At the end of the interview and data saturation, 1856 initial codes were extracted. After 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).
Men should understand their wives, either emotionally or cognitively. This theme contained 2 main categories and 6 sub-categories.
1-1: Emotional understanding
Most participants believed that spouses should pay attention to their wives, encourage them to be hopeful about the future, and, if necessary, make sacrifices. This category had three sub-categories.
1-1-1: Empathetic attention
Some participants stated that a spouse should understand the new situation of his wife during pregnancy, childbirth, and the postpartum period. Also, he should be mindful of the needs and desires of his wife and children to be able to fulfill them.
I can understand that in the situation that she is in, she may sometimes be psychologically disruptive, speak up, and get offended. I should understand her position.”(Participant No.7, spouse, bachelor, group>35 years).
"Not to tell me, the others or my wife want to tell me to do it. I myself must understand what is better to do."(Participant NO.10, Cleric, Master's degree, group>35 years).
Some participants believed that a 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 the postpartum period and follow it up with more attention. He should occasionally attend cares, meetings, classes, and maternity programs to better understand his wife.
1-1-2: Encouraging and giving hope
Some participants believed that a spouse should show his empathetic attention to the wife by asking for her condition, whether through in-person speaking or by telephone or from a person accompanying his wife.
"When she is admitted to hospital, he should be in regular contact with her"(Participant NO.13, Female, Teacher of birth preparation classes, Bachelor's degree, group>35 years).
Spouses should be able to respond appropriately to the wife’s feelings and behaviors during this period, encourage her, and give her hope by showing his enthusiasm for the birth of the child. Some participants referred to the role of a spouse in restoring the wife’s faith through spiritual conversations.
"Whenever I said to him: “I’m worried,” He said: “Trust in God,” and this phrase pleased me" (Participant NO.12, Pregnant woman, Bachelor's degree, group>35 years).
Some participants believed that a spouse should adapt himself to the wife’s conditions until this period ends well as a good memory in her mind. Also, he should not have the same previous expectations in pregnancy and, even more importantly, in the postpartum period. He should lower expectations and practice to raise his tolerance towards the temporal changes of his wife’s behaviors in this period.
"I had a bad nausea, so I even hated smells, even my husband's smell. He was very cooperative with me." (Participant No.13. female, Bachelor's degree, group>35 years).
1-2: Cognitive understanding
From the viewpoint of most participants, spouses should logically understand their wives, be accountable, and have a positive attitude towards pregnancy and postpartum periods. 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 needs to get ready to start the fatherhood process. He should increase his information, get familiar with the signs of risky situations, and handle the required affairs. Moreover, at the end of pregnancy, he should be prepared for the birthing of a new family member.
Some key informants stated that the responsibilities of spouses do not merely culminate with the childbirth process and hospitalization of their wives, but rather they should show their empathy by the presence at the hospital and fulfillment of the needed actions for delivery and discharge of his wife and child from the hospital.
"If men can attend prenatal classes, they will have some awareness of what they should do when they are at home, when their wife has problems" (Participant N0.1, Spouse, Bachelor's degree, group>35 years).
"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 they face a cluttered house when they return home" (Participant NO.5, Female, Faculty member, Ph.D. degree, group>35 years).
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.
"This is not rational that I put everything on my wife's shoulder" (participation NO.3, Spouse, Master's degree, group>35 years).
"He should not take his responsibilities off on other women’s shoulders, although it's possible that they are tired because of making meals or hosting the guests."(Participant NO.12, Cleric, Bachelor's degree, group>35 years).
1-2-3: Reforming Attitudes
Some participants acknowledged having positive attitudes towards pregnancy, childbirth, and postpartum as one of the responsibilities of spouses during this period and believed that they should think of pregnancy and childbirth as a mutual role. If they have a positive attitude and be familiar with the problems of this period, they will not find their wives’ behavioral changes spoiling. Also, they should try to correct the negative and false believes of the people around them.
