Neonatal units should support father-infant bonding and understand how gender assumptions create an unlevel playing field for parents

bonding skin-to-skin father

A group of 11 researchers and practitioners from around the world, convened by The Family Initiative, has published a review of recent research on fathers in neonatal units.

The group draws six conclusions from over 50 articles.

  • Understanding and supporting father-infant bonding and supporting team parenting improves the baby’s health and helps both parents to care for the baby and for each other.
  • Fathers start from a different place from mothers:
  • They are often not considered “natural” carers like mothers are.
  • They are often expected to continue working and to look after older siblings.

“I have never been this stressed before…. I take care of the other children at home and of my job, but I also need to be here – I want to be here as well.”

  • They are under social pressure to appear strong and to hide their distress, particularly from the mother of the baby.

“I don’t want to be weak in front of my wife. I don’t think she knows how bad I am hurting right now.” 

“I have to cheer her up, but no one helps me. It is difficult to bear. I do not show that I am burnt out; instead, I suppress my feelings.”

“I wouldn’t want my wife asking me how I feel.”

  • Fathers should be informed directly, not just via the mother. Peer-to-peer communication for fathers is important.

“It would have been helpful to have maybe more contact with NICU fathers such as men with children who were either currently or had been in the NICU at some point.”

Fathers in neonatal units often feel left out.

“As a father, you feel left out.”

“Everybody around the situation is focused on mom/baby. Dads are left to worry about everything and everyone. As a dad, you may feel lonely.”

The Family Initiative formed the working group after reporting on a series of new research articles here on When a baby is sick there seems to be more acceptance of the idea that there can be a father-baby bond. This contrasts with the wider maternal and newborn health literature, which is ambivalent about the father-baby bond, tending instead only to see a single mother-baby dyad with fathers on the edge as helpers.

“I did a bit of kangaroo with him and when I looked at him….wow! I’m going to be paternal, I know.”

“When I first saw M., it was magic, a miracle! I was all alone in the bloc.”

“The first time I held him skin-to-skin, it was really, like, wow! It was like a communion.”

“I looked at my son and then my daughter and then my wife and I just felt, damn I’m so happy.”

bonding skin-to-skin father

The group presents some of the biological evidence for a direct father bond. Father-baby contact, particularly skin-to-skin, stimulates strong hormonal changes in men – more oxytocin, more prolactin, less testosterone. All these are linked to caring activity (as in mothers). Neurobiological changes also take place triggering ‘emotional empathy’ and ‘socio-cognitive’ networks in the father’s brain (as in the mother’s). When these two networks are strongly activated, the baby is likely to have stronger emotion regulation and social skills four years later.

The group makes 12 recommendations for practice:

  1. Assess the needs of mother and father individually.
  2. Consider individual needs and wants in family care plans.
  3. Ensure complete flexibility of access for fathers to the neonatal unit.
  4. Gear parenting education towards co-parenting.
  5. Actively promote father-baby bonding, particularly skin-to-skin, even in the presence of the mother.
  6. Be attentive to fathers hiding their stress from both professionals and their partners.
  7. Inform fathers directly not just via the mother.
  8. Facilitate peer-to-peer communication for fathers.
  9. Differentiate and analyse by gender in service evaluations.
  10. Train staff to work with fathers and to support co-parenting.
  11. Develop a father-friendly audit tool for neonatal units.
  12. Organise an international consultation to update guidelines for neonatal care, including those of UNICEF.

The members of the group are:

  • Esther A. Adama, Edith Cowan University School of Nursing and Midwifery, Perth, Australia
  • Nancy Feeley, Ingram School of Nursing, McGill University; Centre for Nursing Research & Lady Davis Institute – Jewish General Hospital, Montréal, Canada
  • Duncan Fisher, The Family Initiative, UK [Project Lead]
  • Craig F. Garfield, Departments of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine; Lurie Children’s Hospital of Chicago, USA
  • Jillian Ireland, Poole Hospital NHS Foundation Trust & Visiting Faculty Bournemouth University, UK
  • Minesh Khashu, Poole Hospital NHS Foundation Trust Poole & Bournemouth University, UK [Research Chair]
  • Flora Koliouli, Laboratoire Interdisciplinaire Solidarités, Sociétés, Territoires (LISST), University of Toulouse, France
  • Birgitta Lindberg, Department of Health Sciences, Luleå University of Technology, Sweden
  • Betty Nørgaard, Department of Paediatrics, Lillebaelt Hospital, Kolding, Denmark
  • Livio Provenzi, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
  • Frances Thomson-Salo, Centre for Women’s Mental Health, Royal Women’s Hospital, Carlton, Australia
  • Edwin van Teijlingen, Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, UK


Fisher D, Khashu M, Adama EA, Feeley N, Garfield CF, Ireland J, Koliouli F, Lindberg B, Nørgaard B, Provenzi L, Thomson-Salo F, van Teijlingen E (2018), Fathers in neonatal units: Improving infant health by supporting the baby-father bond and mother-father coparenting, Journal of Neonatal Nursing


Rogelio Cruz Barrera, Instituto Nacional de Perinatología Hospital, Mexico City. © UNICEF/UN0205036/Zehbrauskas

Jim Cherrett, Neonatal Unit of the Royal Devon and Exeter Hospital, Exeter. © UNICEF/UN0204067/Zehbrauskas