At the end of the interview and data saturation, 1856 initial codes were extracted. In the process of analysis and comparison of the data, after classifying codes and removing similar codes, 53 codes were classified in 18 sub-categories, 7 main categories and 3 themes. The final main themes were: "empathy", "accountability" and "consequences" (Table 4).
Table 4: Results of data analysis
code
|
Sub-category
|
category
|
theme
|
Understand the situation
|
Empathetic attention
|
Emotional understanding
|
empathy
|
Pay attention to the needs of the spouse and child
|
Control of feelings and emotions
|
Follow up care
|
Staying in empathic situations
|
Receive the feelings of the wife
|
Encouraging and making hope
|
Displaying enthusiasm and proper feedback to the spouse
|
Induction of faith
|
Reassuring
|
Compatibility with spouse position
|
sacrifice
|
Reduce expectations and demands
|
Resiliency Exercise
|
Pre-pregnancy preparation
|
Readiness
|
Cognitive understanding
|
Pregnancy Preparation
|
Preparations during and after childbirth
|
Commitment
|
Responsibility
|
Lack of deposit of responsibility to others
|
Trying to eliminate negative beliefs
|
Reforming Attitudes
|
Creating positive beliefs
|
Participation in household chores
|
Tangible support
|
supporting
|
accountability
|
Participation in the care of children
|
Material support
|
Trying to get information related to the situation
|
Information support
|
Applying the correct information in related situations
|
Planning before pregnancy
|
Planning
|
Position management
|
Planning for birthday
|
Managing the exposure to unexpected situations
|
Management
|
Creating balance between indoors and outdoors
|
Tension management
|
Positive interventions in risky situations
|
Proper interaction
|
Compassion
|
Action to reduce the spouse's suffering and worries
|
Active participation in prenatal care
|
Dynamic presence
|
Accompany during childbirth
|
Active participation in postpartum care
|
Intellectual intimacy
|
Intimacy
|
Help improve family function
|
consequences
|
Sexual intimacy
|
Emotional intimacy
|
Timely intimacy
|
Spiritual intimacy
|
Psycho-emotional security
|
Security
|
Economic security
|
Communication security
|
flexibility
|
Solidarity
|
Correlation
|
Maintaining the dignity in the family
|
Respect
|
Maintaining the social position
|
Self-esteem
|
mental health
|
Maternal health
|
Improve maternal-neonatal health
|
Physical health
|
Social health
|
Secure attachment
|
Neonatal health
|
Desirable evolution
|
Desirable growth
|
Men should understand their wife, either emotionally or cognitively. This theme contained 2 main categories and 6 sub-categories.
Emotional understanding
Most participants believed that spouses should pay attention to their wives and encourage them and make them hopeful to the future and, if necessary, show sacrifice. This category contained three sub-categories.
Some participants stated that a spouse should understand the new situation of his wife during pregnancy, childbirth and postpartum. He should be mindful of the needs and desires of his wife and children in order to be able to resolve them.
"Not to tell me, the others, or my wife wants to tell me to do it. I must understand myself that what is better to do." (key informant, group > 35 years).
Some participants believed that spouse should be able to control his feelings and emotions in this period and should not transfer them to his wife. He should be mindful of midwifery care of his wife during pregnancy, childbirth and postpartum, and follow up her care. He should occasionally attend in cares, meetings, classes, and maternity programs in order to better understanding of his wife.
- Encouraging and making hopeful
Some participants believed that a spouse should show his empathetic attention to the wife by asking for her condition, whether through speaking in-person or by telephone or through a person accompanying his wife.
"When she is admitted to hospital, he should be in regular contact with her" (key informant, group > 35 years).
Spouses should be able to respond appropriately to the wife’s feelings and behaviors during this period, and encourage her and make her hopeful through showing his enthusiasm for the birth of the child. Some participants referred to the role of spouse in inducing the faith to wife through the spiritual conversations.
"whenever I said to him: “I’m worried”, He said: “Trust in God”, and this his phrase pleased me"(Pregnant woman, group > 35 years).
Some participants believed that spouse should adapt himself to wife’s conditions until this period goes well and to keep a good memory in her mind. Also, he should not have the same expectations in pregnancy and even more importantly, in postpartum, as before. He should lower expectations and practice to raise his tolerance and tolerate the temporal changes of wife’s behaviors in this period.
