How do stillbirth and neonatal death affect fathers? Open University academics have reviewed the available research and presented it in a new article. Dr Alison Davies from the School of Psychology and Counselling describes the findings.
Scoping reviews are an effective way to map the literature on a particular topic or research area in order to identify key theories, concepts and practices. They help identify gaps in the research, including methodological approaches, and are often used to inform research bids for funding. Open University academics conducted a scoping review to explore men’s experiences of the loss of their baby in the immediate post-natal period, and their experiences of ongoing support. The aim of this review was to inform future thinking on recommendations, interventions and priorities for new research.
Worldwide, there are over 4 million perinatal deaths each year (the death of a child during pregnancy or in early infancy). 2016 figures for the UK indicate 5544 babies were stillborn or died in the early neonatal period (ONS,2018). Such loss is linked with poor mental health outcomes such as anxiety, depression and posttraumatic stress disorder (PTSD).
Until now, most research has focused on the psychological measurement of parental grief. The key outcome of these studies suggests that women experience higher levels of grief than men. However, these measurement scales have been critiqued for not being sensitive to male forms of expression.
This is generally explained in terms of social and cultural norms that encourage men to internalise their emotions. Social expectations of ‘being a man’ include not sharing problems or finding ‘masculine’ ways of dealing with problems, such as cutting off from partners or turning to alcohol or substance abuse. Some studies show that fathers’ grief is situated within wider socio-cultural expectations of gender relations, with men internalising their grief in order to ‘be strong’ for their partner.
Other studies, however, point to the importance of paternal identity for men and to the transformative impact of fatherhood on men’s sense of themselves as men. Contemporary fathers are much more likely to participate in obstetric practices such as attending scan, prenatal diagnostic appointments and prenatal classes. These practices encourage an attachment to the unborn infant as well as shaping a prenatal identification as a father, both of which are likely to impact on the intensity of grief experienced. A source of distress for men is the ambiguity of fatherhood when a baby dies and this is compounded by healthcare providers who are more focused on the mother’s welfare.
This review was guided by the following research questions:
1. The impact of perinatal death for men
2. The meaning of the loss for a father’s sense of identity
3. The extent to which men were able to express grief while supporting their partners, and
4. how men’s experience of grief was mediated by the support and care received by health professionals.
The initial search produced 16,144 records, and this was systematically reduced to 27 studies which met the inclusion criteria. Five main themes were identified: The psychological impact of loss; Claiming paternal identity; Fathers’ expression of grief; Fathers’ support needs; Support and care by professionals.
The review produced the following findings:
Men feel pressure to take on a supporter role for their female partner and this may be detrimental to their own health and well-being
There is a loss of identity as father after the death of a baby
Stillbirth and neonatal death can result in men experiencing disenfranchised grief (a lack of social recognition for their grief)
Men are more likely to face challenges to accessing support
While the feelings associated with stillbirth and neonatal death are similar for men and women, the expression of these feelings differ – e.g. Men are more likely to use avoidance and coping strategies such as increased alcohol consumption, indicating that men’s health and wellbeing is an important area of research.
The lack of knowledge of these issues amongst some health professionals and family members can lead to helplessness, marginalisation and feelings of loneliness during grief.
The review identified the following implications for practice
Professionals need to acknowledge paternal loss and the role of men as more than a ‘supportive partner’
Health professionals should be encouraged to invite fathers to engage in appropriate rituals to validate feelings and experiences.
There are also implications for future research:
Future research should focus on men’s health and well-being rather than using psychological measurements which do not fully capture men’s experiences of loss
Here is the link to the full article:
New understandings of
fathers’ experiences of grief and loss following stillbirth and neonatal death:
a scoping review (2019-12)
Jones, Kerry; Robb, Martin; Murphy, Sam and Davies, Alison
Midwifery, 79, Article 102531
You can read more about Alison Davies here http://www.open.ac.uk/people/ad5742
An organisation that provides support related to these issues is https://www.sands.org.uk/our-work/supporting-parents