**3. The father in the context of pregnancy, birth, and postpartum**

This category includes Brazilian studies on paternal involvement during periods of pregnancy, birth, and postpartum, encompassing topics such as breastfeeding and non-normative events, such as postpartum depression, prematurity, and admission to neonatal intensive care units. It is subdivided into the subcategories described below:

#### **3.1. Pregnancy**

Psi and the site of the Health Sciences Descriptors (DeCS), BVS. The terms *father* and *paterni‐ ty* were indexed in at least one of the sites mentioned above. We chose to add the search function on the *paternal* descriptor that makes specific reference to the variable of interest in

Regarding the limits of the search, the studies selected for analysis comprised only scientific articles published between the years from 2000 until 2012, with full text available and that provide results and discussions about the father figure, even when paternity was not the central theme. We excluded books, book chapters, reviews, theses, dissertations, and articles without full text available. From a total of 1447 documents found, 90 complete articles were chosen to be analyzed in function of their contributions to the production of knowledge of fatherhood in Brazil. The analysis of the articles was carried out in according to the structure of nine categories which represent the major topics of interest on fathers and fatherhood research in the Brazilian context. The following we describe each category and present the

This category includes issues investigated by several studies that present the new character‐ istics of family's configurations which are different from the traditional one. It refers to families with stepfather, due to divorce, adoption or remarried families. Examples of the major issues

One study (Grzybowski & Wagner, 2010) investigated parenting practices of mothers and fathers who are divorced or separated, emphasizing that even in this situation mothers were more involved with their children than fathers, and mothers usually cohabited with children. The results reveal a traditional configuration of parental involvement after separation/divorce, meaning that the maternal involvement is greater than the paternal after the end of marriage,

The process of adopting a child has a specific configuration within the family dynamic and organization, once men who wish to have a child see in adoption an opportunity to become fathers. Fathers interviewed referred desire to form a family composed by the couple and their children, although they also reported difficulties with the legal adoption and the threat of biological parents. Parents claim to be happy and satisfied with the adoption, and describe the role of father as good, requiring a present and accountable parent in daily activities. The articles (Andrade, Costa, & Rossetti-Ferreira, 2006; Tomé & Schermann, 2004) dealing with nonbiological parents, as in the case of adoption or stepfathers, refer to the construction of paternity in a context that aims at overcoming the lack of consanguineous ties by affective ones. In adoptive parenthood, even when inserted in the labor market, mothers are the primary caregivers, as well as those who primarily perform the home chores, while fathers assume the

Couples who get together to form a family were, for a long time, the focus of research. However, given current social and economic changes, many women begin to participate

and that cohabitation may lead to greater direct involvement with children.

role of helpers and of dealing with the economic support.

this study.

main finds.

**2. Family configurations**

40 Parenting in South American and African Contexts

referred in this category are described below.

The pregnancy of wife or partner was the subject of seven studies. One of the studies (Piccinini, Silva, Gonçalves, Lopes, & Tudge, 2004) included as participants men who were expecting their first child and the results indicate that fathers were involved in different ways during the pregnancy of their partners, being emotionally connected to both the mother and the baby. However, some of these fathers still found difficulties of involve‐ ment with their children, seemingly not perceiving them as real and showing low emotion‐ al connection to pregnancy. In contrast, one of the studies (Piccinini, Levandowski, Gomes, Lindenmeyer, & Lopes, 2009) investigated the expectations and feelings of future fathers about their babies and the authors concluded that few fathers reported difficulty imagin‐ ing the baby: they had built a mental image of the baby, including their physical and psychological characteristics. Moreover, they had participated in the choice of name and raised concerns about the child's health. Another paper (Krob, Piccinini, & Silva, 2009 ) was characterized as a longitudinal study that investigated the expectation of men during the last trimester of the partner's pregnancy, as well as feelings about fatherhood during the second month of the baby's life. Results indicate that pregnancy was experienced as emotionally intense, characterized by joy, anxiety, and conflict. Men also reported con‐ cerns about the baby and the partner's health, as well as feelings of exclusion. After the child's birth, the sense of exclusion persisted. However, fathers reported positive feelings and satisfaction, confirming the expectations built up during pregnancy. The involvement in caring for the baby was not as effective as planned, although there was great affection and closeness between father and infant (Krob, et al., 2009). These data point to signs of changes concerning paternity during pregnancy, which is increasingly less restricted to the female universe.

father often has a desire to attend the childbirth, though not always receiving the support of team of health care, especially in the case of the father being a teenager (Luz & Berni, 2010).

