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1 57
2 58
3
4
Integrative Review of Factors and 59
60
5
6 Interventions That Influence Early 61
62
7 63
8
9
Father–Infant Bonding 64
65
10 Ashley Renee Scism and Robin Lynn Cobb Q9 66
11 67
12 68
13 Correspondence ABSTRACT 69
14 Ashley Renee Scism, BSN, 70
RN, 2000 Midwood St., Objective: To report on the current state of research analyzing early father–infant bonding, including influential factors
15 71
Apt. 2205, Franklin, TN and interventions, to identify gaps in the literature.
16 Q1 72
37067. Data Sources: CINAHL, MEDLINE, PubMed, and PsychInfo computerized databases were searched using the
17 [email protected] 73
keywords bonding, paternal, father, infant, relationship, engrossment, and postpartum.
18 74
19 Keywords Study Selection: Twenty-eight articles were compiled on the basis of key inclusion criteria. Quality measures were 75
father–infant bonding undertaken using specific components of SQUIRE 2.0 to ensure quality of methodology and data.
20 father–infant relationship 76
21 fatherhood Data Extraction and Synthesis: Each study was carefully dissected and initially arranged in a generic annotated 77
22 father’s role bibliography. This process resulted in pattern recognition and identification of three major themes. The findings of 78
23 every article were compared for commonalities and differences and were synthesized into an integrated review of 79
24 father–infant bonding. 80
25 Results: The synthesis revealed three themes: Father’s Adjustment and Transition, Variables That Influence 81
26 Father–Infant Bonding, and Interventions That Promote Father–Infant Bonding. 82
27 Conclusion: There is an immediate need to perform studies on specific interventions aimed at the promotion of 83
28 early father–infant bonding in the United States. More research is needed to better understand the timing of early 84
29 father–infant bonding and how this bonding influences a provider’s role, attitude, and priority for establishing successful 85
30 bonding interventions for fathers. 86
31 87
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32 88
Accepted September 2016
33 89
34 90
35 91
36 92
37 93
T he concept of mother–infant bonding was Altaweli and Roberts (2010) differentiated the two
Ashley Renee Scism, BSN,
38 RN, is a PhD candidate at first theorized in the late 1960s by Rubin and concepts by positing that bonding refers to feel- 94
Belmont University,
39 was later popularized in the mid-1970s by Klaus ings between a mother and her child, whereas 95
Nashville, TN.
40 and Kennell (Altaweli & Roberts, 2010; Johnson, attachment refers to an infant’s behavioral 96
41 Robin Lynn Cobb, PhD,
2013; Kinsey & Hupcey, 2013). Since then an response to these feelings. For the purpose of our 97
MSN, CNM, is an assistant
42 professor in the Department abundance of research has been dedicated to review, the focus will remain on bonding behav- 98
43 of Nursing, Belmont the study of mother–infant bonding. Lamb (1998) iors rather than on a separate attachment Q2 99
44 University, Nashville, TN. defined bonding as mental, emotional, and phenomena. 100
45 behavioral domains related to the “unparalleled 101
46 experience in an adult’s life involving the forma- The literature supporting mother–infant bonding 102
47 tion of a selective and enduring bond with an is rigorous and of strong quality with proven 103
48 infant” (Altaweli & Roberts, 2010, p. 555). significance on infant growth and development. 104
49 Researchers agree that bonding is a unique and Researchers have effectively measured the effect 105
50 complex phenomenon that occurs between a of key interventions such as rooming in, immedi- 106
51 mother and infant during a sensitive period ate skin-to-skin contact, and breastfeeding on 107
52 (Ataweli & Roberts, 2010; Johnson, 2013; Kinsey immediate mother–infant bonding with outcomes 108
53 & Hupcey, 2013). Attachment is often used that are reproducible in the general population 109
54 interchangeably with bonding (Altaweli & (Altaweli & Roberts, 2010; Johnson, 2013; Kinsey 110
The authors report no con-
55 flict of interest or relevant Roberts, 2010; Kinsey & Hupcey, 2013); howev- & Hupcey, 2013). The role of the provider in the 111
