Th e most fundamental influence in the breastfeeding process is the father ’ s support. The mother feels safer in breastfeeding when she has her partner ’ s support and a more active and effective participation. This study aimed at evaluating the father ’ s knowledge about breastfeeding in a quantitative approach through a transversal cohort study, interviewing 78 fathers in a public maternity in Salvador. The average age of the interviewees was 29 . 9 years and 53 . 8% had an incomplete fundamental schooling. Regarding knowledge of the subject, 10 . 3% believed that breastfeeding can be substituted. All fathers interviewed answered that they support breastfeeding for their children and believe in its benefits; 39 . 7% reported that their opinion could interfere their partner ’ s decision to prolong the process. Moreover, 69 . 2% of the males attended their partner ’ s antenatal meetings, and of these, over a third had no intervention on the subject. Of all the participants, 80 . 8% confirmed that they had participated in the breastfeeding process and emphasized their gratification during this phase. About the paternal opinion, 39 . 7% believed that there is a degree of influence over the partner ’ s decision to breastfeed, and for that reason 50% told the mother their opinion. The study widened the knowledge about the role of the father in breastfeeding, ratifying the importance of their support towards the mother in this process, ultimately contributing to improving the practice and benefiting the mother-child relationship. Therefore, we conclude that those interviewed have some knowledge about breastfeeding, recognize its importance during the process and would like to know mor e.
One of the main influences for the success of breastfeeding (BF) is represented by the support of the father [
The feelings of a man in relation to his partner and child are one of the essential factors to determine the success in pregnancy and birth in all its phases, including BF [
The present research aims to understand the opinion of the fathers about their functions in breastfeeding and the importance of their support. The lack of studies conducted in Brazil focusing on this subject highlights the need to answer questions. The objective of the present study was to describe the knowledge of the father about breastfeeding and the influence of their participation.
This is a transversal study, carried out in the period from March to May 2014, in an important maternity in the state of Bahia, Brazil. All fathers who had their children born in that hospital and were present in the Common Ward (as companions or visitors) at the time, and agreed to take part when asked by the researcher were included in the study. As a non-inclusion criteria were those fathers whose new-borns (NB) were not staying in the common ward due to various clinical complications, or whose partners were admitted in another ward, also due to clinical complications, hampering the exclusive use of breast milk in the immediate afterbirth. Those fathers who refused to participate were also excluded.
Following the ethical aspects according to Resolution 466/12 of the National Health Council (CNS, abbreviation in Portuguese), a Free and Informed Consent Form (TCLE, abbreviation in Portuguese) was signed by the fathers who agreed to take part in the study.
The investigation tool used was an interview composed by two parts: the first one aimed at characterizing the participants, and the second aimed at evaluating the father’s knowledge about the aspects of breastfeeding and the influence of their participation. A pilot project was carried out for internal validation of the interview.
The data generated from the subjective questions were organized and categorized in Microsoft Excel 2010, and used for registration and descriptive data analysis. The sample was of convenience, and as it wasn’t probabilistic, no inferential statistics were calculated, due to the impossibility of an adequate estimative of standard deviation.
The project was approved by the Ethics in Research Committee of the University Hospital Professor Edgard Santos (HUPES), on March 14th 2014, under protocol No. 21731113.5.0000.0049.
At the time of the research at the Common Ward, there were 85 males of which 78 agreed to take part. Four refused and three did not comply with the inclusion criteria (the baby of one father was at the Canguru infirmary and two others had their babies staying in the Neonatal Intensive Care Ward).
