Further Reading for Health Professionals - Paternal Grief

1. Patterson, D., Begley, A., & Nolan, A. (2016). An Evaluation of a Teaching Strategy: The Use of Literature When Teaching Pre-Registration Midwifery Students on Pregnancy and Loss. Nurse Education Today, 38: 42-47. doi: 10.1016/j.nedt.2015.12.019

School of Nursing and Midwifery, Queens University Belfast, Medical Biology Centre, Belfast Ireland, UK

With the use of Seamus Heaney’s poem Elegy for a Still Born Child, midwifery students’ ability to gain insight into the experience of bereaved parents and achieve an emotional grasp of the situation through vicarious experience were evaluated. The data also indicates that vicarious experience gained through reading this poem has helped to nurture sensitivity and professional insight into the impact of still birth on a father. (see in particular ‘Father’s Perspective’).

2. Olson-Garriott, A. N., Gamino, L. A., Davies, E. B., & Gudmundsdottir, M. (2015). Having or Adopting Another Child: Perspectives From Bereaved Fathers. Professional Psychology: Research and Practice, Aug 17. doi:10.1037/pro0000026

University of Denver, CO, USA

How does a clinician comfort a bereaved parent who presents for psychotherapy following the death of a child? What advice is given if the subject turns to the question of having another child? To address these questions, investigators mined archival data from 11 bereaved fathers to gain a more detailed understanding of the experience of fathers who went on to have a subsequent child after losing a child in a pediatric palliative care setting. Phenomenological qualitative methods were used to analyze in-depth interviews with the participants regarding their thoughts, feelings, and perceptions about the decision to have another child as well as how the subsequent child impacted their grief trajectory, mental and physical health outcomes, and overall adaptation and coping. Three primary themes emerged from the data: decision-making process and the waiting game, emerging from mourning, and furthering the connection. Based on these findings, useful strategies to use with bereaved fathers and parents are discussed, and include managing anxiety and ambivalence, rediscovery of joy and happiness, “second chance” at fathering, and enhancing a continued bond with the deceased child.

3. Proulx, M. C., Martinez, A. M., Carnevale, F., & Legault, A. (2015). Fathers’ Experience after the Death of their Child (Aged 1–17 Years). OMEGA-Journal of Death and Dying. doi: 10.1177/0030222815590715

McGill University Health Center, Montreal, QC, Canada

The death of a child is traumatic for parents. The grief of bereaved fathers is inadequately understood since most studies on this subject have focused primarily on mothers. The goal of this phenomenological study was to understand fathers’ experiences following the death of their child. Interviews were conducted with 13 fathers whose child (aged 1–17 years) had died at least 1 and up to 6 years earlier, either from a life-limiting illness or unexpectedly in an intensive care unit in a pediatric hospital in Eastern Canada. The analysis indicates that fathers’ experience deep suffering after the death of their child and feel torn between the past and the future. Three major themes were identified: needing to push forward in order to avoid breakdown, keeping the child present in everyday life, and finding meaning in their experience of grief. Clinical implications for professionals working with this population are discussed.

4. Cacciatore, J., Erlandsson, K., & Rådestad, I. (2013). Fatherhood and Suffering: A Qualitative Exploration of Swedish Men’s Experiences of Care after the Death of a Baby. International Journal of Nursing Studies, 50(5), 664-670. doi: 10.1016/j.ijnurstu.2012.10.014

School of Social Work, Arizona State University, AZ, USA

Background: This study was designed to evaluate fathers’ experiences of stillbirth and psychosocial care.

Methods: Data were collected between 27 March 2008 and 1 April 2010 via a questionnaire posted on the homepage of the Swedish National Infant Foundation. The responses to the following open-ended questions were analyzed using content analysis: “Are you grateful today for anything that health care professionals did in connection with the birth of your child?” and “Are you sad, hurt or angry today about something personnel did in connection with the birth of your baby?”.

