Australian fathers’ experiences of caring for their preterm infants

Abstract

Fathers and/or non‐birthing partners are now actively involved in child‐rearing globally; however some experience emotional difficulties during the perinatal period. With the birth of a preterm infant, parents experience additional stress beyond that normally engendered by having a baby, which can impact on parent‐infant relationship and infant development. In Australia, there is limited evidence on fathers’ experiences of preterm birth. Thus, this study aimed to explore the experiences of Australian fathers of preterm infants including their emotional and physical wellbeing when they have a preterm infant. Narrative inquiry guided the study; 13 fathers whose preterm infant was admitted to Australian neonatal units participated in in‐depth interviews lasting 22–72 min. Data analysis generated four themes: (i) emotional response, (ii) fathers’ wellbeing, (iii) fathering in neonatal unit and during transition home (iv) fathers’ needs in the neonatal unit. The findings revealed that fathers felt emotionally overwhelmed, had specific needs but their role in the neonatal unit was not well defined and they felt mothers were given more attention. Despite feeling excluded, many continued to support their partner and infant. Health professionals must be aware of their unconscious biases toward gender roles in the neonatal unit and utilize strategies to actively include fathers and non‐birthing partners.

1. INTRODUCTION

According to the World Health Organisation's (WHO) Care of Preterm or Low Birthweight Infants Group, preterm birth accounts for nearly 11% of all births worldwide (Darmstadt et al., 2023). In Australia, the rate of preterm birth has remained relatively stable, ranging from 8.3% in 2011 to 8.2% in 2021 (Australian Institute of Health & Welfare, 2023). Infants born sick or before the 37th week of gestation are admitted to the neonatal unit for specialized care. Having an infant admitted to the neonatal unit is a challenging experience that often leads to significant psychological distress for parents (Noergaard et al., 2018; Prouhet et al., 2018). This distress is heightened when the infant is born preterm (Pichler‐Stachl et al., 2016).

The stress experienced by parents of preterm infants is greater than that of those with term infants (Miles et al., 1992; Pichler‐Stachl et al., 2016) and fathers of preterm infants experience more stress than fathers of term infants (Prouhet et al., 2018). Furthermore, the level of stress goes beyond the parents themselves and can negatively affect the infant's mental, behavioral, and developmental well‐being, impacting their short‐ and long‐term health outcomes. Left unmanaged, stress can result in physiological effects including alterations of hormone levels, disruption of the autonomic nervous system, and sleep disturbance which in turn, can lead to impaired cognitive function, elevated blood glucose, elevated blood pressure, and reduced parasympathetic activity (McEwen, 2008). Stress experienced by parents can also impede the infant's emotional regulation, hinder attachment formation, and disrupt parent‐infant interactions (Kowalenko et al., 2012; Wong et al., 2016).

The traditional role of mothers as caregivers has undergone significant transformation in recent decades, and this is due to women's economic status, career aspirations, family dynamics, and women's desire for financial independence; as a consequence, fathers are commonly now actively involved in caring for their children from birth, including those born sick and/or preterm (Denoual et al., 2016; Dutta et al., 2016; Soares et al., 2015; Stefana et al., 2018). However, the balance of research on the topic of parental experiences of having a sick and/or preterm baby is still hugely focused on mothers (Aagaard & Hall, 2008; Breivold et al., 2019; Flacking et al., 2006; McGowan et al., 2017). Evidence suggests that fathers, like mothers, also experience emotional challenges in the perinatal stage (Wong et al., 2016). Fathers, for instance, could have emotions of guilt or inadequacy, particularly if they believe they are not able to completely protect or care for their vulnerable newborn (Thivierge et al., 2023). In addition, fathers’ stress can be exacerbated by societal expectations of masculinity, which may discourage them from openly expressing their emotions or seeking support. During the transition to fatherhood, Genesoni and Tallandini (2009) reported intense psychological changes during the perinatal period and that the emotionally intense postnatal period was influenced by environmental factors such as a lack of health care support tailored to meet the needs of fathers. Almost a decade ago, Wong et al. (2016) further emphasized the high risk of mental health issues during the transition to fatherhood and recommended more research in fatherhood and development of appropriate interventions for men who are becoming a father; however little has been added to the knowledge base since then.

In the neonatal unit, actively involving fathers in the infant's care has reported benefits such as increased attachment, infants’ putting on more weight, and improved exclusive breastfeeding (Garnica‐Torres et al., 2021; O'Brien et al., 2018). In addition, Kim et al. (2017) reported improved physiological well‐being such as increased oxygen saturation in infants whose fathers provided tactile stimulation in the neonatal unit. Fathers’ skin‐to‐skin care for infants has been reported to improve outcomes in neonatal pain management and bio‐physiological wellbeing (Shorey et al., 2016). Moreover, involvement of fathers in caring for the preterm infant enhances the father‐child relationship (Adama et al., 2022). In a recent WHO recommendation for the care of preterm infants, among the 25 recommendations, family involvement and support with specific mention of fathers was recommended as best practice for preterm infants in neonatal units (Darmstadt et al., 2023).

Despite evidence of the benefits of fathers’ involvement in the neonatal units (Kothari et al., 2019; Sarkadi et al., 2008; Tohotoa et al., 2009), there is paucity of research on preterm infants fathers’ experiences and wellbeing when their child is admitted to the neonatal unit. For example, Stefana and colleagues reported valuable insights about fathers’ experiences of having a preterm baby including the inner experience of becoming a father, fear of the infant's death, worries about the preterm birth and the medical condition of their baby (Stefana et al., 2018); however, no data were collected about fathers’ experiences as they transition from the neonatal unit to home or the challenges they faced. Hemle Jerntorp et al. (2021) also found that fathers of preterm infants were worried about their infant's health, and that they were excluded from the care of their infant with the mother's support needs being prioritized over theirs (Hemle Jerntorp et al., 2021). However, this study did not explore the contributing factors to fathers’ exclusion and relegation.

In a recent article Fisher et al. (2018), presented 12 practical recommendations based on international research for including and supporting fathers in neonatal units. These include assessing the needs of mother and father individually; considering individual needs and wants in family care plans; gearing parenting education toward co‐parenting; actively promoting father‐baby bonding and being attentive to fathers hiding their stress. However, to determine the applicability of these recommendations in the Australian healthcare context, it was imperative to explore the Australian fathers’ experiences of having a preterm baby.

2. AIM

The aim of this study was to explore Australian fathers’ experiences of having a preterm infant in the neonatal unit and following discharge.