56 financial relationships. er, researchers have recognized the difference. establishment of mother–infant bonding is well 112

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113 father–infant bonding (Anderson, 1996a; 169

114 The importance of establishing an immediate mother– Ferketich & Mercer, 1995; Palkovitz, 1992; 170
115 infant bond has overshadowed and delayed the efforts of Tudiver, 1981; Weaver & Cranley, 1983). Finally, 171
116 researchers to catalog factors and interventions that affect the recognition of childbirth being more than 172
117 father–infant bonding. a female experience sparked interest in identi- 173
118 fying specific interventions aimed at promoting 174
119 father–infant bonding. 175
120 defined, and an expectation exists that health 176
121 care professionals ensure that the environment is Successful father–infant bonding in the immedi- 177
122 favorable for bonding. Investigators measuring ate postpartum period has been shown to reduce 178
123 the quality of mother–infant bonding have attrib- cognitive delay, promote weight gain in preterm 179
124 uted behaviors such as kissing, cuddling, infants, and improve breastfeeding rates (Bronte- 180
125 providing infant care, holding the infant in an en Tinkew, Carrano, Horowitz, & Kinukawa, 2008; 181
126 face position, and prolonged gazing as positive Garfield & Isacco, 2006). Interventions that 182
127 bonding behaviors (Altaweli & Roberts, 2010; establish an immediate father–infant bond may 183
128 Johnson, 2013; Kinsey & Hupcey, 2013). Failure promote active paternal involvement as the infant 184
129 of effective mother–infant bonding can negatively grows and develops. The lack of direction for 185
130 affect the psychosocial and physical growth and fathers in the immediate postpartum period may 186
131 development of an infant. Negative conse- delay father–infant bonding, potentially altering 187
132 quences for the mother include feelings of hos- the long-term course of paternal involvement as 188
133 tility toward the infant that lead to avoidance, the infant progresses throughout childhood and 189
134 neglect, and increased risk of child abuse adolescence. A father’s involvement that con- 190
135 (Altaweli & Roberts, 2010; Johnson, 2013; Kinsey tinues throughout childhood development is 191
136 & Hupcey, 2013). associated with higher academic achievement, 192
137 better socioeconomic status, and fewer behav- 193
138 The importance of establishing an immediate ioral problems among children (Garfield & 194
139 mother–infant bond has overshadowed and Isacco, 2006; Howard, Burke Lefever, 195
140 delayed the efforts of researchers to catalog Borkowski, & Whitman, 2006). The U.S. Census 196
141 factors and interventions that affect father–infant Bureau (2011) estimated that more than 24 197
142 bonding. Mother–infant bonding theories include million children live in households without their 198
143 quality themes, interventions, and outcomes that biological fathers, and these children are 4 times 199
144 may translate into the concept of father–infant more likely to live at or below the poverty level. 200
145 bonding. For example, researchers analyzing Adolescents who lack paternal involvement have 201
146 positive bonding behaviors of fathers found that the greatest odds of becoming incarcerated and 202
147 fathers exhibit some of the same behaviors as engaging in risky sexual behaviors that increase 203
148 mothers but progress from passive to active the rate of teenage pregnancy (Harper & 204
149 involvement including prolonged gazing, vocal- McLanahan, 2004; Teachman, 2004). 205
150 Q3 izing distinct characteristics of the infant, holding 206
151 the infant in an en face position, smiling, and Despite the substantial evidence to support the 207
152 being in close proximity to the infant (Chally, significance of father involvement, Healthy 208
153 1979; Greenburg & Morris, 1974; Taubenheim, People 2020 does not include an objective for 209
154 1981; Tomlinson, Rothenburg, & Carver, 1991; early father–infant (Centers for Disease Control Q4 210
155 Toney, 1983). However, despite similarities in and Prevention, 2015). In the last 5 years, there 211
156 bonding behaviors, fathers may require in- have been a limited number of studies on 212
