As the smallest unit of the society, family is the most important social environment which provides the child’s growth and development by shaping and directing his/her behaviours. Each family member’s physical, mental and environmental wellbeing contributes positively to the development of the community, as well [1-4]. The perinatal process that includes pregnancy, childbirth and postpartum is an important crisis period affecting the family system [3-5].

During the perinatal period, it is necessary to support the fathers as well as the mothers and provide their participation to the process. Although paternal involvement is beneficial, and this fact is supported by various studies, father involvement in the process is not at the desired level throughout the world. The world started to involve the fathers in the perinatal process in 1960s. The men in Sweden started to attend the pregnant training classes in 1970. In Ukraine, the rate of fathers’ presence at the birth has increased in the last 15 years [6]. Despite the fact that paternal involvement in the perinatal period is supported in developed countries, Turkey has just started to provide fathers’ participation to the process. The fathers in our country are ignored during the perinatal process starting with pregnancy control especially because of the hospital policies. Presence of the first-time fathers during birth is not allowed except in some very special circumstances (such as father’s working as a health staff or special hospital conditions). The lack of support in the perinatal period may affect parental experiences in a negative way [5,6]. In the studies carried out, it was found that that the reasons for parental psychiatric disorders in the postpartum period are lack of social support, mismatch between spouses and stressful living conditions. [7-10]. While the studies about the perinatal period focus on especially the mother and deal with her transition to parenting; the father’s transition process, his perception of fatherhood and paternal involvement in baby care are not taken into consideration [5,11,12].

WHO emphasizes that the health staff should try to contribute to the fathers’ health and provide them with support and counselling about sexual and reproductive health as from the perinatal period [13]. It is stated that father health depends on the relations with the spouse, parents and health staff. Meanwhile, the fathers who are interested in their babies do not show negative health behaviours, which leads to a decrease in their disease symptoms [14]. Nurses can help fathers attend educational program during the postpartum and prenatal periods so that they can adapt their new role easily and have sufficient information about pregnancy, maternal changes and baby care [14]. The aim of this study is to determine the attitudes of first-time fathers towards involvement in baby care and their actual involvement in the process.

The study was carried out descriptively with the aim of determining the attitudes of the first-time fathers towards involvement in baby-care and the status of their actual involvement. Data were collected among 357 first-time fathers whose wives had a natural childbirth in the surveillance service and healthy baby clinic of Ankara Zekai Tahir Burak Training and Research Hospital between 15.04.2010 and 15.09.2010. A data collection form was prepared for determining the first-time fathers’ attitudes to involvement in baby-care and the status of paternal involvement in baby-care.

Written permission for the implementation of the study was taken from the Turkish Ministry of Health. The study was evaluated and approved in terms of ethical eligibility by Hacettepe University Senate Ethics Committee. Additionally, a parental consent form was signed by the participants who meet the sampling criteria. The data obtained in the study were analyzed by means of a Statistical Package for Social Sciences (SPSS) 17.0 for Windows. The compliance of the continuous data with normal distribution was evaluated by Kolmogorov-Smirnov tests and the variances’ suitability for normal distribution was determined. Chi-Square test (Pearson Chi-Square, Fisher Chi-Square) was applied by using descriptive statistics (number, percentage, mean, standard deviation) in order to find the difference between the groups. p<0.05 was taken into consideration as the value of materiality for the comparison of the groups. The power of the study was found to be 80.0% after being calculated with the retrospective power analysis by means of the power and sample size programmed.

The distribution of some descriptive characteristics of participants is given in Table 1. It was found that 64.1% of the fathers are between 26 and 30 years old and their median age is 29.0 ± 2.8 (min=21 max=36). 52.1% of them are high school graduates, 94.4% work somewhere, 87.1% live in the city center and 84.6% live in a nuclear family.

Table 1: Distribution of some descriptive characteristics of the fathers.

Considering the marriage duration of the participants, it was reported that 64.7% of them have been married for about 0-3 years and the median duration of marriage is 3.4 ± 2.0. 43.1% stated that they have a good income and 44.0% described themselves as middle income individuals. The mothers of 58.0% of the participants and the fathers of 52.1% are primary school graduates and about 50% of their wives are high school graduates.

43.7% of the fathers stated that they acquired knowledge and 68.0% of those said that they got that knowledge in the prenatal period. It was reported that 56.4% of the fathers obtained the information about baby-care through internet. books. magazines. television. 29.4% acquired from health staff. Additionally. it was found that 80.1% of the participants got information about nutrition and 39.7% have knowledge about baby sleep.

84.9% of the fathers expressed their need to acquire knowledge about baby-care. 35.0% of the fathers feel insufficient. 40.8% of them find baby-care difficult and 40.0% of them think they do not have enough knowledge on baby-care. 30.5% do not feel themselves insufficient in baby-care. 54.1% of those feeling insufficient said diaper and clothes change will be challenging for them and 44.4% stated that they will have difficulty in every practice.