3. METHODOLOGY AND METHODS

This study utilized the Narrative Inquiry methodology. Narrative Inquiry is a qualitative research methodology that uses participants’ stories as data (Connelly & Clandinin, 1990). This method was deemed fit for this study because it gives participants the opportunity to tell the stories of their lived experiences of caring for their preterm infants. It also provides a deeper understanding of issues and phenomena from the perspective of those living the phenomena. In addition, it combines the principles of Phenomenology and Ethnography methodologies to explore the phenomenon of interest (Clandinin & Rosiek, 2019). It is used in exploratory studies among marginalized or under‐represented groups (Duff & Bell, 2002).

3.1. Setting, sample, and recruitment strategies

The study was made available to all Australian fathers of preterm infants. Advertisements for participants were posted online in generic social media platforms (Facebook, LinkedIn), and through preterm parents’ organizations such as Helping Little Hands in Western Australia and Miracle Babies, which is Australia‐wide. Additionally, flyers were placed in visible areas within one neonatal unit and distributed to fathers attending a nurse‐led clinic for discharged preterm infants in Western Australia.

Fathers who were interested in the study contacted the researchers and were given the study participant information letter and the study consent form. Fathers were reminded that the study is voluntary and that they had the right to not take part or to withdraw at any time without explanation or facing any consequence. Fathers were eligible to participate in the study if they had a preterm infant in the past 12 months, had been admitted to the neonatal unit within Australia, and are above 18 years. Fathers whose child had congenital or surgical complications were excluded.

Key findings

1. Admission of a preterm infant in neonatal unit impacts fathers’ wellbeing as they experience sleep deprivation and strain on their relationship with their partners.

2. Fathers in the neonatal unit experience varied emotional responses, uncertainty about their role and require targeted support to care for their preterm infants within and beyond the neonatal unit.

3. Support in the neonatal unit is essential for fathers’ care confidence at discharge and transitioning home.

Statement of relevance

By understanding the experiences and needs of fathers in the neonatal unit, health professionals can provide targeted support for fathers, thereby supporting secured father‐infant attachment, a fundamental element for infant mental health.

Overall, 18 fathers showed interest, and 13 continued to participate. Reasons for withdrawal included work commitment and lack of response following the initial contact. Ten of the fathers who did participate were from Western Australia and the remaining three were from Australia's Eastern states.

3.2. Ethical consideration

Human Research Ethics Committee approvals were secured for this study prior to data collection. Informed consent was obtained from all participants before the interviews. Participant's privacy and confidentiality were maintained throughout.

3.3. Data collection

Due to COVID‐19 disruptions and restrictions, ethics, recruitment, and data collection were prolonged, thus, we collected data from late 2020 to late 2023. Fathers who consented to the study were interviewed until no new data were emerging from the interviews (data saturation); this was achieved by the 11th interview. However, two additional interviews were undertaken to confirm data saturation. Fathers were given the option of face‐to‐face in‐person or online video conference or telephone. All those who opted for online, or telephone interviews did so because it was convenient for them. Two of the 10 participants in Western Australia were interviewed face‐to‐face and the remainder were interviewed by telephone for convenience. The three fathers from the Australian Eastern States were interviewed online to reduce inconvenience and increase participation. In‐depth interviews were conducted by trained research team members A.C., who is a female experienced neonatal nurse, and E.A., who is a male experienced researcher. Fathers were simply asked to share their experiences of having a preterm infant in the neonatal units and at home. Follow‐up interview questions were asked to gain in‐depth and rich data to understand the phenomenon from the fathers’ perspective. The interviews lasted between 22–72 min. All interviews were digitally recorded and transcribed verbatim.

3.4. Data analysis

The data analysis was an iterative process that involved reading and re‐reading through the transcribed and re‐storied data. Re‐storying is the process of gathering stories, analyzing them for key elements, and then rewriting the story to place it within a chronological sequence, from the beginning, middle, and end. Re‐storying helps to identify the key elements of the story (Ollerenshaw & Creswell, 2002).

Guided by the three‐dimensional narrative framework (Clandinin & Connelly, 2004), re‐storied data were analyzed. The re‐storied data were imported into NVivo software for analysis. After transcribing the interview data, participants’ stories were analyzed in relation to their interaction with other people and health professionals (sociality), time (temporality), and situation or space where the experience happened (place). Fathers’ experiences within the neonatal unit, interaction with health professionals, and periods in their transition from the neonatal unit to home and following discharge were analyzed. After the deductive data analysis within the three‐dimensional narrative framework, inductive analysis of the data was undertaken using thematic analysis (Clarke & Braun, 2021) whereby sociality, temporality, and situation data were further analyzed to generate themes. First, the data was read over and over for familiarization, followed by the generation of initial codes, creating of themes, revising the themes, reflecting, and discussing the themes with authors until they were finalized. This process was very iterative, reflective, and involved all authors.

To ensure rigor in the data analysis, two researchers (E.A.A. and A.C.) conducted the initial data familiarization, re‐storying, and development of the codes and initial themes. This was an iterative process between the two researchers to ensure that there was agreement in the data interpretation and meaning being created. Following this, S.B. and E.M. provided feedback on how the data was linked with the codes and sub‐themes. Further suggestions were given to rename the sub‐themes. E.M. was the last to review the codes, sub‐themes, and themes before finalization. This iterative process ensured that the findings remained true to the data.

4. FINDINGS

Ten of our 13 participants were first‐time fathers. Twelve were in a heterosexual relationship and one was in a same‐sex relationship. The infants’ gestational ages ranged from 26 + 2 to 36 + 6 and their length of stay in the neonatal unit ranged from 5–91 days (Table 1).

TABLE 1.

Father and infant characteristics.

Father's age range	Infant's gestational age	Days in neonatal unit	Number of other children
30–35	28 + 2	65	0
35–40	34 + 0	26	0
25–30	34 + 2	23	0
25–30	34 + 1	28	0
35–40	36 + 5	8	0
35–40	34 + 1	5	0
30–35	36 + 5	6	0
35–40	34 + 3	35	0
40–45	36 + 6	10	1
35–40	34 + 5	21	0
25–30	29 + 3	52	0
40–45	26 + 2	91	3
30–35	34 + 0	63	2

Data from all 13 fathers were analyzed to understand their experiences. Four main themes/threads resulted from the analysis (Figure 1). They are: (1) Emotional response; (2) Fathers' wellbeing; (3) Fathering in the neonatal unit; (4) Fathers needs in neonatal unit and during transition home. The findings provide a comprehensive understanding of how fathers of preterm infants navigate through the neonatal unit and following discharge. Table 2 shows the summary of the findings.