In this research, 28.2% of the fathers had knowledge of some techniques for the correct breastfeeding: the baby should be supported by the mother’s body (10% or 45.5%); the baby should be correctly adjusted on the arm ? baby’s head on the arm and the bottom supported by the mother’s hand (9% or 41%); baby should be inclined (5% or 22.7%); the baby’s mouth should be stimulated to open (3% or 13.6%); the baby should be supported by only one arm/hand (3% or 13.6%); the baby should suck the whole breast (2% or 9.1%); the mother should be seated when breastfeeding (2% or 9.1%); others: hold the breast with a cupped hand, change breasts between feedings, massage
Characters | Number of fathers % (N = 78) | dp |
---|---|---|
Average age (years) | 29.9 | 6.8 |
Marital status | ||
Married | 19.2 (15) | |
Single | 14.1 (11) | |
Stable relationship | 66.7 (52) | |
Level of education | ||
Incomplete fundamental school | 5.1 (4) | |
Complete fundamental school | 9.0 (7) | |
Incomplete intermediate school | 53.8 (42) | |
Complete intermediate school | 24.4 (19) | |
Incomplete superior school | 3.8 (3) | |
Complete superior school | 3.8 (3) |
Knowledge | Number of fathers % (N = 78) |
---|---|
BF can be substituted by another food? | |
yes | 10.3 (8) |
no | 89.7 (70) |
Duration of BF (months) | |
≤3 | 1.3 (1) |
3 - 6 | 17.9 (14) |
6 - 10 | 11.5 (9) |
10 - 12 | 17.9 (14) |
12 - 24 | 28.2 (22) |
>24 | 21.8 (17) |
No answer | 1.3 (1) |
Is there a period for exclusive BF? | |
yes | 82.1 (64) |
no | 17.9 (14) |
Duration of exclusive BF (months) | |
≤1 | 10.9 (7) |
1 - 2 | 4.7 (3) |
2 - 3 | 18.8 (12) |
3 - 6 | 51.6 (33) |
6 - 12 | 14.1 (9) |
Is there a need to introduce complementary food? | |
yes | 97.4 (76) |
no | 2.6 (2) |
When should complementary food be introduced? | |
As soon as the baby is born | - (0) |
When the baby leaves hospital | 5.1 (4) |
When the baby is six months’ old each food has a time to be introduced | 52.6 (41) |
After 2 years | 5.1 (4) |
When the baby does not accept the mother’s breast, at any age | 34.6 (27) |
No answer | 2.6(2) |
Is artificial milk as good as BF? | |
yes | 2.6 (2) |
no | 97.4 (76) |
the breasts (4% or 18.2%); no answer (1% or 4.5%). Among those who declared to have some knowledge for a correct breastfeeding technique, 27.3% of the answers were considered incorrect.
Among all men, 69.2% of those participated in the antenatal meetings during the
Knowledge | Number of fathers % (N = 78) |
---|---|
Are there benefits in breastfeeding? | |
yes | 80.8 (63) |
no | 12.8 (10) |
no answer | 6.4 (5) |
What are the benefits for the mother? | |
Empty the breasts/no waste/avoid petrified milk | 38.1 (24) |
Relationship mother-child | 17.5 (11) |
Prevent diseases/breast cancer | 12.7 (8) |
Lose weight | 6.3 (4) |
Afterbirth recovery/less complications | 4.8 (3) |
Decrease expenses | 4.8 (3) |
Other benefits | 6.3 (4) |
No answer | 22.2 (14) |
Are there benefits for the child in breastfeeding? | |
yes | 100 (78) |
no | - (0) |
What are the benefits for the child? | |
More resistance/improvement in immune system/health | 61.5 (48) |
Development/growth | 50.0 (39) |
Good nutrition/weight gain/best food | 26.9 (21) |
Source of calcium/strong bones/strength | 23.1 (18) |
Emotional bond | 6.4 (5) |
Teething | 3.8 (3) |
Other benefits | 16.7 (13) |
No answer | 6.4 (5) |
Breastfeeding brings benefits for the child in the long term? | |
yes | 70.5 (55) |
no | 29.5 (23) |
Did you notice any difficulties for the mother in breastfeeding? | |
yes | 62.8 (49) |
no | 35.9 (28) |
no answer | 1.3 (1) |
Which difficulties were observed? | |
Pain | 34.7 (17) |
Milk was difficult to come/not enough milk | 22.4 (11) |
Cracks | 20.4 (10) |
Nipple formation/incorrect holding | 20.4 (10) |
Afterbirth movements/correct position | 16.3 (8) |
Petrified milk/leaks | 6.1 (3) |
First time anxiety | 6.1 (3) |
Other difficulties | 6.1 (3) |
No answer | 2.0 (1) |
Functions | Number of fathers % (N = 78) |
---|---|
Participated in the antenatal process during partner’s pregnancy? | |
yes | 69.2 (54) |
no | 30.8 (24) |
Had interest in finding out how to help their partner to breastfeed? | |
yes | 41.0 (32) |
no | 59.0 (46) |
As a father, participates in the breastfeeding process? | |
yes | 80.8 (63) |
no | 19.2 (15) |
As a father, which is your participation? | |
Helps BF process | 71.4 (45) |
