theory exists detailing how husband involvement
during pregnancy influences the couple relationship postpartum or what constitutes good
husband involvement. Building a theory about how husband involvement during
pregnancy affects the couple relationship provides clinicians, physicians, researchers, and
couples with information on how husbands can meaningfully contribute to their wives’
pregnancies in ways that strengthens couple relationships. It is also plausible that a
stronger couple relationship during pregnancy may be a potential protective factor for
maternal health problems during the postpartum time period.
The present study provides information that can be utilized by couples to reduce
pregnancy related stressors during the transition to parenthood. Furthermore, the
information obtained from this study provides knowledge about factors that enable
husbands to participate in their wives’ pregnancies in a way that is meaningful to their
relationship. This study also provides wives with information about how they can
encourage husbands to actively participate during pregnancy and how to help husbands
understand the importance and necessity of paternal involvement during pregnancy.
Lastly, the results of the study are beneficial to professionals who work with couples
through pregnancy and postpartum.
3
Theoretical Framework of the Study
This grounded theory dissertation uses the family life cycle (Duvall, 1977) as a
theoretical framework for the study. The family life cycle is an informative theory that
describes different phases of life that families experience and explains challenges
associated with each stage of life (Duvall, 1988). The theory developed in this
dissertation is a micro-theory about one specific stage in the family life cycle, the
transition to parenthood. The transition to parenthood is just one of many stages within
the family life cycle. Pregnancy is an extremely stressful time for couples making the
transition to parenthood and has many moments of emotional vulnerability in the couple
relationship. Partner involvement, availability, and responsiveness during pregnancy can
greatly impact the couple relationship. The overarching research question for this study
was: How does husband involvement during pregnancy impact the couple relationship
postpartum? Other questions include: What does positive husband involvement look like,
what factors constitute good husband involvement, and what are obstacles to husband
involvement? By answering these questions I was able to develop a theory of how
couples effectively navigate the transition to parenthood through proactive husband
involvement during pregnancy and continued involvement postpartum.
Purpose of the Dissertation
The purpose of this dissertation was to build a theory detailing how husband
involvement during pregnancy can strengthen the couple relationship postpartum. Given
that paternal involvement is associated with better outcomes for families, it is of benefit
4
to researchers, clinicians, and families to know specific actions husbands can take in
order to meaningfully contribute during pregnancy and to understand what factors
contribute to proactive husband involvement. Many husbands want to be involved during
pregnancy, but are unsure of how they can be helpful (Deave et al., 2008). The results of
this study offer new insight into how husband involvement influences perceptions of the
couple relationship. Furthermore, the implications of the results bring to light the
importance and necessity of healthcare providers actively involving husbands in all
aspects of maternal care.
Inquirer’s Stake
I feel extremely passionate about my dissertation topic. As a therapist and a
father, I know the importance of having a strong marital relationship. I also know how
stressful pregnancy can be on the couple relationship. During each of my wife’s
pregnancies we had the opportunity to strengthen our bond as a couple, which enhanced
our relationship going forward. I believe that my involvement during pregnancy made a
difference in strengthening our relationship. To me, involvement means more than
physical support; it involves attending doctor appointments, nesting, emotional support,
and being involved in all aspects of pregnancy. I also know that many fathers feel
passionately about being a good husband and a good father and want to be involved in
their children’s lives from the beginning, but are not sure how to do so. Fathers are
underserved in research in regards to the transition to parenthood, and I hope that my
dissertation changes that.
5
Introduction Summary
Although a wealth of information exists regarding the mother and infant
relationship during pregnancy, little information exists on the couple relationship during
pregnancy in regards to husband involvement and how the couple relationship can be
strengthened. This dissertation produced a theory of how husband involvement during
pregnancy effects the couple bond after pregnancy. Implications for couples, researchers,
and clinicians will highlight the importance of husband involvement for both the couple
relationship and for the health of the family.
6
CHAPTER II
LITERATURE REVIEW
Family Life Cycle
The family life cycle outlines specific stages of development that families
transition through as they grow and develop (Duvall, 1977). According to Duvall, (1977)
families transition through eight stages of development: married couples, childbearing
families, families with preschool children, families with school children, families with
teenagers, families launching young adults, middle-aged parents, and aging family
members. Although not all families experience these stages, the family life cycle is useful
because it identifies stages of life that families commonly encounter and describes
challenges that families may experience during each specific stage (Bengtson, & Allen,
2009). Family scientists can then research each stage of development and provide
clinicians, educators, and families with helpful information about navigating each stage
of the family life cycle. For example, the family life cycle has been used to explain how
families must alter rules and boundaries to accommodate to their children’s growing need
for increased independence as they transition into their adolescent years (Steinberg &
Silverberg, 1987). Families who fail to adjust to the different stages in the life cycle are
at risk for lower marital satisfaction and overall decreased family functioning (Minuchin,
1974).
Researchers working in the field of family studies have made numerous
alterations to Duvall’s original model. Although Duvall’s original concept of the family
7
life cycle is widely accepted and valued, certain researchers felt that the stages were not
comprehensive enough to encompass each familial transition. Carter and McGoldrick
(1988) made modifications, specifically adding the stages of young adults leaving home
and the joining of families through marriage. These additions have inspired researchers to
investigate the stage of emerging adulthood, dating, and how couples can effectively
navigate the transition to marriage. Glick (1989), also critiqued the family life cycle,
highlighting the lack of attention to divorce, remarriage, and single parenting within the
family life cycle. Despite multiple critiques and revisions of the family life cycle, the
theory remains useful in recognizing that families experience many changes and often
need help in how to effectively navigate these changes.
Family Systems Theory
One theoretical framework that helps illustrate how family life cycle transitions
impact the entire family unit is family systems theory. According to family systems
theory, families are made up of individuals that are best understood in the context of the
family (Bowen, 1974). Each individual in the family has relationships with one another,
which impact how they interact with other family members and how they interact with
society. If one family member is struggling, it can impact the entire family, both
individually and collectively.
Each family contains subsystems, such as the martial subsystem or sibling
subsystem, which recursively impact each other (Cox & Paley, 2003). In other words,
families are made up of interconnected individuals who can mutually influence one
8
another. The efforts or involvement of one person can have an impact on the spousal
subsystem and on other subsystems within the family. For example, a husband’s
involvement during pregnancy will have an impact on his partner, potentially effecting
her individual well-being, the quality of their relationship postpartum, as well as each of
their involvement with their newborn child. Family systems theory can help researchers
make sense of the importance of husband involvement during pregnancy and why it is
necessary to study in more detail.
Couple Relationship during Pregnancy
Parenthood introduces a major life cycle change for couples and is one of the
most common inducers of crisis for young families (Walsh, 2015). The transition to
parenthood has an impact on marital quality, with marital quality seeing a modest
decrease during the first six months postpartum (Walsh, 2015; Twenge, Campbell, &
Foster, 2003; Belsky, Lang, & Rovine, 1985). This is especially significant for wives who
report low social support during pregnancy. Women reporting low levels of support from
their husbands during pregnancy also report more symptoms of emotional distress, which
increases the risk of adverse outcomes for women and newborns (Glazier et al., 2004).
These studies underscore the importance of paternal support during pregnancy.
Relational Challenges during Pregnancy
Challenges for men. Recent studies indicate that men are impacted by the
transition to parenthood more so during pregnancy than postpartum, with men reporting
an increase in stress and a decrease in sexual functioning. Furthermore, research shows
9
that many men underestimate the impact that fatherhood will have on their life, both
personally, and relationally (Condon, Boyce, & Corkindale, 2004).
Many men feel unsure about how to positively contribute during pregnancy. This
could come from the fact that gender still plays an important role on how society views
pregnancy (Carter, 2002). It was not many years ago that men were not allowed in the
delivery room, and many cultures still see it as unnatural for a man to be present during
childbirth. In Western culture, the role of fathers has changed from simply being a
breadwinner to being a partner that is involved in all aspects of his children’s life. With
numerous cultural beliefs and attitudes about gender roles in Western society, it is
understandable why fathers and mothers alike may find it difficult to determine what a
husband’s role is during pregnancy.
Overall, the current research provides little information about challenges husband
face during pregnancy. Understandably, most of the research related to pregnancy and
the transition to parenthood focuses on mothers. Additionally, there is also little research
on how husbands can provide emotional or relational support to their spouse or
strengthen their relationship during this time period, as most of the research focuses on
the physical support husbands can provide.
Challenges for women. Pregnancy is often an extremely challenging time for
mothers. Many women suffer from morning sickness, predominantly during the first 3
months of pregnancy, and are at an increased risk for anemia, urinary tract infections,
difficulty sleeping, mental health conditions such as depression or anxiety, hypertension,
10
obesity and weight gain, as well as a chance of developing gestational diabetes (CDC,
2016). Women also experience relational difficulties during pregnancy. Although both
partners may see a decrease in marital satisfaction during pregnancy, some research
suggests that women’s marital satisfaction sees a more severe decrease then men’s
marital satisfaction (Hackel & Ruble, 1992). Furthermore, women are more likely than
men to suffer from depression during pregnancy (Simpson, Rholes, Campbell, Tran, &
Wilson, 2003), which puts them at increased risk for postnatal depression.
Challenges for the couple. There are many challenges and adjustments that must
be made when a couple transitions to parenthood. For many this transition results in new
roles for both husbands and wives (Minuchin & Fishman, 1981). The transition to
parenthood also presents the challenge of accepting new members into the family system,
making adjustments to the marital subsystem, realignment of relationships with extended
family, learning to co-parent, financial considerations, and negotiation of household
duties (Carter & McGoldrick, 1988).
During pregnancy, couples typically experience a decrease in overall marital
satisfaction, participate in fewer recreational activities, and have less positive interactions
with one another, while experiencing an increase in conflict (Belsky & Pensky, 1988).
This increase in conflict is especially problematic as couples have been shown to exhibit
worse problem-solving skills during pregnancy (Cox, Paley, Burchinal, & Payne, 1999).
Couples may fall into a pattern in which decreased relationship satisfaction and increased
conflict reciprocally influence each other in a downward spiral fashion.
11
Among the most difficult challenges expectant couples face is the task of learning
how to effectively co-parent. It was long believed that co-parenting did not begin until
the new child was born; however, it is now theorized that co-parenting begins during the
prenatal stage and not after the birth of the new child (Darwiche, Fivaz-Depeursinge, &
Corboz-Warnery, 2016). Feinberg (2003), proposed four crucial aspects of co-parenting;
1) agreement or disagreement on childrearing issues, 2) division of child-related
caretaking, 3) co-parenting support versus co-parenting undermining, and 4) joint
management of familial interactions. It was determined that these four components can
accurately determine the quality of the co-parenting relationship (Feinberg, 2003).
Furthermore, co-parenting has been found to be either a source of support or a source of
tension and stress in couple relationships (McDaniel, Teti, & Feinberg, 2017).
Additionally, co-parenting is heavily influenced by the current relationship quality of the
couple (Van Egeren, 2004). In fact, research has shown that there is a link between
prenatal co-parenting behaviors and co-parenting behaviors one year after the birth of the
child. (Altenburger, Schoppe-Sullivan, Lang, Bower, & Kamp Dush, 2014). The same
study found that high quality co-parenting prenatally led to increased co-parent support
and a decrease of undermining co-parenting behaviors 9 months after the birth of the new
child. Finally, mothers who perceive their spouse as supportive during pregnancy and
supportive in co-parenting consistently have higher scores of relationship quality
(Durtschi, Soloski, & Kimmes, 2017). This is especially important for first time parents
(Feinberg, 2002).
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In summary, co-parenting during pregnancy is highly influenced by the couple
relationship, sets the standard for future co-parenting behaviors, and can influence the
quality of the couple relationship in a reciprocal manner. Varga et al. (2014) suggested
that pregnancy might be the ideal time to intervene in order to increase paternal
involvement and co-parenting behaviors, thus highlighting the potential importance of the
proposed study.
Healthy Couple Relationship during Pregnancy
Although there are a myriad of challenges and risks associated with the couple
relationship during pregnancy, there are also protective factors that give couples greater
chances for a healthy relationship during pregnancy and thereafter. For example,
planning for pregnancy and higher marital satisfaction during pre-pregnancy was found
to be a protective factor for marriages postpartum (Lawrence, Rothman, Cobb, Rothman,
& Bradbury, 2008). Other protective factors include paternal involvement, partner
support, and a secure couple attachment.
Paternal involvement. Paternal involvement has been empirically linked to
developmental outcomes across a child’s lifespan (Glazier et al., 2004). Although
involvement exists on a continuum and can be defined in a myriad of ways, research
continues to explore developmental, emotional, behavioral, and academic outcomes
across developmental periods. Research suggests that the quality of paternal involvement
during pregnancy is related to a number of maternal and infant health outcomes
postpartum. Previous research has shown that low levels of support from husbands during
13
pregnancy have a negative emotional impact on the emotional well-being of mothers,
which is associated with increased risk for negative mother and child outcomes
postpartum (Glazier et al., 2004). Furthermore, paternal involvement is negatively
related to low birth weight, preterm births, and infants who are small relative to their
gestational age (Alio, Salihu, Korosky, Richman, & Marty, 2009).
Paternal involvement also has the potential to provide positive outcomes for the
new child. Despite the fact that men do not physically give birth to their children, they
can still develop a relationship with their child early on. Many parents describe their
relationship with their unborn child as an intimate experience and often attempt to
communicate vocally with their baby due to the fact that fetuses can recognize voices and
can move in reaction to parental voices (Stainton, 1985). The father-infant relationship
begins and evolves prior to the birth of the child, as fathers develop prenatal and postnatal
representations of their child (Vreeswijk, Maas, Rijk, Braeken, & van Bakel, 2014). This
prenatal representation may very well be a factor in attachment between fathers and their
infants.
Alio and colleagues (2009) examined paternal involvement and pregnancy
outcomes, and discovered paternal involvement was related to higher rates of prenatal
care utilization, reduced rates of children born at a low weight, and lower levels of
smoking and alcohol consumption during pregnancy. The results of the study
overwhelmingly pointed to paternal involvement being associated with better
consequences for both mothers and children.
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Overall, there is significantly less literature that exists in regards to pregnancy and
fathers, compared to that which focuses on mothers. The studies on father involvement
tend to focus on the impact this has on the health and well-being of the mother and the
newborn, rather than the parents’ relationship. Additionally, much of the research on
fathers and pregnancy and infants is outdated, with fathers becoming an underrepresented
population in terms of the transition to parenthood. Further research is needed on the
impact of paternal involvement of the transition to parenthood and the quality of the
couple relationship postpartum.
Partner support. While there is not a vast amount of research about husband
involvement during pregnancy, what is known is that husband involvement is beneficial.
The support one receives from his or her spouse can range from highly involved to highly
disengaged. In terms of pregnancy and paternal involvement, spousal support has shown
to be an important factor related to the mother’s well-being. Women who perceive their
husband as being less supportive during pregnancy are at a much greater risk for
depression during and after pregnancy (Simpson, Rholes, Campbell, Tran, & Wilson,
2003). This finding was especially true for wives who felt insecure in their current
relationship.
One specific way that men often try to support their partner during pregnancy is
by attending antenatal birthing classes. Birthing classes are an effective way of providing
support during pregnancy, however many men are unable to attend these classes due to
conflicting schedules or not being able to take the time off work (Deave & Johnson,
15
2008). The vast majority of research that does exist on husband involvement during
pregnancy focuses mostly on physical support such as transportation to doctor visits and
the hospital, rubbing the wife’s back or feet, and being asked to call the physician during
complications (Carter, 2002). Despite the desire many men have to be involved during
pregnancy, research has found that men find the healthcare system unwelcoming,
intimidating, and unsupportive in terms of learning how to provide support for their
wives’ maternal health (Kaye et al., 2014).
Couple attachment. Couple attachment also plays a role in healthy couple
relationships. Attachment theory has its origins in ethology, information processing,
developmental psychology, cybernetics, and psychoanalysis (Bretherton, 1992).
Attachment theory attempts to explain how infants bond with their primary caregivers
(often mothers), postulating that the strength of the bond between caregiver and infant is
related to the quality and consistency of caregiver responsiveness to the infants’ physical,
emotional, and cognitive needs (Bowlby, 1988). Ainsworth et al. (1978) proposed that
children whose needs are consistently met are more likely to develop a secure pattern of
attachment, while children who experience inconsistent or inadequate caregiving are at
risk for developing insecure attachment patterns.
It is theorized that attachment types developed in childhood carry on into
adulthood and influence the quality of relationships people develop. Adults with secure
attachment usually experience little difficulty becoming close to people and have
relationships characterized as trusting, committed, and higher in satisfaction than
16
individuals with other attachment types (Simpson, 1990). Secure attachment is associated
with a number of positive individual and relational outcomes. When individuals fail to
have secure attachment, emotional regulation becomes more difficult and the incidence
for psychological problems becomes more pronounced (Stevens, 2014). Insecure
attachment is also related to poor mental health outcomes (Dozier, Stovall-McClough, &
Albus, 2008). It may be that the quality of attachment a couple has may impact the way
that they interact with each other during pregnancy, specifically in crucial moments
where one partner may have need of the other.
There has also been research conducted on attachment theory and pregnancy,
although most of the research relates to mother-infant attachment. While there is not a
wealth of literature on the couple relationship and parent-infant attachment, it is known
that the couple relationship does have a significant impact on parent-infant attachment,
with the couple relationship being a predictor of the quality of care infants’ receive (Petch
& Halford 2008). Caregiver-infant bonding and attachment have shown to be crucial in
organizing the infant’s brain in terms of emotional and cognitive development (Sullivan,
Perry, Sloan, Kleinhaus, & Burtchen, 2011). Attachment researchers have explored many
facets regarding the bond between parents and their babies, including the influence of
previous perinatal loss on the current pregnancy attachment (Armstrong, 2002), the
development of maternal-fetal attachment during pregnancy (Salisbury, Law, LaGasse, &
Lester, 2003), the relationships among maternal-fetal attachment, prenatal depression,
pregnancy health practices (Lindgren, 2001), and levels of oxytocin and maternal-fetal
17
attachment during pregnancy and postpartum (Levine, Zagoory-Sharon, Feldman, &
Weller, 2007).
Maternal-fetal attachment has a significant effect on the kind of healthcare
decisions women make during pregnancy, such as eating healthy and refraining from
alcohol (Salisbury, et al., 2003), and is often impacted by the strength of the mother’s
relationship with her partner (Lindgren, 2001), highlighting the importance of the couple
relationship during pregnancy. Increased oxytocin responses are linked to maternal-fetal
bonding (Levine et al., 2007), and some research exists linking secure maternal
attachment to greater activation of reward regions in the brain when interacting with their
babies postpartum, demonstrating the importance of attending to the attachment security
of caregivers, primarily mothers and fathers (Strathearn, Fonagy, Amico, & Montague,
2009).
Relational Challenges Postpartum
The transition to parenthood signifies a major change in the family system after
the birth of a child, and couples may experience a number of challenges after the birth of
their child (Minuchin, 1974). Most couples experience a decrease in marital quality
during the postpartum time period (Shapiro, Gottman, & Carrere, 2000). Many couples
experience a decrease in marital quality due to increased conflict. Increased conflict
levels are often associated with the postpartum period, especially when conflict was high
during pregnancy (Cowan & Cowan, 2000; Kluwer & Johnson, 2007).
18
There is also numerous physical hardships parents experience after pregnancy.
Many parents suffer from disruptions in sleep patterns and increased levels of fatigue,
particularly during the first few months postpartum, with mothers being subjected to
greater levels of sleep deprivation (Gay, Lee, & Lee, 2004). Couples also experience a
decrease in sexual activity, although positive couple communication during this time
period can help couples to maintain intimacy in their relationship (Ahlborg, Dahlof,
Lillemor, & Hallberg, 2005). Qualitative studies have shown that fathers are prone to
feelings of rejection and isolation during the postpartum period due to the emphasis
placed on providing for the needs of the new child (Ahlborg & Strandmark, 2001). This
isolation and rejection can cause relationship dissatisfaction and lower levels of
communication between couples.
Not only do parents suffer physical challenges after pregnancy, but they can also
experience psychological and emotional challenges, such as the baby blues and
postpartum depression. Approximately 15% of mothers (Gavin et al., 2005) and 5-10% of
fathers (CDC, 2017) experience postpartum depression and suffer from symptoms such
as depressed mood, withdrawal from family and friends, feelings of worthlessness,
shame, guilt, and recurring thoughts of death or suicide (American Psychological
Association [APA], 2016). Postpartum depression is associated with substance abuse
(Tannenbaum & Forehand, 1994), intimate partner violence (Roberts, et al., 2006),
communication problems, and overall lower relationship satisfaction (Davey,
Dziurawiec, & O’Brien-Malone, 2006). Partners who feel low levels of spousal support
19
are especially at risk (Goodman, 2004), suggesting that strengthening the couple
relationship earlier, during pregnancy for example, could help mitigate some of the
negative stressors couple’s suffer postpartum.
Learning to co-parent is another difficult challenge parents face after the birth of a
child. There is also a wealth of literature regarding co-parenting after childbirth.
Supportive co-parenting has been linked with increased infant-father attachment,
particularly in boys (Brown, Schoppe-Sullivan, Mangelsdoft, & Neff, 2010). For toddler-
aged children, supportive co-parenting generally leads to greater emotional and social
adjustment, with findings showing children who have difficult temperaments are
especially impacted by the quality of co-parenting they receive (Altenburger, Lang,
Schoppe-Sullivan, Kamp Dush & Johnson, 2017). The ability to co-parent effectively
impacts mothers and fathers differently. Relationship quality in mothers has been found
to be a predictor of co-parenting, whereas father’s relationship quality and co-parenting
has shown to be a predictor of paternal involvement (Christopher, Umemura, Mann,
Jacobitz, & Hazen, 2015; Varga, Gee, Rivera, & Reyes, 2014). In summary, parents who
are able to effectively navigate the challenge of co-parenting are able to provide many
benefits to their children.
Healthy Couple Relationship Postpartum
Despite the potential challenges couples face postpartum, there are protective
factors that can help couples manage challenges and successfully navigate the transition
20
to parenthood. Specific protective factors include positive paternal involvement, partner
support, and a strong couple attachment.
Paternal involvement. Similar to paternal involvement during pregnancy, the
involvement of fathers after children are born has a positive effect on the infant, and, in
some cases, the mother. For example, paternal involvement has been linked to longer
sleeping periods for children, which related to favorable cognitive, behavioral, and
emotional processing and functioning (Bernier, Tetreault, Belanger, & Carrier, 2017).
Longer sleeping periods are beneficial for parents, especially mothers, who are often
sleep deprived during the postpartum time period. Sleep deprivation often leads to worse
health outcomes and increased chance of postpartum depression for mothers (Chang,
Pien, Duntley, & Macones, 2010). Fathers also provide a communicative environment in
which toddlers can develop early language skills that assist with self-regulation,
emotional regulation, and social skills to promote school-readiness (Bocknek, Brophy-
Herb, Schiffman, & Vogel, 2014; Downer, Campos, McWayne, & Gartner, 2008; Tamis-
LeMonda, Shannon, Cabrera, & Lamb, 2004).
Although paternal involvement is associated with positive outcomes across the
life cycle, the empirical body of literature these associations are based upon are subject to
scrutiny. Often, literature fails to address cultural and contextual factors when findings
are interpreted (Cabrera & Garcia-Coll, 2004). Involvement is often defined as an all-or-
nothing construct, or is interpreted as the mere presence of a father figure, but not
necessarily active interaction (Downer, Campos, McWayne, & Gartner, 2008). Finally,
21
research on paternal involvement in later years should be accepted with caution, as most
positive effects have been demonstrated during early childhood, which is typically a time
when parents have more direct impact and influence on children (Saracho, 2008; Skalotis,
2010). Overall, research indicates that paternal involvement is an important factor in
childhood development and has the potential to positively benefit mothers, however there
is little known regarding the influence of paternal involvement on the couple relationship
postpartum.
Partner support. The majority of research on partner support postpartum
addresses physical and financial means of providing support. The most common area of
physical support provided by fathers is household labor. The transition to parenthood is a
time where the division of labor in the household is often reassessed. As couples make
the transition to parenthood, women typically increase the amount of household labor
they perform, while men see their efforts decrease (Kluwer, Heesink, & Vliert, 2002).
This is true even for couples who are more egalitarian in their roles. Most couples do
believe that the more husbands contribute in household labor, the more fair the
relationship is; however, many couples agree that a husband’s contributions as the
breadwinner supersede a fair division of labor in the household (Kluwer et al., 2002).
One conclusion that may be asserted from this research is that providing financially is
seen as the most important type of support a partner can provide and may be a significant
focus for husbands.
22
Gjerdingen and Chaloner, (1994) suggest the type of birth a woman experiences
may play a role in the level of support she receives afterwards, with findings showing
women who give birth through cesarean sections perceived their husbands as providing
greater support in housework and childcare. The authors suggest that husbands might feel
as if their wife needs more support depending on the means through which the baby is
born. The same study found that women were more satisfied with their husband’s support
when the partner participated in household chores such as cooking, dishes, laundry, house
cleaning or repairs, waste removal, and upkeep of vehicles (Gjerdingen & Chalonger,
1994). Although wives in the aforementioned study most often expounded upon the
physical support they received, the most important factor in women’s relational
satisfaction was husband’s expressions of love and affirmations of support towards his
wife. One question that may be asked is, despite the findings that expressions of love and
affirmations of support are the most important factor of partner support, why is most
research conducted on physical support? There is a gap in the literature regarding
emotional support provided by husbands, a gap that this study may be able to fill.
Couple attachment. The couple relationship can experience drastic changes
associated with childbirth. Parents frequently have less quality time to spend together
following the birth of a child (Moller, Hwang, & Wickberg, 2008), which can impact
couple intimacy. It follows that declines in emotional and physical intimacy are
associated with declines in postpartum relationship satisfaction (Theiss, Estlein, &
Weber, 2013; Lawrence, Rothman, Cobb, Rothman, & Bradbury, 2008).
23
In regards to couple attachment postpartum there is a connection between
experiencing stress and seeking support from one’s partner. When individuals perceive
their partner as more supportive, they feel more valued and secure in their relationship
(Collins & Feeney, 2005). If individuals perceive their partner as available, it can
strengthen their ability to ask for specific help or support in times of need (Mikulincer &
Shaver, 2007). Alternatively, if an individual perceives their partner as unavailable, they
may not seek help or support from their partner. Additionally, individuals who have
suffered rejection may be slower to react to their own partner’s emotional needs (Seedall
& Wampler, 2013). Ultimately, relationship dissatisfaction following childbirth is
associated with an increased likelihood of divorce (Salmela-Aro, Aunola, Saisto,
Halmesmaki, & Nurmi, 2006), highlighting the importance of a strong couple
relationship and close attachment with one’s partner.
The postpartum time period is filled with opportunities to respond to the needs of
one’s partner. Husbands may be asked to help with nighttime feedings, changing diapers,
bathing their new baby, increased household labors, and other methods of supporting
their partner. Insecure attachment and low levels of partner support postpartum have
shown to be linked to higher levels of postpartum depression and stress after the birth of a
child (Conde, Figueiredo, & Bifulco, 2011; Iles, Slade, & Spiby, 2011). Conde et al.
(2011) suggested that future research should focus on areas such as couple attachment,
partner support, and the couple relationship during pregnancy in order to understand the
adjustment of couples who are expecting a baby.
24
How husbands have participated during pregnancy and the availability and
responsiveness they have demonstrated to their spouse may have an impact on the
willingness of wives to seek help from their husbands during the postpartum time period.
Couples who strengthen their bond during pregnancy may have indeed found a recipe for
a stronger, more responsive relationship postpartum. If this is the case, it would be of
paramount importance to discover specific ways that couples can strengthen their
relationship during pregnancy.
Justification for the Study
Much of the literature found about the transition to parenthood suggests that
strengthening the couple relationship during pregnancy would benefit couples during and
after pregnancy (Varga et al., 2014; Feinberg, Kan, & Goslin, 2009). Research shows that
husbands want to provide support to their spouse, but either lack the knowledge of how to
help or feel that the current healthcare system does not actively encourage or welcome
their participation. There is a gap in the literature, with very little research or models
about how husbands can meaningfully contribute during pregnancy and what positive
husband involvement looks like. It was the aim of this study to fill this gap.
To date, no theory exists detailing how husband involvement during pregnancy
influences couple relationships postpartum. Many studies discuss the significant changes
that occur during pregnancy, but they do not address how couples can successfully
navigate these changes or how couples can actually strengthen their relationship during
this difficult time. Furthermore, there is relatively little literature that illuminates the
25
ways in which husband involvement during pregnancy influences the quality of the
couple relationship following childbirth. Thus, the purpose of this study was to build a
theory of how husband involvement during pregnancy affects couple relationships
postpartum.
Building a theory of how husband involvement during pregnancy impacts the
couple relationship postpartum provides researchers and clinicians with knowledge of
how husbands can contribute during their wives pregnancy in ways that strengthen the
couple bond for both partners. If husbands’ participation during pregnancy can strengthen
the couple relationship postpartum, then perhaps couples can use this enhanced bond to
help them overcome other trials, crises, or life cycle transitions they may face throughout
their marriage. It is also possible that increasing couple relationship quality during and
after pregnancy may be a protective factor for maternal health problems such as
postpartum depression, which can have severe risks for couples and also impact the
cognitive and social development of children (Letourneau et al., 2012). It is also possible
that positive husband involvement during pregnancy will lead to greater paternal
involvement throughout the entire life of the child. It may be that fathers undervalue the
benefit that they can provide to their partner and children.
Research Questions
The overarching research question for this study was: how does husband
involvement during pregnancy impact the couple relationship postpartum? Additional sub
questions were 1). How do couples describe or define husband involvement? 2) What
26
factors contribute to positive husband involvement during pregnancy? 3) What factors
contribute to uninvolved husbands during pregnancy? 4) In what ways do these factors
impact the quality of the couple relationship postpartum? And, 5) What actions taken by
husbands during pregnancy are most important in strengthening the couple relationship
postpartum? By answering these questions I was able to provide a guide that can be used
to enhance the couple bond during and after pregnancy, a life cycle transition usually
associated with increased stress and lower relational satisfaction.
27
CHAPTER III
METHODS
Design
Given the primary research question and purpose of the study, I determined that a
grounded theory approach would be the most appropriate qualitative methodology for
this study. Grounded theory is a systematic approach for collecting and analyzing
qualitative data to construct theories from the data themselves (Charmaz, 2014). One of
the purposes of grounded theory is to generate a general explanation or theory of a
process, action, or interaction formed by data from participants (Creswell, 2013). In this
study my objective was to build a theory on how husband involvement during pregnancy
impacts the couple relationship postpartum. In order to build a grounded theory, a
researcher needs more than just a basic understanding of the experience; researchers must
offer in depth descriptions about what is being studied. In this case my task was to
provide a detailed depiction on how husband involvement during pregnancy affects the
couple relationship. The best way to acquire in depth descriptions was to conduct
qualitative interviews, which helped me understand how husband involvement impacted
the couple relationship and why certain aspects of husband involvement are so important.
In all qualitative research, including grounded theory, the researchers are the
instruments through which data is collected and analyzed (Charmaz, 2014; Creswell,
2013). As such, I analyzed participants’ responses to interview questions through a lens
comprised of my background, theoretical orientation as a marriage and family therapist,
28
values, and inherent biases. However, participants also played a role as instruments
themselves, and assisted in the development of the results via triangulation methods such
as participating in follow-up interviews and member-checks to evaluate the emerging
theory’s goodness of fit with their experience.
Participants
Participants in the study were heterosexual, married couples who had a baby in
the previous 2-6 months. Eleven couples were recruited for this study, with each partner
being interviewed separately and together, for a total of 33 interviews. Interviewing