Paternity in the Brazilian Context http://dx.doi.org/10.5772/57027 43

The study of Carvalho (2003) aimed to investigate in a public hospital the impact children's birth had on men. The authors conclude that paternal involvement was influenced by various factors, such as institutional difficulties, mothers and fathers' motivation, social representa‐ tions on childbirth and paternity, and the exclusion of father from reproductive health and pediatric services. The presence of fathers was not valued by staff neither as support for mothers, or as a transitional phase to fatherhood (Carvalho, 2003). In this way, is necessary to encourage the participation of fathers in prenatal care, childbirth, postpartum and pediatrics appointments, the training of staff working with families, the expansion of social discussion about fatherhood, and the formulation of labor policies that ensure the presence of fathers in health services. For this reason, it should be noted that it is necessary that hospitals comply with the Brazilian Law No. 11,108, enacted on April 7, 2005, which ensures the presence of the

**3.3. Prematurity and monitoring of the child in the Intensive Care Unit - ICU**

Paternal participation at the ICU in the case of premature births was investigated in four studies. One of the studies (Tronchin & Tsunechiro, 2005) stressed the importance of fathers' presence in child care during hospitalization and in supporting mothers. Another research indicates that fathers of preterm babies engage in psychic reorganization because they need to carry out unexpected activities (Coutinho & Morsch, 2006). The same study presents the concept of 'engrossment', which refers to fathers' predisposition to show paternal concern and interest by their babies. It also claims that fathers' experience in ICU allows them to fall in love with their preterm babies, and to admire their strength and ability to fight for life. The same authors (Coutinho & Morsch, 2006) also showed that the moments of hospitalization consid‐ ered by mothers and fathers as the most painful were the delivery, the first visit to the baby at the ICU, the mother's first visit to the baby in neonatal intensive care unit, and the moment of leaving the hospital, when the couple 'leaves empty-handed', having to leave the child under hospital care. Research results also indicate that having a hospitalized child in the intensive care unit is an experience that triggers unexpected reactions of shock, disbelief, grief, and deep sorrow (Tronchin & Tsunechiro, 2006), fear, anguish, anxiety, loneliness, but also joy and hope (Carvalho, Araújo, Costa, Brito, & Souza, 2009). However, information received from health‐ care professionals is important and represents a relief to parents frightened and frail in the face of this situation. Therefore, studies underscore the need to create models of care that include the father in this process, so that he can learn to work with this reality, defining and imple‐ menting measures to ensure his role in child care (Tronchin & Tsunechiro, 2005; Tronchin & Tsunechiro, 2006). After leaving the ICU, fathers reported to be joyful and to experience a sense of relief. However, this period was also permeated by difficulties, especially for those whose children needed special care. Religiosity and faith were described in two studies, regardless of religion, as an important resource for dealing with the situation (Carvalho, et al., 2009;

partner of choice during women's labor.

Tronchin & Tsunechiro, 2006).

One of the researches (Martini, Piccinini, & Gonçalves, 2010) investigated indicators of *couvade* syndrome in primiparous parents during wives' pregnancy. This syndrome is characterized by a set of physical and psychological symptoms experienced mainly by biological fathers starting in the first and third trimesters of their partners' pregnancy, and ending shortly after the baby's birth. Participants in this study were 30 couples in different periods of pregnancy. Results revealed that more than half of the fathers had physical (increased appetite, food preference, and episodes of nausea) and/or emotional indicators (nervousness and moodiness) associated with *couvade* syndrome. Thus, the presence of indicators of *couvade* syndrome among fathers showed the complexity in the transition to parenthood, and the importance of understanding fathers' experiences and feelings during wives or partners' pregnancy.

