Fathers and breast feeding very-low-birthweight preterm babies

Abstract

Objective

to explore fathers’ experiences of the breast feeding of their very-low-birthweight preterm babies from birth to 12 months of age.

Design

a qualitative study using interpretive phenomenology. Data were collected via longitudinal in-depth individual interviews.

Setting

publicly funded tertiary level hospital, Australia.

Participants

a purposive sample of 17 Australian parents took part in the broader study. This paper reports on data from the seven participant fathers.

Findings

this paper explores the discursive changes in fathers’ accounts of their perspectives on and support of the breast feeding of their preterm baby. The fathers’ accounts highlight their marked influence on breast feeding, their ambivalent experiences related to breast feeding and their struggle in negotiating a parenting role related to baby feeding.

Key conclusions

this study highlights the role and influence that fathers of preterm babies have on breast feeding, and explores the tensions and paradoxes inherent in promoting the ideology of breast feeding while valuing the practice of bottle feeding.

Implications for practice

this study highlights the need to encourage and involve fathers in breast-feeding education including the impact of bottle feeding on breast-feeding outcomes. The active and positive contribution that fathers make towards preterm breast feeding should be acknowledged and encouraged.

Introduction

Throughout the academic and research literature on the experience of being a parent, the tendency is to emphasise mothering (Barclay and Lupton, 1999; Mander, 2004). Indeed, few studies investigate fathering or even joint parenting. Barclay and Lupton (1999) suggest that the body of literature available on fatherhood often represents it as potentially pathological, disruptive, stressful and involving personal struggle. More specifically, in neonatal care, the father is too often the forgotten factor. As Holditch-Davis and Miles (1997, p. 27) argue:

Fathers are left out of the sample, are combined with the mothers for analysis, or are compared with mothers as if mothers were the standard for all parents.

Three decades ago, a study by Benfield et al. (1976) found that fathers reported drastic alterations in daily activity while their partner and baby were hospitalised, assuming a central role in maintaining family stability during the crisis. Since this report in 1976, little research has investigated the paternal aspect of neonatal intensive care and how fathers cope with the drastic changes in daily life. There is, however, a developing body of knowledge on fathering the newborn term baby (Jordan, 1990; Jordan and Wall, 1990; Henderson and Brouse, 1991; May, 1996; Lupton and Barclay, 1997).

There is an associated paucity of research on fathers and breast feeding. It has been common for both researchers and clinicians to ignore the impact of men and their contributions to successful breast feeding (Bar-Yam and Darby, 1997). Fathers of term babies in the USA have been shown to have poor knowledge of breast feeding (Giugliani et al., 1994a, Giugliani et al., 1994b). However, if they had other breast-fed children, attended prenatal classes or had received specific breast-feeding information, they were found to have a significant knowledge of breast feeding (Giugliani et al., 1994a, Giugliani et al., 1994b). In a study investigating the experience of new fathers, Henderson and Brouse identified breast feeding as a frustration because ‘it was the one job the fathers could not participate in even if they wanted to’ (1991, p. 296). Unfortunately, the authors provided no further elaboration and so ‘participation’ remained here a rather ‘all or nothing’ concept.

Jordan and Wall (1990) investigated 56 fathers of healthy term babies with ‘normal’ breast-feeding experiences regarding their attitudes and experiences in relation to new fatherhood throughout the perinatal period. For this group of fathers, the reality of breast feeding was vastly different to their pre-birth expectations. The fathers described how breast feeding maintained the exclusivity of the mother–baby relationship that existed during pregnancy, and therefore breast feeding was considered a potential barrier to the development of father–baby bonds (Jordan and Wall, 1990).

Gamble and Morse (1993) studied 14 fathers of successfully breast-fed term babies and identified a process of adjustment to breast feeding, which they called ‘postponing’. They found that the men in their study used their perception of the mother–baby relationship as a ‘gold’ standard against which to measure their own relationship—thus while breast feeding, the father had to postpone his relationship with the baby until after weaning (Gamble and Morse, 1993). Breast feeding was frequently seen as an inconvenience in life, but fathers accepted this because of its positive benefits for the baby (Gamble and Morse, 1993).