couples separately and together helped in producing a well-rounded ground theory from
multiple points of view. Unmarried, cohabiting couples did not meet inclusion criteria
due to three major concerns. First, adding an additional relationship status variable
(cohabitation) may have made the study too broad. Second, as this study explored the
relationship between paternal involvement and the couple relationship, levels of
commitment to the relationship prior to investigation needed to be comparable. Data from
the National Survey of Families and Households shows that cohabiting couples exhibit
lower commitment to their relationships than married couples (Sassler, Cunningham, &
Lichter, 2009; Nock, 1995). This difference should be explored in future research apart
from the current study. Finally, the findings from this study can potentially be used as a
springboard for future research comparing marital attachment injuries during pregnancy
with later divorce.
29
Couples who had experienced a miscarriage were excluded from the study due to
the fact that experiencing a miscarriage can add increased stress to future pregnancies for
that couple, which can make the couple’s experience of pregnancy very different from
couples who have not experienced a miscarriage. Likewise, couples who had experienced
infertility issues or became pregnant through means such as in-vitro fertilization were
excluded from the study. These couples often have significantly increased stress levels
(McNaughton-Cassill, 2002) and there was potential for greater husband involvement
than couples experiencing pregnancy without infertility difficulties. Finally, couples who
had previously given birth to a child with a developmental disorder were excluded from
the study due to similar reasons as couples who have had a miscarriage or infertility
problems.
There was no inclusion or exclusion criterion for the couple already having
children prior to the study. Men who have already experienced fatherhood may be more
or less involved during pregnancy or more knowledgeable as to how to be involved in a
way that is most beneficial to their partner. The researcher hoped that having first time
parents as well as second, third, or fourth time parents would provide a more rich and in-
depth theory of how husbands can meaningfully contribute during pregnancy and how
husband involvement influences the couple relationship postpartum.
Table 2.1 and Table 2.2 found below provide a brief description of the
participants in the study. Table 2.1 provides a brief description of individual
characteristics of each participant in the study such as age and ethnicity. Table 2.2
30
provides a description of characteristics, which the couple shared such as family income
and number of children.
Table 2.1. Individual Characteristics Demographic Table
Individual Characteristics
Characteristic Sample % N
Age Range(Average)
Husbands 25-36(29.5) 50% -
Wives 24-34(28.3) 50% 22
Race
Caucasian 17 77% -
Hispanic/Latino 4 18% -
Asian 1 5% 22
Religion
Non-Religious 7 32% -
Christian 14 63% -
Jewish 1 5% 22
Education
High School 4 18% -
Associates 4 18% -
Technical 2 9% -
Bachelors 9 41% -
Advanced 3 14% 22
Depression
Yes 4 18% -
No 18 82% 22
31
Table 2.2. Couple Characteristics Demographics Table
Couple Characteristics
Characteristic Sample % N
Household Income
20K or less 3 27% -
20k-50k 0 0% -
50k-75k 5 45% -
75k-100k 1 10% -
100k + 2 18% 11
Children
1 4 36% -
2 2 18% -
3 4 36% -
4+ 1 10% 11
Pregnancy Planned
Yes 8 73% -
No 3 27% 11
Baby Delivered
Vaginally 9 82% -
C-Section 2 18% 11
Recruitment
The participants from this study were recruited through various methods.
Participants were recruited through fliers at local obstetrician and pediatric clinics in Las
Vegas, Nevada, through the University of Nevada Las Vegas, and through social media.
Couples for the study were recruited at 2-6 months postpartum. All participants were
asked about their willingness to participate in follow-up interviews, which could occur
during the theoretical coding portion of the study in order to ensure saturation of data.
Each couple was given a $20 visa gift card for their participation in the study, which they
received upon completion of the interviews.
32
Procedures
Following Institutional Review Board approval (See Appendix A for IRB
approval), purposeful sampling and convenience sampling were used to obtain the sample
for this study. As the population needed for the study was specific (parents who had
recently had a child), healthcare providers were one avenue for gathering participants.
The researcher also visited local obstetricians, pediatricians, and hospitals to obtain
permission to post flyers and advertise the study. The researcher also advertised the study
at the local medical school and nursing program on campus, through graduate and
undergraduate courses at UNLV, and through social media. Snowball sampling and word
of mouth was also used to recruit participants for the study.
Couples who agreed to participate in the study completed a demographic
questionnaire and met all inclusion criteria for the study. After inclusion criteria was met,
participants arranged a time for the researcher to visit their home or contact them via
telephone to conduct interviews with the couple. Seven couples were interviewed via
telephone and four couples were interviewed face-to-face. All face-to-face interviews
were conducted in participants’ home. The lead researcher brought a graduate assistant
to each home interview as requested by the UNLV IRB. Husbands and wives were each
interviewed separately for approximately 20-30 minutes, followed by a couple interview
that lasted for about 20 minutes. Overall, the interviews lasted for about 60-75 minutes.
Couples who were interviewed via telephone were sent the informed consent and
demographics via email and returned the documents signed prior to the beginning of the
33
interviews. Couples who completed the interview via telephone were sent a gift card by
mail following the interview. The researcher contacted each couple within two weeks
after the interview to ensure they received the gift card.
Measures
Participants were asked to complete a brief demographic questionnaire before
beginning the interview process. Each participant was asked his or her gender, age,
ethnicity, religious affiliation, education level, gross family income, how many children
they had, if the pregnancy was planned, by what means the baby was delivered, and if
they had ever been diagnosed with depression. The demographic questionnaire can be
found in Appendix D.
In grounded theory the researcher conducts a semi-structured interview that acts
as the measure. The interview guides for the individual and couple interview can be
found in Appendix C. Questions for husbands included questions such as: can you
describe your overall participation during pregnancy and can you describe moments
where you found it difficult to be involved? Questions for the mothers included: can you
describe your husband’s overall participation during pregnancy and how did your
husband’s involvement during pregnancy influence your current relationship? Questions
for the couple interview included: please discuss your relationship over the course of the
pregnancy and how you feel it may have changed and how did the ways you interacted
with your spouse during pregnancy impact your current relationship?
34
Data Collection
Data was collected through the use of multiple, semi-structured interviews.
Husbands and wives were interviewed separately and then together (Pietkiewicz &
Smith, 2014). Each answered questions regarding the husband's involvement during
pregnancy and how the involvement influenced the quality of their relationship after their
child was born (See Appendix C for he semi-structured interview guides). The
interviewed lasted for approximately 60-90 minutes total with each participant
completing a demographics questionnaire prior to the interview. Each interview was
conducted face-to-face in the participant’s home or via telephone. Participants were
given the option to be interviewed at UNLV’s Center for Individual Couple and Family
Counseling (CICFC) or their own residence as to make sure they were as comfortable as
possible during the interview process. All interviews were audio-recorded, then
transcribed verbatim and coded for analysis. Transcriptions were conducted by the
researcher and by master’s level graduate students.
In grounded theory, interview questions often change or evolve as researchers
conduct theoretical sampling (Charmaz, 2006). Theoretical sampling helps generate a
substantive theory by asking questions that fill in gaps left by initial interviews as well as
expand emergent themes and categories. I began with a predetermined set of semi-
structured questions for early participants and allowed myself to ask follow-up questions
as appropriate. The interview guide was adjusted multiple times as the analysis
35
progressed. Adjusting the interview guide helped me to reach data saturation in all
categories and to create a theory that was grounded in the data.
Data Analysis
Open coding. In grounded theory, data analysis happens recursively and in
several stages, beginning with open coding (Charmaz, 2014). In this stage, the data was
coded word-by-word, line-by-line, and segment-by-segment for actions and processes
related to the research question (Charmaz, 2014). The data was fractured data or broken
up into discreet parts according to the codes assigned (Strauss & Corbin, 1990). Although
not always necessary, word-by-word coding helps researchers to attend to the images and
meanings of each individual word (Charmaz, 2006). This line-by-line and segment-by-
segment coding was used to aid me in recognizing emerging patterns and themes in the
data. Open coding helped refine the data collection process so the interview guide could
be amended before conducting additional interviews and was vital to fill theoretical gaps
left in previous interviews.
Focused coding. In the second stage of analysis, focused coding, I grouped initial
codes according to similar themes, emphasizing actions and processes related to the
primary research question. I also employed constant comparative analysis. Constant
comparative analysis is the process of identifying patterns by comparing one segment of
data with another to determine similarities and differences (Merriam, 2009).
Axial coding. The next step in the coding process was axial coding. Axial coding
is a process of relating categories to subcategories, describing properties and dimensions
36
of categories, and reconstructing the data that was fractured during open coding, in order
to provide a coherent research theory (Strauss, 1987; Strauss & Corbin, 1990, 1998).
Theoretical development. The last stage of analysis was to produce a theory
from the data gathered and analyzed. During this part of the study I put all the coding,
analyzing, and memoing together to form a theory that was grounded in the data. My
overarching research question was how husband involvement during pregnancy impacts
the couple relationship postpartum. Through this study, I sought to create a post-positivist
theory, which seeks to illuminate the key aspects of husband involvement and the
relationship between these and couples’ relationships postpartum. My goal was to
produce a theory that could benefit a diverse range of couples navigating the transition to
parenthood. In this light, I hoped to develop a theory that explicates causes and
explanations and provides some measure of generality and universality (Charmaz, 2014).
Additionally, I desired to provide a theory which healthcare professionals, mental health
professionals, and couples can use when working with couples during pregnancy and
postpartum to increase father involvement, enhance couple relationship quality, and
provide better outcomes for families.
Memo writing. Although memo writing may not be considered as a specific stage
in the analysis process, it is a vital part of grounded theory and the analytic process.
According to Charmaz (2014), memo writing “is the pivotal intermediate step between
data collection and writing drafts” (p. 162). In grounded theory, memo writing is used as
a non-linear, analytic process that helps to move the research through various stages of
37
theoretical development. My early memos described my initial impressions of the data,
helped me explore lingering questions, and guided me in the theoretical sampling
process. I also kept a methodological journal throughout the study, which gave me
specific details for the final “methods and data” section of this study (Charmaz, 2014).
Memoing and keeping a journal provided me with a way of checking my
assumptions, biases, and kept me from drawing premature conclusions during the study.
Other qualitative methods use the concept of bracketing, which involves the researcher
attempting to set aside their own personal experience and examining the phenomenon
with a fresh perspective (Creswell & Poth, 2017). In grounded theory, memoing acts as a
form of bracketing to make sure the theory is grounded in the data and not merely from
the researcher’s own personal experience. Last, I used memos to assist me in the analytic
process of developing focused codes into categories, and categories into a substantive
theory regarding the impact of husband involvement during pregnancy on couple
attachment (Charmaz, 2014; Merriam, 2009).
Theoretical sampling. Like memo writing, theoretical sampling is not
considered a stage of analysis, but a process that is undertaken throughout data collection
and analysis. In theoretical sampling, data was collected until categories were saturated
and fully formed, meaning no new themes were emerging. Through theoretical sampling,
I identified information gaps in the data and sought information to specifically fill the
gaps (Charmaz, 2014). I used several additional forms of data to enhance dependability
and credibility, including interview note-taking, memoing throughout the project, keeping
38
individual research journals, and conducting member checks, as defined below (Merriam,
2009). Theoretical sampling consists of gathering more data focused on specific,
emerging categories in the study. Theoretical sampling can include interviewing certain
participants a second time in order to obtain more information necessary to develop a
theory. Researchers know they have reached data saturation when new categories no
longer emerge from the data (Charmaz, 2014). Theoretical sampling helped me solidify
themes that emerged from the data.
Researcher Reflexivity and Trustworthiness
Researcher reflexivity refers to making any researcher bias transparent (D'Aniello
& Fife, 2017). In the case of this study, reflexivity required me to reflect on and articulate
my biases regarding husband involvement during pregnancy. As a father of three
children who was actively involved in my wife’s pregnancy, I believe that husband
involvement can benefit the couple relationship in numerous ways. I believe that
husbands should be involved in pregnancy and that involvement should encompass more
than just physical support. Based on my own ideas and the research I reviewed, I believe
if husbands are more involved their relationship will benefit as a result. While
undertaking this study I kept track of my biases in order to ensure that the theory
produced was not just a product of my own ideas, but was co-created by my participants
and myself and was grounded in the data that I collected.
In order to ensure trustworthiness in this study, I focused on credibility,
transferability, dependability, and confirmability, as delineated by Anfara et al., (2002).
39
Credibility refers to the thoroughness of data collection and the researcher ensuring that
saturation has been reached. It also is an analysis in which the researcher ensures that
categories and explanations make sense (Patton, 1980). The idea of transferability
focuses on providing a rich, thick description of the phenomenon or engaging in
purposive sampling to ensure that the findings are more generalizable and universal
(Anfara et al., (2002). Dependability is much like the concept of reliability, meaning that
if others were to code the data they would come to the same or very similar conclusions
as the original researcher. Confirmability is similar to being objective about one’s
findings and entails being reflexive as a researcher. It is ensuring that the researcher does
not reach conclusions based on his or her personal experience with the phenomenon.
For this study I used member checks and debriefed often with my dissertation
chair to establish credibility. Transferability was achieved through purposive sampling
and choosing participants based on the needs or objective of the study. I also provided
thick description of the theory. Dependability was achieved through the process of using
a code-recode strategy and through use of a research team, who looked at the data and
emerging findings to provide feedback and direction. A code-recode strategy is when a
researcher initially codes the data, then returns to the data at a later time, usually two
weeks later, to evaluate the findings (Anney, 2014). This ensures that the findings are
consistent over time. My research team consisted of four masters-level marriage and
family therapy students and myself. The research team participated in interviews, helped
make alterations to the interview guide, assisted in each phase of coding, provided
40
feedback, engaged in memo writing, and aided in the development of the grounded
theory. Confirmability was achieved through the process of memo writing and
reflexivity, as I was the primary research instrument in this study (Smith, 2015). Memo
writing helped me acknowledge and bracket out my own experience and brought
awareness of how my own preexisting beliefs might have influenced the decision making
in the research.
41
CHAPTER IV
RESULTS
Description of Grounded Theory
In-depth qualitative analysis resulted in the development of a grounded theory of
husband involvement during pregnancy that depicts the way in which husband
involvement had a positive impact on the couples’ relationships postpartum. The key to
positive husband involvement during pregnancy was proactive husband behaviors. In
this theory behaviors are defined as the way in which one acts or conducts oneself,
especially towards others. In regards to this study that definition can be applied as the
way that husbands act towards their wife.
Figure 1 is a graphic representation of the model of Proactive Husband
Involvement during Pregnancy. Proactive husband behaviors are broken down into seven
unique behaviors, which often interact with and build upon one another. The first
behavior, helping with a positive attitude, provides the foundation for proactive husband
involvement and greatly influences the other six behaviors. As husbands engage in the
first behavior they are able to more easily progress forward and participate in the
subsequent behaviors. Although the proactive husband behaviors will be discussed in a
specific order below, it is important to note that behaviors 2-5 may occur in different
orders over the course of the pregnancy. Husbands who did not sufficiently develop each
behavior had difficulty providing support to their partner and did not seem to benefit
from increased relationship quality postpartum. Husbands who successfully engaged in
42
each behavior provided proactive husband involvement during pregnancy and saw their
relationship strengthened postpartum. The seven behaviors of proactive husband
involvement were identified as: Helping with a Positive Attitude (HPA), Engaging in
Daily Tasks (EDT), Understanding and Empathetic Response (UER), Providing Intuitive
Assistance (PIA), Being Emotionally Available (BEA), Responding during Significant
Moments (RSM), and Providing Continued Support (PCS). As depicted in the model
below, providing continued support is a bridge that connects the behaviors of proactive
husband involvement with a strong couple relationship postpartum, which includes five
specific relationship outcomes: trust, support, maturity, love, and enhanced
communication.
For each behavior in the model, there are obstacles that husbands must navigate
during their efforts to engage in proactive husband involvement. In this model, obstacles
are defined as anything that hinders husbands from being proactively involved during
pregnancy. Navigating these obstacles is necessary in order for the husband involvement
to be most effective and beneficial to the couple relationship. Overcoming obstacles to
husband involvement is not so much one single step in the model, but a continual process
that must be addressed. Certain obstacles are relevant only to specific behaviors in the
model, whereas other obstacles can be found in multiple behaviors. It is also important to
note that husbands overcame obstacles in a variety of ways. There is not one singular
method for overcoming obstacles, as illustrated in the description of the model below.
43
Figure 1. Model of Proactive Husband Involvement
Note: EDT = Engaging in Daily Tasks, UER= Understanding and Empathetic Response,
PIA= Providing Intuitive Assistance, BEA= Being Emotionally Available,
RSM= Responding in Significant Moments, PCS= Providing Continued Support
Part 1: Husband Involvement during Pregnancy
Behavior 1. Helping with a positive Attitude
Helping with a positive attitude was one husband behavior that received great
attention from both husbands and wives within this study. There are many aspects which
define the behavior of helping with a positive attitude. Among those aspects are
willingness, wanting to be involved, not complaining, and completing tasks out of love
and compassion rather than obligation and resentment.
44
Willingness. One of the most important factors of helping with a positive attitude
was husband’s willingness to be involved in whatever task was needed. Regarding a
willingness to help, one wife reported,
He was always willing to help out. He goes to school fulltime and I was working
full-time, so when I came home I would be exhausted and he was exhausted, but
even still after that he would still try really hard. He even missed out on school
and a training he needed to go to because he felt it was more important to be at the
hospital.
Another wife commented on the importance of having a husband who was always
willing to help: “He’d just come home and it’d be about me. It wouldn’t be about him.
Whatever I asked him to do, he would do.” Willingness to help in whatever way possible
was an important factor for many wives.
Wanting to be involved. In addition to willingness to be involved, wives also
commented on the importance of husbands wanting to be involved during pregnancy.
Wives needed to feel like their husband really wanted to be involved. One participant
commented,
I think the single most helpful thing was his mood, his optimism, positivity and
excitedness [sic] for the baby. That made my long days and bad days a little
easier. Him just being so involved and talking about the baby and talking to the
baby, even if I’m having a bad day always made it better.
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Wanting to be involved was not only relevant to everyday tasks, but also included
unique events, such as doctor appointments. In reference to attending doctor
appointments, one wife said, “I didn’t feel like it was always necessary for him to come,
but he still did, like you [husband] wanted to be there.” Having a husband who was
excited and looked forward to participating was a major component of helping with a
positive attitude.
Not complaining. A third component of helping with a positive attitude was not
complaining about participation. There were multiple wives who reported it was helpful
having a husband who did not complain about participation during pregnancy. One wife
reported that it was helpful “knowing that he’ll come home and do whatever I need him
to do, and he won’t get mad at me for it.” Another wife reported, “He never once
complained about anything, ever, and I never had to ask him to do anything. Not a lot of
husbands will do cooking and cleaning and meal planning and shopping and taking the
girls to buy clothes.” Another wife shared her feelings of relief regarding her husband’s
attitude in not complaining or being unhappy about the pregnancy. She stated,
So, when he found out that I was pregnant he was very supportive, even though
he wasn’t necessarily planning on it happening that soon. So that was good, cause
I can’t imagine telling your husband, ‘I’m pregnant’ and they’re like, ‘oh no!’
‘Like, dang it.’ That would be so sad.
Participating out of love. Another facet of helping with a positive attitude was
participating out of love. One husband reported, “You got to know your role and you got
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to do it with love and don’t treat it like a task.” Another father spoke about being
nervous of what was to come, but explained how participating with love helped him,
stating, “Don’t be afraid to just jump in and join the process that is this miracle growing
inside your wife. It's crazy, but it's good.” Another father reported his love of the
experience,
I think just to go into it and don’t miss out. Like enjoy what it is and what life is
and not miss out on it. You can’t always be there for every second of it, but the
big things and those things you can be there for, be there for and enjoy them.
It was clear that participating with love, rather than resentment, helped fathers to
provide support with a positive attitude.
Obstacles to helping with a positive attitude. Although the majority of the
couples reported that husband’s helped with a positive attitude, not all husbands were
able to consistently help with a positive attitude. Husbands and wives spoke of obstacles,
such as lack of sleep, interpersonal struggles, lack of novelty, and other responsibilities
that prevented them from having the attitude they wanted. One husband said, “I know if
she’s lacking sleep she’s going to be more irritable and if I am lacking sleep I’m irritable,
then we’re both just going to have a crappy day.” Another husband reported, “I felt
pretty much like she wanted me there, but she only wanted me there if I wanted to be
there. One time she thought I didn't want to be there, so like, I kind of caused a little
argument.” One husband commented about a few impediments to having a good attitude,
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[Wife] was really sick this pregnancy. She was throwing up a lot and she couldn't
do a whole lot, which kind of frustrated me. I sympathized with her, I really did. It
was really hard because I had so much on my plate too, so many obligations. I
didn't go to every single one of her appointments and I probably should have
made the effort. I wish that maybe I would have gone, but for things that weren't
sonograms, just checkups? I'd already had two children so it lost its novelty.
Wives seemed especially attuned to their husband’s attitude and the impact it had
on their husband’s involvement. One wife stated,
There are times that I just didn't feel it from him either. Like maybe he was
annoyed with me or something. I was feeling, like his desire to be with me, there
are just times that I feel like he pulls away.
Another wife commented on the difficulty of asking her husband for things due to
his attitude,
I think if he comes home and is planning, ‘I’m going to watch the game tonight
and just relax,’ and then I’m like, ‘can you like, do the dishes,’ then he’d be kind
of like, ‘ugh.’ Like ‘cause he had other plans.
Most husbands were able to overcome these obstacles by discussing their
struggles with their wife and by having time to adjust to the new circumstances. Some
even gained a new perspective from knowing that many husbands accomplish similar
tasks. One husband reported, “I’m going to do what every other dumb guy does and
somehow make it happen. If some people can do it, I can definitely do it.” Some fathers
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gained confidence and a better attitude just by knowing it can be done. Overall, the
importance of a positive attitude was felt by both husbands and wives. Displaying a
positive attitude is clearly an important factor for couples and leads to husbands more
effectively participating in the second behavior of proactive husband involvement,
engaging in daily tasks.
Behavior 2. Engaging in daily tasks
Engaging in daily tasks encompasses a variety of different responsibilities and
everyday duties, including, household chores, watching other kids, cooking and cleaning,
and providing other physical support. The most frequently reported tasks were in regards
to helping around the house. One wife reported, “He started working on our basement.
He did a whole bunch of measurements to plan how to build and finish the basement so
that we can build another bedroom for our baby.” Another wife reported,
He did almost everything at home. He did all the grocery shopping and the milk
money and cleaning the house and just making sure that I don’t have to do a lot of
stuff when I came home and making sure the girls are taken care of.
Another wife stated,
Sorry, it’s going to probably bring me to tears. He would just help me around the
house and do stuff for me. He would cook and I think there’s the different love
languages and mine is kind of like acts of service. And so whenever he would,
you know do certain service for me like cooking or cleaning. I think being able to
have him do that for me made me love him so much more.
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Other wives provided examples of helpful daily tasks by their husbands. One wife
commented on how her husband accommodated her need for a cooler temperature in the
house. She said, “He’d be okay with having the AC on a lot more.” Another wife
reported that her husband often helped in taking care of the children,
He helped out more around the house, especially in the morning [with the other
kids]. When I would start falling behind because I would get tired quicker he
would help more with dishes, he would help pick things up and put things away,
and laundry.
Another wife reported “If I’m tired he’ll take the kids, even just in the other room
or something and let me take a nap even though sometimes he’s really tired too.”
Husbands also spoke of engaging in daily tasks, but they often thought of the
support in terms of easing their wife’s burdens and letting them relax. One husband
reported,
The last maybe two months or so I pretty much did everything in the house, like
all the housework. I let her relax and do whatever she needed to be comfortable
up until the baby was born. Anything outside of her work that didn't involve what
she needed to do for work I did basically, to make sure that she's comfortable and
to let her know that I'm still here if she needs anything.
Other husbands reported similar thoughts. One said,
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I did my share of the work around the house, I cooked the meals, I do all the
grocery shopping, I did yard work, I tried to take as much off of [wife] as I could
with the time that I had.
Others spoke of making alterations to their daily lives, “change my schedule, had
to change what I was cooking, change our diets, and what we were doing.” Overall, the
main concern of husbands was doing whatever was necessary to help wives feel relaxed
and comfortable.
Obstacles to engaging in daily tasks. In spite of husbands’ efforts to help ease
their wife’s burdens by helping out, they experienced some obstacles that limited their
ability to help at times. The most common obstacles to engaging in daily tasks were
school and work. One husband reported, “I feel unavailable to her all the time. A lot of
the time, cause I’m at school.” However, this obstacle generally seemed navigable for
most couples. One wife reported “So on his days off he’d help out, like substantially,
he’d help out with anything I needed help with. He would just come home and be really
helpful.” Generally, obstacles to daily tasks were overcome by changes or alterations to
schedules and by being productive in the time that was available to husbands. Engaging
in daily tasks was found to be an important precursor to the next behavior of proactive
husband involvement, understanding and empathetic response.
Behavior 3. Understanding and empathetic response
As husbands engaged in daily tasks centered on helping their wives throughout
pregnancy, they started to gain a better understanding of what their spouse was going
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through. They then used this understanding to respond more empathetically to their wife.
The different aspects that encompass husbands being understanding and empathetic were
understanding hormonal changes can play a large role in behavior, being aware of their
wife’s limitations during pregnancy, and husband’s not taking negative wife behaviors
personally.
Understanding hormonal changes. Husbands and wives were both aware that
wives would experience many different hormonal changes throughout pregnancy and that
the hormonal changes had the possibility to impact behavior. Many husbands knew to
expect the hormonal changes, but they also tried to express empathy about the changes.
One wife mentioned how her husband was understanding of her hormones. She reported,
He was understanding when I would go a little crazy sometimes maybe and he
also wouldn't say ‘Oh, just crazy pregnancy hormones.’ He would actually be
like ‘It's okay.’ He would make sure that I was doing things that I was
comfortable with as well. If we wanted to do something active, making sure it
wasn't something I couldn't do.
Many husbands discussed the importance of making a concerted effort to
understand the changes their wives were experiencing and to act accordingly. One
husband reported,
Expect speed bumps cause there'll be times when the wife's hormones are out of
whack and she's going crazy or she needs something out of this world that you
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don't necessarily know how to give to her, but tell her; explain to her, why you
necessarily can't give it to her or what is stopping you from giving it to her.
Being aware of wife’s limitations. Another aspect of understanding and
empathetic response was husbands’ being aware of their wife’s limitations. One wife
commented,
Um, he kept me in line. I usually like to do things on my own, [laughs] but when
you’re pregnant you’re not supposed to lift and all this other stuff, and he’d
usually keep me in line and kind of help me out when he was home.
Another wife talked about the importance of her husband understanding her and
being empathetic to her in regards to her limitations in performing specific tasks around
the home,
With him being so understanding, I talk to other people that were pregnant or
have been pregnant before, and they just kind of talk about what they’ve been
through. And so just realizing that my husband was like, truly, extremely helpful
compared to a lot of like, my friends from what I’ve heard.
Another wife reported feeling particularly bad about not being able to do more around the
house and said her husband replied with this, “He says, well, you have a baby growing
inside; you’re contributing plenty.”
Don’t take it personally. Part of understanding and empathetic response is the
realization that husbands have to let certain encounters roll off their back and not take
them personally. One father reported,
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Wives will be on an emotional roller coaster for the next 9 months and so if they
want to be close to you then they’ll be close to you. If they want to be distant then
they’ll be distant. But don’t take it personally. I feel like they [husbands] need to
realize that it will get hard and to be aware that there is going to be hardship.
There is going to be really hard times where you might feel a little bit lonely or
whatever, but you need to just push through a little bit and there will be a light at
the end of the tunnel.
Another husband mentioned the importance of knowing there will be arguments during
pregnancy that might be difficult to understand or seem irrational, so it is important to
realize why and not personalize it. He stated,
Understand why she might be reacting that way, so that when it comes time for a
fight or whatever, you can have that in the back of your mind. ‘Oh, she’s mad
because of that.’ It’s not because of what you’re doing or this situation or
whatever, because this situation has happened multiple times before. She’s only
reacted this way this time because of X, Y, & Z.” That way you’re not pinning
any sort of blame or resenting. For me it’s just being conscious of what’s causing
the issue.
Obstacles to understanding and empathetic response. Many husbands were able
to help their wife feel understood and were able to express sympathy for what she was
going through. However, there were instances in which husbands were not able to
understand or express empathy to their partner. There were various obstacles to husbands
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being able to understand or be empathetic. The most prominent obstacles were gender
roles and socialization, education, and a lack of overall communication.
Husbands not being able to understand or wives not feeling understood was often
expressed in terms of gender differences. One wife when commented on the ways her
pregnancy was difficult mentioned
I just think it had a lot to do with me not feeling understood and feeling that alone
feeling. I guess like he doesn't understand what I'm going through with having
work, being pregnant, and having to just my realization of how hard it was going
to be.
Another way that gender impacted ability to understand was in terms of morning
sickness and other physical difficulties associated with pregnancy. For example, one
mother reported,
I think there were some moments when I not only felt like my expectations were
too high for myself because of the sickness, but that his were as well. I think it's
hard for someone to understand what another person is going through when
they're not feeling it themselves. I think that would have been the biggest struggle
is me feeling like ‘oh he doesn't understand what I'm feeling here.’
Another wife spoke about her struggles with trying to give birth vaginally, rather
than by C-section. She was quite stressed about this issue and was frustrated her husband
could not understand the situation. She stated,
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I was really stressed out about the delivery because this was my last chance to
have a vaginal birth. Sometimes I think he didn’t quite get why I was so stressed
out about it. He got really tired of me bringing up the same concern, but it was
still a concern to me so I kept bringing it up. I cried a lot. I was like, ‘this is really
hard and I need you to remember that I’m going through a lot of stuff.’
Husbands also spoke of how gender was an obstacle to adequately understanding
their wife. One husband reported,
Sometimes I couldn’t understand it. So it was like one of those conversations
where it’s like ‘you’re a boy, so you’ll never understand what I’m going through’.
So I kind of felt like ‘you’re right’ I don’t know how to help.
One husband discussed wishing he had received more educational information
from her doctor regarding changes she would be going through, “I feel like the doctor
should involve the husband a little bit more like educating them about what it can it be
like for the wife, so that the husband could be there a little bit more.” Another husband
shared his struggle to understand and communicate with his wife regarding her needs.
He said, “I wanted to help her, but I wouldn't know what to say or what to do. It didn't
seem like anything I could do in my mind would help.”
To a certain extent, the obstacle of gender is difficult to overcome. Because
husbands cannot become pregnant or experience pains and sicknesses associated with
pregnancy, they are limited in true understanding of the experience of pregnancy.
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However, this does not mean this obstacle cannot be overcome. Despite not knowing
exactly what wives’ go through, men can still showed empathy. One father reported,
We don't understand everything going on, what they're feeling, why they're
feeling, but I guess that perseverance, that endurance, to kind of do what you have
to do to support and make them comfortable. We can't go through it for them, we
can't go through pregnancy, we can't go through labor, but we can try to make it a
little less miserable.
Although many husbands failed to completely understand the experience, they