Cognitive understanding
From the viewpoint of most participants, spouses should logically understand their wife and be responsible and have a positive attitude about pregnancy and afterward. This category contained three sub-categories of readiness, accountability and reforming Attitudes.
Some participants believed that when a wife and her spouse decide to have a baby, the spouse needed to get ready to start fatherhood process. He should increase his information, get familiar with the signs of the risky situations and do the appropriate performances. At the end of pregnancy, he should, also, be prepare for birthing of new family member.
some key informants stated that the responsibilities of spouses do not only end with beginning of childbirth process and hospitalization of their wives, but also, they should display their empathy through being at hospital and providing the needed actions for delivery and discharge of his wife and child from hospital.
"It is necessary to provide the necessary conditions for the return of his wife to home. Perhaps one of the things that worries the ladies to go back to the home is that when they return home, they face a cluttered house "(key informant, group > 35 years).
Responsibility
Some participants said that a spouse should be familiar with his duties and responsibilities during this period. He should not expect others to take on his responsibilities.
"he should not take his responsibilities off to other women’s shoulder. It's possible that they were be tired because of making the meal or hosting the guests." (Pregnant woman, group > 35 years).
Reforming Attitudes
Some participants acknowledged to have positive attitudes toward pregnancy, childbirth and postpartum as one of the responsibilities of spouses during this period, and believed that they should not think that pregnancy and childbirth are a female period and they do not have any role. If they have a positive attitude and be familiar with the problems of this period, they will not account their wives’ behavioral changes as spoiling. Also, they should try to correct the negative and false believes of the people around him.
"Even about the false words that people around tell her, for example, recommend a herbal medicine for curing newborn jaundice or colic, he should not let his wife apply that wrong herbal medicine"(key informant, group > 35 years).
Most participants believe that, during this period, in addition to emotional and cognitive understanding, spouses should support their wives and display their compassion through proper management and correct planning and taking the needed actions to reduce their wives’ discomfort and suitable action in dangers. This theme contained 3 main categories and 6 sub-categories.
Supporting
Some participants believed that spouse should support his wife in home care, caring for new children and other children, and financially. He should also increase information and awareness and proper using of the information. This main category contained two sub-category of tool support and information support.
All participants believed that spouses should be involved in homework, especially those that are difficult to do for a pregnant woman. They said that participation of spouses in postpartum is more important than ever before because of adding the newborn cares to her previous activities.
"After childbirth, we should help in all aspects, especially in the first 30-40 days, which is very difficult." (spouse, group > 35 years).
Some participants acknowledged the financially supporting of wife and children and meeting the living expenses and material needs as spouse’s duties.
Some participants emphasized the awareness of subjects related to pregnancy, childbirth and postpartum as spouse’s duties during this period. Also, they should be able to use this information in appropriate situations. In fact, this higher and desirable level of participation develops after cognitive understanding, so that the spouses learn at the cognitive understanding stage and utilize the learned information at this stage. "When wife’s labor pains start, her spouse can remind him the breathing techniques, because she has not focus on this issue."(key informant, group > 35 years).
Position management
Proper planning for childhood and proper management to deal with the situations and challenges of this period was another statement of the participants. This category contained 2 sub-categories: planning and management.
Some participants believed that spouses should plan before childhood. in other words, when they decide to have children. they identified the need to plan for birthing the new member of the family as one of the spouse’s responsibilities during this period.
Some female participants said that spouse should be able to manage the unexpected situations, such as suddenly onset of labor pain or occurring the risk signs, and he should not cause the wife's discomfort. Almost all female participants believed that spouses should make balance between indoor and outdoor and not prefer their job to being with family.
"This psychologically and culturally is needed to attention that “we work to live, not we live to work”. Men must understand that the value of life is much more than money."(Pregnant woman, group < 35 years).
Compassion
Compassion is, in fact, an understanding of the problems and feeling of duty to help solve the problems of ourselves or others that is defined in components such as altruism, kindness and joy. Perhaps, in the general meaning, compassion is confused with empathy, while empathy is a stage prior to compassion (prerequisite) (22). This category contained two sub-categories of: proper interaction and dynamic presence.
Some key informants believed that spouse should be able to take necessary actions in dangerous situations, including dialogue and interaction with health care providers, and get them the needed guidance to manage the situation, well.
"If she is high risk and need special care, for example, special dietary care or certain medication orders, her spouse can interact with her midwifery/doctor" (pregnant woman, group > 35 years).