Voss et al. (1993) undertook a study of 113 fathers and their attitudes to baby feeding. For this study, there was a response rate of 79% and the authors suggest that this indicates that fathers have more interest in baby feeding than they are usually given credit for. More than half of the men (60%) were involved with baby-feeding decisions, 64% sometimes helped with feeding and 17% always helped with baby feeding (Voss et al., 1993). Among individual general comments, the researchers received several that suggested that some ‘fathers felt left out and envious of the “special bonding” between mother and baby while others pointed out that bottle feeding allows them the chance to “have a closer bond” to the baby’ (Voss et al., 1993, p. 177).

Australian research on new fatherhood strengthens this body of literature of fathers and breast feeding. Barclay and Lupton (1999, p. 1016) found that men who wanted to be emotionally involved with their baby in the early weeks of parenting found breast feeding very time consuming for their partners, and it excluded them in a way that was unexpected. Some fathers found the intimacy engendered by feeding the baby helped them to ‘fall in love’ with their baby. Furthermore, bottle feeding established a vehicle for the communication and engagement they sought but had not yet achieved while their baby was breast fed. Men were left feeling more detached than they expected or wanted to be while their partner was breast feeding.

Research has shown that most women decide upon the method of feeding they intend to use for their unborn baby before pregnancy or during the first trimester (Kaufman and Hall, 1989; Lefebvre and Ducharme, 1989; Losch et al., 1995; Jaeger et al., 1997; Earle, 2000). Thomson (1989) interviewed first-time mothers and demonstrated that the father was influential in the decision to breast feed. Giugliani et al., 1994a, Giugliani et al., 1994b has shown that partners providing a favourable attitude towards breast feeding was the most important factor for women associated with a commencement of breast feeding. Women who perceived that the father preferred their baby to be breast fed were 10 times more likely to breast feed than women without the perceived support (Scott et al., 1997).

A significant deficit in the research literature is, however, that most studies investigating feeding intent investigate the general birth population rather than preterm populations. Even within the limited research literature on breast feeding preterm babies, there has been little research attention paid to the particular breast-feeding dynamics and practices associated with very-low-birthweight (VLBW) babies. To address this first deficit, Kaufman and Hall (1989) investigated the feeding choice of 125 women following preterm birth. They found that women with more identified supporters of breast feeding—for example, family and friends—were more likely to choose to breast feed than bottle feed; and while health professionals may have supported a decision to breast feed, it is unlikely they influenced the initial decision (Kaufman and Hall, 1989).

Studies around the world continue to demonstrate an inverse relationship between baby gestation at birth and duration of breast feeding, with some findings indicating that more than half of the women who initiate breast feeding for their preterm baby abandon it prior to the baby's discharge from hospital (Lefebvre and Ducharme, 1989; Ingram et al., 1994; Meier and Brown, 1996; Yip et al., 1996; Jaeger et al., 1997; Furman et al., 1998; Gunn et al., 2000). This body of work demonstrates that despite the number of women commencing lactation following the birth of a preterm baby, very few ever achieve exclusive breast feeding after the baby's discharge from hospital.

Many of the studies cited above are quantitative and while they provide much-needed statistical and epidemiological information, they do not investigate qualitatively the reasons why women cease their efforts to breast feed their preterm babies. Of those studies that explore reasons for cessation of breast feeding—based on questionnaire or structured interview data—perceived milk insufficiency is the most cited reason (Hill et al., 1994; Jaeger et al., 1997). Social support has been shown to be the major source of support for breast-feeding women (Matich and Sims, 1992; Isabella and Isabella, 1994). Mothers of preterm babies have been found to cite partner support as the most useful and the most influential on breast-feeding duration (Kaufman and Hall, 1989).

Whilst it is evident that fathers can have a significant influence in the decision and duration of breast feeding of healthy term babies, and the level of support a woman anticipates from her partner will affect her baby-feeding decisions, little is known about fathers of preterm babies and their experiences regarding breast feeding. Authors such as Bar-Yam and Darby recognise this limitation in current knowledge and suggest that ‘prospective studies that follow the attitudes and actions of women and men … would shed further light on the issues of breast feeding in the perinatal period’ (1997, p. 49). Kenner and Lott (1990, p. 32) recognise that fathers may become more involved with their baby in the neonatal intensive care unit (NICU) environment and that the desire for this continued pattern of caretaking often exists upon discharge. This paper is based on a wider study which redressed the important research gap in our understanding of new parents’ experiences of breast feeding their VLBW preterm baby, and reports in particular on the male participants’ experiences of breast feeding VLBW preterm babies from birth to 12 months of age.