It was reported in the study that 91.3% of the participants decided pregnancy together with their wives. 93.8% said they had planned pregnancy and 73.9% stated that there is someone at home to help them with baby-care. 56.9% of the infants are male (Tables 2 and 3).

Table 2: Distribution of the status of the father’s knowledge acquisition on baby care, their perception of self-sufficiency and anxiety of difficulty.

Table 3: The status of paternal involvement in baby-care in 10 days after birth and the practices which they were involved in n=357*.

All of the fathers said that they participated in at least one of the baby care practices. It was found that 83.2% of the participants relieved their babies’ gas in 10 days after birth. 69.7% put their babies to sleep and 61.6 changed the baby’s diaper (Table 4).

Table 4: Paternal involvement in baby care according to the perception of self-sufficiency and anxiety of difficulty.

It was reported that 94%.0 of the fathers with the feeling of selfsufficiency were involved in baby-care and 83.2 of those who didn’t feel themselves sufficient participated in the process. The difference between the two involvement rates changing according to the perception of self-sufficiency was found to be statistically significant (p<0.05) (Table 5).

Table 5: Distribution of the participants in terms of their descriptive characteristics and perception of self-sufficiency in baby-care.

82.8% of the fathers at the age of 21-25 and 56.8% of those at the age of 26-30 feel sufficient in baby-care. The difference in the rates of perception of self-sufficiency changing according to the age group was found to be statistically significant (p<0.05).

68.1% of the participants whose fathers are at primary or lower education level stated that they feel themselves sufficient in baby care and 72.5% of those whose fathers are at secondary or higher education level said that they find themselves sufficient in baby-care.

As the education level of the participants’ fathers rises. the perception level of self-sufficiency increases. The difference in the rates changing according to the education level of participants’ fathers was considered to be statistically significant (p<0.05). 92.5% of the fathers whose wives are at primary or lower education level and 55.3% of the fathers whose wives are high school graduates or at a higher level of education feel themselves sufficient in baby care. It was found out that as the education level of the participants’ wives rises. the number of those with the feeling of self-sufficiency in baby care decreases. Additionally. the difference in the rates showing changes according to the education level of the wives was to be found significant (p<0.05) (Table 6).

Table 6: Distribution of the fathers according to involvement in pregnancy checks and birth, the presence of someone to help with the baby-care, knowledge acquisition and perception of self-sufficiency.

64.8% of the fathers who participated in pregnancy checks and 66.7 of those who were not involved stated that they feel themselves sufficient in baby-care. The difference between involvement in pregnancy checks and perception of self-sufficiency was found to be statistically insignificant (p>0.05). Considering the fathers’ perception of self-sufficiency in terms of their opinions about involvement in birth. It was found that 52.4% of the fathers who are in favor of participating in birth feel themselves sufficient and 58.5% who do not support that opinion feel themselves insufficient in baby-care. 86.4% of the undecided fathers expressed self –sufficiency. The difference in the rates changing according to the fathers’ opinions about birth involvement was found to be statistically important (p<0.05). It was found that 93.6% of the fathers who have someone to help and 80.6% of those who do not have are involved in baby-care. The difference between the two groups’ involvement in baby care according to the presence of someone to help was found to be statistically significant (p<0.05). All of the fathers (100%) who got information about babycare and 82.6% of those who were not informed said that they are involved in baby-care (Table 7).

Table 7: Distribution of the fathers according to involvement in pregnancy checks and birth, presence of someone to help with baby-care, knowledge acquisition and involvement in baby-care.

59.1% of the fathers having someone to help with baby-care and 81.7% of those not having someone to assist feel themselves selfsufficient in baby-care. The difference in the perception of selfsufficiency between two groups was found to be significant (p<0.05). 89.3% of the fathers who participated in the pregnancy checks and 100% of those who were not involved in that practice stated that they will be involved in baby-care. 89.2% of the participants who are in favor of paternal involvement in pregnancy checks and 95.0% of those who do not support that opinion and 100% of the undecided ones said that they are involved in baby-care. The involvement rates of the willing and unwilling groups are the same (90.2%), which means that the difference is not statistically insignificant (p>0.05).

The postpartum period is an important development process through which families have physical, social and emotional changes. The inclusion of a new member to the family requires preparation of the parents for the new roles and responsibilities and adaptation of them to this new process. For this reason, the father as well as the mother should adapt himself to the physiological and psychological changes, attain the role of paternity, accept his baby and acquire the necessary knowledge and skills for participating in the baby-care.

In our study, it is seen that the primary information sources of the fathers are internet, books, magazines and television (56.4%). Only one third of the fathers (29.4%) stated that they got information from the health staff (Table 2). The study of Plantin and Daneback [14] reported that most of the fathers acquired knowledge from the internet. While in Premberg 65% found that the participants were informed mostly by the health staff, Montigny [15] noted they preferred to get information from the nurses. Today, the widespread use of electronic access resources, television and printed media provides easy access to the desired information.