Results: 113/131 (86%) fathers reported feelings of being grateful. Only 22/131 (16%) fathers reported feeling sad, hurt, or angry. Fathers expressed gratitude when health care professionals treated their newborn “with respect and without fear”, “with extraordinary reverence”, and when their fatherhood was validated by providers. They were also grateful when providers helped them to create memories of their baby. Fathers also reported feeling sad, hurt, or angry when providers were nonchalant and indifferent and when they perceived providers to be uncaring and disrespectful toward their baby.

Conclusion: Bereaved fathers experience overall gratitude for person-centered psychosocial care in the aftermath of stillbirth, particularly when they feel validated as a grieving father and their child is acknowledged with reverence.

Clinical implications: Health care professionals should support fathers by treating the baby who died with respect and dignity and by validating and acknowledging both his grief experiences and his fatherhood just as they would for a grieving mother.

5. Yu-Ting, S., & Fu-Hsuan, C. (2013). Paternal Grief and Nursing Care in Perinatal Deaths. Journal of Nursing, 60(6), 90. doi:10.6224/JN.60.6.90

Perinatal death distresses all family members. Paternal perceptions of perinatal death should be better understood in order to help the expectant father maintain long-term health and quality of life and minimize the potential negative effects of paternal grieving and stress on family and marital relations. Male and female grieving behaviors have been shown to differ significantly. Taiwan society typically expects males to be strong and support the family while avoiding the overt expression or revelation of personal feelings such as grief, regret, and anger. Although fathers may be reluctant to express a need for care, care personnel may facilitate care through such activities as understanding of a perinatal-death father’s feelings, providing related messages about the event to facilitate good decisions, helping him support his spouse, helping him adopt appropriate behaviors and attitudes toward the fetus, and treating him as a grieving father rather than a medical event. This article reviews the literature to explore paternal perceptions and reactions toward perinatal death in order to recognize nursing needs and principles of grieving fathers within the Taiwan cultural context. Further study in this area is recommended.

6. Cholette, Meghan E (2012). Through the Eyes of a Father: A Perinatal Loss. International Journal of Childbirth Education, 27 (2), 33-38.

University of Arizona - PhD candidate in Perinatal Nursing and Perinatal Loss

Perinatal loss prompts profound grief and suffering. This paper presents a review of nursing discourse on suffering and grief arising from perinatal loss. Drawing upon literature and professional experience, it becomes apparent that the paucity of research and minimal society recognition increases the extent to which the paternal experience with perinatal loss is misunderstood and mismanaged. Differences in paternal and maternal grieving need to be supported so that the healing process can be skillfully initiated with families and the child forever lost to them. When these unexpected tragedies occur, perinatal healthcare providers, childbirth educators and doulas are in a unique position to facilitate health, healing and a natural transcendence through creating positive memories.

7. Aho, A. L., Tarkka, M. T., Åstedt-Kurki, P., Sorvari, L., & Kaunonen, M. (2011). Evaluating a Bereavement Follow-Up Intervention for Grieving Fathers and their Experiences of Support after the Death of a Child—a Pilot Study. Death Studies,35(10), 879-904. doi:10.1080/07481187.2011.553318

School of Health Sciences , University of Tampere , Tampere, Finland

This article describes a study designed to evaluate the effectiveness of an intervention program for bereaved fathers and their experiences of it in a sample of intervention (n = 62) and control (n = 41) fathers. Data were collected by 3 scales: the Hogan Grief Reactions Checklist, a scale for measuring received social support, and a scale for measuring fathers’ experiences of the intervention program. Assessment at 6 months after leaving the hospital showed that intervention fathers reported lower grief reaction scores and stronger personal growth. Intervention fathers reported the most emotional support from both health care personnel and peer supporters. The support received was perceived as helpful in coping, and fathers rated the intervention favorably. The findings support the continuation of the intervention.

8. Aho, A. L., Tarkka, M. T., Åstedt-Kurki, P., & Kaunonen, M. (2009). Fathers’ Experience of Social Support after the Death of a Child. American Journal of Men’s Health, 3(2), 93-103. doi: 10.1177/1557988307302094

Department of Nursing Science, University of Tampere, Tampere, Finland

The aims of this study were to describe fathers’ social networks and their experience of social support after the death of a child. The sample consisted of 8 fathers who had lost a child under the age of 3. The data were collected with open-ended questions and interviews. Data analysis used qualitative content analysis. The fathers’ social support networks varied over time and between fathers. The support networks included either just the spouse or the spouse and other people. Social relationships broke down and new relationships formed in their place. The fathers experienced social isolation but also deliberately isolated themselves from human relationships. The support the fathers received was felt to be both positive and negative. Peer support was only positive. Support from professionals was reported to be important but was also criticized. In particular better family care, informal support, and systematic support after leaving the hospital were expected.

