Part 2: exploring views from fathers and perinatal practitioners on the inclusion of fathers by perinatal services

Background This is the second of a two-part series exploring father's inclusion in the perinatal years. The first paper was published in volume 29, issue 4 of the British Journal of Midwifery. This paper explores the results of the study and discussion in relation to previous literature and to professional practice. Positive father involvement during the perinatal period has important implications for families. However, previous research suggests that fathers experience marginalisation, while staff report a lack of training and time for engaging fathers. Aims This study explored fathers' and perinatal professionals' experiences of fathers' involvement during the perinatal period, and ideas for paternal support. Method A Delphi method was employed. Thematic analysis from focus groups informed an online survey which was completed by 24 fathers and 22 professionals. A third-round survey finalised group consensus. Results Both groups agreed on the importance of fathers. Participants suggested improvement ideas, such as supporting fathers with psychological change. Groups disagreed on some ideas, such as fathers receiving a session alone to discuss concerns. Discussion The findings support the inclusion of fathers in perinatal services and a focus on the whole family system. Limitations of this study include low participant diversity and possible selection bias. Implications for further research are discussed.

Part 1: exploring views from fathers and perinatal practitioners on the inclusion of fathers by perinatal services

Background This is the first of a two-part series exploring father's inclusion in the perinatal years. Part 2 will explore the results of the study and discuss in relation to previous literature and to professional practice. Positive father involvement during the perinatal period has important implications for families. However, previous research suggests that fathers experience marginalisation, while staff report a lack of training and time for engaging fathers. Aims This study explored fathers' and perinatal professionals' experiences of fathers' involvement during the perinatal period, and ideas for paternal support. Method A Delphi method was employed. Thematic analysis from focus groups informed an online survey which was completed by 24 fathers and 22 professionals. A third-round survey finalised group consensus. Results Both groups agreed on the importance of fathers. Participants suggested improvement ideas, such as supporting fathers with psychological change. Groups disagreed on some ideas, such as fathers receiving a session alone to discuss concerns. Discussion The findings support the inclusion of fathers in perinatal services, and a focus on the whole family system. Limitations of this study include low participant diversity and possible selection bias. Implications for further research are discussed.

The determinants of the relationship between parents with physical disabilities and perinatal services: a scoping review

Because of recent medical advances and increasing advocacy for the rights of people with disabilities, more and more people with disabilities are becoming parents. Parenthood is considered a fundamental right by the United Nations, and appropriate perinatal services are an important promoting factor for positive parenting experience and practices. Despite this, access to parenthood and access to services is still hindered for parents and future parents with disabilities. This scoping review, based on eighteen (n=18) studies, provides a unique insight into the relationship between parents with physical disabilities and perinatal services.Results suggest that four main determinants influence this relationship: mothers’ needs, professionals’ characteristics, quality of relationship with professionals, and organization of services. Issues related to accessing information and the services themselves were also identified. Finally, a framework for accessibility is presented to better understand how to improve access to appropriate services for parents with physical disabilities.

The Experiences of First-Time Fathers in Perinatal Services: Present but Invisible

Fathers in the UK are becoming more involved in the care of their infants and children. A constructivist grounded theory approach was adopted to explore men’s transition to fatherhood. This paper reports on one of the sub-categories derived from the data. First-time fathers with a child under two were recruited predominantly via social media. Audio-recorded semi-structured interviews were undertaken with an opening question asking men to tell their story of becoming a father. Interviews were transcribed and analysed using constructivist grounded theory methods. This paper reports one core aspect of the research findings which has particular relevance for healthcare professionals. The men in this study were highly appreciative of the care their partner and baby received but consistently reported a lack of father-specific support throughout their journey to fatherhood. This ranged from generally poor communication with healthcare professionals to being ignored and side-lined in maternity settings where they continued to be treated as visitors before, during and after the birth of their baby. Despite similar findings being reported over the last 30 to 40 years and policy directives emphasising the importance of working with fathers, change within healthcare services remains slow. Currently, fathers’ needs are not being adequately met by perinatal services.

Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi

Background By 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016. Methods A CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a “counterfactual site” was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up. Results Women enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (− 37, 95% CrI: − 224, 170%). Conclusions In a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.

A qualitative comparison of experiences of specialist mother and baby units versus general psychiatric wards

Background Mother and baby units (MBUs) are an inpatient mental health service where women experiencing acute severe postpartum psychiatric difficulties can be admitted with their babies. They are currently viewed as best practice in the UK and elsewhere. However, as service provision is fragmented, some women residing in areas without MBUs are admitted to acute general psychiatric wards without their infants. This study aimed to compare qualitatively experiences of these two service types from the perspectives of women and clinicians. Methods Semi-structured interviews were conducted with fifteen women who received treatment for perinatal mental health problems on a general psychiatric ward and/or MBU in England. Two focus groups were also conducted, one with MBU staff (n = 11) and one with acute ward staff (n = 6). Data were analysed thematically. Results Women generally preferred being co-admitted with their baby to an MBU over lone admission to a general psychiatric ward. Women and clinicians felt that MBUs provided more perinatally-focused, family-centred care, and were better-equipped to meet women’s needs. General wards were reported by women and staff to lack the necessary facilities and expertise to support perinatal women adequately, while separation of mothers and babies was often experienced by women as traumatic and detrimental to recovery. However, some areas for improvement were also identified across both service types, particularly relating to difficulties transitioning home post-discharge, inadequate support for family members, staffing issues and access problems (with MBUs). Conclusions Findings suggest that specialist perinatal inpatient care is considered preferable to generic care in the perinatal period from both service user and staff perspectives. Increased collaboration between perinatal and non-perinatal services could help improve perinatal expertise on general psychiatric wards, while further expansion of perinatal services (e.g. to cater for women currently considered too high risk for MBUs and for those discharged from inpatient settings) could tackle other shortfalls in care.