In the study, it was found that 65% of the participants feel themselves sufficient in baby-care (Table 3). Additionally, the difference in paternal involvement rates changing according to the perception of self-sufficiency was found to be statistically significant (p<0.05). Similar, in the study of Salonen [16] it was reported that the fathers having been involved in baby-care in the postpartum period feel themselves more sufficient. In their study, Holmes and Lee [17,18] stated that the fathers who feel themselves sufficient are more likely to be involved in baby-care. In our country, traditionally a woman stays (mother, mother in-law, sister, etc.) with the family to help the mother. Despite the fact that the presence of someone to help the mother with baby-care especially in the postpartum period is an important source of social support for the family, culturally it may prevent the paternal involvement in the process.

In this study, it was found that 69.5% of the fathers have anxiety of difficulty in baby-care (Table 3). The involvement rate of the fathers without any anxiety of difficulty in baby-care is 92.3%, which is more than those thinking that they will have difficulty (85.3%) (p<0.05) (Table 3). In the study of Kuruçırak [19], it was reported that 30% of the fathers had difficulty in baby-care. For this reason, the arrangement of educational programmed on the baby-care issues that the fathers need to learn may increase the perception level of self-sufficiency and promote the involvement in baby-care as a consequence.

87.1% of the participants in the study live in the City Center. Although, all of the fathers living in the county town feel self-sufficient in baby-care, their involvement rate (69.6%) is lower than that of those living in the city center (93.2%). The difference in the involvement rates changing according to the residence was found to be statistically significant (p<0.05). In the study of Carter and Speizer [20], it was reported that the involvement rates do not change according to the residence in the postpartum period. The difference seen in this study may have resulted from two facts. Firstly, the number of fathers living in the county town is low. Secondly, those fathers adopt their gender roles more because of their residence. In addition to this, division of responsibilities in the modernizing families and communities may be the reason for higher involvement rates among the participants living in the City Centre.

84.6% of the fathers in our study live in nuclear families. Both the perception rate of self-sufficiency (62.9%) and the rate of involvement in baby-care (84.6%) among the fathers living in nuclear families are higher than those of the participants in extended families (perception of self-sufficiency 76.4%, involvement 98.2%). However, the difference in the rates according to the family type was found to be insignificant (p>0.05). In the study of Şentürk [21], it was reported that not only the support provided by the spouse but also the assistance taken from his/her family is quite important in the Turkish culture. In nuclear families, the lack of social support in the postpartum period which is an important time of crisis may bring about an increase in the feeling of insufficiency among both fathers and mothers. This situation may be related to the transition of the traditional Turkish family to nuclear type.

While the involvement rate of the participants who are in favor of the paternal involvement in birth is 96.8%, it falls to 86.2% among those who do not support that opinion (p<0.05). At the same time, 52.4% of the fathers who are not in favor of father involvement in birth stated that they feel self-sufficient in baby-care (p<0.05). In the study carried out in our country, 18.8% of the fathers who were not involved in the birth expressed their wonder about witnessing the moment of birth. In the study of Hotun et al. [22] it was reported that 56.0% of the mothers wish to see their spouses beside them. The high involvement rate of the participants who are in favor of paternal involvement in birth shows that the fathers are willing to take role in the perinatal process.

In the study, it was found that the absence of someone to help with baby-care at home increases the perception rate of self-sufficiency (p<0.05) and decreases the involvement rate (p<0.05). In the researches carried out, it was determined that family members, friends and colleagues provide support to the fathers [15,23,24]. Supporting the family and helping the parents with baby-care may psychologically relieve them [25]. The absence of someone to help with baby-care at home may encourage the fathers to get more information about babycare and help them feel more self-sufficient.

In our study, it was determined that the fathers were involved in at least one baby-care practice in 10 days after birth. 83.2% of them relieved the baby gas, 69.7% put their babies to sleep and 61.6% changed diaper. In the study of Özcebe et al. [26] it was reported that 82.4% of the fathers relieved the baby gas in the postpartum period. In other studies, it was found that the fathers acquire new skills on babycare in order to “take the new situation under control”, know the needs of their babies and have the desire to apply the practices they have learned [2,15].

In the traditional social-cultural structure, it is a maternal duty to care for the baby. However, in recent years, the rate of paternal involvement in baby-care has increased by the changes in role expectations. In the process of establishing a family, there should be informative and educational counselling services that can be provided by the nurses for the fathers so that they can be informed about the possible parental changes and be involved in the whole process starting from the pregnancy checks. The fathers should be encouraged to spend more time with their spouses and babies in the postpartum period. Promoting the fathers’ perception of self-sufficiency through informative counselling in the discharge trainings and providing their involvement in baby-care will ensure that the mother, father and the baby continue their physical and psychological development in a healthy way.