9. Bonnette, S. (2009). Men’s Experience of Stillbirth: Gender Identities, Fathering and the Social Mediation of Male Grief. Thesis: University of Newcastle, Bachelor Honours - Bachelor of Social Science (Honours) [full text]

Research within the social sciences examining experiences of stillbirth has consistently focused on women’s perspectives, while men’s perspectives and experiences have received little attention. The limited research available has illustrated the need to incorporate men’s perspectives to gain a better understanding of the gendered character of stillbirth. Biologically determined sex role theories have significantly influenced previous research agenda, shaping, in turn, cultural beliefs around men’s experience of pregnancy loss and the importance and validity of male expression of grief. However, contemporary approaches to gender research focus on the negotiation of identities and multiplicity in masculine and feminine identities. Such theorisations of the social construction of gender and grief provide the conceptual frame for the study presented here. The study is based on a series of qualitative semi-structured interviews with 12 Australian men who had experienced stillbirth. Their accounts begin to reveal the ways in which some men identify as fathers to their unborn and stillborn child and how they develop dynamic and ongoing relationships with their child post stillbirth. The results show that demonstrating masculinities in fathering and grief is complex and negotiated territory, in which masculinities are constructed and enacted in gendered relational contexts.

10. Colon, E. (2008). Paternal Experiences after a Perinatal Loss. Doctoral Thesis, University of South Carolina

Pregnancy loss and stillbirth affect approximately 2 million families a year in the United States (American Pregnancy Statistics, 2000-2007), accounting for the loss of one third of identified pregnancies. While mothers’ grief has been studied extensively, most researchers have overlooked the significant impact pregnancy loss has on the male partner. Evidence exists that men experience profound grief in response to perinatal loss. Using a qualitative, phenomenological method, this study explored paternal grief experiences following pregnancy loss. Nine fathers who experienced perinatal loss revealed their profound grief experience after stillbirth and miscarriage. Fathers described “experiencing” the unexpected events and emotions, “managing” those things within their control, “connecting” with the child and family, and “reflecting” on the significance of the loss. Each of these concepts contributed to the essence of the experience for these men, “being shaped” into who and what they are because of the experience. Findings indicated that fathers need acknowledgement as legitimate grievers, recognition of their intuitive grief style, and physical and creative activities to help them process their grief. Things men indicated that did not help them were meaningless cliches that diminished their loss, critiques of their grieving style, and support groups for verbal sharing of their experience. This study contributes new understanding of paternal perinatal grief. Instead of promoting open expressions of grief, and perinatal grief support groups, caregivers need to provide recognition of fathers’ active/cognitive grieving style, encourage their participation and management during the loss, promote the development of connections with the lost child, and educate the public about fathers’ grief to assist bereaved fathers to feel validated and acknowledged. Further research should focus on types of activities to assist these grieving fathers.

11. Aho, A. L., Tarkka, M. T., Åstedt-Kurki, P., & Kaunonen, M. (2006). Fathers’ Grief after the Death of a Child. Issues in Mental Health Nursing, 27(6), 647-663. doi:10.1080/01612840600643008

University of Tampere, Tampere, Finland

The purpose of this study was to describe fathers’ grief and the changes the death of a child has brought to fathers’ lives. Participants included eight fathers who had lost a child. The data were collected using a questionnaire with open-ended questions and by interviews. Content analysis was used as a means of data analysis.

The grief of the fathers manifested itself individually and dynamically and also in various anticipatory feelings and in physical, social, and behavioural reactions. The death of the child brought both positive and negative changes to the fathers’ lives. Mental health nurses should be aware that depression and other mental illness, as well as unemployment and financial problems, were reported by some of the study participants.