"Even about the false words that people around tell her, for example, recommending a herbal medicine for curing newborn jaundice or colic, he should not let his wife take that wrong herbal medicine" (Participant NO.4, Midwife, Bachelor's degree, group>35 years).
Most participants believed that, during this period, in addition to emotional and cognitive understanding, spouses should support their wives and show their compassion through proper management and correct planning. In this regard, they should also take the needed actions to reduce their wives’ discomfort and handle dangerous situations. This theme contained 3 main categories and 6 sub-categories.
Some participants believed that a spouse should support his wife in home care, taking care of newborn children and other children, and financial affairs. He should also increase information and awareness and acquire the ability to use the information properly. This main category contains two sub-categories, namely tangible support and information support.
2-1-1: Tangible support
All participants believed that spouses should be involved in housework, especially those activities difficult to do for a pregnant woman. They said that the participation of spouses in the postpartum period is more important than ever before due to the addition of newborn care to her previous activities.
"After childbirth, we should help in all aspects, especially in the first 30-40 days, which is very difficult." (Participant NO.1, Spouse, Bachelor's degree, group>35 years).
Some participants acknowledged the financial support of wife and children and meeting the living expenses and material needs as spouse’s duties.
2-1-2: Information support
Some participants emphasized the necessity of men’s awareness of pregnancy, childbirth, and the postpartum period as a spouse’s duties and complained of insufficient awareness in this area. Also, men should be able to use this information in appropriate situations. In other words, this higher and desirable level of participation develops after cognitive understanding, i.e., at the cognitive understanding stage, the spouses' knowledge was increased and in this stage, they utilized that learned information.
"When wife’s labor pains start, her spouse can remind her, the breathing techniques since she is not focused."(Participant NO.13, Teacher of birth preparation classes, Bachelor's degree, group>35 years).
2-2: Position management
Proper planning for childhood and well-suited management to deal with the situations and challenges of this period were other statements made by the participants. This category contained 2 sub-categories: planning and management.
Some participants believed that spouses should plan before childbearing, i.e., when they decide to have children. They identified the need to plan for a new family member's birthday as one of the spouse’s responsibilities during this.
Some female participants said that a spouse should be able to manage unexpected situations, such as the sudden onset of labor pain or the occurrence of risk signs, and he should not cause the wife's discomfort. Almost all female participants believed that spouses should make a balance between indoor and outdoor activities and not prefer their jobs to the family.
"This psychologically and culturally is needed to receive the attention that “we work to live, not we live to work.” Men must understand that the value of life is something rather than money."(Participant NO.17, Pregnant woman, Bachelor's degree, group<35 years).
Compassion is indeed an understanding of the problems, as well as having the duty to help solve the problems of ourselves or others, including key components such as altruism, kindness, and joy. In general meaning, compassion might be confused with empathy, whereas empathy is a stage before compassion (prerequisite) . This category contains two sub-categories: proper interaction and dynamic presence.
2-3-1: Proper interaction
Some key informants believed that spouses should be able to take necessary actions in dangerous situations, including dialogue and interaction with health care providers and giving them the needed guidance to manage the situation accurately.
"If she is at high risk and needs special care, f (e.g., special dietary care or certain medication orders), her spouse can interact with her midwifery/doctor" (Participant NO.12, Cleric, Bachelor's degree, group>35 years).
2-3-2: Dynamic presence
Some participants stated that spouses should actively participate in prenatal care. After sending her to the care centers, the spouse should refer to the doctor/midwife, if possible, and listen to their recommendations and discuss the conditions of his wife with him/her to better meet her needs. Also, in this case, he can enjoy hearing the fetal heart.
"When I was going to receive care, he came inside, wherever allowed, and talked with my doctor." (Participant NO.14, Female, Faculty member, Master's degree, group<35 years).
Although there is no possibility of active participation of spouses in childbirth process in many birth centers of our country, especially in state centers, most of the participants regretted this issue and stated that the spouse should be with his wife and give her encouragement and comfort when he is present in the labor room/operating room. If it is not possible, the spouse should be in contact with the person accompanying his wife or with her assigned midwife and informed of his wife's status. Some participants suggested that the center’s conditions should provide the possibility that the spouse is the first person meeting his wife after childbirth. Also, some participants believed that spouses should also accompany their wives and newborns in postnatal care and play an active role.
