Couple & Family Therapy Faculty Publications School of Medicine

8-19-2020

Active Husband Involvement During Pregnancy: A Grounded

Theory
Brandon P. Eddy
University of Nevada, Las Vegas, [email protected]

Stephen T. Fife
Texas Tech University

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Repository Citation
Eddy, B. P., Fife, S. T. (2020). Active Husband Involvement During Pregnancy: A Grounded Theory. Family
Relations 1-16.
http://dx.doi.org/10.1111/fare.12486

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ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 1

Active Husband Involvement during Pregnancy:

A Grounded Theory

Brandon P. Eddy

University of Nevada Las Vegas

Stephen T. Fife

Texas Tech University

Brandon Eddy, Ph.D., Couple and Family Therapy Program, University of Nevada Las Vegas,

Las Vegas, NV, [email protected]

Stephen Fife, Ph.D., Community, Family, and Addiction Sciences, Texas Tech University,

Lubbock, TX, [email protected]

We have no conflicts of interest to disclose.

Address correspondence to Brandon Eddy, Couple and Family Therapy Program, 4505 S.

Maryland Pkwy, Las Vegas, NV 89154, [email protected], (702)-895-3117.

ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

Abstract

Objective: The purpose of this grounded theory qualitative study was to build a theory

describing how husband involvement during pregnancy impacts the couple relationship.

Background: The transition to parenthood presents a significant life change for couples.

Although many couples experience this life cycle change, there is relatively little empirical

research on how husbands can meaningfully contribute during pregnancy and how husband

involvement impacts the couple relationship postpartum. Method: Eleven heterosexual, married

couples were interviewed regarding husband involvement during the couple’s most recent

pregnancy. Data collection included separate interviews with each partner and with each couple.

Results: The results are presented in a grounded theory of active husband involvement during

pregnancy and its influence on the couple relationship postpartum. Accounts from participants

indicate that active husband involvement during pregnancy helps to strengthen the couple

relationship postpartum. Active husband involvement consists of four interrelated ingredients:

helping with a positive attitude, instrumental support, emotional support, and responding in

significant moments. Couples described five distinct ways the couple relationship was enhanced

by active husband involvement: increased trust, a more mature relationship, greater love,

enhanced communication, and continued support. The theory also includes husbands’ efforts to

navigate various obstacles to active husband involvement. Conclusion: Active husband

involvement during pregnancy consists of many different behaviors and leads to strengthened

couple relationships postpartum. Implications: This study highlights the need for a greater

emphasis on the couple relationship during pregnancy and provides healthcare providers and

researchers with information about how they can encourage active husband involvement during

pregnancy.
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

Active Husband Involvement during Pregnancy: A Grounded Theory

The transition to parenthood presents a substantial life change for couples (Walsh, 2015).

Many couples experience joy and happiness during this time; however, some also experience

increased stress and anxiety and decreased intimacy and marital satisfaction (Fillo, Simpson,

Rholes, & Kohn, 2015; Lawrence, Rotham, Cobb, Rotham, & Bradbury, 2008). Many parents

lack knowledge about how to effectively navigate the transition, feeling unprepared to make the

change (Deave, Johnson, & Ingram, 2008). More specifically, many fathers report feeling unsure

about how to provide support to their spouse during pregnancy (Deave et al., 2008).

Although pregnancy can be a stressor on the couple relationship, couples who have

higher marital satisfaction during pregnancy typically have healthier relationships postpartum

(Lawrence et al., 2008). Additionally, women are less likely to smoke while pregnant and more

likely to receive prenatal care when their partner is involved (Martin, McNamara, Milot, Halle,

& Hair, 2007), providing evidence that prenatal husband involvement can promote better health

outcomes. Although there is evidence that paternal involvement during pregnancy is beneficial to

maternal health, there is little research that investigates how paternal involvement can benefit the

couple relationship or how the couple relationship can be strengthened during pregnancy. The

purpose of this study was to create a theory detailing how husband involvement during

pregnancy can contribute to a stronger couple relationship postpartum.

REVIEW OF THE CURRENT LITERATURE

Family Life Cycle

The family life cycle (Duvall, 1977) provides a framework for different stages of

development families will experience as they grow and mature. Although there is great

variability in the course a family may take (McGoldrick, Preto, & Carter, 2016), the family life

cycle is useful in identifying challenges families may experience during each stage of
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

development, affording researchers the opportunity to study each stage and provide information

about how families can best navigate them (Bengston & Allen, 2009). Families who fail to adjust

to the different stages in the life cycle are at risk for lower relationship satisfaction and overall

decreased family functioning (McGoldrick et al., 2016).

Parenthood introduces a major life cycle change for couples and is one of the most

common inducers of crisis for young families (Pinquart & Teubert, 2010; Walsh, 2015). There

are many challenges and adjustments that must be made during and after pregnancy. Pregnancy

and the birth of a child often has an impact on marital quality (Mitnick, Heyman, & Smith Slep,

2009), with marital quality seeing a modest decrease during the first six months postpartum; this

is especially true for wives who report low social support during pregnancy (Walsh, 2015).

Women reporting low levels of prenatal support from their husbands also report more symptoms

of emotional distress, which increases the risk of adverse outcomes for women and newborns

(Glazier, Elgar, Goel, & Holzapfel, 2004).

Understandably, most of the research related to pregnancy focuses on wives and mothers,

as pregnancy can be a challenging time. Many women suffer morning sickness and are at an

increased risk for anemia, urinary tract infections, sleeping difficulties, and mental health

conditions such as depression or anxiety (CDC, 2016). Women may also experience relational

difficulties during pregnancy (Simpson, Rholes, Campbell, Tran, & Wilson, 2003). Although

both partners may see a decrease in marital satisfaction over the course of the pregnancy, some

research suggests that women’s marital satisfaction sees a more severe decrease than men’s

marital satisfaction (Lawrence et al., 2008). Furthermore, women are more likely than men to

suffer from depression during pregnancy (Don & Mickelson, 2014), which also puts them at

increased risk for postpartum depression (Simpson, et al., 2003).

ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

Paternal Involvement During Pregnancy

Fathers want to be involved during pregnancy, but often feel unsure about how to

positively contribute or experience challenges in their attempts to participate (Xue, Shorey,

Wang, & He, 2018). One challenge men experience is balancing their personal and work life

with the new expectations occurring in their family life (Genesoni & Tallandini, 2009). This

could be related to societal views of gender, pregnancy, and parental roles (Carter, 2002). In

Western culture, the role of fathers has changed from simply being a breadwinner to being a

partner who is involved in all aspects of his child’s life (McGoldrick et al., 2016). With this shift

in expectations, fathers may find it difficult to determine what their role is during pregnancy.

The transition presents the challenge of accepting new members into the family system,

realignment of relationships with extended family, renegotiation of household duties, and

learning to parent and co-parent (McGoldrick et al., 2016). It was long believed that co-parenting

did not begin until the new child was born; however, it is now theorized that co-parenting begins

during the prenatal stage (Darwiche, Fivaz-Depeursinge, & Corboz-Warnery, 2016). Women

who perceive their partners as supportive during pregnancy and supportive in co-parenting

consistently have higher levels of relationship quality (Durtschi, Soloski, & Kimmes, 2017). Co-

parenting during pregnancy is highly influenced by the couple relationship and sets the standard

for future co-parenting behaviors (Darwiche, Fivaz-Depeursinge, & Corboz-Warnery, 2016).

Varga, Gee, Rivera, and Reyes (2014) suggest that pregnancy may be the ideal time to focus on

paternal involvement and various co-parenting behaviors.

Paternal involvement during pregnancy can be defined in a myriad of ways and

influences a number of factors related to the wellbeing of mothers and children. Although there

has been a recent focus on including fathers when examining experiences associated with the

transition to parenthood, the research on fathers and on paternal involvement during pregnancy is
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

limited. The existing literature points to the positive impact related to paternal involvement (Alio

et al., 2010; Don & Mickleson, 2014; Lawrence et al., 2008; Martin et al., 2007; Powell, &

Karraker, 2019). Across cultures paternal involvement is associated with higher rates of prenatal

care utilization, reduced rates of infants born at a low weight, lower levels of smoking and

alcohol consumption by mothers during pregnancy, and decreased risk of maternal postpartum

depression (Alio, Salihu, Korosky, Richman, & Marty, 2010; Yargawa & Leonardi-Bee, 2015).

Wives also report better postpartum adaptation and higher relationship satisfaction when they

perceive their spouse as supportive during pregnancy (Durtschi et al., 2017; Powell, & Karraker,

2019). On the other hand, low levels of support from husbands during pregnancy have a

negative relation with the emotional well-being of wives, which is associated with increased risk

for negative outcomes for wives and babies postpartum (Glazier et al., 2004).

In available literature, most of the research on husband involvement during pregnancy

focuses on husbands’ physical support as related to the health and well-being of the mother and

the newborn. Less research has focused on than the parents’ relationship or the potential for

husbands to provide emotional support throughout pregnancy and postpartum (Carter, 2002).

Despite the interest men may have to be involved during pregnancy, many are unsure

how to help (Carter 2002; Deave et al., 2008; Kaye et al., 2014). Both mothers and fathers report

desires that the healthcare system involve men to a greater extent in maternal healthcare

(Widarsson, Engström, Tydén, Lundberg, & Hammar, 2015); however, research shows many

men find the healthcare system unwelcoming, intimidating, and unsupportive in helping them

learn how to best provide support for their wives’ emotional health (Kaye et al., 2014). This can

contribute to husbands lacking the information they need to provide support to their partner

during pregnancy.
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

The Present Study

Much of the literature on the transition to parenthood suggests that strengthening the

couple relationship during pregnancy would benefit couples during and after pregnancy (Alio et

al., 2010; Don & Mickleson, 2014; Varga et al., 2014,). Pregnancy and the postpartum time

period are filled with opportunities for partners to respond to each other’s needs. Couples who

strengthen their bond during pregnancy may experience a stronger, more responsive relationship

postpartum (Lawrence, et al., 2008). Thus, it would be important to discover specific ways that

couples can strengthen their relationship during pregnancy. Our review of existing research

suggests there is little guidance to help husbands identify ways to meaningfully contribute to

their partners’ well-being during pregnancy and determine what positive husband involvement

during pregnancy would entail. It is the aim of this study to address this gap in the literature.

METHODS

Participants and Procedures

Participants were heterosexual, married couples who had a baby within two to six months

of participating in the study. Couples who had experienced miscarriage, infertility issues, became

pregnant through means such as in-vitro fertilization, or had a child from a previous pregnancy

with a developmental disorder were excluded due to potentially higher levels of stress during

pregnancy (McNaughton-Cassill, 2002) that could impact the level and type of husband

involvement during pregnancy. Purposive and convenience sampling were used to recruit

participants through local obstetrician and pediatric clinics, the local university, and social

media. Both first-time parents and parents who had children previously were included in the

sample for various reasons. First, men who had already experienced fatherhood may be more

knowledgeable as to how to be involved in a way that is most beneficial to their partner. The

researchers also hoped that having first time parents as well as second, third, or fourth time
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

parents would provide a more rich and in-depth theory of how husbands can meaningfully

contribute during pregnancy and how husband involvement influences the couple relationship

postpartum. Characteristics of the participants can be found in Table 1 and Table 2.

[Insert Table 1]

[Insert Table 2]

Data Collection and Analysis

Data collection and analysis were guided by procedures of grounded theory. Grounded

theory is a systematic approach for collecting and analyzing qualitative data in order to construct

theories from the data (Charmaz, 2014). The purpose of grounded theory is to move beyond

merely descriptive outcomes toward generating a general explanation or theory of a process,

action, or interaction (Creswell & Poth, 2018). The procedures of grounded theory facilitate the

process of inductively developing a theory that is grounded in the data, rather than from pre-

existing ideas (Corbin & Strauss, 2008). In this study, the objective was to build a theory of the

process of husband involvement during pregnancy and identify how this involvement impacts the

couple relationship postpartum.