157 terventions that are unique to the phenomenon of interventions that promote early father–infant 213
158 father–infant bonding. bonding. Furthermore, most research pertaining 214
159 to the concept of father–infant bonding, including 215
160 The examination of the process of father–infant the qualitative lived experiences of fathers, 216
161 bonding did not occur until the late 1970s and variables that affect the bonding process, and 217
162 early 1980s, when researchers first questioned interventions aimed at promoting early bonding, 218
163 the importance of father involvement during the have not been published in the United States. 219
164 immediate postpartum period (Bowen & Miller, Typically, researchers examined only one 220
165 1980; Greenberg & Morris, 1974; Tudiver, 1981; small element of father–infant bonding in an 221
166 Weaver & Cranley, 1983). During the late 1990s attempt to identify the most influential factor or 222
167 researchers started to focus on factors that intervention (Brandao & Figueiredo, 2012; Cheng, 223
168 positively or negatively influenced the process of Volk, & Marini, 2011; Erlandsson, Dsllna, 224

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225 Q5 Fagerberg, & Christensson, 2007; Freeman, Subsequently, the articles were carefully 281
226 2000; Taubenheim, 1981; Toney, 1983). We did dissected for pertinent findings related to early 282
227 not identify a review that described a compre- father–infant bonding. Twenty-eight articles were 283
228 hensive list of techniques and interventions that reviewed and included eight qualitative studies, 284
229 are effective at promoting bonding between a seven literature reviews, five observational 285
230 father and newborn in the immediate postpartum studies, three mixed-methods designs, two 286
231 period. The purpose of our literature review was quantitative studies, one quasiexperimental 287
232 to report on the current state of research on early study, one correlational study, and one metasyn- 288
233 father–infant bonding, including influential factors thesis. Because there was no restriction on date 289
234 and interventions, in an effort to identify gaps of publication, the articles included for review 290
235 within the literature. ranged from 1974 through 2016. Most studies 291
236 were conducted outside of the United States in 292
237 countries such as Canada, Great Britain, 293
238
Literature Search Process and Portugal, Sweden, Taiwan, and Thailand. After 294
239 Results analysis, all 28 qualifying articles fit into one of 295
240 A literature search was performed using the three major themes: Father’s Adjustment and 296
241 computerized databases of CINAHL, PubMed, Transition, Variables That Influence Father–Infant 297
242 MEDLINE, and PsychInfo. The keywords Bonding, and Interventions That Promote Father– 298
243 bonding, paternal, father, infant, relationship, Infant Bonding. We performed an in-depth data 299
244 engrossment, and postpartum were used in comparison within each category with special 300
245 various combinations. Because the results were attention to commonalities and differences in 301
246 voluminous (>3,000), parameters were narrowed outcomes. Finally, data synthesis involved inte- 302
247 down to include only those articles written or gration of recurrent findings, reporting conflicting 303
248 translated in the English language, articles literature results, and highlighting unique 304
249 that pertained to father–infant bonding and research articles. 305
250 interventions with infants younger than 1 year, 306
251 and articles on bonding in human subjects. To 307
252 perform a thorough review, there was no restric- Data Synthesis 308
253 tion on date of publication. A total of 28 articles Father’s Adjustment and Transition 309
254 were selected for inclusion in the review because The labor, birth, and postpartum periods are 310
255 of their relevance to the topic. significant times of adjustment and transition for 311
256 fathers. Fathers reported that fatherhood begins 312
257 at the moment of birth, whereas for mothers, 313
Quality
258 motherhood often begins when they receive 314
Evaluation of data quality included a review of