FIGURE 1.

Summary of themes and sub‐themes

TABLE 2.

Themes, sub‐themes and quotations.

Theme	Sub‐themes	Quotations
Theme 1: Emotional responses	Neonatal unit feeling	“The whole experience was worrying, and we were worried about what was going to happen with him “(Father 9)
		It was a bit of confronting situation, the size of the newborn (preterm infant) especially. I had been through 4 full terms plus babies before…but when you saw it (preterm infant) in the real life and it is your own kid, it was really shocking (Father 4)
		I guess initially I felt a little bit helpless cause I do not know what to do. All I can do is just stand there and stare at it (baby) (Father 1).
		You know there is a baby there (incubator), I mean I would not have felt like that if she was full term (Father 11).
		I felt like I wasn't very emotionally connected to him (baby) (Father 12)
		I was really scared. I was really unprepared, and it was exhausting; absolutely exhausting. I think that is the other thing I think it is gonna take me a long time to recover from the exhaustion (Father7).
		I was still worried that you know, maybe she wouldn't last very long because she (baby) is very early (Father 1).
		I was feeling not too bad when [baby] needs to go to special care unit. That moment doesn't bother me, now but I still remember it like…scary (Father 3).
		I felt fairly overwhelmed, like very emotional, you know, very kind of easily, easily upset (Father 12)
		I was quite lucky because I got to spend that time with him (baby), just me and him in the special care nursery without mother. I was quite relaxed because I felt that we were in in the best spot…Even though, it was a big thing, I was not worried or concerned at all (Father 6).
	Fathers’ coping	I mean, that is life… life is going to throw you a lot of things that you just have to be open minded and just be ready and be you know, welcoming (Father 2).
		I do not really like to tell my difficulty to friends of mine, I just want to get used to it (Father 3).
		I would be vulnerable and really…she [partner] is the person who receives my vulnerability, apart from that, I am quite resilient, I am really just quite self‐ supporting (Father 7)
		I was quite close to my parents, so I was really communicating with them and telling them what is going on. My parents always supportive as well, so they were always asking what is going, I was always talking to them, they are very supported (Father 9).
		Yes, I did already spoken with my father on this, he's helped me get through a few things. Same with my mother they will always give me support and same with the whole family, you know “you are doing well”, “you are doing great”, “You know you are doing the right thing”. (Father 11).
		I want to build up my knowledge, reading about a premature baby what I need to do while I am in the special care nursery (Father 7)
		Where to get support…so we found things like miracle babies and things like that online, and found that quite useful (Father 5)
Theme 2: Fathers’ wellbeing	Sleep deprivation	…the only challenging time was just the time limit of like driving home, trying to wash the clothes on time and trying to make it back to the hospital and time for feed and then come back, pick up the clothes and it just a bit of sleep deprivation the first …and the sleep, not enough sleep (Father 2)
		At the start, we were a bit lower in sleep, a few times we were a bit grumpy to each other. Just a bit lack of sleep (Father 3)
		I was very tired, but I also knew that it was going to be a long day. So, when we had opportunities, I was sleeping (Father 6)
		Yeah, but I was probably equally, you know, struggling myself. I think that is always challenging, but…, of course, when you're sleep deprived, you can get a bit short‐tempered and things like that (Father 5)
		Lot of sleepless nights. Hmm, yeah, just exhaustion, I think. Trying to get him in some kind of routine and feeding and sleeping (Father 12).
		I was very tired that day, I left work at about half to six, I have not had anything to eat from about half six onwards… So, you can't both sleep in the same room and not get any sleep… you end up going to sleep in different shifts (Father 7).
		He got good care in the nursery, and it gave us a bit of time to kind of de‐stress and recover from everything. When he was in the hospital, we get some good sleep (Father 9).
		Even yeah, even with (baby) in here [neonatal unit] I thought oh yeah, like, we should be able to get some good sleep for a couple more weeks, but yeah, it was still tiring (Father 13).
	Impact on relationship with partners	I think for us, it was closer actually… it is actually just made us more joyous and more feel like closer like a family. It's a good thing for our relationship. You know where we feel like, we really can rely on each other (Father 2).
		The experience is actually making our relationship even stronger (Father 10).
		On both sides, positive and negative. Definitely there is low there, there is a lot of emotions. Initially just coming in term of the premature side of things, that was hard and then we went through. I guess it is grief (Father 4)
		It is definitely put a little bit of strain on it, but. What I guess my stronger as well so (Father 3).
		I think we will have to make time for each other eventually, you know, set aside some each other, you know, go for dinners and stuff like that (Father 6)
		Whenever one of us is down, the other one, you know, will jump in and pick up the slack and do what is absolutely needed.
		Heaving the baby in the 1st place was a big thing, that brought us closer together as well. It's definitely getting better (Father 9)
		I can image it is really hard for all parents and all couples to deal with that. It does create a little bit of strain in your relationship. Yeah, I think time would be the healer for all of us (Father 7).
		No and yes (to impact on relationship) …we need to support each other, and that sort of thing and we'll do what is needed. The other, whenever one of us is down the other one, you know, will jump in and pick up the slack and do what is absolutely needed (Father 11).
Theme 3: Fathering in the neonatal unit	Fathers’ role in neonatal unit	When you are at hospital, the main challenge for me was around the capacity of being a new dad or an impending dad and not knowing that preterm labor (Father 7)
		… because my wife was in the hospital for a month before the baby was born, she did been through an enormous amount kind of…, so I felt a sense of need to kind of support her (Father 5).
		I feel a sense to support her (mother), but…I am equally struggling (Father 13)
		We split between (wife) and myself, so when it is due for a feed, something we do share…so like usually if I do the feed and I will go changing nappy and (wife) change clothes and then I will give her bottle and set her to bed, (Father 1).
		You have 10 times as much work, 10 times as much emotional and psychological distress. You are not celebrating having a baby initially, you're running around in quite a lot of stress and anxiety and you're trying to look after lots of people, do you best (Father 7).
		It was a very hard process for the first three days for her. Being under the general anesthetic as well, it made a little bit shaky, a little bit different. She wasn't so sure of herself and me being the support there that helped get over there (Father 11).
		Trying to keep mum healthy, keep her happy. So that she could carry baby through as long as possible (Father 3).
		I was there caring mum full time, doing everything changing and nappies (Father 2).
		Being a dad is a hard work isn't it, I didn't realize. I am not sure if everybody underestimates it, but I definitely did (Father 7)
		I know that everyone knew [birth mother's] name, and because she was the birth mother…but no one knew my name, I was always “the partner” I just think they took the birth mother as the main carer, the main person, but sometimes, it is not the case (Father 6).
		So like early on, when he [baby] was ready to have kangaroo care and my wife was still unable to get out of bed because she had an emergency Ceasar, they basically wouldn't let me be the first one to hold him. They were like ohh no, we like the mother to do it and my wife was saying no, no, no, and I found that quite hard and there are just a few instances (Father 5).
		So with my wife, she gets all the phone calls from the nurse and all that sort of stuff. I don't think I got one phone call. Yeah, no one's specifically said I wanna talk to (me) (Father 1).
		I think as a parent, you're used to being more involved in the medical care of your children. So doctors talk to you about it and ask you questions. But in those early days, the doctors and nurses just did what they had to do to keep him alive. I think that was hard to deal with, yeah (Father 5).
		When I leave, by the time I return, they have made decisions, I mean, not major ones but I would have loved to contribute to it (Father 6).
	Uncertainty about role expectations	I suppose in certain point, we weren't really sure what is expected for us to ask, or we were not sure whether we were coming in enough or too much. Although they said you can be there whenever, but sometimes I feel we maybe go in too much in one day (Father 3)
		I did not really know what to expect with the whole nursery and what was going on with (Father 9).
		There was a point I just wasn't sure how things were going (Father 4).
Theme 4: Fathers needs in neonatal unit and during transitioning home	Hands‐on caregiving	Even early on helping a little bit with some of the cares they (nurses) did, you know, they do every 4 or 6 hours and then things like nappy changes feeding and then once we introduced a bottle (Father 11)
		Very early on, we did not do much, and then after a little while they would let us do like kangaroo care… And then. Once he was a bit bigger then we could do things like changing his nappy and things like that (Father 1)
		The nurse and midwife suggested: toward him going home he could come 2‐3 feeds in a raw, a couple breastfeeds in a raw, being there with him, so we change our visiting time a bit later (Father 4)
		… I guess as we felt comfortable asking lots of questions and saying can we do this, can we do that or can you show us and you know, by the time he left, we were really confident kind (Father 11)
		So initially I think that they did the first few cares and I would watch and they would talk through what they're doing. So they just say oh, right now we're just taking the temperature and we are gonna make sure that they're kept nice and warm (Father 11)
		The nurses were really good, they made us do thing for him. We got to learn from the nurses what they do and how they do things (Father 6)
		We start to give him massage, he loves it. It gives him some much relieve. The massage is really nice exercise for bonding as well. The bath is definitely help as well. (Father 7)
	Recognition as an equal parent	I think one thing I experienced a bit early on was, a really clear preference for talking to and dealing with the mother rather than the father (Father 1).
		My number's been put down and my partner's number's been put down and locked. My phone's never been rung by (health) professionals to let me know what's going on… I haven't been involved like (my partner). It would be nice if they called me, you know (Father 2).
		I think personally, there is probably a lot of factors involved, the father probably is the main breadwinner, so has to go to work. I'm just lucky that I work for a company that has a substantial parental leave policy (Father 4)
		I know that everyone knew [my partner's] name, because she was the birth mother, and everyone knew [baby's] name, but no one knew my name, I was always “the partner”. But then, there was one of those who knew my name, and it made me feel like I was also included (Father 6).
	Information sharing	They were all asking, you know, letting me know what they are doing (Father 11)
		I think both parents should be offered the opportunity to hear from the doctor directly. I did not feel angry for what happed because I know lack of resource, I know doctor cannot wait around forever for me, but I think maybe a system they may ask if I could be on the phone same time (Father 6).
		…at the very basic you need to be aware of when we need to make our hospital plan when we need to have a backup with it (Father 7).
		The nurses explained everything: what was happening, why they were doing, what they were doing (Father 2)
		The nurses on site actually explained to me that he had a few issues and that he had to go up to the Children's Hospital. They were honest with us as well in term of his progress and the plan to be transferred. They had been kept us up to date, they were very positive and they were very honest with me as well (Father 11)
		There is not enough information there in terms of directly given to parents about what to expect, how transition could be from the term baby perspective, preterm baby could be totally different, from the preemie expectation (Father 10).
		If there was a package just explaining: when you get there, we would like you to feed the child or we would like you to change nappies or we don't want you to be hands on at all, and that sort of thing. Just yeah, just to help people understand where they stand (Father 11).
		Yeah, it [resource for fathers] just has to be a one side or two sides of PDF for dads, it does not have to be massive (Father 7)
		Even if it's on the phone speaker, just would like to have a chat with doctor, being able to ask some questions would be nice (Father 6)
		Yeah, I have joined a couple of bad groups just to get a bit more support but. Just on social media. More support for the fathers is good as well so (Father 3).
		The decision process is quite hard we never got any good information about that at all we did not understand the implication about premature baby which is a bit confronting when you found that out, basically after you made that decision (Father 4).
	Transitioning Home	The nurses are there. Even when we are caring for her, the nurses are still there. She is still hooked up” (Father 1).
		“…the special nursery nurses they just guided me through all the steps (Father 2).
		“The hospital said to come back for the nurse‐led clinic review 1 week after discharge, that is good to know. The child health nurse visits us…after discharge from the clinic” (Father 3).

