Exploring Fathers’ Experiences of Pregnancy After a Prior Perinatal Loss

Following pregnancy loss and neonatal death, studies suggest that men may engage in more instrumental grieving styles.

“Following pregnancy loss and neonatal death, studies suggest that men may engage in more instrumental grieving styles, which includes using activities, distraction or problem-solving approaches to grief, as opposed to intuitive styles which use emotion-focused approaches including outward displays of crying, talking about grief, or seeking social support [9, 16, 28–35].”

A smaller number of studies have suggested potential benefits of this role, particularly among people who are instrumental grievers, for whom this role could provide purpose.

“However, a smaller number of studies have also suggested potential benefits of this role, particularly among people who are instrumental grievers, for whom this role could provide purpose [30, 41].”

Qualitative studies indicated that men often feel that their role is primarily as a 'supporter' to their female partner after pregnancy loss.

“Qualitative studies indicated that men often feel that their role is primarily as a ‘supporter’ to their female partner”

Men felt unable to express their emotions due to the expectation that they maintain control of the situation and be a comfort to their female partner.

“together with the associated outcome of feeling unable to express their emotions due to the expectation that they maintain control of the situation and be a comfort to their female partner.”

Seven qualitative studies reported similar themes, particularly that of men feeling that their role was primarily as a 'supporter' to their female partner.

“Seven studies which aimed to describe men’s experiences of pregnancy loss either in the context of another pregnancy or as an occurrence in itself reported similar themes, particularly that of men feeling that their role was primarily as a ‘supporter’ to their female partner [10, 39–44].”

These studies examined the normative social expectation that males ought to be caretakers and sources of strength.

“These studies examined the normative social expectation that males ought to be caretakers and sources of strength”

Men often reported feeling unable to respond to their female partners with emotional support, preferring instead to respond with instrumental support by absorbing practical strain such as paying the bills.

“men often reported feeling unable to respond to their female partners with emotional support, preferring instead to respond with instrumental support by absorbing practical strain such as paying the bills”

Men experienced internal feelings of stress and vulnerability which intensified their role of 'protector' in subsequent pregnancies following a previous loss.

“they nevertheless experienced internal feelings of stress and vulnerability which intensified their role of ‘protector’ in subsequent pregnancies following a previous loss.”

Many men would make the effort to appear overtly 'strong' and return to their regular life as a coping strategy.

“while many men would make the effort to appear overtly ‘strong’ and return to their regular life as a coping strategy”

Participants in three studies reported a struggle in recognising their transition into fatherhood and questioned if they had the right to the 'father' title following a loss.

“participants in three studies reported a struggle in recognising their transition into fatherhood, and questioned if they had the right to the ‘father’ title following a loss [41, 43, 46].”

Men typically feel as though they need to take on a 'supporter' role for their female partner, which may come at the expense of their own health and wellbeing.

“men typically feel as though they need to take on a ‘supporter’ role for their female partner, which may come at the expense of their own health and wellbeing [10, 39–44].”

The existing body of research indicates that pregnancy loss may lead to a loss of identity related to both the anticipated father role, and the grief and loss associated with changes after a pregnancy loss.

“the existing body of research indicates that pregnancy loss may lead to a loss of identity related to both the anticipated father role, and the grief and loss associated with the changes which may come after a pregnancy loss [41, 43, 46].”

Seventeen included studies grouped together different types of loss as part of the investigation of grief (e.g., miscarriage and stillbirth, stillbirth and neonatal death, or all three types together).

“Finally, 17 studies also grouped together different types of loss as part of the investigation of grief (e.g., miscarriage and stillbirth, stillbirth and neonatal death, or all three types together) [24, 46, 57–61, 73, 77, 80, 83, 84, 86, 88–90, 93].”

Other men in 10 studies reported less intense reactions, including stating that their partners experienced worse grief in comparison to them.

“However, other men in 10 studies (some overlapping with the above 14 studies) also reported less intense reactions, including stating that their partners experienced worse grief in comparison to them [56, 61, 69, 71–75, 78, 79].”

In 14 qualitative studies, men reported that the loss of their baby was a significant life event, regardless of gestational or neonatal age.

“In 14 qualitative studies, men reported that the loss of their baby was a significant life event, regardless of gestational or neonatal age [46, 57–62, 66, 73, 75, 79, 81, 82, 85].”

Actions that increased attachment included spending time with the baby and attending ultrasound appointments to 'see' the baby and hear the heartbeat.

“Actions that increased attachment included spending time with the baby [66, 85], and attending ultrasound appointments to ‘see’ the baby and hear the heartbeat [46, 61, 62, 66, 73, 79, 82, 85].”

In 11 qualitative studies, men who had developed a bond with their baby throughout the pregnancy described more intense grief following a subsequent loss.

“In 11 qualitative studies, men who had developed a bond with their baby throughout the pregnancy described more intense grief following a subsequent loss [46, 58, 60–62, 73, 75, 79, 81, 82, 85].”

In three qualitative studies, men's grief continued into subsequent pregnancies/children, with added concerns and vigilance due to knowledge of potential risks.

“However, in three qualitative studies examining experiences of grief into subsequent pregnancies/children, it was clear that men’s grief did continue, along with added concerns and vigilance due to the knowledge of potential risks [73, 74, 80].”

Men who reported religious or spiritual beliefs found this to be a source of comfort in coping with their grief (eight qualitative studies).

“In eight qualitative studies, men who reported religious or spiritual beliefs also found this to be a source of comfort in coping with their grief.”

In three studies, some men reported the supporter role was helpful, giving them a meaningful task to focus on.

“In three studies, some men reported feeling as though this supporter role was helpful, as it gave them a meaningful task to focus on [69, 73, 75].”

In 10 of 16 studies looking at support, family and/or friends were a helpful facilitator to men's coping following loss.

“In 16 studies looking at support, 10 found family and/or friends to be a helpful facilitator to men’s coping following the loss [56, 57, 59, 66, 72, 73, 75, 79, 81, 82].”

Seven qualitative studies reported negative or absent interactions with family and friends.

“However, seven qualitative studies also reported negative – or a total absence of – interactions with family and friends [59–62, 73, 75, 80].”

In 10 studies, some men reported positive experiences with healthcare staff.

“In 10 studies, some men reported positive experiences with healthcare staff [46, 60, 61, 64, 68, 73, 75, 78, 81, 82].”

Some men in qualitative studies expressed less extreme reactions to loss, indicating representation of a range of experiences.

“However, some men in qualitative studies also expressed less extreme reactions to the loss, indicating representation of a range of experiences [56, 61, 69, 71–75, 78, 79].”