259 confirmation of pregnancy (Longworth, Kingdon, 315
authenticity, methodologic quality, and informa-
260 & Cert, 2011; Sansiriphun, Kantaruska, Klunklin, 316
tional value related to father–infant bonding. This
261 Baosuang, & Liamtrirat, 2015). Most men 317
evaluation was based on specific components of
262 entered into parenthood with the expectation of 318
SQUIRE 2.0 (2015), including (a) Was the specific
263 establishing an immediate, emotional bond with 319
aim of the study clearly stated?, (b) Did the article
264 their newborns. However, when fathers were not 320
provide a significant problem description?, (c)
265 equipped with the skills and knowledge neces- 321
Were the measurement and data analysis tools
266 sary to effectively bond or lacked guidance 322
valid and reliable?, (d) Were results significant
267 during labor and birth, feelings of frustration, 323
and generalizable?, (e) Did the article compare
268 resentment, and alienation were commonly 324
results with findings from previous studies?, (f)
269 reported (Anderson, 1996b; Erlandsson, 325
Was an effort made to minimize study limitations?,
270 Christensson, & Fagerberg, 2008; Longworth, 326
and (g) Was the information relevant to the review
271 Kingdon, & Cert, 2011; Montigny & Lacharité, 327
topic? We assigned a grading scale of strong for
272 2004; Sansiriphun et al., 2015). The provider 328
articles that met six or seven of the criteria, fair for
273 who solely focuses on mother–infant support, 329
articles that met four or five of the criteria, and
274 interventions, and outcomes may alienate the 330
weak for articles that met three or fewer of the
275 father, which has the potential to cause separa- 331
criteria (see Supplemental Table S1).
276 tion in the parenting dyad rather than to create a 332
277 cohesive family bonding experience. As a result, 333
278 Data Extraction fathers report delayed onset of feeling bonded to 334
279 Initially, we read through all articles and orga- their infants from 6 weeks to 2 months postpartum 335
280 nized them into a general annotated bibliography. (Anderson, 1996b; Cheng, Volk, & Marini, 2011; 336

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337 fatherhood. The perception of spousal support or 393

338 Demonstration of the importance of effective bonding strength of the marital relationship was the most 394
339 interventions may lead to the development of national commonly reported factor that affects a father’s 395
340 goals to support the bonding process in the father–infant parenting attitude and behavior (Anderson, 396
341 dyad. 1996a; Goodman, 2005; Montigny, Lacharité, & 397
342 Amyot, 2006; Weaver & Cranley, 1983; Yu, 398
343 Hung, Chan, Yeh, & Lai, 2012). A lack of 399
Tomlinson, Rothenburg, & Carver, 1991). These
344 spousal support decreased the emotional 400
findings are consistent with those of a metasyn-
345 connection between father and infant and there- 401
thesis of father–infant bonding performed by
346 fore inhibited the transition to fulfillment of effec- 402
Goodman (2005), who suggested that fathers
347 tive bonding (Anderson, 1996a; Goodman, 2005; 403
move toward effective bonding as they transition
348 Weaver & Cranley, 1983; Yu, Hung, Chan, Yeh, & 404
through four distinct phases: entering with
349 Lai, 2012). A mother’s satisfaction with birth out- 405
expectations, confronting reality, working to
350 comes and her assessment of spousal compe- 406
create one’s role, and reaping the rewards. The
351 tence and ability to provide support dictates the 407
lack of confidence to be actively involved during
352 degree of maternal gatekeeping (Palkovitz, 408
birth, coupled with inexperience and alienation,
353 1992). The gatekeeper phenomenon is recog- 409
may explain why fathers’ expectations of imme-
354 nized when a mother controls the amount of 410
diate bonding seem unrealistic.
355 access a support person has to the infant. A 411
356 greater degree of gatekeeping performed by the 412
Fathers reported strong desires to love, and pro-
357 mother limits a father’s access to the infant during 413
tect, and nurture their children (Anderson, 1996b;
358 the sensitive bonding period. 414
Goodman, 2005; Montigny & Lacharité, 2004).