4.1. Theme 1: Emotional responses of having a preterm infant in the neonatal unit

All the respondents experienced a range of emotions when their infants were admitted to the neonatal unit. These included negative emotions at the early stages of admission to mixed and positive emotions toward the end of the admission period. At the onset of unplanned birthing and admission of their baby to a neonatal unit, fathers experienced a feeling of lack of power, feeling lost, and inability to support their infants and partners. This theme comprises of two subthemes: Neonatal unit feelings and Fathers coping.

4.1.1. Neonatal unit feelings

This sub‐theme demonstrates fathers’ emotions within the neonatal unit. At the early stages following admission to the neonatal unit, there were many negative emotions such as feeling scared, constant worry, restlessness, stressed, and concerned. For some fathers, like Father 9, the “whole experience was worrying” and they were “worried about what was going to happen” (Father 9).

Some fathers found the neonatal unit environment shocking and overwhelming, as they had not anticipated it. This was even more pronounced for fathers like Father 4, whose previous children had been born at full term:

“It was a bit of a confronting situation, the size of the newborn (preterm infant) especially. I had been through 4 full terms plus babies before…but when you saw it (preterm infant) in the real life and it is your own kid, it was really shocking.” (Father 4)

The feeling of lost and helplessness was experienced by most fathers in the initial days as they navigate their way to settle in the neonatal unit. Father 1 said, “I guess initially I felt a little bit helpless cause I don't know what to do. All I can do is just stand there and stare at it (baby)” Others experienced grieving of the loss of their supposedly perfect healthy infant; as Father 11 shared, “You know there's a baby there (incubator), I mean, I would not have felt like that if she was full term.”