were still capable of showing empathy to their partner and doing whatever they could to
make the experience less painful. Showing empathy and compassion towards one’s
partner does not require a full understanding of the experience. In some cases, it is the
effort that counts, and this is one proactive behavior where effort was vital for navigating
obstacles.
Husbands who strove to understand their wife and show empathy for her seemed
to better progress forward in their support of her. Because these husbands were actively
working to understand their wife and the situation in general, they were often looking for
ways to meet her needs more efficiently. These husbands were able to move from
understanding and empathy to Behavior 4, providing intuitive assistance.
Behavior 4. Providing intuitive assistance
Once husbands had a better understanding of their partner and what they were
experiencing, they were able to provide an enhanced kind of support during pregnancy.
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Husbands learned to recognize and anticipate their wife’s needs or in other words,
provide intuitive assistance. A few of the ways husbands developed intuitive assistance
was through gaining information through classes, the internet, or books, and by
observation of their spouses’ patterns and behaviors. Both husbands and wives spoke of
the helpfulness of intuitive assistance.
One wife described how helpful it was when her husband would provide support
without her asking. She said, “It meant more to me when he would do things when I
didn’t ask him to.” Another wife reported how nice it was to have her husband anticipate
how to meet some of her needs,
One time it wasn't anything super significant, but he took me out to look at the
stars because I wanted to get out. I just wanted to get out of the apartment, but I
was really tired at the same time. I'd say just his thoughtfulness and thinking of
what would make me comfortable.
Another wife commented on the fact that her husband became adept at
recognizing her needs, such as needing extra sleep or requiring more help with household
duties,
So the other two children wake up at 6 and he would usually get up at 6 and let
me sleep for another hour. Then he would also just help with other housework
like he would do a batch of laundry probably every week, but just like little things
when I would start falling behind.
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Another wife commented that her husband paid close attention to her behaviors in
order to anticipate her needs. She explained,
If I started acting off, he’d notice it. He’d catch on to body language even. He
would let me take baths in Epsom salt to kind relax, cause I’d run a lot when I
was pregnant and my hips hurt so I’d always go take baths. He’d do the cleaning
cause I couldn’t really clean the tub as easily with a big belly in the way. He’d
basically just step in. It was like, ‘okay, you’re in pain and you probably just need
to like sit down and relax, so I’ll do the sweeping and the mopping today.’
Although husbands were diligent in their efforts to meet their wives’ needs,
anticipating the needs of your partner can be difficult, as explained by this wife, “The
mom has so many needs and she doesn’t even know she has those needs. So it’s like
extra; you need someone to kind of help you out.” In reference to her husband’s response
to her cravings, one wife responded, “He kept asking ‘do I need to make a store run?’ So
he’d try to keep stuff on hand.” Another wife commented that her husband would “Try to
keep the kids out of the way” when he could tell she was having a rough day. Through
observation, husbands developed the behavior of intuitive assistance.
Husbands also spoke of the need to be ready or to be prepared to support their
wife and prepared themselves in different ways. For example, one said, “I think I just
realized what was needed and what I needed to do and was more apt to do it, so I'd just
do what I needed to do, for her sake more or less than me.” Another husband reported,
“The best way I would think is that I tried to read up on the internet or listen to the doctor
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talk to her. But a lot of it was new for me, obviously.” One husband expounded about
his journey of intuitive assistance by saying,
At first, I didn’t know [how to help]. I would ask what I could do to help. It was
so routine that I’d say that, she’d just say ‘Can you just stop? I don’t know how
you can help, just find out somehow.’ I would then make mental notes of little
things I could tell were bothering her, or little things that would be beneficial to
her or make her life easier or happier or more enjoyable for her. I felt it was all to
do with observation of what she needed the most and then acting on those
observations. Without having to ask, take in everything that they say and go
beyond that. Like she didn’t say she needs this, but I’m sure it would be helpful.
Because a lot of the time she doesn’t know what she wants, and a good husband
would kind of know her and know that this would help.
Another husband shared how he came to recognize her needs,
I kind of learned her patterns. For example when we would go to the doctor,
Chick-fil-A came out with their milkshakes she loved those so I would be like
we’re going up to the doctor and she's probably going to want that.
One husband reflected on his process of developing intuitive assistance, “You're
not going to be perfect because you're using your own senses and not talking, but try to
pick up on subliminal signals and try to address her needs.”
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Other husbands spoke of how they used technology and education to help them
anticipate her needs. One husband said he, “Read some books, read online blogs, lots of
blogs, used that bump app.” Another husband said,
You got to know your wife very well. You’ve got to know what she needs
emotionally. I would say be willing to understand what people need and like.
Find ways to do it without them asking. I mean, it’s so easy now, you know, do
stuff online. You can look up if you have questions, you can get a handle on it.
Wives also noticed the effort that their husbands’ went to in order to obtain
information of what was needed. When speaking of her husband, one wife noticed the
research her husband was doing. She reported, “We did a lot of research. A lot of
YouTube stuff. Lots of googling and shopping together, and husband did a lot of
research. I would say that husband did a lot more research than I did.” Another wife said,
“He took a class at school- developmental psychology- just mostly because he wanted to
learn about babies growing.”
Obstacles to intuitive assistance. As with all the previous behaviors, there were
times where husbands were not able to provide intuitive assistance. Among the most
common obstacles were a lack of observation, disconnect in communication between the
couple, and being distracted while at home. One wife commented about needing to
constantly prompt her husband to provide support for her,
He just didn’t do the extra stuff. He just acted like we always would. I wouldn’t
expect to need that really, cause I like to think I’m pretty independent and stuff,
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but I definitely told [husband] a few times, “I just need you to love me.’ ‘I need
you to love me extra.”
Another wife mentioned the disconnect in communication between her and her
husband. She stated, “I always think that [husband] is supposed to know in my brain
what I want him to do, but I have to tell him.” Another wife mentioned that her husband
didn’t seem to focus on what needed to be done while at home, focusing on the TV or his
phone instead, “Sometimes it was like, ‘are you even paying attention?’ [He’s] looking at
the screen and I’m like, ‘you’re not even looking.’”
Obstacles to intuitive assistance were overcome in different ways. Some couples
were more communicative about their needs, which in turn helped husbands to be more
intuitive about what was needed. Other times, arguments would arise between couples
over unmet needs, giving husbands more information as to what help was most needed.
Other husbands overcame the obstacle by focusing on their wife once they got home from
work or school, rather than placing their attention on their phone or the TV. Husbands
who actively observed and anticipated their wife’s needs were then able to provide
intuitive assistance, which also made them more aware of their partner’s emotional needs.
Being aware of emotional needs enabled husbands to engage the proactive husband
behavior, being emotionally available.
Behavior 5. Being emotionally available
The concept of emotional availability was a common theme discussed by both
husbands and wives, although there were many different ways of describing the behavior.
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The concepts of checking in; just listen, don’t fix; being present; and reassurance of
availability, are all aspects of emotional availability.
Checking in. The concept of husbands’ checking in on their partner was
mentioned by several participants. One wife reported, “He would always ask me how my
day went, how I was feeling, probably not super consistently, but regularly. So that I
knew he was thinking about me and how I was doing. He was super supportive.”
Another wife commented that her husband checking up on her was very helpful and made
her feel like her husband cared more, “I would know that if he was asking more often that
he is actually thinking of wanting to help me.” Another wife shared similar views, “He
made it feel like he was really there for me and checking in on me and remembering that
I’m really pregnant, even though I might not look it.”
Don’t fix, just listen. Another important component of emotional availability is
the behavior of listening instead of always trying to “fix” the problem. One wife
discussed the importance of husbands just being there for their wives,
The woman is so emotionally on a roller coaster that there is absolutely nothing
that the man can do to solve her emotional problems. So it’s allowing her to know
that it’s okay and that you’re there to listen and to support and that even though
she’s going to be happy one second and completely distraught the next, that’s
okay.
Another participant gave a particularly vivid image of her experience of wanting
her husband to listen to her instead of trying to fix her problems. She explained,
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Have you seen that YouTube video with the nail in the head? There’s a girl with
a nail in her forehead. Not real obviously, but she’s got a nail in her forehead and
doesn’t know it and talking to her husband like, ‘I just have this headache. I don’t
know why and it won’t go away. And all of my sweaters are snagged and I don’t
know why.’ And the guy’s like, ‘its cause you have a nail’ and she’s like, ‘stop
trying to fix it! Like just listen!’ But he’s like ‘if you just pulled the nail out,’ you
know? And so I told [husband] about that cause he always wants to fix it. I just
want to vent to you. You can’t solve it. I just need to tell you.
Another wife shared a similar experience of the importance of husbands’ just
needing to listen. She reported, “I would talk to him about my day, like, ‘walking around
today at 38 weeks really sucked.’ He’s like ‘yeah that sucks.’” Overall, it was very
meaningful for wives to have a husband that was not always concerned with fixing, but
instead provided space for listening and validating the experience the wife was going
through.
Being present. Being present was also very important to wives. One wife
commented on how wonderful it was to not have a husband who was distracted by video
games or TV. She reported,
I feel lucky that I have somebody that’s willing to let me go take a bath and not be
consumed in playing a video game or be consumed in playing World of Warcraft
or something like that. Like he was always open and like listening to what I
needed or what I felt like I wanted.
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Another wife mentioned the importance of being present during her emotionally difficult
moments. She said, “He was just there, he listened. He never really talked me out of my
fears; it was just that he was present.” The behavior of being present and in the moment
with one’s wife was an important part of being emotionally available.
Reassurance of availability. It was also important for wives to know that their
husband, while not always physically present, could be there if needed. One wife
reported,
The third trimester of my pregnancy I was kind of having these weird episodes
where I thought that we were going to have the baby. I was starting to have these
weird pains in my belly. It was kind of scary cause I didn’t know if they were
contractions or if my water was about to break. I had to go to the ER a few times
and every time he was in school. I would call him and every time I’d call he’s
like, ‘okay, I’ll be there in a minute.’ He dropped whatever he was doing and
came to be with me at the hospital.
Another wife expressed similar sentiments, commenting on how she knew her husband
was always there for her if needed,
He was always willing to help. Even during the labor and delivery part he didn’t
leave my side. He even missed out on school and a training he need to go to
because he felt it was more important to be at the hospital. Even though I had
done it before and I felt like I was fine and he could leave, he didn’t want to leave.
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Husbands also recognized the importance of being emotionally available to their
partner. One husband shared how he would call his wife often, to check in on her. He
reported, “I called [wife] quite a lot, every so often during work. One in the morning,
lunch break, and then one in the afternoon.” Another husband explained how he felt it
was important for his wife’s emotional well-being to let his wife know that he could
always be there if needed,
I think it was more of an emotional need. Not the fact that I needed to be there all
the time, but she just needed to know that I could [emphasis] be there, if she
needed me. She knew that I would do everything I could to drop everything there
and get home as quickly as I could.
One husband mentioned the importance of listening to your spouse and being a
calming presence for them, instead of trying to fix all their problems.
Be willing to listen to her frustrations, calm her anxiety. Listen to what she needs
and those moments of conversation. Problem solving is one of my go tos, but I
think one of the better moments is just on me listening. I think her most
significant needs were probably just kind of having someone to listen.
Other husbands provided similar thoughts, “What she needs most, lots of the time,
I mean obviously someone to talk to and listen to her, right? Communicate, let you know
that you are there for them, and listen.” All in all, it was important for husbands to make
a concerted effort to check in with their partner, listen to them, be present with them, and
reassure their partner that they were available to them if needed.
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Obstacles to emotional availability. There were numerous obstacles that
prevented husbands from being as emotionally available as they or their spouse would
have liked. Among the different obstacles were husbands being overwhelmed or
depressed, husbands not having their own needs met, a lack of communication, and being
distracted with technology. One husband commented about his own needs saying,
If I did have a need I wouldn't tell her, I'd either take care of it myself or figure
out a different way to get it to not put any more burden on her. Not only do I feel
like I can take care of everything I need myself because that's just who I am, but
at the very least, it's because the last thing she needs to worry about is what I
need.
While some husbands could provide for their own needs and the family’s needs,
others struggled with the task,
I had more responsibilities with school and work. There is so much going on that
my efforts and my energy kind of went to other things. So probably when she
needed it more I just didn’t have the energy to put in and focus on the family.
Another husband shared his struggles in not having his own needs met. He stated,
I'm not bitter but, a lot of times when you're married with children both parents
become the least important people in the household, but because I was the
primary caregiver I felt like the least important person in the house.
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One wife speculated how her husband’s mental health may have played a role, “I
think it's always been a little tricky ‘cause he does have depression and he feels a little
insecure, so he has a hard time expressing his emotions and things.”
Sexual intimacy was also a need husbands had, which was difficult to fulfill
during pregnancy. Numerous participants mentioned a lack of physical intimacy during
pregnancy, but also noted that they knew it was temporary and they could be physically
intimate without participating in sexual relations. When asked how the couple kept a
lack of sex from becoming problematic, one wife reported, “When we went to bed we
would still talk to each other and cuddle and everything. We just didn’t get very physical
towards the end.” Most couples were able to navigate this obstacle fairly well, with the
knowledge that the lack of sexual intimacy would be temporary.
Overall, the obstacle of husbands’ feeling overwhelmed or not having their own
needs met seemed to be largely overcome by open communication between partners.
Contrary to some of the husbands’ beliefs, their partner was worried that they were taking
on too much or were not communicating their own needs well enough. One wife
reported,
Maybe [husband] could just tell me his needs every once in a while during
pregnancy cause I was worried that he was taking on too much. Even then, if he
did I don't know if it would have been better for us, I just feel like I wanted him
to. I think a lot of what I ended up stressing about was whether or not he was ok.
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Another wife shared her view of how important it is for couples to communicate during
pregnancy. She stated,
I think communicating how you’re feeling or what you’re going through on both
sides. I can see a barrier coming up and feeling shut off from the other person,
just cause you’re not talking about what you’re going through. It’s different for
both people. I’m sure pregnancy was a million times different for my husband
than it was for me, and so talking about it opens your eyes a lot more.
Being distracted. Husbands’ being distracted was another obstacle to being
emotionally available. One father shared his experience of occasionally being distracted
during pregnancy and how it impacted his connection with his wife. He stated,
I think there’s days where I feel like I’m on autopilot, probably because I’m tired.
And she might say, ‘He’s on his phone too much.’ When I get home I don’t want
to talk about heavy stuff. I just want to veg and play with the kids and watch TV.
So sometimes the heart to heart that my wife wants to have, I don’t want to.
Another father shared how his lifestyle and media usage played a role in being
emotionally unavailable to his partner. He stated,
I think my diet made me more tired. I’m naturally a night owl. I’ll be up till 1
a.m. watching TV. I think that mixed in with work makes me, I wouldn’t say
brain dead, but a little bit more numb to the day to day of what’s going on with
her and at the house.
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One wife shared her frustrations about her husband not being present with her.
She said, “He watches TV while he’s rubbing my feet and it’s very halfhearted. It’s like
he forgets and I’m like, ‘come on!’ I have to remind him.” Whether it was due to being
overwhelmed or exhausted or using too much technology while at home, there were
many husbands that found themselves distracted and therefore unable to be emotionally
available to their wife.
As with the previous obstacle, the obstacle of being distracted was often
overcome by couples communicating with one another. Husbands and wives both
recognized that pregnancy was an adjustment for both partners and that each partner will
have “off” days or where the partner just needs to relax and engage in some self-care.
Husbands who were able to navigate obstacles to being emotionally available were also
able to more easily engage in the next behavior, responding during significant moments.
Behavior 6. Responding in significant moments
Many of the couples expressed that they had significant moments throughout the
pregnancy that had the potential to bring them closer together or create distance between
the couple. If husbands responded positively during these moments the couple seemed to
become stronger and benefit, despite the hardship. If husbands did not respond
appropriately there was the potential for hurt feelings, relationship trauma, or attachment
injuries. Among the significant moments are false labors or false miscarriages, health
concerns, the labor and delivery process, and other life events; each with the potential for
relationship growth or relationship harm.
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False labors or false miscarriages. One wife shared her story of how her
husband helped her during a false labor she experienced,
I went into false labor early and I had to call him and he was on shift, and he was
able to leave work and come help and support me in the hospital. That was really
supportive because I was really worried that he wasn't going to be able to leave,
but he was and was able to be there for me.
Another wife commented on how her husband’s response during a false miscarriage
brought them together and became a moment that made the couple stronger, instead of
further apart. She reported,
It was January and we went to the doctor. We found out we were pregnant. Then
I was called back a few days later and they had told me that I’d miscarried. I had
no symptoms of miscarriage whatsoever. We were both kind of like, “okay, what
do we do now?” And for him [husband], he just, he held me while I was bawling
and everything. He held me and told me that everything was going to be okay
and I think that was important for him to be strong in that situation. I think it
brought us even more close together going through the emotional side of
miscarriage.
Her husband shared his perception of the same experience. In his response, it can be seen
how many of the previous proactive husband behaviors led to him being understanding,
emotionally available, and supportive during this significant moment of pregnancy.
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In the beginning they thought we had miscarried, but we didn’t. I think it brought
us a little bit closer together and it’s harder for me to relate to it because I’m not a
woman, never had a baby. It was a moment that I tried a little harder to
understand. Cause it’s something huge and she thought she had lost the baby. So
obviously I’m going to try my hardest to make myself available and try to
understand to help her feel better even though she’s not going to feel better.
Life events. Another participant shared her experience about how difficult it was
for her to work while being pregnant and how much her husband’s positive response
meant to her:
I was going through a very emotional time working full time. That was like a
really devastating part to have to go back to work after having my first baby and
then having to be pregnant the entire time while being a mom was just detrimental
to myself. He was so supportive every day, pushing me to do my best.
Labor and delivery. One mother shared how her husband’s support during labor
and delivery was significant for her and brought them closer as a couple. She stated,
It was a pretty painful delivery this time and he was there to support me. He did
whatever he could to make me feel better. I wouldn't have wanted to go through
that delivery by myself. I was able to tell him that I needed him to be next to me
because I was in pain and I needed the support. I feel it was a rather significant
thing in my delivery.
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Wives also spoke of the birthing process being a significant moment for the
couple. One wife reported, “This is kind of a cliché answer, but giving birth is kind of a
miraculous experience and we both get to be there for it together, so it's kind of
spiritually very touching.” Another wife reported how important it was to have her
husband with her during labor.
He would coach me through it. It was really nice to have him by my side. He was
really involved. He wasn’t grossed out or anything so that was nice. You hear
dads say ‘I don’t want to see it.’ He was really excited for her to come.
One wife had to be rushed to the operating room for an emergency C-section and
mentioned how comforting it was for her to have her husband there, “That was kind of
scary for us, but he was able to be there throughout the whole thing.”
Health concerns. Health concerns were also present for some couples. One wife
experienced gallstones during pregnancy and was forced to go to the emergency room.
She shared how her husband’s support during this time was especially meaningful,
There was one time we went at midnight and once we went in at 4 AM and he
stayed with me the whole time. I think having him be there for me was really nice
and I knew that he had a lot going on. Being able to have him there with me was
really supportive. He dropped whatever he was doing at school to come to be
with me at the hospital.
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Another wife shared how she had nerve damage in her leg from a previous pregnancy,
which caused her instability in her legs causing her to fall quite often. She reported about
her husband’s response,
I think definitely the first time I fell, well not the first time. It happened like a few
times. That was significant because I couldn’t do it by myself, so I had to rely on
someone else. For me, having to completely rely on someone else was hard, so it
like helped foster trust.
Husbands were more hesitant to give themselves credit for responding during the
significant moments, but did acknowledge the importance of being there for their wives,
“It’s definitely a hard time for them and having someone that they can count on. That's
really what it comes down to, that they know they have somebody that they can count
on.” Another husband, when discussing a significant moment with his wife, said, “Isn’t
that funny how different our perspectives are? I don’t remember stuff like that, you
know? It’s so funny. I didn’t put a lot of weight to those. I just did them.” Overall, wives
were much more apt to remember and discuss significant moments than husbands were.
Obstacles to responding in significant moments. There were also significant
moments where husbands did not respond in a helpful manner. One obstacle to
responding during significant moments was disappointment. One father, who had two
older children, was hoping for a specific gender for their third child. When the gender
was revealed, it was not the gender he had been hoping for. His wife expressed a
difficulty associated with that. She reported, “[Husband] just didn’t want to discuss a
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baby name, which is really hard for me because I felt that was something that we had to
do together and he just didn’t want to.” The husband participated in naming the baby
after the birth, but the wife stated it was a significant thing for her to wait that long and
for him to not participate earlier. Ultimately the obstacle here was not overcome.
Another obstacle to responding in significant moments was when husbands were
not fully involved in the labor process. One wife shared her disappointment in how her
husband failed to participate during labor, “[Husband] didn’t wanna watch, didn’t wanna
cut the cord. He was sitting right there facing the wall.” Another wife shared her
thoughts regarding her labor experience. She stated,
So [husband] came with me and he pretty much slept on the pull out couch thing
all that night while I was having contractions. Looking back, I don’t think I
should have let him sleep, to be honest. I think I could have used some snuggles
or something.
Although the couple often discussed these times where the husband failed to
respond during significant moments, wives were still left with hurt feelings and
disappointment regarding the experience.
Overall, there are many different obstacles that can hinder husbands from
responding during significant moments, however the biggest hindrance found in the
present study was husbands not engaging in the previous steps of proactive husband
involvement. Generally, husbands who did engage in the previous steps responded well
during significant moments. The fathers who did not engage in those behaviors,
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generally responded poorer in significant moments. Husbands who did respond in
significant moments, felt the impact of their involvement and persisted in the behaviors
they had exemplified during pregnancy. They naturally moved on to the last behavior of
proactive husband involvement, providing continual support.
Behavior 7. Providing continued support
As wives talked about their husbands’ involvement during pregnancy, a very
apparent theme arose: many husbands were continuing to proactively support their wives
after pregnancy and in many of the same ways as during pregnancy. One wife said, “He
did almost everything at home and he still has been doing it.” Another wife said,
He does get up in the middle of the night to, you know, bottle feedings and stuff and he’ll
sometimes help more on weekends. He just helps out more and he tries to hold her
[baby] more whenever he comes home from work.
One mother reported how even simple tasks after the baby is born can impact the
couple relationship. She stated “Even if it’s just changing the baby’s diaper it’s a
bonding experience and they need to be part of that baby’s life, which then helps the
relationship because one does not feel like they have to do everything.” Another wife
reported that her husband was still making additional time for her. She stated, “We still
have lunches together”, which was a trend the husband started during the pregnancy in
order to support his wife and connect with her. One wife discussed her husband’s
continued positive attitude and availability, “He was always willing and is still willing to
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talk in his free time to make sure I’m okay.” When questioned about the couple
relationship since the baby was born, another wife responded,
Great, it’s been really, really, great, because he has been even more helpful and
positive than I could have imagined. He’s been so great about waking up at 2 in
the morning and 4 in the morning, and washing bottles, even though he’s busy.
It’s been a nice, I don’t want to say surprise, but better than I even thought.
The statements provided describe how proactive husbands continue their support
in behaviors previously mentioned: displaying a positive attitude, engaging in daily tasks,
understanding, intuitive assistance, and emotional support. Although the seventh
behavior comes post pregnancy and is not technically considered husband involvement
during pregnancy, the step is important for multiple reasons. To begin with, the first few
weeks postpartum are a time period where wives still require significant help from their
partner. Although the child has been born, wives still have physical limitations and
require the same sort of proactive husband involvement as during pregnancy. One could
say that the first few weeks postpartum is an extension of the pregnancy itself. If
husband support ended immediately following childbirth, there would likely be some
relational difficulties associated with that. Additionally, continued support acts as a
bridge that links husband involvement during pregnancy with relational outcomes
postpartum. To many wives continued support postpartum is a message from their
husband; a message that husbands still care about them and are still invested in the
relationship. Continued support sends a message to wives that husband involvement will
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remain, thereby enforcing the positive relational benefits from husband involvement
during pregnancy.
In summary, the behaviors described in this section are all factors in proactive
husband involvement. In order to understand what impact these behaviors had on the
couple relationship postpartum, husbands and wives were each asked: How did husband
involvement during pregnancy impact your current relationship? Nearly every
participant had strong views on this question. This led to the second part of the theory:
How husband’s efforts during pregnancy influence the couple’s relationship postpartum.
Part 2. Strong Couple Relationship Postpartum
In addition to the ways in which husbands were proactively involved during
pregnancy, couples also spoke about how husband involvement during pregnancy
impacted their current relationship. They described five distinct ways that the couple
relationship was enhanced postpartum: Increased trust, better support, a more mature
relationship, greater love and appreciation, and enhanced communication. These
represent important relationship outcomes arising from proactive husband involvement,
all which contribute to a strong couple relationship postpartum.
Increased trust. When describing how the couple relationship had changed as a
result of husband involvement, many couples discussed an increased sense of trust. This
increased trust directly tied to certain proactive behaviors exhibited by husbands during
pregnancy. In the case of trust, the behaviors of being emotionally available and
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providing support during significant moments were especially meaningful. One wife
described how those behaviors led to greater trust. She reported,
It [husband’s involvement] showed me how much he loved me. I knew that I
could trust him with really anything and I knew that when I had difficult time he
was going to make every effort to be there and to support me, not just things
related to our life, but related to my own life, my own passions, any kind of talent
or any kind of skill that I want to develop. I trust him more and rely on him more
for his advice and his encouragement.
Another wife responded similarly, connecting the proactive behaviors of engaging in
daily tasks and with increased trust. She stated, “I think really the trust thing where you
have to rely on someone else as I happened to rely on him.” Another wife explained the
importance of having her husband accessible and available to her, “Just having him
always be there for me during the pregnancy when I needed him to be there. I know I can
always call him now.” Because of her husband’s proactive behaviors, this wife knew that
her husband would be there in the significant moments, which led to her having increased
trust in him.
Husbands were also able to articulate how certain behaviors led to better
relational outcomes, such as increased trust. One husband explained, “I think in a way it
[his involvement] helped her feel like I cared for her and that I was always there when
she needed me type of a thing.” This husband knew that his behavior was an indicator to
his wife that she could count on him.
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Better support. Participants who spoke of how husband involvement impacted
their relationship often mentioned feeling more supportive of one another. Wives felt
more support from their husbands and felt more supportive towards their husband as well.
Each partner felt as if they could lean on one another for strength and support.
Participants felt like this increased support for each other was an aspect in having a
stronger relationship postpartum. One wife shared her thoughts about how her husband
engaging in daily tasks helped her feel more supported in their relationship during and
after pregnancy. She stated,
We definitely were more supportive of one another. Whenever I would ask him
to do something he would. He’d do it. If I wanted him to rub my back, he’d do it.
He would always help me out, but I think that helped our relationship cause I
knew that he would always do stuff for me!
Another wife responded about how having a better understanding of one another
has helped them to better support each other after the birth of their child. She explained,
“He’s been able to help me be a better mom and I’m able to help him be a better father,
and I think in turn that helps us become a better support system to one another.”
Husbands also mentioned how helping with daily tasks increased the amount of
support their wives felt. One husband said, “I think it [his involvement] impacted it [the
couple relationship] for good because she was able to see that ‘he’s [speaking of himself]
here to support me he's here to help me.’” Another husband commented about how being
emotionally available helped his wife feel supported. He said,
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I think it kind of shows that I could be there to listen, be there to support, and be
flexible with the preparations. I guess sacrificing some of that personal time that I
might have wanted or might have taken initially, but being more present and
appreciating and contributing she sees my effort and dedication to my family.
Overall, both husbands and wives spoke of feeling an increased support for one
another postpartum due to the behaviors that husbands exhibited throughout pregnancy.
A more mature relationship. A number of participants explained how their
relationship was stronger or more mature as a result of their husband’s involvement
during pregnancy. In regards to her husband’s participation and continued support
afterwards, one wife stated, “We have really grown and I feel like we’re on a different
level of marriage or relationship.” Her husband’s continued support had made her feel as
if her marriage had been taken to the next level; a level where they were more equal in
their partnership. Other wives commented on how helping with a positive attitude
impacted the quality of their relationship. For example, one wife replied,
His willingness to be so helpful. Not just for me to be the little housewife doing
everything and he can just sit back and relax when he gets home. I guess it's just
strengthened us a little bit by little bit.
Another wife spoke in detail about learning to communicate and understand each
other’s needs more fully led to the maturation of their relationship. She stated,
Well, we went through a bunch of rough patches. I think now we are closer, we
have a more mature relationship. During our pregnancy we had to reprioritize
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what we wanted in life or what we were doing and some things we cut out of our
lives and other things we picked up.
Husbands also felt that working to understand their spouse was a key part of
strengthening their relationship. For example, one husband reported that pregnancy was
a relationship builder for him and his wife because, “We’ve increased in what we
understand of each other and what we’ve seen of each other.”
Love and appreciation. Many of the participations spoke at length about how
husband involvement during pregnancy increased love and appreciation for one another
beyond pregnancy. One wife replied about how her husband engaging in daily tasks
made her love and appreciate him more deeply,
Well, I can't imagine having a better father for my girls, and I can't imagine
having a better husband, because not a lot of husbands will do cooking and
cleaning and meal planning and shopping and taking the girls to buy clothes and
not a lot of husbands will do that just to do it, to help. Do you know what I mean?
Another wife reported that her husband always striving to be available helped make her
love and appreciate him more and, in turn, feel loved and appreciated by him more,
I definitely love him more. Throughout the pregnancy my love for him grew a lot
more because I knew how good of a dad he was going to be. Cause he always
strives to do his best. And I think the best is being with his family and helping his
family. Throughout the pregnancy I was his family so he helped me out a lot.
