The women who were interviewed had a mean age of 25.9 years, ranging from 18 to 35 years old. The partners varied in age from 19 to 37 years old with a mean age of 27.9 years. The women and their partners were mainly White-British but there was one South-East Asian couple, and three where one partner was White-British and the other Brazilian, Dutch or Asian. They had a range of socio-economic backgrounds and came from several different geographical areas of the two healthcare organisations. The women's employment status was varied, for example, these included several different professions (n = 6), administrators (n = 4), teachers (n = 2), secretaries (n = 2), looking after the home (n = 2) and manual worker (n = 1). There were also two women who were unemployed and one who was a student. The partners' employments ranged from those who were manual workers (n = 7) to those who were professionals (n = 6). One was also a student, one who was unemployed and another who was on Incapacity Benefit.
We aimed to recruit equal numbers of women who were in a stable relationship and those who said that they were not. However, recruitment of women who were without a partner was very slow and we recruited only four in the time available. Nevertheless, we found their views were similar to other women in the study and they did not introduce subjects that had not already been raised.
Themes arising from the interviews
The themes that emerged from the antenatal interviews included: types of support received and available to the women and their partners; their views on their preparation for parenthood, the postnatal period and baby care; and the information they received and sources of this information. Postnatally, issues included some of those above (support, information and preparation) but in addition, the following were highlighted: breastfeeding and the pressure to do so; parents' relationships and the challenges they had been, and were, going through; and partners' perspectives on their involvement and inclusion in the care his partner had received both antenatally and postnatally. Parents also expressed feelings such as fear, excitement and joy about becoming parents. These themes will be discussed below, following the transitional process from pregnancy to parenthood, rather than the order of importance.
Support received and available
The women identified five groups of people who were important to them for support: their partners, their own parents, friends and colleagues, health professionals and antenatal and/or postnatal groups. The partners, however, only mentioned their own partner, their colleagues and health professionals as avenues of support that were open to them.
The main area of support that the women expected to, and felt secure in turning to, were female relatives, mainly their mother, but aunts, grandmothers and sisters were also mentioned.
My mum...she's been pretty good. She knows not to overstep the line. She's suggesting but she won't ever say.
[mother #20045, postnatal interview]
The importance of the woman's mother really stood out. This was in contrast to the men who occasionally mentioned their own father, mostly in the sense that they wanted to offer their own child a different fathering experience.
Postnatally, the practical aspect of support and help that their mother gave them ranged from aspects of baby care to housework, cooking and/or babysitting, so that the couple could have 'time out'.
Everything [things her mum helped her with]. Draw a bottle, tea, cooking, housework, everything.
[mother #20037, postnatal interview]
Friends and colleagues
The women valued friends who had been through childbirth recently or who had experience of childcare. 'The information and support they could offer was greatly appreciated and sought after. In some instances these were relatively new friends who they had met at their antenatal classes but who had had their babies before them. The sharing of experiences was of paramount importance, in one instance this included the helpfulness of an interactive website. In comparison, the men appeared to lack support networks, some even felt that they had no-one to turn to, apart from their partner and, for some, their work colleagues.
Yes, my colleague's just had a baby, about 6 months old now ...then we've got the old administrator who says what it was like in her day and things like that what the pregnancy was like and the involvement of a man.
[partner #20010, antenatal interview]
Others felt they could only turn to health professionals, due to a lack of support from other sources. One father felt very strongly that, because he was employed, he was unable to access any support and therefore felt punished for working.
...I mean all my sort of friends from school I have lost contact with and I haven't really got any friends, nothing like that, it's basically work. I felt that, because I worked, I wasn't being allowed to be involved in any of it. I felt punished for working...you are missing everything.
[partner #20052, postnatal interview]
The support received from community health professionals was described as being quite varied but generally more positive than negative. Comments related to the importance of continuity of care, both from the midwife and health visitor, especially because this was often not achieved. The women also thought that the role of the midwife in the postnatal period should be longer than two weeks due to the trust that had built up antenatally.
....in those two weeks you've built up such a relationship. I felt comfortable and... a few weeks is not long enough for breastfeeding and all that...When she left I felt very alone.... Because she takes all my notes and I didn't have any contact numbers for the health visitor. What do I do in the next week?.... A relationship with someone, it's trust isn't it? [mother #20058, postnatal interview]
Those families who had received only one home visit from the health visitor, in contrast to frequent midwives' visits, were critical of the small amount of contact.
She just came the once [health visitor]....she said we don't visit anymore. You will have to come up to the surgery.
[mother #20039, postnatal interview]
Antenatal and postnatal groups
Some of the women had attended antenatal classes. These classes are usually held during the day, which makes it difficult for some working men to attend with their partners. Women who kept in postnatal contact with those in their antenatal group greatly valued the support. One or both parents spoke highly of this source of support and mentioned it several times.