359 415
The conceptualization of being a father allowed
360 Fathers consistently reported that a lack of con- 416
them to create their own unique role and antici-
361 fidence in their ability to care for their infants 417
pate lifestyle changes. They learned to make
362 decreased the quantity and quality of time spent 418
sacrifices, establish new priorities, and balance
363 bonding with their infant (Anderson, 1996a; 419
tasks to create a closer connection to mother
364 Goodman, 2005; Montigny & Lacharité, 2004). 420
and newborn (Anderson, 1996b; Erlandsson,
365 Ferketich and Mercer (1995) found no significant 421
Christensson, & Fagerberg, 2008; Goodman,
366 difference between bonding scores of experi- 422
2005; Sansiriphun et al., 2015). Once fathers
367 enced verses inexperienced fathers. However, 423
effectively navigate the bonding process, they
368 other researchers showed that fathers who were 424
reap the rewards. Fathers who effectively bonded
369 present at the births reported higher bonding 425
by providing physical care to their infants re-
370 scores than fathers who did not attend the births 426
ported the greatest feelings of satisfaction, sense
371 (Bowen & Miller, 1980; Greenburg & Morris, 427
of elation, and connectedness (Anderson, 1996b;
372 1974). In addition, fathers who attended the 428
Goodman, 2005; Greenburg & Morris, 1974).
373 births had higher bonding scores than fathers 429
374 who attended prenatal classes (Bowen & Miller, 430
Researchers indicated that fathers feel they
375 1980). Palkovitz (1992) found that couples 431
navigate the bonding process alone. Anecdotal
376 believed it was critical that fathers were present 432
Q6 evidence suggested that the significance of
377 for birth and had longer initial contact with the 433
father–newborn bonding in the immediate post-
378 infant for effective bonding. The evidence sug- 434
partum period is underappreciated and that the
379 gests that the events surrounding the birth and 435
father’s role is often overlooked during initiation of
380 postpartum period influence a father’s confidence 436
bonding between mother and newborn. Pro-
381 in effective bonding and that fathers may benefit 437
viders’ lack understanding of interventions that
382 from more hands-on involvement. 438
would be most effective to enhance the father–
383 439
infant bonding process, and an unpleasant
384 Finally, societal attitudes play a major role in 440
experience during the adjustment and transition
385 father–infant bonding. Traditionally, childbirth has 441
period, may promote an attitude that negatively
386 been viewed as a feminine experience, and 442
affects the father–infant relationship.
387 society identifies the male as a father by associ- 443
388 ation only (Draper & Ives, 2013; Longworth, 444
389 Variables That Influence Father–Infant Kingdon, & Cert, 2011). Montigny and Lacharité 445
390 Bonding (2004) found that fathers believed that society 446
391 As a father attempts to create a relationship with did not recognize the importance of their 447
392 his infant, key variables affect the transition to new roles. The outdated social, cultural, and 448

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449 workplace norms of fatherhood by association the world. Toney (1983) found that the frequency of 505
450 contrast with a man’s experience, because bonding behaviors at 12 to 36 hours after birth did 506
451 fathers have a strong desire to be a source of not differ between fathers who had early physical 507
452 love and protection while nurturing the child contact and fathers who had delayed physical 508
453 (Anderson, 1996b; Goodman, 2005; Montigny & contact. However, in one study fathers who had 509
454 Lacharité, 2004). These norms exist worldwide: early physical contact showed more caressing 510
455 fewer than half of all countries offer paid paternity behaviors at 3 months postpartum than fathers 511
456 leave, whereas almost all offer maternity leave who had delayed contact (Rodholm, 1981). Q7 512
457 (U.S. Department of Labor, 2015). Specifically, in Taubenheim (1981) found that fathers who actively 513
458 the United States, only three states offer paid participated in caretaking activities in the early 514
459 paternity leave to employees (U.S. Department of postpartum period, specifically feeding the 515
460 Labor, 2015). newborn or assisting with breastfeeding, showed a 516
461 greater frequency of bonding behaviors such as 517
462 Interventions That Promote Father–Infant holding the infant in an en face position and 518
463 Bonding expressing positive vocalizations toward the 519
464 Traditionally, the focus during labor and birth has infant. Finally, infant massage has been shown to 520
465 understandably been concentrated on mother indirectly promote father–infant bonding by 521