Guidance/observation of process | 33.3 (21) |
Help in caring for the baby and home | 23.8 (15) |
Concern with the well-being/affection towards the mother | 4.8 (3) |
As a father, supports that your child is breastfed by the mother? | |
yes | 100 (78) |
no | - (0) |
Does your opinion interfere in your partner’s decision to breastfeed for longer or less time? | |
yes | 39.7 (31) |
no | 60.3 (47) |
Which should be the changes for a higher level of male participation in breastfeeding? | |
Higher awareness/more paternal participation | 24.4 (19) |
Increase of paternal licence/holidays in this period | 11.5 (9) |
More guidance for the fathers about BF | 10.3 (8) |
Creation of talks/courses for basic instructions for men | 9.0 (7) |
More opportunities/time to participate | 3.8 (3) |
Other changes | 6.4 (5) |
No answer | 42.3 (33) |
Suggestions to formulate a program to influence fathers to participate more in the breastfeeding process: | |
Dynamic programs/courses/talks/workshops | 30.8 (24) |
More incentive for fathers to participate in the antenatal | 10.3 (8) |
More information on the subject | 9.0 (7) |
Articles/advertisements in the media to stimulate | 9.0 (7) |
More guidance/information/theory and practice classes in the maternities and common wards | 5.1 (4) |
Other suggestions | 6.4 (5) |
No answer | 26.9 (21) |
pregnancy, and 90.7% (49) felt welcomed during these appointments when they could join. However, 79.6% of the men present in the meetings were not approached or had any advice or guidance regarding “how the father should or should not participate in breastfeeding”. Of the 39.7% of fathers who had some guidance―during the antenatal meetings or outside―the information given included: how to help the mother to care/breastfeed the baby (48.4% or 15%); the importance of father’s affection (3.2%, or 1%); the benefits/importance of BF (29%, or 9%); and the importance of the father in the antenatal meetings (3.2%, or 1%).
In this study, 85.9% (67) of the men believed that the father should participate in some way in breastfeeding, and the reasons given were the following: the father’s participation is important for the child (34.8% or 24%); it is necessary to support/help the mother when she is absent/unable (30.4% or 21%); it is important to guide/stimu- late/seek knowledge/follow the breastfeeding process (27.5% or 19%). However, only 41% of those interviewed had any interest in finding out how to help their partners with breastfeeding. Based on this answer, the kind of participation they believe they should have involves: help care for the baby (47.4% or 37%); stimulate/support/ob- serve/guide the breastfeeding process (35.9% or 28%); the paternal presence in all phases is fundamental (12.8% or 10%); help the mother in her chores (10.3% or 8%). The 14.1% (11) who answered that the father should not participate in the BF process justified their answer saying that they do not need to help/do not have time/could disturb the process/father’s participation is not necessary.
Among the interviewed, 100% of the fathers argued that their baby should be breastfed by the mother, and the reasons given were: BF is important/necessary (57.7% or 45%); only the mother could give that/it is her role (28.2% or 22%); milk from the mother is safer/healthier (11.5% or 9%); the love is transmitted during this process (6.5% or 5%).
When asked what was the feeling present during the BF process, the men answered: they felt happiness/joy/safety/well-being (80% or 63%); they also felt responsible for the process/baby’s feeding (5.1% or 4%); they did not find breastfeeding a difficult phase (2.6% or 2%); others―weird feeling, that they were more experienced than the first- time mother, feeling of being present (9% or 7%) and no answer (7.7% or 6%). Half the fathers had discussed with the mother of their child their opinion about breastfeeding, whereas only 39.7% believed that their opinion about breastfeeding could interfere their partner’s opinion regarding breastfeeding for longer/less time. A final suggestion from the interviewed was the creation of a program focused on a higher level of fathers’ involvement in breastfeeding, introducing the theme naturally in their leisure time, th- rough information given by community workers or during the antenatal meetings.