After receiving IRB approval, eleven couples (n = 22) were recruited for the study. Each

partner was interviewed separately first, and then the couple was interviewed together, totaling

33 interviews. There were no major discrepancies between individual and couple interviews;

however, when discrepancies were noticed the interviewer would ask a follow up question in the

couple interview to clarify. Seven couples were interviewed via telephone and four couples were

interviewed face-to-face in the participants’ home. Sturges and Hanrahan (2004) compared

transcripts of telephone interviews with transcripts of face-to-face interviews and found no

significant difference, concluding that telephone interviews can effectively be used in qualitative

research.
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

The interviews lasted for 60-90 minutes and were audio-recorded and transcribed

verbatim for analysis. Data collection and analysis were guided by the primary research

questions: how does husband involvement during pregnancy impact the couple relationship

postpartum and what factors contribute to positive husband involvement? Researchers utilized a

semi-structured interview guide, which allowed flexibility to ask follow-up questions and gather

more information on specific topics as appropriate. Analysis occurred concurrently with data

collection, and we adjusted the interview guide and fine-tuned the focus of the interviews as the

analysis progressed. Some participants were contacted for follow-up questions as a result of

modifying the interview guide. Data collection continued until the theoretical categories were

saturated and interviews did not yield any new information related to the emerging theory. This

process helped us achieve saturation in all categories and create a theory that was grounded in

the data.

A few sample questions from the interview guide for husbands were: Can you describe

your overall involvement during pregnancy?, and Can you describe moments where you found it

difficult to be involved or supportive of your wife during pregnancy?. Sample questions from the

interview guide for wives were: What were you most significant needs and how did your

husband respond to them?, and How did your husband’s involvement during pregnancy impact

your current relationship?. A sample question from the couple interview guide is: What was the

most helpful thing your spouse did to support you during pregnancy?.

Data analysis followed common procedures of grounded theory: open coding, focused

coding, axial coding, theoretical sampling, and constant comparison (Charmaz, 2014; Corbin &

Strauss, 2008). First, research team members separately coded the interviews line-by-line for

actions and processes related to the research question. Focused coding facilitated the

identification of emerging patterns and themes and helped refine the interview guide and the data
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

collection process. The initial codes were grouped according to similar themes, emphasizing

actions and processes. Throughout the analysis, researchers employed constant comparative

analysis, by comparing one segment of data with another to determine similarities and

differences (Creswell & Poth, 2018). Axial coding was used to relate categories to subcategories,

to describe properties and dimensions of categories, and to reconstruct the data into a coherent

theory. Following open coding, research team members met regularly to discuss coding, evaluate

emerging categories, and resolve discrepancies. When discrepancies arose, team members

discussed these until a consensus was reached regarding the meaning of categories or the

relationships between categories.

Throughout the analysis, researchers engaged in memoing and theoretical sampling

(Charmaz, 2014). Memos described initial impressions of the data, helped explore lingering

questions, and guided researchers in the theoretical sampling process. Memoing also provided

researchers with a way of checking assumptions and biases and avoiding premature conclusions.

Theoretical sampling occurred throughout data collection and analysis and consisted of gathering

data on specific, emerging categories. Data collection and analysis continued until categories

were saturated and fully formed (see Corbin & Strauss, 2008). Last, researchers synthesized all

the coding, analyzing, and memoing together to form a coherent theory on the process of

husband involvement during pregnancy that illuminates key aspects of husband involvement and

the relationship between husband involvement and the couple relationship postpartum.

Researcher Reflexivity and Trustworthiness

Researcher reflexivity refers to making researchers’ biases transparent (D’Aniello & Fife,

2017). This required us to reflect on our preconceptions regarding husband involvement during

pregnancy. Both the first and second authors are trained as family systems scholars and marriage

and family therapists. Additionally, both are married and have had experience supporting our
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

wives through pregnancy. We engaged in the research with the belief that husband involvement

during pregnancy would be beneficial to the couple relationship. We remained cognizant of our

personal experiences and biases in an effort to remain faithful to the experiences of the

participants and solidify the trustworthiness of our results.

In order to ensure trustworthiness in this study, researchers focused on credibility,

transferability, confirmability, and dependability, as delineated by Anfara, Brown, & Mangione,

(2002). For this study researchers used member checks and debriefed often to establish

credibility. Three participant couples (n=6) reviewed the results and provided their thoughts and

feedback regarding the theory. Transferability was achieved by providing thick description of the

theory. Confirmability was addressed through the process of memo writing and researcher

reflexivity. Dependability was achieved through the process of using a code-recode strategy, the

use of a research team during data collection and analysis, and soliciting feedback from

grounded theory scholars regarding the analysis and results. The research team consisted of four

females and two males, all graduate students or faculty members in a couple and family therapy

program. Certain members of the research team had personally experienced pregnancy, while

others had not. The research team was diverse in ethnicity, religiosity, sexual identity, and in

values and viewpoints.

RESULTS

Overview of the Grounded Theory

In-depth qualitative analysis resulted in the development of a grounded theory of active

husband involvement during pregnancy that depicts some ways husband involvement can have a

positive impact on couples’ relationships postpartum. According to the theory developed in this

study, the key to positive husband involvement is active efforts on the part of husbands.

Figure 1 is a graphic representation of the model of Active Husband Involvement during

ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

Pregnancy. Active husband involvement is organized into four unique components or behaviors

that interact with and build upon one another. In this theory, behaviors are defined as a husband’s

conduct or actions towards his wife. The first component, helping with a positive attitude,

provides the foundation for active husband involvement and directly influences the other

components of husband involvement. As husbands engage in helping with a positive attitude,

they are able to more easily engage in the other behaviors. Helping with a positive attitude can

give rise to two additional components of involvement: instrumental support and emotional

support. Based on the analyses here, these two components appeared to interact in a reciprocal

manner and to facilitate the final component in the model, responding in significant moments.