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The behavior of helping with a positive attitude and being available was also
spoken of in terms of strengthening the couple relationship. When answering how her
husband’s involvement impacted her current relationship, one wife described how her
husband’s positive attitude during pregnancy strengthened their relationship. She stated,
I feel like if he were to not be great during the pregnancy, I think we would be in
a much worse place. I think the main idea is his general attitude and how he
shows that he cares with all of these little things, by like checking on me, and
making sure I’m getting taken care of made a significant positive impact on our
relationship.
Husbands also recognized how the love and appreciation in their relationship had
changed as a result behaviors such as positive attitude and engaging in daily tasks. One
husband said,
I think it [husband involvement] affected our relationship because it’s the first
time that she’d been pregnant. I really took time out to do things. I think it
affected her to know that I cared enough about her to do special things for her and
help her.
Another husband reported about the importance of his involvement, specifically in taking
the time to better understand her and her needs. He stated how once he understood her
needs he really had the opportunity to serve her as she needed. His efforts to better
understand her needs helped him to feel more love and appreciation for his wife, which
helped strengthen their relationship after pregnancy. He said,
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I feel like I grew really close to her because I had the opportunity to serve her. I
think for me personally it was, when you have this opportunity to serve someone
you grow in appreciation for them and what they are doing for you or for who
they are.
Enhanced communication. Many participants spoke of having better
communication postpartum, due in large part to husbands who made it clear that they
wanted to understand the needs of their wife and how they could best help. Two of the
more salient quotes come from two of the wives. The first wife reported that her husband
communicating his needs to her and asking about her needs changed their interaction
patterns,
When you had a need you didn’t just hold it back and wait for the other person to
guess what your need was, because that would just frustrate. We did that when
we were first married. We’d be frustrated and be like “oh, I have this need but I
want you to guess what it is because that’s cute.
The second wife reported that having a husband who helped with a positive attitude and
who could be counted on in significant moments made it easier to talk to her husband
when she suffered from postpartum depression in a previous pregnancy. She explained,
So with our last pregnancy, not this one, but the one before, I got really bad
postpartum depression and I think it helped feeling like I could talk to my
husband since he’s been supportive through the whole pregnancy. So I think
another thing too if the husband’s really supportive during the pregnancy, for
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future couples, to talk to his wife like after [pregnancy] if she starts seeming off or
more down than usual.
From the information provided by participants, it was apparent that proactive
husband involvement during pregnancy not only increases couple communication in day
to day issues, but can also help wives feel comfortable enough to discuss something as
serious as postpartum depression with their husband, a diagnosis that many wives keep
secret from their husband, choosing instead to suffer in silence.
Inconsistent/Inattentive Husband Involvement
In contrast to the majority of couples in the study, there were also cases where
husbands struggled to consistently and attentively engage in proactive behaviors. As a
result, these couples seemed to display some characteristics of a weakened couple
relationship postpartum. One wife commented that she always felt like her husband’s
participation in the pregnancy was for the baby and not for her. She felt as though he
tried to understand the pregnancy in general and not necessarily how the pregnancy
would impact her and what her needs would be. In reference to his involvement and their
current relationship she reported,
Yeah I guess I feel like he's a really focused person and a lot of the involvement
during pregnancy was for her [the baby] health. We both agreed it would be good
to have emotional stability, eat healthy, get exercise and he was super supportive
of those kinds of things, which were for her, but for the things like my emotional
health and his emotional health he wasn't so much there for that part. His
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involvement made me more confident in him being a great father but a little less
confident in him being a great husband. With me it's [the couple relationship]
kind of a scary place. I don't feel like there's a lot of relationship there.
Another wife, who had mentioned her husband’s emotional unavailability and
lack of response to significant moments, explained her thoughts on the current state of
their relationship. She wondered about her decision to marry him, “But sometimes, I
don’t know. I would say there’s a lot of times I don’t know, did I marry the right
person?” It was clear that the lack of support she felt during pregnancy had carried over
into the postpartum time period.
One wife, when asked how her husband’s involvement impacted her current
relationship, replied, “Wow, I don't know that it influenced or changed anything very
much.” She then expounded on why she felt that way and what she had needed during
pregnancy in order to feel more supported. It was clear that this wife did not feel
understood and did not think her husband was emotionally available to her during
pregnancy. In reference to the unmet needs she experienced she stated,
Listen to what each other has to say and be really receptive to each other's
feelings and emotions and help each other through whatever concerns the other
person might have to try to ease the burden of whatever it is they're going through
because every feeling is important to validate.
There were three wives in the study who did not feel their relationship was
strengthened by their husband’s involvement. Overall, they were not unhappy with the
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daily tasks or the physical support received; they seemed to be unhappy with the lack of
intuitive assistance and lack of emotional availability on the part of their husband,
attitude playing a large role in those behaviors. Additionally, 2 of the wives whose
husbands were less involved during pregnancy seemed to exhibit some characteristics of
depression. Although participants did not complete a depression assessment, an overall
depressed mood and affect was observed by the researchers.
Summary of Findings
Overall, most of the couples in the study reported that they believed their
relationship had benefitted in some way as a result of the husband’s involvement, and all
couples saw some sort of change in the relationship; either for good or for bad. When
husbands engaged in proactive behaviors during pregnancy there were five distinct ways
in which the relationship was enhanced. When husbands did not engaged in proactive
behaviors, wives generally became less satisfied in their relationship or less confident in
their partner. There were some husbands and wives that actually viewed pregnancy as an
opportunity to come closer together, rather than a challenge to overcome. One final
summative quote comes from one of the husbands in the study. This husband explained
his thoughts about how he believes pregnancy can be a time to strengthen the couple
relationship. He said,
Having a baby doesn't have to ruin your relationship or doesn't have to take away
from your relationship. Having a baby is something that can bring you together if
you are both willing to work together to be a team. You see in research and in the
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news people saying how marital satisfaction goes down when you have a kid, but
I don't necessarily think that has to be the case. I think it's the way the couple kind
of takes it on as a burden or as an opportunity.
The quote from this husband exemplifies the qualities of a husband who is
proactive in his involvement during pregnancy. This husband demonstrates the
importance of a positive attitude and a willingness to do whatever tasks are necessary to
provide understanding, empathy, intuitive assistance, and emotional availability that will
help a husband to be able to support to his wife through significant moments and to
continue providing support postpartum. These are the qualities that make up proactive
husband involvement and can lead to a stronger relationship postpartum.
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CHAPTER 5
DISCUSSION
Summary of Grounded Theory
According to the model, proactive husband involvement began with helping with
a positive attitude. A positive attitude was most often displayed by a willingness to help
and by expressions of excitement regarding the pregnancy. Having a positive attitude
then enabled husbands to participate in the other proactive husband behaviors, such as
engaging in daily tasks, more effectively. All husbands engaged in helping their wife
with daily tasks, however husbands who displayed a more positive attitude while helping
sent an unspoken, yet impactful message to their partner about a desire and willingness to
be involved during pregnancy.
Husbands who engaged in daily tasks with a positive attitude were then able to be
more understanding and empathetic to their spouse. Although husbands could not
physically relate to being pregnant, they proactively worked on understanding, as best
they could, some of the challenges their wife would experience. They also displayed
empathy for the difficulties their wife would deal with. Husbands who gained this deeper
understanding and empathy were then more able to provide intuitive assistance to their
partner. Providing intuitive assistance meant that husbands would try to anticipate or
recognize their wife’s needs more quickly, sometimes even before their wife realized
what she needed. This was done mostly through research and observation. Although
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husbands would ask what their spouse needed, they wanted to learn her needs so well she
would not have to ask.
Husbands who provided intuitive assistance were able to recognize the
importance of being emotionally available. Being emotionally available meant that many
husbands had to switch gears from wanting to fix every problem, to simply listening and
being present with their wife. Wives also needed reassurance from their husband that
although the husband could not always be physically present, they could be emotionally
present or that they would be physically present as soon as reasonably possible. The
behavior of emotional availability was important, especially in terms of responding
during significant moments. Every couple in the study reported that they had experienced
some type of significant moment, which had the potential to bring them closer together or
create distance in the couple relationship. Husbands who had been proactively involved
were better able to provide support to their partner in the significant moments. Proactive
husbands were more prepared for these moments because of the type of involvement they
had displayed; they understood their wife differently and had created a sense of trust for
the bonding opportunity to take place.
Proactive husband involvement did not end at responding during significant
moments, it transitioned into providing continued support. Many husbands and wives
from the study reported that husbands maintained certain behaviors and persisted in their
proactive involvement after their child was born. Husband involvement seemed to
expand into paternal involvement and a new kind of relationship or partnership as
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parents. Proactive husband involvement resulted in five specific outcomes in the
couples’ relationships: Increased trust and reliability, providing better support for one
another, a more mature relationship, deeper love and appreciation for each other, and
enhanced communication in their relationship. The increases in those five aspects led to
a stronger couple relationship postpartum. In summary, the theory illustrates how
proactive husband involvement facilitates a stronger couple relationship postpartum.
Connecting the Current Theory to Previous Research
Past research has shown that husband involvement is not a simple singular
behavior, but is complex and multifaceted (Carter, 2002). The results from the present
study support those previous findings and provide in-depth descriptions about the
multiple aspects that encompass husband involvement. As illustrated by the grounded
theory, husband involvement during pregnancy has significant implications for the
quality of the couple’s relationship postpartum. Husband involvement is indeed complex,
yet underrepresented in the current research literature.
This study intended to answer specific questions in order to fill gaps in the
literature regarding the transition to parenthood. The main overarching question was how
husband involvement during pregnancy impacts the couple relationship postpartum.
Other questions were how couples describe husband involvement, what factors contribute
to positive husband involvement, what factors contribute to low husband involvement,
and in what way do these factors impact the quality of the couple relationship
91
postpartum? Throughout the course of the research study, all of the research questions
were addressed.
How the couple relationship is strengthened. The grounded theory of proactive
husband involvement addressed the main research question of how husband involvement
during pregnancy impacts the couple relationship postpartum. Proactive husband
involvement was found to increase trust, support, understanding, love and appreciation,
and communication for couples. Consistent with previous research, partner support
during pregnancy seemed to be a protective factor for couple relationship postpartum
(Lawrence, et al., 2008). In this study, proactive husband involvement did not just
protect the couple, it appeared to make the couple relationship stronger afterwards. This
occurred as husbands provided daily aid to their spouse, sought to better understand their
partners, worked to intuitively care for their spouse, provided emotional support,
responded during vital moments, and continued providing support during the postpartum
period.
Research prior to this study indicated that when spouses perceive their partner as
more supportive, they tend to feel more valued and secure in their relationship (Collins &
Feeney, 2005). The results from this study support and extend those findings by
providing detailed descriptions of behaviors that provide meaningful support to wives
during and after pregnancy. Wives in this study who reported high levels of husband
involvement were found to feel more loved and appreciated in their relationship during
the course of pregnancy and postpartum. We also found that when wives perceived their
92
husband as being available, they were more likely to ask for help in times of need. This
finding supports previous research on the importance of emotional availability in the
couple relationship (Mikulincer & Shaver, 2007).
Another finding from this study that connects with previous research is the
possibility that couple relationship quality during and after pregnancy may be a protective
factor for maternal health problems, such as postpartum depression (Letourneau et al.,
2012). One wife in the present study reported that her husband’s positive involvement in
a previous pregnancy had made her feel better about her relationship and more able to
share her struggles of postpartum depression with him. Although husband involvement
did not prevent postpartum depression from occurring, the wife did comment that her
husband was an important source of support to help her work through her postpartum
depression. This provides some evidence that husband involvement during pregnancy
may be a protective factor for maternal health issues, such as postpartum depression.
Difficulties in the couple relationship. Husband involvement also had the
potential to harm the relationship if husbands were not involved in meaningful ways. As
with previous research (Glazier, et al., 2004), lower levels of husband support during
pregnancy seemed to lead to more emotional difficulties for wives, whereas wives who
reported having a husband with high levels of involvement were found to report better
emotional well-being. Another finding that is consistent with previous research is that
women who perceive their husband as being less supportive during pregnancy are at a
much greater risk for depression after pregnancy (Simpson, et al., 2003). Although most
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of the women in our study reported high husband involvement, the participants who
reported low husband support and involvement did tend to display as more depressed and
spoke of more emotional difficulties when compared to wives with greater husband
support. Nevertheless, the sample size of this study is relatively small, and future research
might further test this relationship empirically.
Husband involvement defined. Although husbands and wives both discussed the
husbands’ involvement during pregnancy, they tended to describe it slightly differently.
Men were more likely to discuss husband involvement primarily in terms of physical
support. This is consistent with previous findings, which emphasized husband
involvement in terms of helping out at home and providing financial support (Carter,
2002). On the other hand, women were more likely to mention ways they had been
emotionally supported, but did speak of physical support as well. One interesting
discovery is that some women reported that their most pressing needs were physical in
nature, but highlighted the way they felt emotionally supported by their husband.
Furthermore, physical acts of service seemed to provide an extra sense of emotional
support for women during pregnancy, as compared with times of non-pregnancy.
Consistent with previous research (Kaye et al., 2014), both husbands and wives agreed
that husbands should be emotionally and physically available to their wife, be considerate
of her situation, and have a positive attitude and motivation (Lamb, Pleck, Charnov, &
Levine, 1987).
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Obstacles to involvement. There were several factors that contributed to
husbands being less involved during pregnancy. One common barrier to involvement
was that of gender. Consistent with previous research (Carter, 2002), many participants
spoke of husbands not being able to understand what the wife is going through because of
gender. Additionally, some husbands in the study mentioned that the healthcare system
in general can be tricky for men to navigate due to the focus of pregnancy being primarily
on mother and baby. A lack of knowing how to contribute due to gender differences was
a prominent theme found.
Participants also spoke of a decrease in sexual satisfaction and sexual frequency
as a factor in being less connected as a couple during pregnancy. This was one finding
that the researchers did expect to occur. According to previous research, men report a
decrease in sexual functioning during pregnancy, which often results in higher stress
levels and feelings of disconnection with their partner (Condon et al., 2004). Although
couples can expect a decrease in sexual activity during pregnancy, positive
communication in the couple relationship can help couples to still have needed levels of
intimacy (Ahlborg, et al., 2005). This was also highlighted by the participants in our
study. Both husbands and wives in the study spoke of the importance of sexual relations
in their marriage, and although they were cognizant of the fact sexual frequency would
decrease, they did acknowledge its importance for the couple relationship and spoke of
the necessity of communicating about sex during pregnancy.
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The most common barrier to husband involvement was work and school. Again,
this finding is consistent with previous research that explains how many husbands desire
to be involved, yet experience difficulty in acquiring the time off to do so (Deave &
Johnson, 2008). Many of the husbands in this study were heavily involved in academic
programs or work. Fathers reported difficulty in attending visits to the obstetrician and in
providing their wife with the support of their physical presence, however this barrier was
largely mitigated by husbands rearranging schedules, providing extra support while at
home, or providing emotional support via phone calls, texting, and video chatting such as
Skype. Previous literature suggests that using technology can increase intimacy and
closeness in couples (Twist & Hertlein, 2013; McKenna, Green, & Gleason, 2002). In
this study, technology was often used by husbands to communicate availability and to
inform the wife that her husband was thinking of her.
Specific areas of relationship impact. The last question of the study was: In what
ways does husband involvement impact the quality of the couple relationship postpartum.
One way the couple relationship was impacted was in terms of feeling loved and
appreciated. Proactive husband involvement generally led to both husbands and wives
reporting feeling more loved and appreciated. Our findings support the research that
wives who perceive their partner as more supportive during pregnancy, feel more secure
and valued in their relationship (Collins & Feeney, 2005). The present study also found
that couples had more trust in their relationship, in large part due to husbands being
responsive to the needs of their partner. Partners who perceive their spouse as available
96
and responsive are more likely to seek support in times of need (Mikulincer & Shaver,
2007). Conversely if husbands were not available to their partner or did not respond
positively the result was hurt feelings or an attachment injury, which made wives less
likely to seek their partner in significant moments; again this finding is consistent with
prior research regarding the impact that partner response has on couple attachment
(Seedall & Wampler, 2013).
Overall, the greatest strength of this study is highlighting the distinct behaviors
that encompass proactive husband involvement. Most research presented on husband
involvement during pregnancy places its focus on physical tasks. Physical tasks, while
important, make up only one component of proactive husband involvement. It is the
more subtle behaviors such as helping by possessing a positive attitude and providing
intuitive assistance that really defines what proactive husband involvement is. Many
husbands know they need to emotionally support their partner, but this study gives
specific actions they can engage in that will help them participate during pregnancy in a
manner that meaningfully demonstrates support and strengthens their relationship
postpartum. Each behavior highlighted in this study provides explicit details about how
to proactively engage in each behavior, and the details are grounded in data obtained
from husbands and wives who have been through the transition to parenthood.
Clinical Implications
There are several implications from this study that could prove beneficial to
medical professionals, MFT’s, and other mental health practitioners. The field of
97
marriage and family therapy has recently placed a new and dedicated focus on integrated
healthcare between MFT’s and healthcare providers (Tyndall, Hodgson, Lamson, White,
& Knight, 2012). Many of the following implications have the possibility to have
significant changes on the way maternal healthcare is approached and on creating more
of an emphasis on the couple relationship during pregnancy.
Implications for medical professionals. The findings from the study suggest
some interesting implications for doctors, nurses, and other medical professionals who
work with mothers and couples during pregnancy. First, there is the need to provide
better psychoeducation to husbands regarding what their wife is experiencing and how to
provide support. One thing that is fairly clear from research is that many husbands attend
obstetrician appointments with their wife, and there are many opportunities for healthcare
providers to engage with husbands. Some husbands in this study reported that the doctor
was happy to include them, would engage them in conversation during appointments, and
included them in any way that they could. Other husbands report feeling invisible during
the doctor visits. Given the impact that husband involvement can have on maternal well-
being, medical professionals should be encouraged to be more intentional about including
husbands. The first step is to actually acknowledge them as a partner in their spouse’s
healthcare and realizing the potential they have to increase maternal health outcomes.
Additionally, providing husbands with education about pregnancy and ways they can be
supportive will further help them be involved.
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Another implication for healthcare providers is the role husbands can play in
navigating maternal healthcare issues such as postpartum depression. Past research and
findings from this study have shown that wives who have experienced and shared their
struggles of postpartum depression with their husband, are subject to better outcomes.
The couple relationship is currently an untapped resource for maternal health. Enlisting
husband’s assistance in learning to recognize behaviors and provide support for mothers
could be a vital tool for healthcare providers.
Implications for MFT’s. The grounded theory developed in this study has
several implications for MFTs who work with couples during pregnancy. One implication
is the need for MFT’s to effectively work with healthcare providers to help strengthen
couple relationships during pregnancy. The healthcare system is fairly ambivalent
towards husbands and partners during pregnancy and other maternal health care related
issues (Kinanee & Ezekiel-Hart, 2009). If mental health professionals, such as MFT’s,
were able to collaborate with healthcare providers, specifically obstetricians, there could
be more of an emphasis placed on the couple relationship during pregnancy and how that
benefits the couple and their new child. Research has shown that integrated healthcare
between physicians and mental healthcare providers can lead to better outcomes such as
improved general health, reduced depression, better occupational functioning, and
treatment that is more cost-effective (Katzelnick et al., 2000). It has also been noted,
specifically by patients, that integrated care promotes family-centered outcomes, not just
individual patient-centered outcomes (Hodgson, McCammon, & Anderson, 2011). In
99
other words, integrated healthcare is not just concerned about individual health; it is
concerned with the entire family’s health. Pregnancy is one area of healthcare that has
the potential to weaken or strengthen each member of the family and therefore, is an ideal
situation for integrated healthcare.
Another implication of this study is the need to provide husbands with more in
depth information on the ways they can support their partner. Husbands participating in
first time pregnancies experienced a steep learning curve in understanding how to best
help their partner. However, husbands who were not first time fathers also reported they
could benefit from more information about the pregnancy process and how to be most
helpful to their partner. Current research on husband involvement tends to focus solely
on providing physical support; leaving husbands with little information about how to
emotionally support their partner. The current study fills some of the gaps in the
literature and provides valuable information for husbands on how to emotionally support
their spouse during pregnancy, however it is imperative that counselors and other mental
health professionals place a greater emphasis on emotional support.
The need for effective communication during pregnancy is also an important
implication. Some participants in the study reported that couples would occasionally
participate in mind reading, rather than straightforward communication. The pattern was
fairly consistently exhibited in a 3-step process. First one partner would wait for their
needs to be met by the other. They would then become frustrated when their partner did
not instinctively know their need. Finally, there would be a blowup or the need would
100
“spew out like a volcano”, as one participant described. This process would repeat itself
when husbands did not learn intuitive assistance or when the couple’s communication
patterns did not improve and continued in this cycle. Therapists working with pregnant
couples should focus on the importance of partners communicating their needs to each
other and provide couples with tools to effectively do so.
One major implication is the aspect of how gender is still a major obstacle in
husband involvement. Today’s society expects husbands and fathers to be involved in
more ways than ever before; however, men still receive the message, either overt or
covert, that they do not belong in the world of maternal health. MFT’s can play a vital
role in breaking down gender barriers. Men must know that they are both needed and
wanted during pregnancy, by their partner, by the healthcare system, and by society as
whole. Encouraging husbands to attend doctor’s meetings, birthing classes, and baby
showers will send the message to husbands that they are a vital part of pregnancy. Men
must feel like they are partners in pregnancy, not viewers watching from a distance.
Application with MFT Model. In order to illustrate how therapists can use
knowledge of proactive husband behaviors, I will apply a specific MFT model,
Contextual Family Therapy, to therapeutic work with couples and pregnancy. Contextual
Family Therapy (CFT) was developed by Ivan Boszormenyi-Nagy. Among the major
components of CFT are fairness in relationships, relational ethics, relationship ledger, and
indebtedness versus entitlement (Boszormenyi-Nagy & Spark, 1973). Fairness in
relationships allows family members to give more freely and to feel comfortable when
101
making requests for their own needs. Relational ethics refers to degree of fairness or
reciprocity in relationships. The relationship ledger keeps track of the balance of give and
take in the relationship. If give and take in relationships is not fairly equal, a partner may
start to feel indebted to the other or feel entitled if their partner does not give back in the
relationship. It is important that each partner understand their own contribution to give
and take in the relationship.
Applying CFT with proactive husband involvement during pregnancy may be
used to help couples keep their relationship ledger balanced. Because wives are the
partner who becomes pregnant, are responsible for the health of the child during
pregnancy, and deliver the baby, there is a constant pattern of giving by wives during this
time. If husbands do not engage in proactive husband involvement this could potentially
unbalance the relationship ledger. One participant in the study commented that he would
have felt indebted to his wife had he not actively participated and supported her
throughout the pregnancy. This couple might not have had a sense of fairness in their
relationship, which could have prevented them from both giving and asking for relational
needs during the pregnancy and thereafter.
Couples who have proactive husband involvement may not be in need of therapy
during or after pregnancy, however couples who did not report proactive husband
involvement may be in need of therapeutic services. A therapist could help couples
navigate obstacles to proactive husband involvement or help partners participate in
exoneration, the process of holding partners accountable, while removing blame and hard
102
feelings associated with the event (Ducommun-Nagy, 2009). Exoneration can also help
promote forgiveness and reconciliation for couples who did not have proactive husband
involvement during pregnancy. Although CFT was the chosen model for this application,
many MFT models could be applied to proactive husband involvement.
Implications for Future Research
There are many findings from this study that could benefit from additional
research. One of the implications from the study is regarding couple’s technology use to
stay connected during pregnancy. Couples reported that technology was used by
husbands to express to their wives that they were thinking about them and were available
to support them, even if husbands were not physically present. Technology use was also
found to be negative in some couple relationships. Some wives reported that their
husband was less present emotionally and more distracted while at home due to
technology use. It may be worth investigating in greater detail how technology can be
used to enhance or detract from husband involvement during pregnancy.
Another implication is the impact that husband involvement can have on maternal
mental health. One participant in the study reported that she had suffered from
postpartum depression after one of her pregnancies. She mentioned that the manner in
which her husband was involved during pregnancy made her more willing to talk to him
about her postpartum depression, which enabled him to help her work through that
diagnosis. It could be valuable to explore if there is a relationship between willingness to
103
share feelings of postnatal depression with a spouse and level of involvement during
pregnancy. The current study provides evidence that there could indeed be a relationship.
Another implication of the study is in regards to husbands and their comfort with
the healthcare system. Although the healthcare system is not part of the current theory,
there were important considerations that were mentioned by husbands during interviews.
Generally speaking, husbands find the healthcare system unwelcoming and apathetic
regarding husband involvement (Carter, 2002). Participants in the present study had
mixed emotions, with the overall conclusion that the healthcare system does not actively
encourage or discourage husband involvement during pregnancy. One exception was the
way that fathers in the study were treated by nurses. Husbands explained that labor and
delivery nurses were the most likely healthcare worker to actively involve husbands. It is
possible that doctors taking the time to discuss the importance of husband involvement
could play a role in how partner’s engage with their spouse during pregnancy, thereby
increasing the likelihood for positive couple outcomes.
Lastly, one interesting trend in the study related to one of the ways wives felt
loved by their husband during pregnancy. Multiple participants reported feeling loved by
their husband’s acts of service towards them. Acts of service is prominently discussed in
The 5 Love Languages (Chapman, 1995). Chapman discusses how there are different
ways in which individuals feel loved by others. The love languages have been
investigated and research suggests that love languages factor into the maintenance of
couple relationships (Egbert & Polk, 2006). Chapman further explains how love
104
languages can change over time and depending on life circumstances. With knowledge
that wives in the present study consistently reported acts of service had an impact on
feeling loved by their husband, it may prove beneficial to further investigate husband and
wife love languages during pregnancy. Husbands not having their own needs met was an
obstacle to husband involvement, and knowing how husbands could more effectively
have their needs met could prove beneficial to the couple relationship during pregnancy
and thereafter.
Limitations
As with all research, this study has limitations. The first limitation of the study
relates to the sample, in terms of education level, ethnic makeup, and socioeconomic
status. Most of the participants in the study had an education above a high school
diploma. The fathers who participated in the study were especially educated, which
could afford them more knowledge about how to effectively participate during
pregnancy. A sample of less educated participants might have resulted in different
barriers to participation in pregnancy and alternative ways of providing support to
partners.
Similar to the high education level, the sample is also skewed toward a high
socioeconomic level/status. The majority of the participants in the study had a family
income of $50,000 or higher. According to the 2016 US Census, the median family
income in the United States is about $59,000. This would place the majority of
participants in the study as middle to high class income status. As such, these
105
participants might be privy to resources that individuals of lower incomes may not be
able to ascertain.
In addition to the education and income level of the participants, the sample is not
very diverse in terms of ethnicity. A large number of the participants were of Caucasian
heritage. A moderate number of participants were of Hispanic or Latino decent and one
participant identified as being of Asian heritage. A future study on this subject would
most likely want to diversify in terms of race or ethnicity.
An additional limitation of the study is the potential for mental health problems,
such as depression, to impact the findings of the study. It is possible that some
participants could have been suffering from postpartum depression, which could have
possibly skewed the way they view their participation or their husband’s participation
during pregnancy. As a researcher and mental health provider, I do have experience with
depression and the characteristics people who have depression often display, however, I
could not fully grasp the impact of depression on interactions between the participants
due to not assessing for depression at the time of the interviews.
Summary
The aim of the study was to create a theory of how husband involvement during
pregnancy impacts the couple relationship postpartum. The theory created postulates that
proactive husband involvement improves the couple relationship postpartum. Proactive
husband involvement is comprised of many behaviors, which if engaged in can
strengthen a couple’s relationship in terms of trust, support, overall maturity, love, and
106
communication. Although some behaviors may take time and patience to develop, the
basic building block of proactive husband involvement is a positive attitude, a behavior
that all husbands are capable of displaying.
107
REFERENCES
Ahlborg, T., Dahlöf, L. G., & Hallberg, L. R. M. (2005). Quality of the intimate and
sexual relationship in first‐ time parents six months after delivery. Journal of Sex
Research, 42(2), 167-174.
Ahlborg, T., & Strandmark, M. (2001). The baby was the focus of attention–first‐ time
parents’ experiences of their intimate relationship. Scandinavian Journal of
Caring Sciences, 15(4), 318-325.
Ainsworth, M.S., Blehar, M.C., Waters, E., & Wall, S. (1978). Patterns of attachment: A
psychological study of the strange situation. Oxford, England: Lawrence Erlbaum.
Alio, A.P., Salihu, H.M., Korosky, J.L., Richman, A.M., & Marty, P.J. (2009). Feto-
infant health and survival: Does paternal involvement matter? Maternal and Child
Health Journal, 14, 931-937.
Altenburger, L. E., Lang, S. N., Schoppe-Sullivan, S. J., Kamp Dush, C. M., & Johnson,
S. (2017). Toddlers’ differential susceptibility to the effects of coparenting on
social–emotional adjustment. International Journal of Behavioral Development,
41(2), 228-237.
Altenburger, L. E., Schoppe-Sullivan, S. J., Lang, S. N., Bower, D. J., & Kamp Dush, C.
M. (2014). Associations between prenatal coparenting behavior and observed
coparenting behavior at 9-months postpartum. Journal of Family
Psychology, 28(4), 495.
American Psychological Association. (2016). Postpartum depression. Retrieved June 24,
2016, from http://www.apa.org/pi/women/resources/reports/postpartum-
depression.aspx
Anfara Jr, V. A., Brown, K. M., & Mangione, T. L. (2002). Qualitative analysis on stage:
Making the research process more public. Educational Researcher, 31(7), 28-38.
doi: 10.3102/0013189X031007028
Anney, V. N. (2014). Ensuring the quality of the findings of qualitative research:

