The participants were mainly first time parents who were geographically located across the Perth metropolitan area. These locations included western (high income), eastern (average income), southern (lower income) and northern (average income) suburbs . The age of mothers ranged from 18 to 37 years and fathers from 26 to 48 years. The majority of participants were married (70%, n = 53) or living in a defacto relationship (29%, n = 21), with two participants being single.
A number of practical support strategies were suggested by the mothers and included: assistance with meal preparation, housework such as washing dishes and/or clothes, shopping, bathing the baby, bringing the baby to the mother for a night-time feed and measures to assist the mother to relax, such as a neck massage. As far as providing emotional support, women suggested that their partner could give praise or compliments, plus boost her confidence with encouraging comments acknowledging her breastfeeding efforts.
Analysis of the data revealed two major themes, "Dads do make a difference" and "Wanting to be involved", relating to paternal support with sub-themes describing the perceptions of effective paternal support from both mothers and fathers. Mothers' responses identified three common sub-themes relating to fathers making a difference, which were: "Anticipating needs and getting the job done", giving "Encouragement to do your best" and having a "Paternal commitment to breastfeeding". Fathers' responses identified three common sub-themes related to being involved, which were: "Wanting relevant information", "Learning the role" and "Being an advocate".
Pseudonyms and participants age have been used to illustrate the participants' comments to support the themes developed.
Mothers' major theme: Dads do make a difference
The theme "Dads do make a difference" emerged from all focus groups with a wide range of situations presented where fathers made a difference and numerous examples of practical ways in which they helped, including assistance with expressing breast milk:
"Without him I couldn't have done it [breastfeed], I couldn't have expressed for the two weeks that I did." (Melissa, age 27)
Similar thoughts were expressed by Camilla who acknowledged how much her partner supported her efforts when her family was pro formula feeding:
"None of my family has breastfed and they thought it was a step backwards. Only poor people breastfeed. They didn't understand what the urgency and importance of breastfeeding was for me. Without him [partner] I couldn't have done it [breastfed] really." (Camilla, age 22)
Anticipating needs and getting the job done
Just being there to offer support as needed and sharing the new parenting burden was identified by many of the mothers as an important role. One mother spoke about how useful it was that her partner was able to remember the attachment and positioning skills for breastfeeding;
"He was sort of assisting me when the lactation consultant was around and he would remind me later, because I would forget things like that. He would actually observe and try to make suggestions about positioning and attachment, which was good for both practical and moral support."(Jane, age 28)
Mothers reflected on some of the ways their partners anticipated their needs and assisted them with their newborn babies:
"He just knew that that's what I needed; I didn't have to say the baby's awake, get up. He just got up straight away and brought her to me." (Sarah, age 33)
Carol offered examples of how her partner allowed her to take some time out:
"He'd come up and just hold the baby, so I could have a shower or grab something to eat." (Carol, age 32)
On occasions when mothers felt overwhelmed they relied on their partners to continue running the house:
"I was getting no sleep at that time; you know feeding her was taking two hours. Then there was an hour gap and I would have to start feeding her again, so he pretty much did everything; cooked, cleaned, went to work." (Pamela, age 29)
Another mother recognised the importance of her partner being home in the first few weeks post birth to help her.
"It was great to have him there during the day. I think it's really important that husbands need to be home each day for the first month to help, because that's when the problems tend to happen." (Marg, age 26)
Encouragement to do your best
Offering the mother acknowledgement for the effort being put into breastfeeding and giving emotional support was seen to be especially important. Mothers talked about the difficulties in the first few weeks at home with a newborn, and how important it was that their partner was encouraging and accepted the time commitment to breastfeeding. As the following mother related:
"Just that encouragement, you know when your partner says you're doing a good job in those early days when you're feeding for 40 minutes or an hour, I found that really helpful." (Juanita, age 34)
One mother talked about her increased sense of confidence knowing her partner trusted her to do the best for their baby:
"It's like he trusts that I will do what is best for the baby." (Robin, age 23)
Acts of affection and kindness were greatly appreciated and acknowledged as this mother described:
"He got up during the night and gave me cuddles when I was in tears, and my nipples were cracked and sore and bleeding, that was really helpful." (Dina, age 21)
Another mother talked about the importance of her partner just being there, accepting of her commitment to breastfeed:
"He was fully aware that my job at that time was to feed the baby, and for him to just be there." (Rhani, age 30)
Anticipating needs, emotional support and a commitment from the father to support and promote breastfeeding, led to the third sub-theme.
Paternal commitment to breastfeeding
Believing that breast milk was best for their child and willing to do what was necessary to assist his partner to breastfeed, saw one father go "head to head" with the hospital staff following his partner's emergency caesarean birth.