Active husband involvement involved several different kinds of efforts and did not

always occur smoothly or successfully. It also included working through challenges and

overcoming obstacles. In this model, obstacles are defined as anything that hinders husbands

from being actively involved during pregnancy. For each component in the model, there were

obstacles that husbands needed to navigate as they engaged in active husband involvement.

Successfully navigating these obstacles was a continual process necessary for husband

involvement to be effective and beneficial to the couple relationship. Husbands reported

overcoming obstacles in a variety of ways, as described in a later section.

Husbands who engaged in these behaviors and worked to overcome the associated

obstacles provided active husband involvement during pregnancy, which was associated with a

stronger couple relationship postpartum. In contrast, husbands who were not consistently

engaged in each behavior or did not effectively navigate the related obstacles often had difficulty

providing support to their partner, and these couples do not seem to benefit from improved

relationship quality postpartum. As depicted in the model, the four components of active

husband involvement facilitate a strong couple relationship postpartum, which includes five
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

specific relationship outcomes: trust, maturity, love, enhanced communication, and continued

support.

[Insert Figure 1]

Active Husband Involvement

Helping with a positive attitude. Helping with a positive attitude received great

attention from both husbands and wives in the study. It is the foundational component of active

husband involvement, as it represents the underlying attitude behind the remaining factors that

make up active husband involvement. It reflects an orientation toward involvement, as described

by husbands and wives in the study. There are many dimensions to helping with a positive

attitude. Among the most prominent are willingness, wanting to be involved, not complaining,

and completing tasks out of love and compassion rather than obligation and resentment.

One of the most important factors of helping with a positive attitude was the husband’s

willingness to be involved in whatever capacity was needed. Regarding a willingness to help,

one wife reported, “He was always willing to help out. He goes to school fulltime and he was

exhausted, but he would still try really hard.” In addition to their husband’s willingness to be

involved, wives also commented on the importance of their husbands’ desire to be involved

during pregnancy. One participant commented, “I think the single most helpful thing was his

mood, his optimism, positivity and excitedness for the baby. That made my long days and bad

days a little easier.” A third component of helping with a positive attitude was not complaining

about participation during pregnancy. One wife reported that it was helpful “knowing that he’ll

come home and do whatever I need him to do, and he won’t get mad at me for it.” The last facet

of helping with a positive attitude is participating out of love. One husband reported, “Know

your role and do it with love. Don’t treat it like a task.” Helping with a positive attitude, rather

than resentment, helped fathers provide instrumental and emotional support.

ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

Instrumental support and emotional support. In our analysis of participants’

experiences, we found that instrumental and emotional support were related in reciprocal

manner. Instrumental support refers to specific efforts husbands made to provide physical

support on behalf of their partners throughout their pregnancy. This support involves engaging in

daily tasks and providing intuitive assistance. These behaviors reciprocally influence and are

influenced by efforts to provide emotional support, the third aspect of the model that includes

empathic responses and being emotionally available.

Engaging in daily tasks. This theme encompasses a variety of different responsibilities

and everyday duties, including household chores (e.g., cooking and cleaning), watching other

kids, and providing other physical support. The most frequently reported tasks involved helping

around the house. Husbands spoke of engaging in daily tasks, seeking to ease their wife’s

burdens and let them relax. One husband reported, “The last two months I did everything in the

house. I let her relax and do whatever she needed. Anything outside of her work I did, to let her

know that I’m here if she needs anything.” Although husbands were more likely to discuss

involvement in terms of physical support, wives also noted its importance. One wife reported,

“He did a whole bunch of measurements to plan how to build and finish the basement so that we

can build another bedroom for our baby.” Another stated, “He would help around the house. He

would do certain service for me like cooking or cleaning. That made me love him so much

more.” Overall, the main concern of involved husbands is doing anything necessary to help

wives relax and feel comfortable.

Empathic response. As husbands engaged in daily tasks they gained a better

understanding of what their spouses were going through, which helped them respond more

empathically to their partner. Aspects of empathic response include: understanding hormonal

changes, being aware of their wife’s limitations, and not taking their wife’s actions or words
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

personally.

Husbands who acknowledged the hormonal changes their wives experienced throughout

pregnancy exhibited greater empathic responsiveness. Wives in the study appreciated their

spouses’ efforts to be patient and understanding. One wife reported, “He was understanding

when I would go a little crazy sometimes.” Several husbands also discussed the importance of

making a concerted effort to understand the changes their wives were experiencing.

The last two aspects of empathic response were awareness of their wife’s limitations and

not taking offense. One wife commented on her husband’s empathic response regarding her

limitations, “I usually like to do things on my own, but when you’re pregnant you’re not

supposed to lift and other stuff. He’d help me out when he was home.” Husbands also realized

that they needed to let certain encounters roll off their back and not take offense. One husband

reported, “Wives will be on an emotional roller coaster. If they want to be close to you then

they’ll be close to you. If they want to be distant then they’ll be distant. But don’t take it

personally.”

Providing intuitive assistance. As husbands strove to understand their wives and show

empathy for them, they provided meaningful support during pregnancy. Through this process of

striving, husbands learned to recognize and anticipated their wife’s needs, or in other words,

provided intuitive assistance. Husbands developed a sense of what their wives needed by

observing their spouses’ patterns of behavior and through education via classes, the Internet, or

books. One wife commented that her husband paid close attention to her behaviors in order to

anticipate her needs. She explained, “If I started acting off, he’d notice it. He’d catch on to body

language even. He’d just step in. It was like, ‘You probably just need to like sit down and relax,

so I’ll do the sweeping and the mopping today.’”