Another study (Witter & Guimarães, 2008) aimed at verifying the perception of pregnant teens (females) regarding the participation of their partners in monitoring pregnancy. The study showed that about 66% of the participants had their partners participating in the process of pregnancy in several ways, which indicate the evidence of fathers' positive attitudes and behaviors towards pregnancy. Another study involving pregnant adolescents stresses the importance of rethinking the question of including fathers in prenatal public programs (Siqueira, Mendes, Finkler, Guedes, & Gonçalves, 2002).

Thus, it is clear that men can experience their wives or partners' pregnancy in terms of physical and emotional dimensions. The father participation in children's lives from pregnancy corroborates the perception of pregnancy as a period of transition to the exercise of parenthood, allowing the emergence of feelings of inclusion, and helping men to develop their new role as fathers. At this stage, values and priorities are reconfigured in the conjugal relationship. Some men refer concerns about fetal malformation, adversities in contemporary world, and the period of adolescence their children will face (Bornholdt, Wagner, & Staud, 2007). Other concerns related by adolescent fathers in the exercise of parenthood are financial difficulties, and the desire to be involved in children's development.

#### **3.2. Childbirth**

The investigation of father's involvement in childbirth was the subject of four studies. The experience of childbirth is considered a unique experience in the men and women's lives. One of the studies (Perdomini & Bonilha, 2011) revealed that fathers understand that their role involves to be present, to give comfort, and to use words of support. Fathers believe the opportunity of experiencing the birth of their child, regardless of the number of births accompanied by them, to be a unique experience, and a moment hard to explain. Another study (Motta & Crepaldi, 2005) showed that mothers think be important the presence of their partners in the delivery, because they represent important emotional support references. The father often has a desire to attend the childbirth, though not always receiving the support of team of health care, especially in the case of the father being a teenager (Luz & Berni, 2010).

and satisfaction, confirming the expectations built up during pregnancy. The involvement in caring for the baby was not as effective as planned, although there was great affection and closeness between father and infant (Krob, et al., 2009). These data point to signs of changes concerning paternity during pregnancy, which is increasingly less restricted to the

One of the researches (Martini, Piccinini, & Gonçalves, 2010) investigated indicators of *couvade* syndrome in primiparous parents during wives' pregnancy. This syndrome is characterized by a set of physical and psychological symptoms experienced mainly by biological fathers starting in the first and third trimesters of their partners' pregnancy, and ending shortly after the baby's birth. Participants in this study were 30 couples in different periods of pregnancy. Results revealed that more than half of the fathers had physical (increased appetite, food preference, and episodes of nausea) and/or emotional indicators (nervousness and moodiness) associated with *couvade* syndrome. Thus, the presence of indicators of *couvade* syndrome among fathers showed the complexity in the transition to parenthood, and the importance of understanding fathers' experiences and feelings during wives or partners' pregnancy.

Another study (Witter & Guimarães, 2008) aimed at verifying the perception of pregnant teens (females) regarding the participation of their partners in monitoring pregnancy. The study showed that about 66% of the participants had their partners participating in the process of pregnancy in several ways, which indicate the evidence of fathers' positive attitudes and behaviors towards pregnancy. Another study involving pregnant adolescents stresses the importance of rethinking the question of including fathers in prenatal public programs

Thus, it is clear that men can experience their wives or partners' pregnancy in terms of physical and emotional dimensions. The father participation in children's lives from pregnancy corroborates the perception of pregnancy as a period of transition to the exercise of parenthood, allowing the emergence of feelings of inclusion, and helping men to develop their new role as fathers. At this stage, values and priorities are reconfigured in the conjugal relationship. Some men refer concerns about fetal malformation, adversities in contemporary world, and the period of adolescence their children will face (Bornholdt, Wagner, & Staud, 2007). Other concerns related by adolescent fathers in the exercise of parenthood are financial difficulties,

The investigation of father's involvement in childbirth was the subject of four studies. The experience of childbirth is considered a unique experience in the men and women's lives. One of the studies (Perdomini & Bonilha, 2011) revealed that fathers understand that their role involves to be present, to give comfort, and to use words of support. Fathers believe the opportunity of experiencing the birth of their child, regardless of the number of births accompanied by them, to be a unique experience, and a moment hard to explain. Another study (Motta & Crepaldi, 2005) showed that mothers think be important the presence of their partners in the delivery, because they represent important emotional support references. The

(Siqueira, Mendes, Finkler, Guedes, & Gonçalves, 2002).

and the desire to be involved in children's development.

female universe.