12. Badenhorst, W., Riches, S., Turton, P., & Hughes, P. (2006). The Psychological Effects of Stillbirth and Neonatal Death on Fathers: Systematic Review. Journal of Psychosomatic Obstetrics & Gynecology, 27(4), 245-256. DOI:10.1080/01674820600870327

St George’s University of London, UK

Objective. To review the available evidence on the psychological effects of perinatal death on fathers.

Method. Electronic search of CINAHL, MEDLINE and PsycINFO databases from 1966–2005. Inclusion criteria: papers describing at least one psychological outcome for fathers who had experienced stillbirth or neonatal death. Exclusion criteria: papers not in English, dissertations, reviews, books without original data, intervention studies, studies of parents without separate results for fathers, studies where perinatal loss was not distinguished from other losses, first person accounts of a single experience, studies reporting on fewer than five fathers. Seventy-seven potential papers were obtained and screened by two authors. Seventeen studies were included. Study quality was rated using a checklist and main findings were summarized.

Results. Quality of methodology varied. Qualitative studies described classical grief responses, but less guilt than mothers. Fathers described experiences related to their social role and potential conflict between grieving couples. Quantitative research reported symptoms of anxiety and depression, but at a lower level than mothers. Fathers may develop post-traumatic stress disorder following stillbirth.

Discussion. Case prevalence of psychological disorders is unknown. More good quality research is needed. The social role of fathers as carers for their partners needs recognition when planning care for bereaved families.

13. O’Leary, J. & Thorwick, C. (2006). Fathers’ Perspectives during Pregnancy, Postperinatal Loss. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN 35 (1): 78-86. DOI: 10.1111/j.1552-6909.2006.00017.x

School of Nursing, University of Minnesota, Minneapolis, USA

Objective: To present information about the father’s perspective during the experience of a pregnancy following perinatal loss. Design: Descriptive phenomenology. Setting: Interviews were done in a venue chosen by fathers (home, clinic). Participants: Ten fathers who had experienced a loss within the prior year and were currently with that partner in a subsequent pregnancy. Four themes emerged: Recognition, preoccupation, stoicism, and support. Conclusions: Participants describe the need to be recognized by others. The orderly conduct of their daily lives is disrupted by preoccupation with the pregnancy. They feel unable to share their own anxiety and fear because they want to protect the mothers. Societal pressure to “be strong” and the belief that “men don’t share” appear to inhibit fathers from getting support. Strategies to assess and support fathers emotionally at the time of loss and in the subsequent pregnancy need to be explored.

14. Turton, P., Badenhorst, W., Hughes, P., Ward, J., Riches, S., & White, S. (2006). Psychological Impact of Stillbirth on Fathers in the Subsequent Pregnancy and Puerperium. The British Journal of Psychiatry, 188(2), 165-172. DOI: 10.1192/bjp.188.2.165 [full text]

Division of Mental Health, St George’s University of London, London, UK

Background Approximately 1 in 200 UK pregnancies ends in stillbirth. Although serious psychological effects of stillbirth on mothers are well established, much less is known about the impact of such loss on fathers.

Aims To assess the psychological morbidity of fathers in the pregnancy and post-partum year subsequent to a stillbirth, to test within-couple effects and to identify risk factors.

Method This was a community-based cohort study of 38 pregnant couples whose previous pregnancy had ended in stillbirth, and 38 pair-matched controls. Psychological assessments took place antenatally and at 6 weeks, 6 months and 1year postnatally.

Results Fathers in the index group experienced significant levels of anxiety and post-traumatic stress disorder antenatally, but all of their symptoms remitted postnatally (after the birth of a live baby). Fathers’ symptom levels were lower than those of mothers at all time points. In contrast to mothers, fathers experienced greater anxiety when a subsequent pregnancy (following stillbirth) was delayed.

Conclusions The vulnerability of fathers to psychological distress during the pregnancy after a stillbirth needs to be recognised.

15. Beder, J. (2004). Bereavement after Miscarriage: The Man’s Experience. In Voices of Bereavement: A Casebook for Grief Counselors. Brunner-Routledge, New York ; Hove.

Last reviewed: 19/5/24