Although some husbands were diligent in their efforts to meet their wives’ needs,
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

anticipating the needs of one’s partner can be difficult. One wife explained, “The mom has so

many needs, and she doesn’t even know she has those needs.” Nevertheless, through

observation, husbands developed the ability to provide intuitive assistance. For example, one

husband said, “At first, I didn’t know [how to help]. I would make mental notes of things I could

tell were bothering her, or things that would be beneficial to her. It was all to do with acting on

those observations.” Wives also noticed and appreciated their husbands’ efforts to sense what

they needed and provide appropriate help.

Being emotionally available. Participants’ accounts suggested that husbands who

actively observed and anticipated their wife’s needs were able to provide intuitive assistance,

which communicated their emotional availability to their spouse. Emotional availability was a

common theme discussed by husbands and wives and includes the concepts of checking in; just

listen, don’t fix; being present; and reassurance of availability.

Husbands’ regularly checking in on their partner was mentioned by several participants.

One wife reported, “He would always ask me how my day went, how I was feeling, so that I

knew he was thinking about me and how I was doing.” Another important component of

emotional availability was listening instead of trying to “fix” the problem. One wife discussed

the importance of husbands just being there for their wives, “There is nothing that the man can

do to solve her [his wife’s] emotional problems. It’s allowing her to know that it’s okay and that

you’re there to listen and support.” Being present was also very important to wives. One wife

commented on how wonderful it was to have a husband who was not distracted. She reported, “I

feel lucky that I have somebody that’s willing to let me go take a bath and not be consumed in

playing a video game or something. He was always listening to what I needed.” One husband

shared how he felt it was important for his wife’s emotional well-being to let his wife know that

he could always be there if needed, “I think it was an emotional need. Not the fact that I needed
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

to be there all the time, but she just needed to know that I could be there, if she needed me.”

Our analysis of the data showed that there were occasional differences in the type of

support emphasized by husbands and wives. Some men in the study highlighted involvement in

terms of physical support, while some wives emphasized emotional support. In relation to this,

some wives emphasized the importance of husbands responding to their physical needs yet

highlighted the positive emotional impact of their husbands’ responsiveness to these needs.

Although there were some gender differences, both husbands and wives discussed the

importance of instrumental and emotional support.

Responding in significant moments. Every couple in the study described experiencing

at least one significant moment that had the potential to bring them closer together or create

distance between them. Each couple described one or more of these moments that resulted in

relationship growth, rather than harm. Husbands who had been actively involved in the ways

described above were better able to provide support to their partner in these critical times.

Husbands’ efforts to help with a positive attitude and effectively provide instrumental and

emotional support helped prepare them to respond positively during significant moments.

Participants’ responses indicated that if husbands responded positively, the couple became closer

and stronger, despite the hardship. If husbands did not respond appropriately, there was the

potential for hurt feelings and emotional distance.

One wife shared her story of how her husband’s response during a false diagnosis of a

miscarriage brought them together and made the couple stronger. She reported, “I was told I’d

miscarried. I had no symptoms of miscarriage. And he just held me while I was bawling. I think

it brought us even more close together.” When her husband described his perception of the same

experience it could be seen how many of the previous active husband behaviors led to him

responding appropriately during this significant moment. Another wife shared how her
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

husband’s support during labor and delivery was significant for her and brought them closer as a

couple. She stated, “It was a pretty painful delivery this time, and he was there to support me. He

did whatever he could to make me feel better. I wouldn’t have wanted to go through that by

myself.” Health concerns were also present for some couples. One wife shared how she had

nerve damage in her leg from a previous pregnancy, which caused her instability in her legs,

causing her to fall quite often. She reported, “I had to rely on someone else [her husband]. For

me, having to completely rely on someone else was hard, so it helped foster trust.”

Obstacles to active involvement. As stated previously, husbands encountered obstacles

while attempting to engage in active involvement during pregnancy (see Figure 1). Some

obstacles were more relevant to specific components, while other obstacles could impact

multiple components. The most common obstacles experienced by husbands were: 1) feeling

overwhelmed, 2) experiencing interpersonal struggles, 3) gender differences, and 4)

disengagement. A variety of efforts helped husbands overcome or lessen the effect of these

obstacles.

Feeling overwhelmed. Feeling overwhelmed consisted of attempting to balance work,

school, and other responsibilities while also experiencing limited resources of time, energy, and

sleep. One husband commented, “There was so much going on. I just didn’t have the energy.”

Most husbands were able to overcome these obstacles by discussing their struggles with their

wife and by having time to adjust to the new circumstances.

Interpersonal struggles. This obstacle entailed difficulties in various aspects of the

couple relationship; such as husbands not having their own needs met. For example, many

couples reported a decrease in sexual intimacy. When asked how the couples kept a lack of sex

from becoming problematic, one wife reported, “When we went to bed we would still talk to

each other and cuddle and everything.” Most couples were able to navigate this obstacle fairly
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

well with good communication and knowing that the lack of sexual intimacy would be

temporary.

Gender differences. In conjunction with miscommunication or insufficient

communication, gender differences were also a common obstacle. Because husbands cannot

become pregnant or experience pains and sicknesses associated with pregnancy, they were

limited in their understanding of the experience, especially if the couple was not communicating

well. However, despite not knowing exactly what wives go through, husbands were still capable

of showing empathy. One husband reported, “We don’t understand everything going on, what

they’re feeling. We can’t go through it for them, but we can try to make it less miserable.”

Overcoming gender differences did not require a full understanding of the other’s experience; it

required husbands to show empathy and compassion towards their partner. It was the effort that

mattered.

Disengagement. The last major obstacle was disengagement. This describes moments

where a husband was not making observations about how he could help his wife and was

distracted by technology such as television, cell phones, or video games. One husband reported,

“There are days where I’m on autopilot. I just want to play with the kids and watch TV.