Looking at trustworthiness criteria. Journal of Emerging Trends in Educational
Research and Policy Studies, 5(2), 272-281
Armstrong, D. S. (2002). Emotional distress and prenatal attachment in pregnancy after

perinatal loss. Journal of Nursing Scholarship, 34(4), 339-345.
108
Banse, R. (2004). Adult attachment and marital satisfaction: Evidence for dyadic
configuration effects. Journal of Social and Personal Relationships, 21(2), 273-
282.
Belsky, J., & Pensky, E. (1988). Marital change across the transition to parenthood.
Marriage & Family Review, 12(3-4), 133-156.
Belsky, J., Lang, M. E., & Rovine, M. (1985). Stability and change in marriage across the
transition to parenthood: A second study. Journal of Marriage and the Family,
47(4), 855-865.
Bengtson, V. L., & Allen, K. R. (2009). The life course perspective applied to families
over time. Sourcebook of family theories and methods (pp. 469-504). Springer
US.
Bernier, A., Tetreault, E., Belanger, M.E., & Carrier, J. (2017). Paternal involvement and
child sleep: A look beyond infancy. International Journal of Behavioral
Development, 41(6), 714-722.
Bocknek, E.L., Brophy-Herb, H.E., Fitzgerald, H.E., Schiffman, R.E., & Vogel, C.
(2014). Stability of biological father presence as a proxy for family stability:
Cross-racial associations with the longitudinal development of emotion regulation
in toddlerhood. Infant Mental Health Journal, 35, 309-321.
Boszormenyi-Nagy, I., & Spark, G. M. (1973). Invisible loyalties: Reciprocity in
intergenerational family therapy. Harper & Row.
Bowen, M. (1974). Alcoholism as viewed through family systems theory and family
psychotherapy. Annals of the New York Academy of Sciences, 233(1), 115-122.
Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. New York:
Brunner-Routledge.
Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary
Ainsworth. Developmental Psychology, 28(5), 759.
Brown, G. L., Schoppe-Sullivan, S. J., Mangelsdorf, S. C., & Neff, C. (2010). Observed
and reported coparenting as predictors of infant–mother and infant–father
attachment security. Early Child Development and Care, 180, 121–137.
Cabrera, N.J., & Garcia-Coll, C. (2004). Latino fathers: Uncharted territory in need of
much exploration. In M.E. Lamb (Ed.). The role of the father in child
development (4th ed., pp. 98–120). Hoboken, NJ: Wiley.
Carter, B., & McGoldrick, M. (Eds.). (1988). The changing family life cycle (2nd ed.).
109
Boston, MA: Allyn & Bacon.
Carter, M. (2002). Husbands and maternal health matters in rural Guatemala: Wives’
reports on their spouses’ involvement in pregnancy and birth. Social Science &
Medicine, 55(3), 437-450.
Centers for Disease Control and Prevention. (2017). Depression among women.
Retrieved from http://www.cdc.gov/reproductivehealth/depression/
Centers for Disease Control and Prevention. (2016). Pregnancy Complications. Retrieved
from:https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregcomplicat
ions.htm
Chang, J. J., Pien, G. W., Duntley, S. P., & Macones, G. A. (2010). Sleep deprivation
during pregnancy and maternal and fetal outcomes: is there a relationship? Sleep
medicine Reviews, 14(2), 107-114.
Chapman, G. (1995). The five languages of love. Chicago: Northfield.
Charmaz, K. (2006). Constructing grounded theory: A practical guide through