Attachment and bonding issues were also narrated by some fathers. For example, Father 12 said “I felt like I wasn't very emotionally connected to him (baby)”. For some fathers the negative emotional impact was felt weeks after their baby had been discharged from the neonatal unit. Father 3, speaking at 3 weeks after his baby came home, recalled, “I was feeling not too bad when (baby) needs to go to the special care unit. That moment does not bother me now, but I still remember it like…scary.”

Conversely, a few fathers saw the neonatal unit as an opportunity to bond with their infants while the mother recovered from labor. These fathers had positive emotional experiences in the early stages of neonatal unit admission. Father 6, was one such participant who had this experience and shari feeling,

… quite lucky because I got to spend that time with him (baby), just me and him in the special care nursery without mother. I was quite relaxed because I felt that we were in in the best spot…Even though, it was a big thing, I was not worried or concerned at all (Father 6).

4.1.2. Fathers’ coping

Following the birth of a preterm infant, fathers adopted different coping strategies to deal with their stressors. While some adopted an open mind to what was happening, others trusted the health professionals, and some engaged in task‐oriented activities to keep their minds occupied. Others used their personal coping strategies and relied on trusted individuals such as their partners and family. Learning more about preterm birth and care also helped some fathers to cope. Despite the emotional difficulties experienced by the fathers, none of them sort for professional support for their mental health. For some fathers, preterm birth was a usual life challenge and must be dealt with without any support. This was exemplified in Father 2′s account:

I mean, that's life… life is going to throw you a lot of things that you just have to be open‐minded and just be ready and be, you know, welcoming (Father 2).

Some fathers kept to their own ways of coping with the preterm birth and kept things to themselves as stated by Father 3 in this except:

I don't really like to tell my difficulty to friends of mine, I just want to get used to it (Father 3).

Other fathers depended on trusted individuals in their lives and their own coping strategies. Sharing their vulnerability and getting support from families and friends was an approach several fathers in this study used to cope with the stressors of having a preterm birth. The interview excerpts from three fathers (Father 7, 9, and 11) classically demonstrate this:

Father 7 was comfortable sharing his vulnerability with his partner as in, “I would be vulnerable and really…she [partner] is the person who receives my vulnerability, apart from that, I am quite resilient, I am really just quite self‐ supporting”.

Father 9 utilized his close relationship with his parents to debrief and receive support: “I was quite close to my parents, so I was really communicating with them and telling them what's going on. My parents were always supportive as well, so they were always asking what is going on, I was always talking to them, they are very supportive”.

Using trusted family members as a resource to cope with the birth of a preterm infant was also seen in the interview with Father 11, a first‐time father as in, “Yes, I'd already spoken with my father on this, he's helped me get through a few things. Same with my mother they'll always give me support and same with the whole family, you know “you're doing well”, “you're doing great”, “You know you're doing the right thing”.

Some fathers actively sort for informational support to understand and cope with the preterm birth.

The fathers were yearning for information “…to build up their knowledge” as demonstrated in the extract from Father 7, “I want to build up my knowledge, reading about a premature baby what I need to do while I am in the special care nursery”. Additionally, other fathers explained that the preterm parenting support groups and the internet were their main source of support as exemplified in the following quote from Father 5, “Where to get support…so we found things like miracle babies and things like that online and found that quite useful”.

4.2. Theme 2: Fathers’ wellbeing

This theme illustrates the impact of preterm birth and neonatal unit admission on fathers' wellbeing. It comprises two subthemes: lack of sleep and impact on relationship with partners.

4.2.1. Sleep deprivation

Fathers’ stress and the need to support the birthing partner and baby resulted in lack of sleep. The additional role of taking care of the home; the long‐distance travel to the neonatal unit to visit their partner and infant resulted in limited sleep or sleep deprivation. While fathers generally did not complain about this, they stated that tiredness and constant worry were the main issues that affected their sleep. Some fathers reported being easily irritable and short‐tempered due to sleep deprivation as shared by Father 2:

“…the only challenging time was just the time limit of like driving home, trying to wash the clothes on time and trying to make it back to the hospital and time for feed and then come back, pick up the clothes and it just a bit of sleep deprivation the first …and the sleep, not enough sleep”

Fathers’ irritability and “grumpy” feelings toward their partners were associated with inadequate sleep as explained by Father 3 in the following quotation: “At the start, we were a bit lower in sleep, a few times we were a bit grumpy to each other. Just a bit lack of sleep”

Spending long days in the hospital with the infant and birthing partner resulted in some fathers feeling “tired” and looked out for “opportunities” to sleep. This was captured in the following quote, “I was very tired, but I also knew that it was going to be a long day. So, when we had opportunities, I was sleeping” (Father 6).

The emotional impact of sleep deprivation on fathers’ wellbeing was demonstrated in the interview data as some become easily “irritable” and “short‐tempered”, which could potentially impact on their relationship with their partners, mental wellbeing, and productivity at work. The following quotation from Father 5 captures the essence of sleep deprivation on father's wellbeing, “I think that's always challenging, but…, of course, when you're sleep deprived, you can get a bit short‐tempered and things like that (Father 5).

Once the preterm infant was admitted or discharged home, fathers had to change their daily routines to adjust to their child's sleep‐wake patterns. In Father 6′s account, they narrated how the preterm birth had impacted their sleep, “…you will probably only sleep every hour, like in between, like 6:00 a.m. to midday” (Father 6). In another excerpt, Father 12 described how his experience of “lots of sleepless nights” resulted in “exhaustion” as he struggled with getting the infant into a routine.

Lot of sleepless nights. Hmm, yeah, just exhaustion, I think. Trying to get him in some kind of routine and feeding and sleeping (Father 12).

As most fathers had to juggle between visitation to the neonatal unit and work, sleep deprivation became a norm for them. The interview excerpt from Father 7 summarizes this finding in the data:

“I was very tired that day, I left work at about half to six, I haven't had anything to eat from about half six onwards… So, you can't both sleep in the same room and not get any sleep… you end up going to sleep in different shifts” (Father 7).