"Normally, he doesn't engage in discussions like this. But he'd taken it in and when it was necessary, he's stepped up and pushed back the medical staff and said to them 'breast milk is best. It's on tap. It's here, it's available, and that's what my baby's having.' And that meant the world to me. It's one of those situations where I could easily have come out of the general anaesthetic and gone. 'Crap, my baby's had formula for its first feed,' but it hadn't because Dad was on the ball, to say 'No'." (Julie, age 26)
Another mother spoke of the commitment and support from her husband to express breast milk to ensure their baby didn't have formula:
"She just wasn't a strong feeder, and I needed a lot of support; there was never any mention of formula or anything like that. He just knew to get the pump, and we pumped for six weeks." (Anna, age 32)
Using computer technology assisted the next father in his commitment to breastfeeding and reduced the attachment difficulties for his partner:
"Getting the attachment right was a bit challenging and I remember one night he went to our laptop computer, brought it into the bed and we watched a little demonstration on breastfeeding. He set that up for me, helping me get the attachment right." (Jacqui, age 22)
The mothers' experiences reflected how "Dads make a difference". However, when the fathers' data were analysed the major theme "Wanting to be involved" emerged. Three sub-themes also emerged: "Wanting relevant information"; "Learning the role" and "Being an advocate".
Fathers' major theme: Wanting to be involved
Fathers participating in the study all wanted to be involved with parenting and parenthood, but many of them felt they were unprepared and lacked the relevant information to be effective in their parenting role. One father spoke about feeling left out and neglected because he didn't understand what his partner was going through:
"I felt like I was missing out on intellectual stimulation, missing out on emotional stimulation and physical. I think a lot of those things; the feeling of neglect could have been avoided by having someone explain to me what the women really go through and how to make things easier or better." (Imran, age 29)
Responses from fathers indicated there was a need for ready access to support specific to father's needs.
"Give some advice on how to be supportive to the mother when she is struggling with breastfeeding/baby blues." (Jason, age 22)
Fathers indicated they believed men may be reluctant to ask for help or not know who to ask or where to ask:
"Let fathers know why mothers need assistance and what they can do to help once the child comes along. Encourage them to get involved in day to day stuff." (Michael, age 32)
Wanting relevant information
The men were consistent in identifying their need for "warts and all information".
"Information on relationship changes, hormonal changes of the partner and how best to support and handle those changes. Supporting your partner when she has problems like postnatal depression, no sex drive, changing hormones, crying/yelling/angry outbursts - learning to understand and support rather than chastise and think there is something wrong with your partner." (John, age 32)
Many of the fathers felt inadequate in their lack of knowledge about this new role in their lives and some felt resentful that they were not as informed as their partners. Even though fathers had often attended antenatal education classes they still felt inadequately prepared:
"You want similar information that mother's are given in mother's group on how to feed, nurture, and bond. Antenatal classes give the impression that fathers have nothing to do with their child." (Peter, age 38)
Most fathers believed they needed much more information about pregnancy, childbirth, breastfeeding and parenting. As Mark said:
"Provide information on why breastfeeding is best for baby and mother." (Mark, age 38)
Another father talked about the need for reassurance and support for fathers:
"It is easy to feel that the mother knows what to do and for the dad to stand back because he is a bit scared of doing it wrong. Confirmation that the mother is just as out of her depth as the father, and that it is a team effort." (Julio, age 25)
The following quote illustrates one father's need for information about difficulties associated with breastfeeding. His concern and horror about a piece of his wife's nipple falling off was in no way mediated by any of the information he had received during the antennal education process:
"Badly cracked nipples, one was so bad a small piece of the nipple fell off and left a hole, I didn't know what to do." (Muhammad, age 23)
Without exception, all the participating fathers wanted to be part of the parenting experience, but needed to learn the role.
Learning the role
The requirement for pragmatic information and realistic solutions being incorporated into learning the role were identified by participants who talked with pride about their babies and what it meant to be a father. As one dad said:
"Watching him develop, having cuddles, anticipating of our future together. Seeing part of yourself in your little boy. Showing him off to family, friends and everyone else. Seeing him smile. Watching him interact with his beautiful mother." (Rick, age 37)
Many of the fathers had ideas about what would have been useful for them to know before they had the baby. As the following father related:
"How to support your partner, things you can do to be involved. How to comfort your partner, the kind words you can say to support her. Hints on helping and understanding new mothers. Some advise on caring for the new baby." (John, age 27)
One father talked about having a realistic view of what to expect: and just being there as a comfort for his partner: "A no bullshit idea of what to expect and how to help even if that means doing nothing but being there with her and the baby." (Pete, age 28)
Being a breastfeeding advocate
Fathers discussed the need to advocate to family members and health professionals on the importance of their baby being breastfed.
"It is actually a sacrifice but at the same time, people should realize that if you feed baby properly [breastfeed] you will have your life more comfortable than if you don't. When baby's happy then everything is good." (Andre, age 37)
To be there and protect and defend parenting decisions against negative or unhelpful interference such as extended family who encouraged formula or undermined the mother's efforts was very important for fathers. As this father explained to his extended family:
"This is our parenting journey. Please be respectful, we feel it's best to do it this way [breastfeed]. Thank you for understanding." (Aaron, age 36)
Another father spoke about the advocacy role he played when the midwives at the hospital wanted to give his baby formula, knowing his partner wanted to breastfeed:
"I know you want to breastfeed, so stick to your guns." (Jarrad, age 40)
Supporting the decision to breastfeed in public without feeling shame was highlighted by the following father's comments. He also describes the shift from a sexual to functional use of the breast:
"When you're out and about sometimes it can be little bit concerning for a new mum to you know, just hang it all out. I guess there's still that well, it's like shame, and you don't want everyone looking at things [breasts] that have been private. And suddenly you've gone from being a sexual thing to a kitchen utensil." (Eric, age 38)