qualitative research. Sage Publications Ltd, London.
Charmaz, K. (2014). Constructing grounded theory: A practical guide through

qualitative analysis (2nd ed). Thousand Oaks, CA: Sage.
Christopher, C., Umemura, T., Mann, T., Jacobvitz, D., & Hazen, N. (2015). Marital
quality over the transition to parenthood as a predictor of coparenting. Journal of
Child and Family Studies, 24(12), 3636-3651.
Collins, N. L. & Freeney, B. C. (2005). Attachment processes in daily interaction:
Feeling supported and feeling secure. Unpublished manuscript, University of
California, Santa Barbara.
Condon, J. T., Boyce, P., & Corkindale, C. J. (2004). The first time fathers study: A
prospective study of the mental health and wellbeing of men during the transition
to parenthood. Australian and New Zealand Journal of Psychiatry, 38(12), 56-64.
Conde, A., Figueiredo, B., & Bifulco, A. (2011). Attachment style and psychological
adjustment in couples. Attachment & Human Development, 13(3), 271-291.
Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: The big life
change for couples. Lawrence Erlbaum Associates Publishers.
110
Cox, M. J., & Paley, B. (2003). Understanding families as systems. Current directions in
psychological science, 12(5), 193-196.
Cox, M. J., Paley, B., Burchinal, M., & Payne, C. C. (1999). Marital perceptions and
interactions across the transition to parenthood. Journal of Marriage and the
Family, 611-625.
Cox, M. J., Paley, B., Payne, C. C., & Burchinal, M. (1999). The transition to
parenthood: Marital conflict and withdrawal and parent–infant interactions. In M.
J. Cox & J. Brooks-Gunn (Eds.), The advances in family research series. Conflict
and cohesion in families: Causes and consequences (pp. 87-104). Mahwah, NJ:
Lawrence Erlbaum Associates.
Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five
approaches. Sage publications.
Creswell, J. W., & Poth, C. N. (2017). Qualitative inquiry and research design: Choosing
among five approaches. Sage publications.
D'Aniello, C., & Fife, S. T. (2017). Common Factors' Role in Accredited MFT Training
Programs. Journal of Marital and Family Therapy, 43(4), 591-604
Darwiche, J., Fivaz-Depeursinge, E., & Corboz-Warnery, A. (2016). Prenatal Intuitive