42 Parenting in South American and African Contexts

**3.2. Childbirth**

The study of Carvalho (2003) aimed to investigate in a public hospital the impact children's birth had on men. The authors conclude that paternal involvement was influenced by various factors, such as institutional difficulties, mothers and fathers' motivation, social representa‐ tions on childbirth and paternity, and the exclusion of father from reproductive health and pediatric services. The presence of fathers was not valued by staff neither as support for mothers, or as a transitional phase to fatherhood (Carvalho, 2003). In this way, is necessary to encourage the participation of fathers in prenatal care, childbirth, postpartum and pediatrics appointments, the training of staff working with families, the expansion of social discussion about fatherhood, and the formulation of labor policies that ensure the presence of fathers in health services. For this reason, it should be noted that it is necessary that hospitals comply with the Brazilian Law No. 11,108, enacted on April 7, 2005, which ensures the presence of the partner of choice during women's labor.

#### **3.3. Prematurity and monitoring of the child in the Intensive Care Unit - ICU**

Paternal participation at the ICU in the case of premature births was investigated in four studies. One of the studies (Tronchin & Tsunechiro, 2005) stressed the importance of fathers' presence in child care during hospitalization and in supporting mothers. Another research indicates that fathers of preterm babies engage in psychic reorganization because they need to carry out unexpected activities (Coutinho & Morsch, 2006). The same study presents the concept of 'engrossment', which refers to fathers' predisposition to show paternal concern and interest by their babies. It also claims that fathers' experience in ICU allows them to fall in love with their preterm babies, and to admire their strength and ability to fight for life. The same authors (Coutinho & Morsch, 2006) also showed that the moments of hospitalization consid‐ ered by mothers and fathers as the most painful were the delivery, the first visit to the baby at the ICU, the mother's first visit to the baby in neonatal intensive care unit, and the moment of leaving the hospital, when the couple 'leaves empty-handed', having to leave the child under hospital care. Research results also indicate that having a hospitalized child in the intensive care unit is an experience that triggers unexpected reactions of shock, disbelief, grief, and deep sorrow (Tronchin & Tsunechiro, 2006), fear, anguish, anxiety, loneliness, but also joy and hope (Carvalho, Araújo, Costa, Brito, & Souza, 2009). However, information received from health‐ care professionals is important and represents a relief to parents frightened and frail in the face of this situation. Therefore, studies underscore the need to create models of care that include the father in this process, so that he can learn to work with this reality, defining and imple‐ menting measures to ensure his role in child care (Tronchin & Tsunechiro, 2005; Tronchin & Tsunechiro, 2006). After leaving the ICU, fathers reported to be joyful and to experience a sense of relief. However, this period was also permeated by difficulties, especially for those whose children needed special care. Religiosity and faith were described in two studies, regardless of religion, as an important resource for dealing with the situation (Carvalho, et al., 2009; Tronchin & Tsunechiro, 2006).

#### **3.4. Puerperium**

One of the studies (Oliveira & Brito, 2009) investigated fathers' attitudes in the household during the postpartum period, and concluded that men take care of their partners and offer them advice concerning physical recovery and injury prevention. Fathers also recognize that the partner and the newborn require more dedication and time after birth, and develop attitudes of dedication and concern about the child's health. Their accounts also confirm they prepare financially for children's arrival, playing the role of main provider to the family (Jager & Bottoli, 2011; Oliveira & Brito, 2009).

on several factors, including welfare, availability and satisfaction of both mothers and fathers with their activities. Fathers and mothers tend to evaluate positively their performance of parental roles, and to feel satisfied, although not so competent, in relation to their functions. Stress and emotional well-being may interfere with their satisfaction and perception of their