Sometimes the heart to heart my wife wants to have, I don’t want to.” One wife mentioned that

her husband didn’t seem to focus on what needed to be done while at home, focusing on the TV

or his phone instead. Another wife shared her disappointment in how her husband failed to

participate during labor, “[Husband] didn’t want to watch, didn’t want to cut the cord. He was

sitting right there facing the wall.” These obstacles were largely overcome by open

communication between partners.

Overall, there were numerous obstacles husbands needed to overcome in order to be

actively involved during pregnancy. These obstacles could be personal in nature or come from
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

external sources. Despite each couple’s unique circumstance, obstacles were mostly navigable

with patience, time to adjust, empathy, compassion, and communication.

Strong Couple Relationship Postpartum

In order to understand what impact these behaviors have on the couple relationship

postpartum, husbands and wives were each asked: How did husband involvement during

pregnancy impact your current relationship? Nearly every participant had strong views on this

question. This led to the second part of the theory: How husband’s efforts during pregnancy

influence the couple relationship postpartum.

Analysis of the participants’ interviews indicated that husbands’ efforts to be positive,

helpful, understanding, attuned, available, responsive, and supportive led to positive relationship

outcomes postpartum. Couples described five distinct ways that the couple relationship is

enhanced: Increased trust, a more mature relationship, greater love, enhanced communication,

and continued support. These represent important relationship outcomes arising from active

husband involvement.

Increased trust. When describing how the couple relationship changed as a result of

husband involvement, couples discussed an increased sense of trust, which arose from certain

behaviors exhibited by husbands during pregnancy. One wife described, “It [husband’s

involvement] showed me how much he loved me. I trust him more and rely on him more.”

Another wife responded similarly, “Just having him be there for me during the pregnancy when I

needed him. I know I can always call him now.” Husbands also described how certain behaviors

led to better relational outcomes. One husband explained, “I think it [his involvement] helped her

feel like I cared for her and that I was always there when she needed me.”

A more mature relationship. Many couples explained how their relationship was

stronger or more mature as a result of their husband’s involvement during pregnancy. One wife
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

stated, “We have really grown, and I feel like we’re on a different level of marriage or

relationship.” Her husband’s continued support had made her feel as if her marriage had been

taken to the next level, a level where they were more equal in their partnership. Another wife

spoke in detail about how learning to communicate and understand each other’s needs more fully

led to the maturation of their relationship. Husbands also reported that working to understand

their spouse was a key part of strengthening their relationship.

Love and appreciation. Many of the participants spoke at length about how husband

involvement during pregnancy increased the love and appreciation between spouses beyond

pregnancy. For example, one wife reported that her husband always striving to be available

helped her love and appreciate him more and, in turn, feel increased love and appreciation from

him, “I definitely love him more. Throughout the pregnancy my love for him grew. He always

strives to do his best. He helped me out a lot.” Husbands also recognized how the love and

appreciation in their relationship had changed as a result of behaviors such as positive attitude,

engaging in daily tasks, and understanding responses. One husband said, “I think it [husband

involvement] affected our relationship because I really took time out to do things. I think it

affected her to know that I cared enough about her to do special things for her and help her.”

Enhanced communication. Many participants spoke of having better communication

postpartum, due in large part to husbands who made it clear that they wanted to understand the

needs of their wife and how they could best help. One spouse reported that her husband

communicating his needs to her and asking about her needs changed their interaction patterns.

Another reported that having a husband who helped with a positive attitude and who could be

counted on in significant moments made it easier to talk to her husband when she suffered from

postpartum depression in a previous pregnancy. She explained, “With our last pregnancy I got

really bad postpartum depression and I think it helped feeling like I could talk to my husband
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

since he’s been supportive through the whole pregnancy.” Active husband involvement during

pregnancy not only enhanced couple communication in day to day issues, but also helped wives

feel comfortable enough to discuss something as serious as postpartum depression with their

husband, a challenge many wives keep secret from their husbands and others close to them

(Kendall-Tackett, 2016).

Continued support. As wives talked about their husbands’ involvement, it became clear

that many husbands continued to actively support their wives after pregnancy and in many of the

same ways as during pregnancy. One wife said, “He did almost everything at home and has still

been doing it.” Another wife reported that her husband continued making additional time for her.

She stated, “We still have lunches together,” which was an effort the husband made during the

pregnancy in order to support his wife. Another wife discussed her husband’s continued positive

attitude and availability, “He was always willing and is still willing to talk in his free time to

make sure I’m okay.” When questioned about the couple relationship since the baby was born,

another wife responded, “It’s been great. He’s been more helpful and positive than I could have

imagined.”

Actively engaged husbands described continued support through many of the behaviors

described above. The first few weeks postpartum were a time when wives still required

significant help. Participants who spoke of how husband involvement positively impacted their

relationship mentioned feeling more supportive of one another. Wives felt more support from

their husbands and towards their husband as well. One wife shared her thoughts about how her

husband engaging in daily tasks helped her feel more supported. She stated, “We are definitely

more supportive of one another. Whenever I would ask him to do something he’d do it. He

would always help me out. I think that helped our relationship.” Husbands also mentioned how

helping with daily tasks increased the amount of support their wives felt. One husband said, “I
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

think it [his involvement] impacted it [the couple relationship] for good because she was able to

see that ‘he’s [speaking of himself] here to support me, he’s here to help me.’”

Continued support anchored and extended active husband involvement into the couple

relationship postpartum. To many wives, continued support postpartum was a message from their

husband that they still cared about them and were still invested in the relationship. Continued

support sent a message to wives that husband involvement would remain, thereby enhancing the

positive relational benefits from husband involvement during pregnancy.

A final summative quote that exemplifies the qualities of husbands in our study who were

active in their involvement during pregnancy comes from one husband who shared his thoughts

about how he believes pregnancy can be a time to strengthen the couple relationship:

Having a baby doesn’t have to ruin your relationship or take away from your relationship.

Having a baby can bring you together if you are both willing to work together to be a

team. You see in research and in the news people saying how marital satisfaction goes

down when you have a kid, but I don’t think that has to be the case. I think it’s the way

the couple kind of takes it on as an opportunity.