Comparing sleep when their infants were in the neonatal unit and home, some fathers reported that they had some good sleep as they were confident that their baby will be well cared for by the health professionals while they were away. Despite this self‐assurance, some fathers experienced sleep deprivation during admission as narrated by Father 9 and Father 3 below:

He got good care in the nursery, and it gave us a bit of time to kind of de‐stress and recover from everything. When he was in the hospital, we got some good sleep (Father 9).

Even yeah, even with [baby] in here [neonatal unit] I thought oh yeah, like, we should be able to get some good sleep for a couple more weeks, but yeah, it was still tiring (Father 3).

4.2.2. Impact on relationship with partners

The preterm birth and admission had impact on the relationship of fathers with their partners. While some fathers had a positive experience in their relationships such as bringing them closely together as a team, others experienced negative outcomes such as undue strain in their relationship leading to feelings of irritability and frustration.

For some fathers such as Father 2, the birth of the preterm infant brought them “more joyous” and feeling like closer like family”. The birth was considered “a good thing for our relationship” as they felt they “can rely on each other”. Father 10 shared the same sentiment in his narration,

“The experience is actually making our relationship even stronger”.

Majority of the fathers acknowledged that the preterm birth had significant benefits and detrimental impact on their relationship. The following narrations from the data demonstrate this finding:

On both sides, positive and negative. Definitely there is low there, there is a lot of emotions. Initially just coming in term of the premature side of things, that was hard and then we went through. I guess it is grief (Father 4)

I can image it's really hard for all parents and all couples to deal with that. It does create a little bit of strain in your relationship. Yeah, I think time would be the healer for all of us (Father 7).

4.3. Theme 3: Fathering in the neonatal unit

Being a father to a preterm infant for even the most experienced father was challenging. Fathers were caught between looking after the wellbeing of their partners and the preterm infant. The fathers’ role in the neonatal unit was blurred; however, at discharge, they felt they could contribute more to caring for their family. This theme has two sub‐themes: role of the father in the neonatal unit and uncertainty about role expectation.

4.3.1. Fathers’ role in neonatal unit

In the neonatal unit, fathers were making sense of their new role as a father of a preterm infant. For fathers such as Father 9, the anxiety of not knowing “what to expect with the whole nursery and what was going on” because the child is born preterm was overwhelming. While narrating his experience, Father 7, like other fathers, expressed how challenging their role as a father was in the neonatal unit in the following extract:

“When you're at hospital, the main challenge for me was around the capacity of being a new dad or an impending dad and not knowing that preterm labor” (Father 7).

Another role that was prominent among all fathers was finding the balance between supporting their partner and infant. They referred to themselves as, in Father 11 words, “being the support” for the birthing mothers. Fathers felt a heavy responsibility of caring for both mother and baby following the traumatic birth. For Father 11, it was “a very hard process” for his partner to do the cares while recovering, so fathers like Father 5 “felt a sense of need to kind of support her [birth mother]”. Other fathers like Father 1, shared the caring responsibility with his wife as he narrated, “if I do the feed and I will go changing nappy and [wife] change clothes and then I will give her bottle”.

In their supportive role, some fathers felt they also needed support as they were equally struggling psychologically. Fathers tend to hide their emotional struggles in order to support their partners and the preterm infant. This is exemplified in the following interview with Father 13 and Father 12:

I feel a sense to support her [mother], but…I am equally struggling (Father 13)

I was the one that was breaking down crying (Father 12)

Fathers learnt to provide cares such as feeding, bathing and skin‐to‐skin cares in the neonatal unit which helped to build their confidence in their role. These fathers felt supported by the health professionals in the neonatal unit as shown in Father 11 and Father 14′s account:

The nurse also showed me how to do tube feeding as well, I felt great to have this experience and it actually wrapped my head around what was going on there, that actually helped me (Father 11).

Being involved in the cares, kind of giving you more of confident talking to the midwife or doctors about his condition and your thoughts in it (Father 4)

She [infant] really enjoyed the experience of getting fed and getting held. You know, lay on my chest a little that was good (Father 2).

While some fathers enjoyed the father's role in the NICU, others found it daunting. Some first‐time fathers found that the additional care required by the preterm infant makes the fathering role challenging as narrated by Father 7:

Being a dad is a hard work, isn't it? I didn't realize. I am not sure if everybody underestimates it, but I definitely did. It is hard already being a dad for the first time and also to experience as a dad of preterm baby (Father 7).

Some fathers also experienced exclusion in their quest to be fathers to their newborn preterm infants. This was also obvious in same‐sex relationships where the mother was the focus of care at the neglect of the non‐birthing parent. This experience was also prominent in post‐discharge.

So, like early on, when he (baby) was ready to have kangaroo care and my wife was still unable to get out of bed because she had an emergency Caesarean, they basically wouldn't let me be the first one to hold him. They were like, “oh no, we like the mother to do it”, and my wife was saying “no, no, no” and I found that quite hard and there are just a few instances (Father 5).

In terms of fathers’ mental health support, fathers reported the lack of focus on fathers. They felt they were “treated differently” and following discharge, “no one's specifically said I wanna talk” to them. In their experience, mothers were given more priority than them:

Oh, I've got treated differently than the mums…I asked for help and like I said, I want to speak to someone [for mental health support] and then they didn't come and speak to me for a couple of days like 3 days and I was also right by then. When fathers are there, they should be treated equally (Father 12).

In the neonatal unit and after discharge, some fathers felt excluded from making decisions about their infant's care:

When I leave, by the time I return, they have made decisions, I mean, not major ones but I would have loved to contribute to it (Father 6).

So with my wife, she gets all the phone calls from the nurse and all that sort of stuff. I don't think I got one phone call. Yeah, no one's specifically said I wanna talk to [you] (Father 1).

4.3.2. Uncertainty about fathering role expectation

The data that made up this sub‐theme shows that fathers were unsure about what is expected of them in the neonatal unit. They “were not really sure what is expected for us to ask, or we were not sure whether we were coming in enough or too much (Father 3)”. This sentiment was also captured by Father 9 in their narrations as, “I didn't really know what to expect with the whole nursery and what was going on with” and in Father 4′s narration as, “There was a point I just wasn't sure how things were going”. Most fathers experienced uncertainty around their role:

I suppose in certain point, we weren't really sure what is expected for us to ask, or we weren't sure whether we were coming in enough or too much. Although they said you can be there whenever, but sometimes I feel we maybe go in too much in one day (Father 3).