In the population studied, 85.9% were married or in a stable relationship. Papp (20,012) [
Regarding the father’s schooling, it was noted that over half of the sample had between six and nine years of completed education, similar to what was found by Silva PP et al. (2012) [
Regarding the benefits for the nursing mother and infant, 80.8% of the participants answered that if the mother chooses to breastfeed, she can have the following benefits: strengthening of bond mother-child, prevention of diseases/breast cancer, weight loss, faster recovery post-birth/less chances of complications. These results were contradictory to those found in the study by Silva BT et al. (2012) [
A study by Arora et al. (2000) [
In the present study, 69.2% of the fathers participated in the antenatal meetings during pregnancy. However, 20.4% of those who were present in the antenatal meetings were not approached, or had any advice or guidance about breastfeeding. This data reflect the present context of health assistance and highlights the importance of training aimed at an active paternal inclusion in the puerperal pregnancy.
In some studies [
Those fathers who participated in the breastfeeding period by helping the process corresponded to 80.8%, corroborating with the most recent research on the subject. However, there are controversies with what had been reported in previous research, such as Piazzalunga et al. (2009) [
Silva BT et al. (2012) [
In the results presented, 100% of those interviewed considered that their child should be breastfed, a higher result than that obtained by Garcia-Fragoso et al. (2013) [
The main reasons found in our research given by the fathers to support breastfeeding were: BF is important/necessary (57.7%); only the mother can provide/it is her obligation (28.2%); BF is safer/healthier (11.5%) and bond is established in this process (6.4%). This confirms the results of Silva PP et al. (2012) [
The feeling described by the parents regarding the breastfeeding process is described as happiness/joy/safety/well-being in 80% of the cases, in accordance with the study by Silva BT et al. (2012) [
Finally, as a suggestion of those interviewed for this study, in order to demystify the subject of breastfeeding for men, the question was raised about whether there would be a recommendation to create a program for fathers to get more involved in this process. Already described in the literature [
A series of studies have been demonstrating the effectivity of interventions with fathers and the duration of BF. Pisacane et al. (2005) [
It is important to note that the limitations of this study, which implicated in a decreased potential for analysis and external validity of the research, arose from the fact that the interviews were conducted in a hospital, after the child’s birth. This could mean that the visiting/companion fathers were already interested in the subject. This is an inherent limitation of transversal cohort studies, which do not intend to establish a cause and effect relationship, but nevertheless signal the hypotheses about the association being evaluated. The benefits of this study included broadening the knowledge about the role of the father in BF, which could reflect on the importance the mother gives to this process, contributing to the continuation of this practice and benefiting the new-born. Additionally, this was the first study to take into account the father’s feelings, knowledge and participation in this important moment for the child’s life.
There is a need for further studies about the subject in other regions, in order to formulate guidelines to highlight the importance of the men in the child’s and mother’s daily routine. However, this study succeeded in broadening the knowledge surrounding this theme with the following conclusions: 1) the fathers do have some knowledge about breastfeeding, however they do not have a deep understanding of the techniques, benefits and characteristics of BF; 2) men are moving away from the role of mere spectators and becoming main actors in the breastfeeding process, characterizing a more caring, effective and expressive participation; 3) the positive feeling is predominant among the fathers during BF; 4) the fathers recognize the importance of participating in the child’s care, especially in breastfeeding; 5) the participants of the interview supported the idea that their children should be breastfed by their own mothers; and finally 6) the fathers wish for more guidance from the health institutions and professionals.
Lima, F.T., Santana, A.C., dos Santos, G.M., Albergaria, T.F. dos S. and Silva, L.R. (2016) The Knowledge and Participation of the Father in Breast Feeding, Salvador, Brazil. Open Journal of Obstetrics and Gynecology, 6, 559-571. http://dx.doi.org/10.4236/ojog.2016.610072