....the people who are really useful are the people that go through it at the same time...... Without that we'd really be struggling, without that network of mums that H [his partner] only met through antenatal classes....we don't need any help/support, or very little, other than this antenatal group.
[partner #20058, postnatal interview]
The usefulness of this 'support' was mainly perceived as reassurance; that, as new parents, they were all going through similar difficulties and experiences. In addition, it was encouraging that trying out different solutions to problems to find out what suited them best was not only normal and acceptable but also common practice.
Yeah we all get together and sort of lash things out and talk, babies...and you know everybody learns from their own experiences and if we all can sort of contribute, that's really good.
[mother #20055, postnatal interview]
It also provided a forum in which the mothers (since they often consist only of women) could exchange hints and tips as to what had 'worked' for each of them, eg. in relation to sleeping problems. The mothers often then fed the advice and reassurance back to their partners.
Preparation for parenting and baby care
Both parents alluded to the fact that antenatal classes were mainly aimed at the woman and they were generally not well attended by expectant fathers. They said that the topics covered in the classes were useful but mainly concentrated on pregnancy and birth, with little if any, discussion about parenthood.
I would say that that was one thing that I haven't received the information on, the baby element, bay care...when it is here and that's probably why I'm not so confident really.
[woman #21004, antenatal interview]
Antenatally, although the expectant parents felt excited about life with a baby they also expressed feelings of apprehension about caring for their baby about both the practical and general aspects of caring for a baby. They felt unprepared for becoming parents. The men articulated feelings of ignorance and fear about soon having a baby at home.
...how to hold a baby. I know the principle, but the actual doing it....The fact that you can't communicate, you can't talk... [partner #20010, antenatal interview]
Postnatally, in the first few weeks with their new baby, many parents mentioned feelings of surprise, confusion and excitement. They also spoke of overwhelming emotions towards their baby: amazement, love and a sense of great responsibility; that it was a life-changing event.
Every time I see her I still cannot believe she is mine or I am really a mum now (laughter)....It changes your whole life completely...there are no words to describe it really, but it is just overflowing with joy.
[mother #20036, postnatal interview]
The parents drew attention to the different ways in which they each interacted with their baby and the consequent reactions their baby displayed. For example, parents noticed that the father often played more with their babies, especially on return from work but that the mother was often able to calm their baby more easily when upset.
And sometimes my husband is quite jealous because every time she sees me, it is like, she sees me as comfort you know. I am the one feeding her, singing to her something like that. Every time she sees her dad she is always playing. My husband says, how come she does not sleep with me, every time she sees me it is like playtime. She always plays with her dad.
[mother #20033, postnatal interview]
Type and sources of useful information
Parents gathered, and were given, information from a variety of sources, both before and after their baby was born. Family and friends, work colleagues, healthcare professionals, discussions at antenatal appointments and antenatal classes, leaflets and books, television, videos and the internet were all referred to. In addition, as previously mentioned, their own parents' knowledge often appeared to be valued even though it was not usually recent.
The midwife was generally seen as a reliable source of information and someone to whom the woman could turn for advice and support. The two main sources of information given out by midwives were the NHS Pregnancy Book, a Department of Health, evidence-based, comprehensive guide given to all expectant parents , supported by a variety of leaflets. The Pregnancy Book was singled out by many parents as being very useful, comprehensive and something that they referred to on a regular basis.
Yeah, it's brilliant [NHS Pregnancy Book], I always look there when I need reassurance or just a little read through really.
[woman #20004, antenatal interview]
Most parents had read books, some of which they had bought, others had been given or lent them by family and friends, or borrowed from the library. Antenatally, parents watched television programmes relating to pregnancy and birth, and accessed the internet. Commercial gift packs, given to women early in pregnancy, were mentioned by many women, especially those who had signed up to receive weekly emails about their pregnancy. However, such advertising was not acknowledged as potentially influential in their choice of products. Nonetheless, whether in the form of literature, television programmes or services, there appeared to be few resources intended for fathers either ante- or postnatally, especially for those who were unable to take time off during the day.
I was sort of trying to push for information and I was finding it hard to get...from a dad's point of view.
[partner #20014, antenatal interview]
For blokes that don't work the same sort of hours as I do there is actually one [a group] run with just dads, run just through the day...but I mean there is nothing I heard of for dad's in the evenings....I would have loved to have done it. You know, meet a couple of people. [partner #20052, postnatal interview]
In discussing what else might have been helpful to them, eight parents raised the idea of a new DVD that could be specifically targeted at them. For those other parents who themselves did not mention the idea of a DVD, this was introduced at the end of the interview. They felt that an innovative DVD would be a helpful and supportive resource to have when entering parenthood. They thought that if one was available, late pregnancy would be a good time to watch it when they would have time to do so.