4.4. Theme 4: Fathers needs in NICU and during transition home

Fathers in the neonatal unit were appreciative of the support provided by the health professionals. They were grateful for those who spent time with them to explain and guide them through the care of their infants. The fathers’ needs in the neonatal unit include clear guidance and hands‐on practice, which make them feel in control of the situation; informational needs so that they can make informed decisions and the need to be treated equally as mothers. It was evident that fathers felt they have been excluded in information sharing which impacted on their ability to make decisions for their sick neonates. This theme contains four sub‐themes: hands‐on caregiving, recognition as equal parent, information sharing and transitioning home.

4.4.1. Hands‐on caregiving increased fathers’ caring confidence

Fathers enumerated instances where they felt their needs were met in the neonatal unit, particularly when they were supervised by nurses to provide care. The support received from the nurses include, encouraging “…fathers to do more hands‐on touching to baby, talk to him”, “kangaroo care”, “nappy change”, “take temperature”, “cuddle her to sleep”, “feeding and bathing” and “give him massage”. Father 11 experienced that “the more I touched the baby the less anxious we were” and Father 7 noted the massage was “…nice exercise for bonding as well”.

The support with hands‐on caregiving and its impact after discharge are echoed in Father 6 and Father 11′s account as:

“The nurses were really good, they made us do things for him. We got to learn from the nurses what they do and how they do things” (Father 6).

“… I guess as we felt comfortable asking lots of questions and saying can we do this, can we do that or can you show us and you know, by the time he left, we were really confident kind” (Father 11).

4.4.2. Information sharing

Informational needs were evident among fathers as they seek to be actively involved in the care of their infants. Fathers had “lots of queries”, “a lot going on” and “curious to know how things will be done for the best outcome” for their infant. Fathers who “…like to be a pretty informed kind of parent”, did their “own research on medical things” to make sense of their preterm infant's health and care. For fathers who were encouraged by health professionals to ask questions about their infant's health, their lack of knowledge resulted in a dilemma as seen in Father 13′s account, “They invite you to ask questions, but if you don't know, which questions will you ask?”

Regarding prompt information sharing, fathers felt they were regarded as “secondary parents”. They faced the challenge of health professionals sharing information with birth mothers only, as explained by Father 6, “…because my partner is the actual birth mother, most of the information was sent to her because I was not there [neonatal unit]”. For some fathers, “not being able to participate…was challenging” Another challenge experienced by fathers is, “getting different advice from different people”. This was “confusing” for fathers as they seek for what is “best” for their infants.

Based on their experience, fathers provided suggestions on how health professionals can involve them in information sharing including, “a package just explaining…to help people (fathers) understand where they stand” and using telehealth to involve fathers during medical rounds. These recommendations are illustrated in the following extracts:

Yeah, it [resource for fathers] just has to be a one side or two sides of PDF for dads, it doesn't have to be massive (Father 7).

Even if it's on the phone speaker, just would like to have a chat with doctor, being able to ask some questions would be nice (Father 6).

4.4.3. Recognition as an equal parent

Few fathers in the study felt recognized and involved in their child's health decision‐making. Most of them felt that health professionals “took the birth mother as the main carer” and referred to them as “the partner”. Fathers did not feel acknowledged even when they were present in the neonatal unit during medical rounds as depicted by Father 1, “I mean, we did have doctors that were coming in doing checks but there was not really an introduction, …they did their checks and then they go tell the pediatrician or the nurses… Blah blah blah blah, I do not know what they said.” This sub‐theme was well captured in the experience of Father 6 below:

“I know that everyone knew (my partner's) name, and because (my partner) was the birth mother, and everyone knew (baby's) name. But no one knew my name, I was always “the partner” I just think they took the birth mother as the main carer, the main person, but sometimes, it is not the case” (Father 6).

Few fathers felt fully included in the care of their infant. These fathers described themselves as “engaged parents” and “family protective person” who wanted to be recognized and involved as much as the mother. For some fathers, this is their usual way of life with their previous children.

They were very supportive. For me particularly, I was included in everything, so I didn't get any less support than [birth mother] outside of the stuff she needed to, or she was going through (Father 4).

The fathers’ needs regarding inclusion and recognition, were summed up in the following quote by Father 5:

“Maybe the hospitals could do a better job of proactively engaging with parents and kind of giving them a sense of what supports available, including some that is tailored specifically to dads “(Father 5).

4.4.4. Transitioning home

Transitioning home was experienced by fathers differently. While some fathers felt prepared for the home transition, few expressed feelings of being underprepared for discharge. Nurses and other healthcare professionals made the transition smooth by actively involving fathers in their infants’ care during their time in the neonatal unit. For example, fathers who were engaged in the cares in the neonatal unit felt prepared. Father 1 and 2, relived this experience in the following quotation:

“The nurses are there. Even when we're caring for her, the nurses are still there. She's still hooked up” (Father 1). “…the special nursery nurses they just guided me through all the steps (Father 2).

Preparing fathers for the transition involved more than understanding and performing cares to include ongoing support when the infant is discharged. The NICU's support for follow‐up visits to check how the infant and parents are settling in the home was appreciated by fathers. The presence of nurse‐led neonatal clinics supported fathers transition before referral to community child health nurses:

“The hospital said to come back for the nurse‐led clinic review 1 week after discharge, that is good to know. The child health nurse visits us…after discharge from the clinic” (Father 3).

Conversely, fathers who did not have a positive experience of the home transition felt they “lose confidence and any reassurance that has been established [in the neonatal unit]” (Father 10); and suggested checklist of activities to support their transition home.

5. DISCUSSION

The study explored the experiences of fathers of preterm infants within the neonatal unit. The findings of the study show that fathers in the neonatal unit have unique experiences including hidden emotional difficulties, sleeplessness, exclusion, and relationship issues which can impact on their wellbeing, confusion on their fathering roles, and their specific needs within the neonatal units. From coming to terms with the medical complexities surrounding preterm birth and the infant's condition to uncovering their own needs, fathers of preterm infants face a myriad of challenges that require support pre and post‐discharge. When these challenges are assessed appropriately, health professionals can design individualized plans that incorporate fathers’ needs, thereby stimulating family‐centered care and the creation of a supportive environment that promotes resilience (Fisher et al., 2018).

In this study, fathers wanted to be involved in their infant's care in the neonatal unit; however, they faced challenges of being excluded or not being recognized as an equal parent. Fathers felt they were considered “secondary parents” or “the partner” at the neonatal unit. These findings are similar to those reported in Adama et al. (2017). In that study, fathers reported being excluded in the care of their preterm infants. They felt mothers or birthing partners were given priority than the non‐birthing partner. Strauss et al. (2019) also arrived at a similar conclusion, indicating that fathers were eager to be part of the care in the neonatal unit. Nonetheless, some fathers who considered themselves as being “engaged” played their “supportive” role, although they felt the health professionals could have supported them well. While neonatal unit health professionals are willing to involve fathers, they may not be adequately trained to communicate effectively with distressed fathers. Therefore, it is important to consider implementing interventions that can help staff improve in these areas as the early father‐infant relationship is essential for bonding and attachment, positive infant mental health, and developmental outcomes (Fisher et al., 2018; Knappe et al., 2021).