Dynamic presence
Some participants stated that spouse should actively participate in prenatal care. After attending her to the care centers, should go to the doctor/midwife, if possible, and listen to the recommendations and discuss with him/her about his wife and be aware of her condition to be better able to meet her needs. Also, in this case, he can enjoy of hearing the fetal heart.
"When I was going to care, he was coming inside, wherever allowed, and was talking with my doctor." (key informant, group < 35 years).
Although there is no possibility for actively participating of spouses in childbirth process in many birth centers of our country, especially in governmental centers, most of the participants, while regretting this issue, stated that in the possibility of spouse’s presence in the labor room/operating room, the spouse should be with his wife and give her encouragement and comfort. If is not possible, spouse should be in contact with the person accompanying his wife or with her responsible midwife and be informed of his wife's condition. Some participants suggest that center’s conditions should be in such a way that spouse was the first person that meet the wife after the childbirth. Also, some participants believed that spouses should also accompany their wife and newborn in postnatal care and play an active role.
"After childbirth, he should carry his baby for screenings, such as thyroid screening." (key informant, group > 35 years).
Consequences
From participants' point of view, men's participation in perinatal care has positive outcomes such as helping improve family function and improving the maternal and neonatal health. This theme contained two main categories and six sub-categories.
Help improve family function
The participants referred to creating and enhancing of intimacy, sense of security, increasing of coherence and respect among family members as positive outcomes of spouse’s participation in this period. This category contained four sub-categories.
Intimacy is the ability to establish deep relationships in couples to resolve conflicts and to share the experiences that it requires to has in common and to the sense of internal security from other person.
Some participants believed that, in result of spouse participation, family members, especially couples, were more likely to interact with each other through exchanging of views and information and to be similar in attitudes and to respect for another opinion (intellectual intimacy), the spouse and wife become sexually closer (sexual intimacy), productive talks between couples is increasing and they feel well emotionally that these lead to their physical and mental health (emotional Intimacy). In addition, spouse gives more time to his wife and children (time intimacy) and even, a sincerely spiritual relationship between couple is created (spiritual intimacy).
"When a woman shares her plan with her spouse, she has more energy, she can pay attention to her body and even is effective in the marital and sexual relationship. She is not tired." (key informant, group < 35 years).
Security
Some female participants referred to the feelings of reliance on spouse, peace of mind of wife and children, financially because of spouse’s efforts to meet the financial needs of his family and also better communication of family members, especially the relationship between the father and his children as some consequence of spouse participation.
"If a spouse has empathy and cooperation, then the woman has a warm back for herself." (spouse, group > 35 years).
Solidarity
Solidarity is the feeling of correlation, bondage and emotional commitment that members of a family have toward one another (23). Some participants emphasized the spouse’s participation as a factor for causing the greater solidarity among family members. They believed that participating spouses had more flexibility in their behaviors.
"for my second baby, I was going to bring her to Valiasr Hospital for birthing, but she said that I want to go Izadi Hospital. I'm not agree, however, I went her to Izadi."(spouse, group > 35 years).
Respect
Some men participants stated that if a spouse be involved with his wife, she feels that she has a good situation and dignity in life. In addition, it would preserve and enhance the social status of children in the future. Some participants believed that the participation of men helps maintain and increase the confidence of his wife and children.
"if you sometimes hand up the back of your wife’s neck, your children's self-esteem will rise. In general, the child's personality is formed from house." (spouse, group > 35 years).
Improve maternal-neonatal health
The participation of spouses, in addition to improve the function of the family, help promote the maternal and infant health.
Some participants stated that the participation of spouse improved the physical and mental health. In addition, having the peace of mind and the feeling of not being alone and having a secure and reliable support in the face of social problems improves the wife’s social health.
"If spouse participates at home, his wife will rest further and will become healthy earlier and her stitches will get better sooner." (spouse, group > 35 years).
"When a woman sees her spouse at her side and he does everything to ensure her comfort, she will surely feel peace and convenience. She feels that she has a backing and there is someone in difficult circumstances that can help her and she is not alone. "(key informant, group > 35 years).
Neonatal health
Some participants stated that spouse participation creates a deeper emotional relationship between mother and baby and makes a secure attachment. even, it has a positive effect on the child’s developmental process especially on psychological and emotional development.
"If the father is involved in the care of his or her child ... it certainly will affect the psychological development of the children." (Key informant, group > 35 years).