This demonstrates the importance of a positive attitude and a willingness to do whatever is

necessary to support one’s wife during and beyond pregnancy.

Inconsistent/Inattentive Husband Involvement

Overall, most (9 out of 11) of the couples in the study reported that their relationship was

stronger as a result of the husband’s involvement. However, as illustrated by some of the

couples, when husbands did not engage in active behaviors, wives generally became less

satisfied in their relationship or less confident in their partner. There were two cases, in

particular, in which husbands struggled to consistently and attentively engage in active behaviors

during the pregnancy. As a result, these couples seemed to display some characteristics of a
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

weakened couple relationship. One wife commented she always felt as if her husband’s

participation in the pregnancy was for the baby and not for her. She reported,

I feel like a lot of the involvement during pregnancy was for her [the baby], but for my

emotional health he wasn’t so much there. His involvement made me less confident in

him being a great husband. With me it’s [the couple relationship] kind of in a scary place.

Another wife, who had mentioned her husband’s emotional unavailability and lack of response to

significant moments, led her to wonder about her decision to marry him, “I would say there’s a

lot of times I don’t know, did I marry the right person?” Overall, wives who did not feel their

relationship was strengthened were not unhappy with the instrumental support that they received;

however, they were disappointed with the lack of emotional support provided by their husband.

This suggests that meaningful husband involvement during pregnancy is much more than doing

extra household chores or providing other forms of physical support. Active husband

involvement is a complex, multidimensional process of various behaviors and attitudes.

DISCUSSION

Past research suggests that husband involvement is not a singular behavior, but is

complex and multifaceted (Carter, 2002). The results from the present study provide in-depth

descriptions about various aspects that encompass active husband involvement. However, there

is little research on the connection between husband involvement during pregnancy and the

couple relationship postpartum. As illustrated by the grounded theory presented in this paper,

husband involvement during pregnancy had significant implications for the quality of the couple

relationship postpartum.

Existing empirical literature lacks information regarding the specific ways husbands can

provide emotional support, with more of a focus on physical or instrumental support (Yargawa &

Leonardi-Bee, 2015). The theory developed in this study outlines specific behaviors associated
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

with active husband involvement. The grounded theory developed in this study highlights the

critical aspects of active paternal involvement (i.e., helping with a positive attitude, instrumental

support, emotional support, and responding in significant moments) and illustrates the

interconnected relationship between instrumental and emotional support that husbands can

provide their wives during pregnancy. Although husbands and wives both discussed husband

involvement during pregnancy, they tended to describe it in slightly different ways. Similar to

research by Carter (2002), men in the current study were more likely to discuss husband

involvement in terms of physical support, while women were more likely to highlight emotional

support. One interesting finding is that some women reported their most pressing needs were

physical in nature but placed more emphasis on the way they felt emotionally supported by their

husband. Physical support seemed to provide an extra sense of emotional support for women

during pregnancy. Consistent with research by Kaye et al. (2014), husbands and wives in the

study agreed that husbands should be emotionally and physically available to their wife, be

considerate of her situation, and display a positive attitude.

In addition to illustrating the aspects of active husband involvement, the results indicate

there are several factors that may contribute to husbands being less involved during pregnancy.

One prominent obstacle to involvement is gender (Carter, 2002). Being unable to personally

experience pregnancy makes it difficult for husbands to understand the experience. School and

work are also common obstacles to husband involvement. Deave & Johnson (2008) found that

husbands desire to be involved, but experience difficulty in acquiring the time off work.

Husbands in our study reported difficulty in attending visits to the obstetrician and in providing

their wife with the support of their physical presence; however these obstacles were largely

mitigated by husbands rearranging schedules, providing extra support while at home, or

providing emotional support via phone calls, texting, and video chatting.
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

Among the couples in the study, active husband involvement during pregnancy was

associated with trust, relationship maturity, love, communication, and continued support within

the couple relationship postpartum. Consistent with previous research, partner support during

pregnancy seems to be a protective factor for couple relationship postpartum (Lawrence, et al.,

2008). Active husband involvement does not just protect the couple, it potentially strengthens the

couple relationship. Prior research has indicated that when spouses perceive their partner as more

supportive and reliable, they tend to feel more valued and secure in their relationship (Collins &

Feeney, 2005). The results from this study elaborate upon those findings by providing detailed

descriptions of behaviors that provide meaningful support to wives during and after pregnancy.

Wives in this study who reported high levels of husband involvement and emotional attunement

described feeling more loved and appreciated during pregnancy and postpartum. Furthermore,

this study supports research from Mikulincer & Shaver (2007), who found that wives who

perceive their husband as being available are more likely to ask for help in times of need.

In contrast to active husband involvement, the lack of husband involvement has the

potential to harm the relationship. As with previous research (Glazier, et al., 2004), wives who

reported lower levels of husband support during pregnancy also reported more emotional

difficulties postpartum; whereas wives who reported having a husband with high levels of

involvement reported better emotional well-being. Previous research suggests that women who

perceive their husband as being less supportive during pregnancy are at a much greater risk for

depression after pregnancy (Simpson, et al., 2003). Although most of the women in our study

reported high husband involvement, participants who reported low husband involvement spoke

of more emotional difficulties and relationship concerns when compared to wives who reported

greater husband support. Additionally, if husbands were not available to their partner or did not

respond positively, the mothers reported hurt feelings akin to an attachment injury (Johnson,
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

Makinen, & Milikin, 2001). As suggested in prior research (Seedall & Wampler, 2013), a lack of

responsiveness to a significant need may result in wives being less likely to seek their partner in

future significant moments.

Consistent with other studies (Condon, et al, 2004), decreases in sexual satisfaction and

sexual frequency during pregnancy can be a source of stress and disconnection for a couple

relationship. Couples in the study indicated that this challenge was addressed through effective

communication. This finding aligns with previous research findings that open and direct

communication about sexual intimacy and desires can benefit couples throughout pregnancy and

postpartum (Ahlborg, Dahlof, & Hallberg, et al, 2005).

