A study in Denmark of 12 fathers whose babies are in a neonatal intensive care unit has identified a number of ways in which fathers have different experiences and needs to mothers. Different social expectations on men and women about work, care and vulnerability collide with the actual needs of families with a very sick baby. The paper contains a comprehensive list of references on fathers in NICUs dating back to 1991.
The study makes two key recommendations:
- Healthcare professionals must be aware of the different cultural expectations of men as fathers and women as mothers and how these norms shape different needs. Care should be organised accordingly.
- Organise networks of fathers for sharing experiences.
The research consisted of observations of several fathers and mothers at the NICU, an interview with five of them, and additional more detailed interviews with four new fathers. A group discussion was also organised, involving three other fathers in the NICU.
Men are expected to be the lead earner
In Denmark fathers only get 2 weeks of paternity leave in the first 14 weeks. This creates a dilemma for fathers of sick babies. They want to take leave in the first 2 weeks when their babies are in the most critical condition; but they also need it later on, including when the baby comes home. Furthermore, fathers are typically left in sole care of any older brothers or sisters of the baby.
“I think it is hard not to be in the NICU, and it is hard to leave it all to my wife, but I also want to save my paternity leave for when they get home; it is difficult.”
“What will happen when I start working? I cannot manage to go to the hospital before taking care of our older daughter. It will be awful if I cannot see my newborns and wife for a whole week.”
“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.”
Work commitments also mean that sometimes fathers get no information directly from staff, only via the mother. This leads to feelings of being out of control and not a full parent (see more on this problem below).
Women are expected to be the lead carer and are considered “natural” carers; men are not
Staff mainly focus on the mother. Mothers get more information because the fathers have to earn and to look after older children. The aspirations of fathers, however, are changing, and typically men now want close relationships with their children. This impacts on fathers’ experiences of NICUs.
“As a father, you feel left out.”
Some fathers express the belief that this is OK – that mothers are natural carers. It is not clear from the research, however, if such beliefs predate the situation or are formed as a way of making sense of the situation.
In contrast, all the fathers of babies born by Caesarean described in positive terms how this was an opportunity for them to care, something that gave them pleasure and pride.
“During the first three or four days, I was actually the only one who had contact with him. Of course, my wife was sad that she could not be there, but for me it meant that I become closely connected to him, much more than if his mother had been well.”
The idea that mothers are natural carers and men are not can lead to mothers and fathers reacting differently to their own uncertainty and lack of confidence. Fathers may need and want more detailed and specific instruction, fearful of their perceived innate inability to care.
“Tell me what it means when my son raises arms. It means, “I want peace.” It is helpful to receive specific instructions. Try to interpret it your way [the nurses say]. What am I supposed to interpret? I have no idea.”
Fathers expressed the wish that staff could schedule doctors’ ward rounds when fathers could be present.
Men are expected to be strong and protective
The fathers in the Danish study expressed constant worry and an inability to relax. “There is chaos in my mind,” as one father said. But they also described how they strive to appear calm and show none of this.
The fathers stated that their role was to fulfil their partner’s needs and expectations, and that they did not expect such support from their partners.
“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.”
“My wife does not know that I am about to lose patience.”
Fathers said they needed time alone with staff, so that they can talk freely about their difficulties without showing their vulnerability to their partners, whom they did not expect to meet their own needs.
Some fathers said a network of fathers is needed, where the fathers can share vulnerable feelings in the context of not feeling able to share this with their partners.
“It would be good to have some kind of a network of fathers. We have to be brought together before we can talk to each other.”
Multiple earlier studies from France, Canada, Sweden, Australia and UK have shown that fathers on NICUs do not feel at liberty to let go emotionally and need to feel in control of the situation, primarily through receiving very good information directly from staff.
The researchers make a number of specific recommendations for how practice on NICUs should take account of these different experiences of mothers and fathers.
- Recognise that fathers are competent and important caregivers as are mothers, and tell fathers this.
- Support fathers in achieving a sense of control while family members are hospitalized.
- Involve the fathers in childcare.
- Make sure that fathers are informed by the staff about their infants’ health and treatment.
- Organise networks of fathers for sharing experiences.
- Be conscious of cultural norms and expectations regarding men and fathers.
Noergaard B, Ammentorp J, Fenger-Gron J, Kofoed P-E & Johannessen H (2017), Fathers’ needs and masculinity dilemmas in a neonatal intensive care unit in Denmark, Advances in Neonatal Care 17.4
Photo: Christian Wilcox. Creative Commons.