"After childbirth, he should carry his baby for neonatal cares, such as thyroid screening."(Participant NO.5, Female, Faculty member, Ph.D., group>35 years).
From the participants' standpoint, men's participation in perinatal care has positive outcomes, such as helping the improvement of family function and maternal/neonatal health. This theme contained two main categories and six sub-categories.
3-1: Help with the improvement of family function
The participants referred to creating and enhancing intimacy, sense of security, coherence, and respect among family members as positive outcomes of spouse’s participation in this period. This category had four sub-categories.
Intimacy is the ability to develop deep relationships among couples to resolve conflicts, share the experiences, and receive a sense of internal security from the other side.
Some participants believed that spouse participation leads family members, especially couples, to interact with each other more likely through exchanging views and information. Furthermore, they will be similar in attitudes and respect the opinions of one another (intellectual intimacy). Also, the husband and wife become sexually closer (sexual intimacy), productive talks between couples increase, and they feel well emotionally, resulting in their physical and mental health (emotional Intimacy). Furthermore, the spouse spends more time with his wife and children (time intimacy), and a sincere spiritual relationship might be built between the couple as well (spiritual intimacy).
"When a woman shares her plan with her spouse, she gets more energy, can pay attention to her body, and is effective in the marital and sexual relationship. She is not tired."(Participant NO.16, Midwife, Bachelor's degree, group<35 years).
Some female participants attributed the feelings of reliance on the spouse, peace of mind of wife and children, and financial comfort to spouse’s efforts to meet the financial needs of his family and better communication of family members, particularly the relationship between the father and his children as a consequence of spouse participation.
"If a spouse has empathy and cooperation, then the woman is warmly backed."(Participant NO.1, Spouse, Bachelor's degree, group>35 years).
Solidarity is the feeling of correlation, bondage, and emotional commitment that members of a family have toward one another . Some participants assumed the spouse’s participation as a factor for causing greater solidarity among family members. They believed that participating spouses have more flexible behaviors.
"For my second baby, I was going to bring her to the Valiasr Hospital for birthing, but she said that she wants to go to the Izadi Hospital. Although I did not agree, I brought her to the Izadi hospital."(Participant NO.7, Spouse, Bachelor's degree, group>35 years).
Some male participants stated that if a spouse is involved in his wife’s pregnancy, childbirth, and the postpartum period, she feels that she has a good situation and dignity in life. Also, 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 self-confidence of his wife and children.
"If you sometimes pull the back of your wife’s neck up with your hands, your children's self-esteem will rise. In general, the child's personality mainly forms in the house."(Participant NO.1, Spouse, Bachelor's degree, group>35 years).
3-2: Improvement of maternal-neonatal health
In addition to improving the function of the family, the participation of spouses helps promote maternal and infant health.
3-2-1: Maternal health
Some participants stated that the participation of spouses improves physical and mental health. Furthermore, peace of mind, the feeling of not being alone, and having secure and reliable support in the face of social problems improve the wife’s social health.
"If a spouse participates at home, his wife will rest further, become healthy in a shorter time, and her stitches will get better sooner."(Participant NO.19, Spouse, Diploma, group>35 years).
"When a woman sees her spouse at her side, doing everything to ensure her comfort, she will surely feel peace and convenience. She feels that she is backed, and there is someone that can help her in difficult circumstances, and she is not alone."(Participant NO.5, Faculty member, Ph.D., group>35 years).
3-2-2: Neonatal health
Some participants stated that spouse participation develops a deeper emotional relationship between mother and baby and makes a secure attachment. Also, it might have a positive effect on the child’s developmental process, especially on psychological and emotional development.
"If the father is involved in the caring process of his or her child ... it will certainly affect the psychological development of the children."(Participant NO.5, Faculty member, Ph.D., group>35 years).