Paternity in the Brazilian Context http://dx.doi.org/10.5772/57027 45

In another study (Bruschini & Ricoldi, 2012), fathers reported to children's care and domestic tasks with their wives, even corroborating the role of others as providers and moral supervisors. Furthermore, men showed concern for being involved in tasks related to feeding, hygiene, and doing the homework. The traditional role often includes the affective dimension and fathers' concerns with children (Freitas et al., 2009; Pereira Junior, Si‐ queira, & Rezende, 2011). Although there is evidence of the increases paternal involve‐ ment in child care, the same is not true with respect to household chores, indicating the predominance of fathers' care to the child, but not of fathers as the main responsible for the home (Sutter & Bucher-Maluschke, 2008). Some fathers, even performing activities such as feeding, bathing and caring directly to their children, still refer to these activities as female responsibilities in children's lives, while considering themselves responsible for disciplining, guiding, and monitoring of children's conducts (Bustamante, 2005a; Romanel‐ li, 2003). Satisfaction in the relationship with their wives seems to favor the involvement of fathers with the child and increases their participation in basic care and responsibili‐ ties in raising children (Bustamante, 2005b). Participants reported that being a father includes functions that go beyond the responsibility as providers, thus involving being

In relation to educational practices, participants reported frequently adopting inductive practices - indicating to children the consequences of their behaviors to other people, while calling attention to logical aspects of the situation -, in contrast to coercive practices, charac‐ terized by the direct application of imposition to control children's behaviors (Piccinini, Frizzo, Alvarenga, Lopes, & Tudge, 2007). It was also found that participants displayed a profile closer to self-relational models in relation to their socialization goals. Parents wanted their children to be self-reliant, independent, and professionally successful, while valuing them being honest

In synthesis, studies show changes in both paternal functions and parental roles, resulting from the increased participation of women in the labor market. It has been noted a greater paternal involvement in childcare and household chores, even if mothers continue to be identified as the main responsible for such activities. Although fathers and mothers have different roles, they seem to be complementary, and to express changes if their participation in children's care, moving from a traditional model of division of labor to the sharing of functions. The social, economic and family changes, the concepts of co-parenting and the notion of complementarity of parental functions are important factors to be considered in the study of parental involvement and in the characterization of maternity and paternity in

parental role (Ribas, Ribas Junior, & Valente, 2006).

present and establishing limits and responsibilities to children.

and executors of his duties with the family and society.

contemporary family.

Another article (Maranhão, Gomes, & Oliveira, 2012) showed that during pregnancy men had performed tasks that require more physical effort (such as cooking, doing the laundry, and performing other heavy activities). When the baby was born, however, this concern disap‐ peared and fathers failed to assist mothers with household chores, while spending more time caring for their children, especially when they are older. In this way, one other study (Falceto, Fernandes, Baratojo, & Giugliani, 2008) involving 153 families with babies of four months, the authors concluded that there is a high prevalence of families in which the father is not actively involved in children's care, especially when the marital relationship is problematic and mothers do not have a paid job. The feeling of emotional detachment between the couple appears as a significant factor in the postpartum period (Maranhão, et al., 2012).

Regarding breastfeeding, studies have indicated that men do not participate in encouraging this practice, because they did not have this experience in their own families, schools and/or health institutions. Hence, they do not recognize the importance of this act (Pontes, Alexan‐ drino, & Osório, 2008; Pontes, Alexandrino, & Osório, 2009). The authors propose the con‐ struction of a model to encourage fathers' involvement in this practice, and to design a health program with the goal of changing the culture of breastfeeding, increasing the duration of breastfeeding.

Regarding the non-normative events in the puerperium, the differences in dyadic (motherinfant, father-infant and mother-father) and triadic relationships (father-mother-child) were investigated in families with and without maternal depression, during a session of free interaction (Frizzo & Piccinini, 2007 ). Only one category involving cognitive stimulation was significantly different between the mother-infant and father-child dyads in families with maternal depression, indicating that, despite the depression mothers stimulated their babies more than fathers. Families without the experience of depression also showed higher disen‐ gagement (less emotional involvement and responsiveness) in father-infant than in motherinfant dyads. For the authors, it is possible that fathers exercise a moderating role in the possible effects of maternal depression in the family, perhaps mitigating such effects in triadic contexts, once there seems to be a change in the family pattern in families with maternal depression.