It would be nice if the midwives could do a mini-video like thing? About mothers' experiences? Let other mothers know about what's going on, what's going to happen to them....Yeah, 'cos you could sit in your own comfort of your own home and watch it in detail, and you can always play it back to yourself.
[woman #20007, antenatal interview]
I've looked in DVD stores and found that there isn't really that much, it's more to do with exercise and pregnancy, but that would be an excellent addition.
[partner #20024, antenatal interview]
Women mainly gained advice and information about breastfeeding from midwives, either in antenatal classes where videos might have been used, or through being given leaflets to read.
but we did one yesterday on breastfeeding ....the breastfeeding was one of the most informative for me.. they picked up in the itinerary that this one was gonna be about breastfeeding so none of the men that normally come came.
[woman #21004, antenatal interview]
Men often excluded themselves from the antenatal breastfeeding sessions because they did not feel that breastfeeding was relevant to them. Their partners were usually of the same opinion and this was sometimes backed up by midwives who told them they didn't need to attend when breastfeeding was being discussed.
I think if it was general feeding he would have, because it was just breastfeeding he didn't feel that he'd have anything to do with it. [woman #20022, antenatal interview]
The majority of women started breastfeeding and wanted to succeed in doing so but many commented on the pressure they felt, from health professionals, to continue.
We struggled on for six days trying to breastfeed. It wasn't so much that the midwife pushed you to carry on breastfeeding, because when we made the decision that we wanted to stop they were actually really supportive. I was worried that I was going to get given a hard time, but they were actually fantastic. [mother #20055, postnatal interview]
During the antenatal interviews the women and their partners were aware that they themselves might change when they became parents but made few allusions to the possibility of any change in their relationship.
The bit afterwards I think we both know that we'll change quite a lot, personality wise and stuff, I think we'll both change a lot. [woman #21003, antenatal interview]
This was in contrast to postnatally when parents talked openly about the additional stresses on their relationships. They expressed surprise at the demands that had been placed on their relationships and the effect that having a baby had had on them as a couple.
We don't argue, we don't snap at one another. And......knowing I was doing it...for no good reason and was upsetting her ... things would've been different if we hadn't been as strong together. If you got any, any stress in your marriage, and a kid, they would struggle I think. [partner #20051, postnatal interview]
There was also some sadness and bemusement that no-one had talked to them about the changes they would experience in their relationships. Postnatally, they could understand why the changes had taken place but would have preferred to have been warned in advance.
[Partner]: I mean if the awareness could have been made a lot more, because no one ever really spoke to us about that other side...and the relationship with us and the baby. It was never the relationship with us.
[Mother]: About relationships, like, it was always about the baby. [postnatal interview #20052]
Making time to talk and spending time together were recognised as valuable ways to reduce relationship tensions. Although these were common feelings, the parents made many positive comments about feeling like a family and enjoying their baby.
I think that we're probably closer if anything because we sort of feel like a complete package.
[mother #20036, postnatal interview]
The interview experience itself allowed couples 'time out' to discuss their feelings, concerns and relationships. It often proved to be a positive experience that highlighted the need for them to make time to communicate their feelings. For one couple, the partner implied that they might have split up if they hadn't realised the need to make that time.
If this carried on we would not have been together for this meeting. We sort of sat down and we tried about two or three different ways and thought about it .. now we've got just back to the way we were before. The only difference is we've got a little girl. [partner #20051, postnatal interview]
The womens' partners generally felt very involved with the woman's pregnancy but often felt excluded from antenatal appointments and classes.
I didn't find it very useful to be honest with you, because it was not ... it was more on S. [his partner] and her pain. I don't ... I wasn't ready and they didn't involve ...The only thing they said I could really do was just be there and that was it really.
[partner #20013, antenatal interview]
The men mentioned there was a lack of information for them and that they were personally given none of the contact numbers for midwives, health visitors etc.
I was terrified... you know the sort of the care is, it is very much geared towards the women, I am not aware of anyone or have any numbers that I can speak to.
[partner #20058, postnatal interview]
They generally felt unprepared for caring for a baby, both the practical aspects as well as concern about being unable to communicate with their new baby.
I' m absolutely petrified..suddenly they are going to release you with this child that doesn't communicate in English and you're going to take this thing home.
[partner #20023, antenatal interview]
Some also reflected on how difficult it had been to go back to work and to achieve a work-life balance. They also spoke about feeling excluded from advice and support once they were working.
...trying to get a balance between the relationship and the baby. After two weeks I had to go back to work but I did not want to leave her. [partner #20039, postnatal interview]