Coparenting Behaviors. Frontiers in psychology, 7, 1-6.
Davey, S. J., Dziurawiec, S., & O Brien-Malone, A. (2006). Men’s voices: Postnatal
depression from the perspective of male partners. Qualitative Health Research,
16(2), 206–220.
Deave, T., & Johnson, D. (2008). The transition to parenthood: What does it mean for
fathers? Journal of advanced nursing, 63(6), 626-633.
Deave, T., Johnson, D., & Ingram, J. (2008). Transition to parenthood: The needs of
parents in pregnancy and early parenthood. BMC Pregnancy and Childbirth, 8(1),
30.
Downer J., Campos, R., McWayne, C., & Gartner, T. (2008). Father involvement and
children’s early learning: A critical review of published empirical work from the
past 15 years. Marriage and Family Review, 43(1/2), 67-108.
Dozier, M., Stovall-McClough, K. C., & Albus, K. E. (2008). Attachment and
psychopathology in adulthood. In J. Cassidy & P.R. Shaver (Eds.), Handbook of
attachment: Theory, research and clinical applications. New York: Guilford.
111
Ducommun-Nagy, C. (2009). Forgiveness and relational ethics: The perspective of the

contextual therapist. In Forgiveness and reconciliation. Springer, New York, NY.
Durtschi, J. A., Soloski, K. L., & Kimmes, J. (2017). The dyadic effects of supportive
coparenting and parental stress on relationship quality across the transition to
parenthood. Journal of Marital & Family Therapy, 43(2), 308-321.
Duvall, E. M. (1977). Marriage and family development (5th ed.). Chicago, IL: J. B.
Lippincott.
Duvall, E. M. (1988). Family development’s first forty years. Family Relations, 37,
127–134.
Egbert, N., & Polk, D. (2006). Speaking the language of relational maintenance: A
validity test of Chapman's five love languages. Communication Research
Reports, 23(1), 19-26.
Feinberg, M. E. (2002). Coparenting and the transition to parenthood: A framework for

prevention. Clinical Child and Family Psychology Review, 5(3), 173–195.
Feinberg, M. E. (2003). The internal structure and ecological context of coparenting: A

framework for research and intervention. Parenting: Science and Practice, 3, 95–
132.
Feinberg, M. E., Kan, M. L., & Goslin, M. C. (2009). Enhancing coparenting, parenting,
and child self-regulation: Effects of family foundations 1 year after
birth. Prevention Science, 10(3), 276-285.
Fillo, J., Simpson, J. A., Rholes, W. S., & Kohn, J. L. (2015). Dads doing diapers:
Individual and relational outcomes associated with the division of childcare across
the transition to parenthood. Journal of Personality and Social
Gary, C. (1992). The Five Love Languages: The Secret to Love that Lasts.
Gavin, N., Gaynes, B., Lohr, K., Meltzer-Brody, S., Gartlehner, G., & Swinson, T.
(2005). Perinatal depression: A systematic review of prevalence and incidence.
Obstetrics & Gynecology, 106(5, Part 1), 1071–1083.
Gay, C. L., Lee, K. A., & Lee, S. Y. (2004). Sleep patterns and fatigue in new mothers
and fathers. Biological Research for Nursing, 5(4), 311-318.
112
Gervan, S., Granic, I., Solomon, T., Blokand, K., & Ferguson, B. (2012). Paternal
involvement in multisystemic therapy: Effects on adolescent outcomes and
maternal depression. Journal of Adolescence, 35, 743-751.
Gjerdingen, D. K., & Chaloner, K. (1994). Mothers' experience with household roles and
social support during the first postpartum year. Women & Health, 21(4), 57-74.
Glazier, R. H., Elgar, F. J., Goel, V., & Holzapfel, S. (2004). Stress, social support, and
emotional distress in a community sample of pregnant women. Journal of
Psychosomatic Obstetrics & Gynecology, 25(3-4), 247-255.
Glick, P. C. (1989). The family life cycle and social change. Family relations, 123-129.
Goodman, J. H. (2004). Paternal postpartum depression, its relationship to maternal

postpartum depression, and implications for family health. Journal of advanced
nursing, 45(1), 26-35.
Hackel, L., & Ruble, D. N. (1992). Changes in the marital relationship after the first baby
is born: Predicting the impact of expectancy disconfirmation. Journal of
Personality and Social Psychology, 62, 944 – 957.
Hodgson, J. L., McCammon, S. L., & Anderson, R. J. (2011). A conceptual and empirical
basis for including medical family therapy services in cancer care settings. The
American Journal of Family Therapy, 39(4), 348-359.
Kaye, D. K., Kakaire, O., Nakimuli, A., Osinde, M. O., Mbalinda, S. N., & Kakande, N.
(2014). Male involvement during pregnancy and childbirth: Men’s perceptions,
practices and experiences during the care for women who developed childbirth
complications in Mulago Hospital, Uganda. BMC pregnancy and
childbirth, 14(1), 54.
Katzelnick, D. J., Simon, G. E., Pearson, S. D., Manning, W. G., Helstad, C. P., Henk, H.
J., ... & Kobak, K. A. (2000). Randomized trial of a depression management
program in high utilizers of medical care. Archives of Family Medicine, 9(4), 345.
Kinanee, J. B., & Ezekiel-Hart, J. (2009). Men as partners in maternal health:

Implications for reproductive health counselling in Rivers State,
Nigeria. International Journal of Psychology and Counselling, 1(3), 039-044.
Kluwer, E. S., Heesink, J. A., & Vliert, E. (2002). The division of labor across the
transition to parenthood: A justice perspective. Journal of Marriage and
Family, 64(4), 930-943.
113
Kluwer, E. S., & Johnson, M. D. (2007). Conflict frequency and relationship quality
across the transition to parenthood. Journal of Marriage and Family, 69(5), 1089-
1106.
Lamb, M. E., Pleck, J. H., Charnov, E. L., & Levine, J. A. (1987). A biosocial
perspective on paternal behavior and involvement. Parenting across the life span:
Biosocial dimensions, 111-142.
Lawrence, E., Rothman, A. D., Cobb, R. J., Rothman, M. T., & Bradbury, T. N. (2008).
Marital satisfaction across the transition to parenthood. Journal of Family
Letourneau, N. L., Dennis, C., Benzies, K., Duffett-Leger, L., Stewart, M.,
Tryphonopoulos, P. D., & Watson, W. (2012). Postpartum depression is a family
affair: Addressing the impact on mothers, fathers, and children. Issues in Mental
Health Nursing, 33, 445-457.
Levine, A., Zagoory-Sharon, O., Feldman, R., & Weller, A. (2007). Oxytocin during
pregnancy and early postpartum: Individual patterns and maternal–fetal
attachment. Peptides, 28(6), 1162-1169.
Lindgren, K. (2001). Relationships among maternal–fetal attachment, prenatal

depression, and health practices in pregnancy. Research in Nursing &
Health, 24(3), 203-217.
Iles, J., Slade, P., & Spiby, H. (2011). Posttraumatic stress symptoms and postpartum
depression in couples after childbirth: the role of partner support and
attachment. Journal of Anxiety Disorders, 25(4), 520-530.
Martin, L. T., McNamara, M. J., Milot, A. S., Halle, T., & Hair, E. C. (2007). The effects
of father involvement during pregnancy on receipt of prenatal care and maternal
smoking. Maternal and child health journal, 11(6), 595-602.
McDaniel, B. T., Teti, D. M., & Feinberg, M. E. (2017). Assessing coparenting

relationships in daily life: The Daily Coparenting Scale (D-Cop). Journal of Child
and Family Studies, 1-16.
McKenna, K. Y., Green, A. S., & Gleason, M. E. (2002). Relationship formation on the
Internet: What’s the big attraction? Journal of social issues, 58(1), 9-31.
McNaughton-Cassill, M. E. (2002). Support groups help manage stress. Fertility Weekly,

7-8.
114
Merriam, S. B. (2009). Qualitative research: A guide to design and implementation. San

Francisco: John Wiley and Sons.
Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics,

and change. Guilford Press.
Minuchin, S. (1974). Families and family therapy. Harvard University Press.
Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA:
Harvard University Press.
Moller, K., Hwang, C. P., & Wickberg, B. (2008). Couple relationship and transition to
parenthood: Does workload at home matter? Journal of Reproductive and Infant
Psychology, 26, 57–68.
Nock, S. L. (1995). A comparison of marriages and cohabiting relationships. Journal of