466 and infant well-being; however, this has left reducing stress associated with an irritable infant 522
467 fathers feeling disconnected and wanting a more (Cheng, Volk, & Marini, 2011). 523
468 active role (Draper & Ives, 2013; Longworth, 524
469 Kingdon, & Cert, 2011; Premburg, Carlsson, Draper and Ives (2013) discussed the impor- 525
470 Hellstrom, & Berg, 2011). Most interventions to tance of including fathers in the antenatal and 526
471 promote father–infant bonding have focused on labor processes to allow shared decision-making 527
472 providing opportunities for physical contact and possibilities, reduce maternal fear, increase 528
473 involvement during birth. The universal interven- maternal support, and promote advocacy for the 529
474 tion for mother–newborn bonding is skin-to-skin birthing plan. The active involvement of men in 530
475 contact during the immediate postpartum period antenatal care and labor might increase maternal 531
476 (Altaweli & Roberts, 2010; Johnson, 2013; Kinsey trust and allow for more access to the newborn 532
477 & Hupcey, 2013). The promotion of skin-to-skin at birth, thus counteracting the gatekeeper 533
478 contact by fathers has been limited in newborns phenomenon. The development of maternal trust 534
479 born by caesarean or in situations of maternal can translate into spousal support that has been 535
480 compromise, despite known benefits, including shown to be paramount in promoting effective 536
481 less newborn crying time, promotion of a calm father–infant bonding. 537
482 environment for feedings, regulation of newborn 538
483 body temperature, increased newborn metabolic 539
484 adjustment, and facilitation of effective father– Implications for Practice and Future 540
485 newborn interaction (Erlandsson, Dsllna, Research Initiatives 541
486 Fagerberg, & Christensson, 2007; Shorey, In our literature review, we described the current 542
487 Hong-Gu, & Morelius, 2016). Fathers consis- state of research and synthesized findings into 543
488 tently reported that early physical contact, not themes of Father’s Adjustment and Transition, 544
489 necessarily skin-to-skin, was one of the most Variables That Influence Father–Infant Bonding, 545
490 effective interventions to initiate bonding and Interventions That Promote Father–Infant 546
491 (Brandao & Figueiredo, 2012; Cheng, Volk, & Bonding. A gap in research is the limited 547
492 Marini, 2011; Greenburg & Morris, 1974; evidence supporting standardized interventions 548
493 Taubenheim, 1981). to improve immediate father–infant bonding as 549
494 currently exist for mother–infant bonding. There- 550
495 Opportunities for physical contact after birth fore, future researchers should focus on deter- 551
496 include umbilical cord cutting, holding or touching mining effective bonding interventions and 552
497 the newborn, participating in caretaking activities, identifying optimal timing for implementation. 553
498 and performing newborn massage. A father’s 554
499 participation in umbilical cord cutting has been Nurses are instrumental in the initiation of early 555
500 shown to increase feelings of intimacy and father–infant bonding and the provision of 556
501 connection with infant long term (Brandao & anticipatory guidance during the bonding pro- 557
502 Figueiredo, 2012). Umbilical cord cutting may be cess. It is crucial that health care providers, 558
503 viewed as a symbolic event, because the father is specifically nurses, are knowledgeable about 559
504 able to assist in the process of bringing new life into the research supporting father–infant bonding. 560

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561 Finally, most studies in our review were published 617

562 Future research should focus on the timing of early father– before 2005 and were not conducted in the 618
563 infant bonding and how that influences a provider’s role United States. Currently, Healthy People 2020 619
564 for establishing successful bonding interventions for does not specify an objective supporting the 620
565 fathers. bonding process between a father–infant dyad 621
566 like there is in other countries. The outdated 622
567 societal, cultural, and workplace perception of 623
The collaborative practice, support, and education
568 fatherhood by association results in a lack of paid 624
provided by nurses has been linked to a positive
569 paternity leave worldwide. Therefore, the role of 625
perception of birth events, which in turn promotes
570 health care providers to initiate successful father– 626
a father’s alliance with his partner and increases
571 infant bonding during the immediate postpartum 627
his level of confidence and competence in infant
572 period becomes instrumental in an effort to 628
care (Montigny & Lacharité, 2006; Montigny,
573 neutralize external barriers before discharge. 629
Lacharité, & Amyot, 2006; Palkovitz, 1992).