The emotional responses reported by the fathers are not surprising given the unique environment and the physical characteristics of their child. Further, taking on the role of the supportive partner without or less support for themselves can be overwhelming. Fathers remain the inconspicuous parent, who despite their own emotional struggle must remain strong to support the mother and the baby (Garfield et al., 2021). Many fathers in our study did not seek for professional psychological help, one sought for it, but help came rather too late. This finding shows that fathers' emotional support is not prioritized in the neonatal unit. This has short‐term and long‐term impacts on the father especially when they do not have family and friends to support them. Our findings are consistent with other previous studies that have reported psychological disorders among neonatal unit fathers (Baldoni et al., 2021; Garfield et al., 2021). Similar findings were reported in a longitudinal multi‐method study that explored the experiences of fathers supporting their partners during their infants’ admission to the neonatal unit (Stefana et al., 2022). They found that such fathers assumed a protective role but hid their needs and feelings from their partners to prevent further upheavals, although they experienced significant emotional stress and needed support. The interventions available for fathers’ psychological wellbeing are limited within the Australian setting (Ocampo et al., 2021). In Ocampo et al.’s review, of the seven included studies on psychological interventions for NICU fathers, only one was undertaken in Australia, further demonstrating the lack of evidence on the psychological support for neonatal unit fathers (Thomson‐Salo et al., 2017).

The general wellbeing of fathers was impacted by the birth of the preterm infant as they experienced limited or lack of sleep because they must be available for the infant and the birthing mother. Consistent with Coles et al. (2022), fathers reported poor sleep resulting in mental wellbeing concerns such as irritability and frustrations. According to the fathers, they could not get adequate sleep because of several factors such as providing constant support to the mother and baby. Lack of sleep has far‐reaching consequences including irritability, frustration, and the long‐term effects manifested in chronic diseases. Thus, addressing sleep deprivation and providing support to fathers in managing their sleep patterns will be beneficial. This could be achieved by providing resources to combat stress, providing education on sleep hygiene, and facilitating access to support groups. Our findings echo Edéll‐Gustafsson et al. (2015) study which identified parental stress as a cause of sleep deprivation in the neonatal unit and recommended keeping the family together as a solution. While few fathers found that the birth of the preterm infant has brought them and their partners closer, they admitted that the initial stages were very challenging. We recommend that the father‐mother‐infant relationship should be considered during and after the neonatal unit discharge.

The father's role in the neonatal unit was challenging for fathers to decipher as there appear to be no guidelines or protocols for staff to include fathers. Fathers reported feeling lost, excluded, and ignored. Some felt they were not regarded equally as the mother. This finding is not surprising as previous studies have reported similar findings (Adama et al., 2017; Fisher et al., 2018). Although fathers were uncertain about their role, they were clear about their needs. Examples of fathers’ needs included equal recognition and inclusion in the care of their preterm infants; sharing of information and supporting them to provide practical care such as skin‐to‐skin, feeding, nappy changing and spending quality time with their preterm infant. These needs were also highlighted in our previous study (Adama et al., 2022). Therefore, incorporating them into neonatal training, policies and procedures will ensure that all fathers are adequately supported in the neonatal unit and that their needs are met.

While the present study offers valuable experiences of fathers in the neonatal unit, there are limitations that need to be mentioned. First, the study had a small sample size, and therefore the results cannot be generalized. Future studies involving larger, more diverse participants would validate our findings. Secondly, the study showcased in‐depth experiences of fathers in neonatal unit but limited by a lack of specific demographic information such as socioeconomic, education, and racial background. Thirdly, the study may be affected by recall bias, as fathers may not accurately remember their experiences, emotional state, and coping mechanisms. The present study also focused on fathers in Australia, lacking the exploration of race, culture, and socioeconomic status of fathers. Additionally, future research should explore the experiences of same‐sex parents in the neonatal unit, as the current study involved only one same‐sex non‐birthing parent. Although this participant's experiences were similar to those of heterosexual fathers, the limited representation of same‐sex non‐birthing parents highlights the need for further research in this area.

5.1. Implications for clinical practice

The findings of this study show that fathers of preterm infants in Australian neonatal units experience emotional difficulties, negative impact on their wellbeing and have specific needs for their well‐being in the neonatal unit. It is apparent that fathers are mostly the “other parent” that are forgotten or excluded when their child is admitted to the neonatal unit. Therefore, neonatal clinicians should be aware of these emotional difficulties, support needs and provide relevant support to fathers. Through this, not only will the fathers’ mental and physical wellbeing be supported, the long‐term infant mental health and family dynamics will also be stabilized. Additionally, as recommended by Ocampo et al. (2021), we strongly recommend further research into the interventions to support fathers' wellbeing in Australian neonatal units.

5.2. Implications for policy

In Australia, the paid parental leave was initiated in 2011 and has undergone several amendments to include both parents (Department of Social Services, 2024). From July 2026, it is proposed that each parent will receive 4 weeks of parental leave to support greater care sharing responsibilities (Department of Social Services, 2024). Given that the preterm infant may spend more than 4 weeks in the neonatal unit, the findings of this study support the need for additional paternity leave for fathers who have had a traumatic start to parenting. Additional paternal leave will support fathers’ transition to fatherhood and involvement in caring for their infants at home, which in turn could support their mental health, wellbeing and return to work after a traumatic birth, and potentially support their infant's mental health.

6. CONCLUSION

A preterm infant birth whether expected or unexpected has profound impact on fathers. Through this narrative inquiry study, fathers shared their experiences of emotional difficulties, wellbeing, specific needs and role in the neonatal unit. While mental health struggles were obvious among the fathers, most of them did not seek for professional therapy or support, which suggests that more has to be done by health professionals to understand the needs of fathers, offer targeted supports and incorporate father‐specific support into neonatal unit policies and procedures.

Adama, E. A. , Adua, E. , Mörelius, E. , Chang, A. , Srinivasjois, R. , & Bayes, S. (2025). Australian fathers’ experiences of caring for their preterm infants. Infant Mental Health Journal, 46, 298–316. 10.1002/imhj.70011

DATA AVAILABILITY STATEMENT

Data available on request due to privacy/ethical restrictions.