Family Issues, 16(1), 53-76.
Patton, M.Q. (1980). Qualitative evaluation methods. Newbury Park, CA: Sage
Petch, J., & Halford, W. K. (2008). Psycho-education to enhance couples’ transition to

parenthood. Clinical Psychology Review, 28, 1125–1137
Pietkiewicz, I., & Smith, J. A. (2014). A practical guide to using interpretative

phenomenological analysis in qualitative research psychology. Psychological
Journal, 20(1), 7-14.
Roberts, S. L., Bushnell, J. A., J. A., Collings, S. C., & Purdie, G. L. (2006).
Psychological health of men with partners who have postpartum depression.
Australian & New Zealand Journal of Psychiatry, 40(8), 704-711.
Salisbury, A., Law, K., LaGasse, L., & Lester, B. (2003). Maternal-fetal attachment.
Jama, 289, 1701-1701.
Salmela-Aro, K., Aunola, K., Saisto, T., Halmesmäki, E., & Nurmi, J.-E. (2006). Couples
share similar changes in depressive symptoms and marital satisfaction
anticipating the birth of a child. Journal of Social and Personal Relationships, 23,
781–803.
Saracho, O. (2008). Fathers’ and young children’s literacy experiences. Early Child
Development and Care, 178, 837-852.
115
Sassler, S., Cunningham, A., & Lichter, D. T. (2009). Intergenerational patterns of union
formation and relationship quality. Journal of Family Issues, 30, 757-786.
Seedall, R. B., & Wampler, K. S. (2013). An attachment primer for couple therapists:
Research and clinical implications. Journal of Marital and Family
Therapy, 39(4), 427-440.
Shapiro, A. F., Gottman, J. M., & Carrere, S. (2000). The baby and the marriage:
Identifying factors that buffer against decline in marital satisfaction after the first
baby arrives. Journal of Family Psychology, 14(1), 59.
Simpson, J. A. (1990). Influence of attachment styles on romantic relationships. Journal

of Personality and Social Psychology, 59(5), 971
Simpson, J. A., Rholes, W. S., Campbell, L., Tran, S., & Wilson, C. L. (2003). Adult
attachment, the transition to parenthood, and depressive symptoms. Journal of
Personality and Social Psychology, 84, 1172 – 1187.
Skalotis, E. (2010). Changes in parental involvement in secondary education: An

exploration study using the longitudinal study of young people in England. British
Educational Research Journal, 36, 975-994.
Smith, J. A. (Ed.). (2015). Qualitative psychology: A practical guide to research

methods. Sage.
Stainton, M. (1985). The fetus: A growing member of the family. Family

Relations, 34(3), 321-326.
Stevens, F. L. (2014). Affect Regulation Styles in Avoidant and Anxious

Attachment. Individual Differences Research, 12(3), 123-130.
Steinberg, L., & Silverberg, S. B. (1987). Influences on marital satisfaction during the
middle stages of the family life cycle. Journal of Marriage and the Family, 751-
760.
Strathearn, L., Fonagy, P., Amico, J., & Montague, P. R. (2009). Adult attachment
predicts maternal brain and oxytocin response to infant cues.
Neuropsychopharmacology, 34, 2655-2666.
Strauss, A. L. (1987). Qualitative analysis for social scientists. Cambridge University

Press.
116
Strauss, A., & Corbin, J. M. (1990). Basics of qualitative research: Grounded theory
procedures and techniques. Sage Publications, Inc.
Sullivan, R., Perry, R., Sloan, A., Kleinhaus, K., & Burtchen, N. (2011). Infant bonding
and attachment to the caregiver: Insights from basic and clinical science. Clinics
in Perinatology, 38(4), 643-655.
Tamis-LeMonda, C.S., Shannon, J.D., Cabrera, N.J., & Lamb, M.E. (2004). Fathers and
mothers at play with their 2- and 3-year-olds: Contributions to language and
cognitive development. Child Development, 75(6), 1806-1820.
Tannenbaum, L., & Forehand, R. (1994). Maternal depressive mood: The role of the
father in preventing adolescent problem behaviors. Behaviour Research and
Therapy, 32(3), 321-325.
Theiss, J.A., Estlein, R., & Weber, K.M. (2013). A longitudinal assessment of
relationship characteristics that predict new parents’ relationship satisfaction.
Personal Relationships, 20, 216-235.
Twenge, J. M., Campbell, W. K., & Foster, C. A. (2003). Parenthood and marital
satisfaction: A meta‐ analytic review. Journal of marriage and family, 65(3),
574-583.
Twist, M. L., & Hertlein, K. M. (2013). The couple and family technology framework:
Intimate relationships in a digital age. Routledge.
Tyndall, L., Hodgson, J., Lamson, A., White, M., & Knight, S. (2012). Medical family
therapy: Charting a course in competencies. Contemporary Family Therapy, 34,
171–186. doi: 10.1007/s10591-012-9191-9.
Van Egeren, L. A. (2004). The development of the coparenting relationship over the
transition to parenthood. Infant Mental Health Journal, 25, 453–477.
Varga, C. M., Gee, C. B., Rivera, L., & Reyes, C. X. (2014). Coparenting mediates the
association between relationship quality and father involvement. Youth & Society,
49(5), 588-609
Vreeswijk, C. M., Maas, A. B., Rijk, C. H., Braeken, J., & van Bakel, H. J. (2014).
Stability of fathers’ representations of their infants during the transition to
parenthood. Attachment & Human Development, 16(3), 292-306.
Walsh, F. (2015). Strengthening family resilience. New York: Guilford Press.
117
APPENDICES
APPENDIX A. LETTER OF IRB APPROVAL
UNLV Social/Behavioral IRB - Expedited Review

Approval Notice
DATE: January 16, 2018
TO: Katherine Hertlein

FROM: UNLV Social/Behavioral IRB
PROTOCOL TITLE: [1171698-4] Husband Involvement During Pregnancy

SUBMISSION TYPE: Revision
ACTION: APPROVED
APPROVAL DATE: January 15, 2018
EXPIRATION DATE: January 14, 2019
REVIEW TYPE: Expedited Review
Thank you for submission of Revision materials for this protocol. The UNLV
Social/Behavioral IRB has APPROVED your submission. This approval is based on an
appropriate risk/benefit ratio and a protocol design wherein the risks have been
minimized. All research must be conducted in accordance with this approved submission.
PLEASE NOTE: Upon approval, the research team is responsible for conducting the
research as stated in the protocol most recently reviewed and approved by the IRB, which
shall include using the most recently submitted Informed Consent/Assent forms and
recruitment materials. The official versions of these forms are indicated by footer which
contains approval and expiration dates. If your project involves paying research
participants, it is recommended to contact Carisa Shaffer, ORI Program Coordinator at
(702) 895-2794 to ensure compliance with subject payment policy.
Should there be any change to the protocol, it will be necessary to submit a Modification
Form through ORI - Human Subjects. No changes may be made to the existing protocol
until modifications have been approved.
118
ALL UNANTICIPATED PROBLEMS involving risk to subjects or others and SERIOUS

and UNEXPECTED adverse events must be reported promptly to this office. Please use
the appropriate reporting forms for this procedure. All FDA and sponsor reporting
requirements should also be followed.
All NONCOMPLIANCE issues or COMPLAINTS regarding this protocol must be

reported promptly to this office.
This protocol has been determined to be a Minimal Risk protocol. Based on the risks, this
protocol requires continuing review by this committee on an annual basis. Submission of
the Continuing Review Request Form must be received with sufficient time for review
and continued approval before the expiration date of January 14, 2019.
If you have questions, please contact the Office of Research Integrity - Human Subjects
at IRB@unlv.edu or call 702-895-2794. Please include your protocol title and IRBNet ID
in all correspondence.
Office of Research Integrity - Human Subjects

4505 Maryland Parkway. Box 451047. Las Vegas, Nevada 89154-1047
(702) 895-2794. FAX: (702) 895-0805. IRB@unlv.edu
119
APPENDIX B. INFORMED CONSENT
Department of Couple and Family Therapy
TITLE OF STUDY: Husband Involvement during Pregnancy

INVESTIGATOR(S): Katherine Hertlein, Ph.D., Brandon Eddy, M.S.
For questions or concerns about the study, you may contact Brandon Eddy at
brandon.eddy@unlv.edu OR Katherine Hertlein at katherine.hertlein@unlv.edu
For questions regarding the rights of research subjects, any complaints or comments
regarding the manner in which the study is being conducted, contact the UNLV Office of
Research Integrity – Human Subjects at 702-895-2794, toll free at 877-895-2794 or
via email at IRB@unlv.edu.
Purpose of the Study

You are invited to participate in a research study. The purpose of this study is to build a
theory detailing how husband involvement during pregnancy impacts the couple
relationship postpartum.
Participants
You are being asked to participate in the study because you fit these criteria: Married,
heterosexual couples who had baby 2-6 months ago. Participants who have a history of
misscarriage, or became pregnant through assisted reproductive technology do not meet
inclusion criteria for this study. The informed consent must be signed by both partners
prior to the interview. If both partners do not sign the informed consent form then the
interview will not take place.
Procedures
If you volunteer to participate in this study, you will be asked to do the following:
Complete a demographic questionnaire prior to the interview. Participants will then be
interviewed individually for 20-30 minutes and then interviewed together as a couple for
20-30 minutes. Altogether this should take approximately 60-90 minutes All interviews
will be audio-recorded.
Benefits of Participation
There may be direct benefits to you as a participant in this study. However, we hope to
learn how couples can strengthen their relationship during pregnancy, a time that is
usually high stress for couples.
120
Risks of Participation
There are risks involved in all research studies. This study involves little risk to
participants. For this study you will be asked to discuss challenging or stressful moments
you experienced during you or your spouse’s most recent pregnancy. You may choose
not to answer any question you feel uncomfortable with.
Cost/Compensation
There is no financial cost to you to participate in this study. The study will take 60-90
minutes of your time and you will be compensated for your time. Upon completion of all
interviews you will receive a $20 Visa Gift Card. If either partner chooses to withdraw
from the study prior to completion of the interviews they will not qualify for the gift card.
Confidentiality
All information gathered in this study will be kept as confidential as possible. No
reference will be made in written or oral materials that could link you to this study. All
records will be stored in a locked facility at UNLV for 10 years after completion of the
study. After the storage time the information gathered will be deleted.
Voluntary Participation
Your participation in this study is voluntary. You may refuse to participate in this study
or in any part of this study. You may withdraw at any time without prejudice to your
relations with UNLV. You are encouraged to ask questions about this study at the
beginning or any time during the research study.
Participant Consent:
I have read the above information and agree to participate in this study. I have been able
to ask questions about the research study. I am at least 18 years of age. A copy of this
form has been given to me.
Signature of Participant Date Printed Name
Audio/Video Taping:
I agree to be audio taped for the purpose of this research study.
121
APPENDIX C. GROUNDED THEORY INTERVIEW GUIDES
Semi-Structured Interview Guide for Husbands
1. What kind of things did your wife do to prepare for the baby and what was your
involvement in those things?
2. Can you describe your overall participation during pregnancy?
3. How would you describe your emotional connection with your spouse before
pregnancy?
4. How would you describe your emotional connection with your spouse during
pregnancy?
5. How would you describe your current emotional connection with your spouse?
6. Please elaborate about occasions, if any, that you were unresponsive or unavailable to
your wife during pregnancy.
7. When you look back on the pregnancy, what were your wife’s most significant needs
and how did you respond to them?
8. How did you ensure your own needs were met during pregnancy?
9. Please describe any significant moments or instances during pregnancy that you feel
impacted or changed your relationship positively or negatively?
10. Please elaborate about the moments, if any, that you felt excluded or unimportant
during the pregnancy?
11. Can you describe moments where you found it difficult to be involved or difficult to
support your wife during the pregnancy?
12. Were you as involved as you would have liked to be during the pregnancy? If not,
could you please explain what hindered your involvement?
13. Can you describe the quality of your relationship with your spouse since you had your
baby?
14. How do you think your involvement during pregnancy influenced your current
relationship?
15. What do you think constitutes good husband involvement and where did you learn it?
16. What advice would you give to pregnant couples to help them maintain a great
relationship?
122
Semi-Structured Interview Guide for Wives
1. What kind of things did you do to prepare for the baby and what was your husband’s
involvement in those things?
2. Can you describe what your husband’s overall participation during pregnancy?
3. How would you describe your emotional connection with your spouse before
pregnancy?
4. How would you describe your emotional connection with your spouse during
pregnancy?
5. How would you describe your current emotional connection with your spouse?
6. How did your husband emotionally support you during pregnancy?
7. Please elaborate on the moments, if any, that your husband was unresponsive or
unavailable to you during pregnancy?
8. When you look back on your pregnancy, what were your most significant needs and
how did your husband respond to them?
9. How did your husband express his needs during pregnancy?
10. Will you describe any significant moments or instances during pregnancy that you
feel impacted or changed your relationship positively or negatively?
11. What times do you wish your husband would have been more involved during
pregnancy?
12. Can you describe the quality of your relationship with your spouse since you had your
baby?
13. How did your husband’s involvement during pregnancy influence your current
relationship?
14. What advice would you give to pregnant couples to help them maintain a great
relationship?
123
Semi-Structured Interview Guide for Couple Interview
1. Please discuss your relationship over the course of the pregnancy and how you feel it
may have changed?
2. Will you discuss how each of you expressed needs that you had during the pregnancy?
A. How well did your spouse meet those needs?
3. How did you make decisions regarding prenatal care and childbirth?
4. Do you believe the healthcare system encourages or hinders husband involvement
during pregnancy?
A. Why?
B. What might the healthcare system do to more actively encourage husbands to be
involved?
5. Were there times your husband tried to support you, but just wasn’t as helpful as he
intended?
A. Can you explain why?
6. How did you know the best way to support your wife during pregnancy?
7. Looking back, what was the most helpful thing your husband did to support you?
8. Looking back, what would you do differently to support your spouse?
9. How did the ways in which you interacted with your spouse during pregnancy impact
your current relationship?
10. What challenges did you experience in terms of physical intimacy? How do you think
that impacted your relationship?
11. Can you share your experience of the delivery with me?
124
APPENDIX D. DEMOGRAPHIC QUESTIONNAIRE
Sex
o Male
o Female
Age_____________
What is your Race/Ethnicity?

o Black or African American
o Hispanic/Latino
o Caucasian/White
o Asian/ Pacific Islander
o Native American
o Multiracial
o Other
What is your religious affiliation?

o Catholic
o Protestant
o Mormon
o Jewish
o Muslim
o Non-religious
o Other
o Prefer not to answer
What is the highest level of education you have completed?

o Some high school
o High school graduate
o Associates degree
o Technical Training degree
o Bachelor’s degree
o Advanced degree
125
What is your gross income level for the previous year?

o $20,000 or less
o $20,000-50,000
o $50,000-75,000
o 75,000-100,000
o $100,000+
How many children do you have?

o 1
o 2
o 3
o 4+
Was your pregnancy planned?

o Yes
o No
By what means was your baby delivered?
o Vaginal Birth
o C-Section
Have you ever been diagnosed with depression?

o Yes
o No
126
E. RECRUITMENT FLYER
Couple and Family Therapy Program

University of Nevada Las Vegas
Husband Involvement during Pregnancy
We are looking to interview heterosexual, married couples

who have had a baby in the previous 2-6 months.
As a participant in this study, you would be asked to discuss your relationship during your
most recent pregnancy.
Your participation would involve completing a short demographic questionnaire, one

individual interview, and one couple interview. The interviews will take approximately 60-
90 minutes. Interviews will take place at the participant’s residence, at the Center for
Individual, Couple, and Family Counseling at UNLV, or via telephone. Couples who have
a history of miscarriage, or became pregnant through assisted reproductive technology do
not qualify for this study
In appreciation for your time, you will receive a $20 Visa gift card
For more information about this study, or to volunteer for this study, please contact:
Brandon Eddy
brandon.eddy@unlv.edu (801-814-6000)
OR
Katherine Hertlein, Ph.D.

Katherine.hertlein@unlv.edu (702-895-3210)
The study has been reviewed and approved by the

Institutional Review Board, UNLV
127
F. SAMPLE MEMOS
Early Stage
First off, I feel extremely pleased by how the interview went. There are definitely tweaks
that need to be made to some interview questions, but overall I think the questions
adequately covered early, middle, and late stages of pregnancy, as well as how the
current relationship is
One thing I noticed was how the wife mentioned that emotional support was the thing
most appreciated by her. The husband seemed to feel that he didn’t provide enough
support, but his wife reported that he was amazing providing emotional support. I
wonder if different genders interpret emotional support differently.
Late Stage
After many interviews I am definitely noticing a theme of emotional support being the
most important kind of husband involvement. Most husbands seem aware of the
importance of emotional support, however each has a different way of providing
emotional support. Some take part in physical tasks, which helps their wife emotionally.
Others attempt to limit the wife’s stress or give her space to relax emotionally. Others
aren’t sure what to do, so they just express a willingness to do whatever is necessary to
help their spouse.
128

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Husband Involvement during Pregnancy: A grounded theory

Brandon P. Eddy, M.S.

Couple, Marriage, and Family Therapy

Submitted to the Graduate Faculty

Stephen Fife, Ph.D.

Jason Whiting, Ph.D.

Nicole Piland Springer Ph.D.

Jaclyn Cravens, Ph.D.

First, I wish to acknowledge my dissertation committee. To my chair, Steve,

mentorship and for pushing me to go further than I thought possible. Additionally I

participated in transcription, aided me in coding, and were a fantastic research team

from start to finish. Thank you.

Next I wish to acknowledge family members who have provided me support.

an education. My entire academic journey started with your persistent encouragement.

Mason. In order to be successful in my schooling, I have had to be gone from home

LIST OF TABLES .................................................................................................. vi

CHAPTER I: INTRODUCTION .......................................................................... 1

CHAPTER II: LITERATURE REVIEW............................................................. 7

CHAPTER III: METHODS ................................................................................... 28

CHAPTER IV: RESULTS ..................................................................................... 42

Behavior 6: Responding in Significant Moments ......................................... 70

REFERENCES ........................................................................................................ 108

husband involvement during pregnancy impact the couple relationship postpartum?

involvement during pregnancy helps to strengthen the couple relationship postpartum.

Proactive husband involvement consists of 7 behaviors: helping with a positive

attitude, engaging in daily tasks, understanding and empathetic response, providing

engaged in proactive husband involvement found the couple relationship strengthened

Keywords: Proactive Husband Involvement, Pregnancy, Transition to Parenthood,

Family Life Cycle

2.1. Individual Characteristics Demographics Table .............................................. 31

Importance of the Study

Belsky, Lang, & Rovine, 1985).

transition to pregnancy is prenatal planning and a stable relationship before pregnancy.

pregnancy have been found to have healthier relationships postpartum (Lawrence,

satisfaction during pregnancy generally leads to a decrease in marital difficulties after

satisfaction, it could prove beneficial to examine how husband involvement during

pregnancy positively or negatively impacts the couple relationship.

Although there is evidence that paternal involvement during pregnancy is

involvement during pregnancy contributes to stronger couple relationship postpartum.

There is a wealth of information on how pregnancy negatively impacts the couple

to build a theory of how husband involvement during pregnancy affects couple

relationship postpartum. To date, no theory exists detailing how husband involvement

husband involvement. Building a theory about how husband involvement during

pregnancies in ways that strengthens couple relationships. It is also plausible that a

maternal health problems during the postpartum time period.

pregnancy related stressors during the transition to parenthood. Furthermore, the

husbands to participate in their wives’ pregnancies in a way that is meaningful to their

understand the importance and necessity of paternal involvement during pregnancy.

through pregnancy and postpartum.

Theoretical Framework of the Study

relationship. Partner involvement, availability, and responsiveness during pregnancy can

involvement? By answering these questions I was able to develop a theory of how

couples effectively navigate the transition to parenthood through proactive husband

involvement during pregnancy and continued involvement postpartum.

Purpose of the Dissertation

order to meaningfully contribute during pregnancy and to understand what factors

contribute to proactive husband involvement. Many husbands want to be involved during

importance and necessity of healthcare providers actively involving husbands in all

aspects of maternal care.

I feel extremely passionate about my dissertation topic. As a therapist and a

stressful pregnancy can be on the couple relationship. During each of my wife’s

difference in strengthening our relationship. To me, involvement means more than

physical support; it involves attending doctor appointments, nesting, emotional support,