574 There is an immediate need to perform studies 630
575 with specific interventions aimed at promoting 631
Although research has focused on increasing
576 early father–infant bonding in the United States. 632
fathers’ caretaking activities as an intervention for
577 More research is needed to better understand 633
early infant bonding, only one researcher directly
578 the timing of early father–infant bonding and how 634
measured the effect of assisting with infant
579 that influences a provider’s role, attitude, and 635
feeding on paternal bonding (Taubenheim, 1981).
580 priority for establishing successful bonding 636
Giefer and Nelson (1981) implemented a post-
581 interventions for fathers. The establishment of 637
partum caretaking skills class for fathers and
582 effective bonding interventions may lead to the 638
found that fathers are more likely to participate in
583 development of national goals aimed at 639
infant care with instructor-led, hands-on practice.
584 supporting the bonding process between the 640
However, these authors did not analyze the effect
585 father–infant dyad. 641
of these classes on bonding behaviors. We did
586 642
not find any studies in which researchers exam-
587 643
588
ined the effect of other caretaking activities such Conclusion 644
as giving infant baths, changing diapers, or Fatherhood is an exciting but difficult time of
589 645
swaddling on father–infant bonding. transition and adjustment, especially for first-time
590 646
591 fathers. Fathers desire to be recognized as 647
The provider who encourages umbilical cord equals in the parenting dyad in terms of nurturing,
592 648
cutting at birth actively involves the father in the loving, and bonding with their infants. The
593 649
birth process and provides an opportunity for moment of birth symbolizes the beginning of
594 650
hands-on interaction. This act alone may be an fatherhood. The events surrounding birth and the Q8
595 651
effective intervention to improve immediate fa- perception of support through the transition
596 652
ther–newborn bonding. However, more research process affect father–infant bonding. The
597 653
is needed to determine the effect of umbilical involvement of fathers in the labor and birth pro-
598 654
cord cutting on early father–newborn bonding. cess provides an opportunity for immediate
599 655
600 physical contact with the infant, which has 656
Our findings suggested that perception of been reported as one of the most effective
601 657
spousal support or strength of the marital rela- interventions to promote bonding. More research
602 658
tionship is the most significant variable on a is needed to examine effective bonding
603 659
father’s attitude and behavioral interaction with interventions for fathers in the immediate post-
604 660
the infant (Anderson, 1996a; Goodman, 2005; partum period, and in doing so, we may begin to
605 661
Montigny, Lacharité, & Amyot, 2006; Weaver & appreciate the importance of their roles and
606 662
Cranley, 1983; Yu et al., 2012). However, we did change the birth and postpartum processes.
607 663
not locate any research focused on improving
608 664
communication techniques among expectant
609 665
610
couples. The perceived lack of guidance during Supplementary Material 666
the immediate postpartum period of fatherhood, Note: To access the supplementary material that
611 667
coupled with limited knowledge of infant accompanies this article, visit the online version
612 668
caretaking skills by the father, may influence the of the Journal of Obstetric, Gynecologic, &
613 669
degree of gatekeeping performed by the mother, Neonatal Nursing at http://jognn.org and at http://
614 670
therefore limiting paternal access to the infant. dx.doi.org/10.1016/j.jogn.2016.09.004.
615 671
616 672

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