Implications

A growing body of research is focused on integrated care between mental health

professionals and healthcare providers (Tyndall, Hodgson, Lamson, White, & Knight, 2012).

This study suggests a need for a greater emphasis on the couple relationship during pregnancy,

which has implications for both medical professionals and mental health professionals who

receive specialized training in working with couples. If mental health professionals were able to

better collaborate with healthcare providers, specifically obstetricians, more attention could be

given to the couple relationship during pregnancy. Integrated healthcare leads to better health

outcomes and treatment that is more cost-effective (Katzelnick et al., 2000). Patient reports

indicate that integrated care promotes family-centered outcomes (Hodgson, McCammon, &

Anderson, 2011), making pregnancy an ideal situation for integrated healthcare.

This study also provides couple therapists with more in-depth information on possible

ways they can help husbands support their partners and be responsive to their needs during

pregnancy and postpartum. Husbands in the study reported they could benefit from more

information about the pregnancy process and how to support their partner. Previous research on
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

husband involvement focuses primarily on providing physical support, leaving husbands with

little information on how to emotionally support their partner (Carter, 2002). Results of this

study highlight the process of providing both physical and emotional support. Therapists

working with pregnant couples should focus on the importance of partners communicating their

needs to each other and provide couples with tools to effectively do so. Therapists can facilitate

communication about individual needs and promote responsiveness between partners by utilizing

principles and interventions from attachment-based therapies (Johnson, 2019), as pregnancy

provides couples with many opportunities to increase or to decrease their attachment with their

partner.

Finally, although husbands and fathers are more involved during pregnancy and

postpartum parenting than in the past (Powell & Karraker, 2019), men often receive the implicit

message that they do not belong in the world of maternal health (Kaye et al, 2014). Marriage and

family therapists and other mental health professionals can play a vital role in breaking down

gender barriers as they work with couples during and after pregnancy. Men must know that they

are both needed and wanted during pregnancy. Encouraging husbands to attend doctor’s

meetings, birthing classes, and baby showers will send the message to husbands that they are

vital partners in pregnancy, not viewers watching from a distance.

Limitations and Future Research

As with all research, this study has limitations. One limitation relates to the sample in

terms of education level, ethnicity, socioeconomic status, and marital status of participants.

Many participants had attended college, which may have afforded them more knowledge about

how to participate during pregnancy. A less educated sample may have resulted in different

barriers to participation in pregnancy and alternative ways of providing support. The sample also

trends toward a higher socioeconomic status. As such, these participants might be privy to
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

resources that individuals of lower incomes are not. In addition, a large number of the

participants were of Caucasian heritage. In terms of participants’ marital status, participation was

limited to married couples. This may pose some limitations in terms of relating the findings to

the experiences of non-married couples. Future research should employ a more diverse sample.

Another limitation is related to the social location of the researchers. Our experiences as

educated, White, American, male parents undoubtedly influenced our conceptualization of the

study, as well as the analysis and interpretation of the data. Nevertheless, through use of a

research team and our own reflexivity, we strove to remain aware of these influences and

faithfully represent the experiences of the participants. Researchers with different social

locations may have understood the data differently and drawn different conclusions.

Another limitation comes from asking participants to recall events that happened prior to

the birth of their child, which was anywhere from 2-6 months prior to the interview. Although

researchers attempted to enlist participants in a timely manner following pregnancy, there is the

possibility that had partners been able to share their in-the-moment feelings they would have

provided more details or had a better recall of their interactions. It is also possible that some

participants disclosed information differently in front of his or her spouse when compared to

their own individual interview. Future researchers might choose to interview couples during the

pregnancy to evaluate husband involvement.

A final limitation is related to the data collection procedures and sample size. Data

collection occurred through in-person and telephone interviews. In spite of this difference, all

participants provided rich, informative narratives of their experiences. Also, a larger sample may

have provided additional information about the experience of couples and the influence of

husband involvement. Although the sample included only eleven couples, each participant

shared in-depth, detailed accounts of the husbands’ involvement and the ways in which this
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

influenced their relationship. The analysis resulted in rich, thoroughly-developed categories.

Results from the study suggest additional research is needed on husband involvement

during pregnancy. A few couples reported that technology was used by husbands to express to

their wives that they were thinking about them and were available to support them, even if they

were not physically present. However, technology use was also found to be negative, with some

wives reporting that their husband was less present emotionally and more distracted due to

technology use. Future studies may investigate how technology can be used to enhance or detract

from husband involvement during pregnancy.

Another important area of future research is the impact of husband involvement on

maternal mental health. One participant in the study reported that she had suffered from

postpartum depression after one of her pregnancies. She mentioned that the manner in which her

husband was involved during pregnancy made her more willing to talk to him about her

postpartum depression, which enabled him to help her work through that diagnosis. It could be

valuable to explore if there is a relationship between willingness to share feelings of postpartum

depression with a spouse and level of involvement during pregnancy. The grounded theory

developed in the study suggests there was higher couple relationship satisfaction where there was

high husband involvement; however, quantitative data on couple relationship satisfaction or

mutual support were not collected. Future research could investigate this association.

Conclusion

As described by the grounded theory developed in this study, active husband involvement

during pregnancy is embodied by four primary categories of behavior patterns. Associated with

each positive behavior are common challenges or obstacles for both husbands and wives to

navigate. Most of these challenges are mitigated through effective communication, compassion,

empathy, patience, persistent effort, and maintaining a positive attitude. The transition to
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

parenthood can be difficult; however, the results of this study provide practical guidance for

husbands during pregnancy and for healthcare professionals. Ultimately, the grounded theory

developed in this study illustrates that active husband involvement not only strengthens the

couple relationship through pregnancy, but also strengthens the couple relationship postpartum.

Couples who strengthen their bond during pregnancy make a wise investment that may pay off

with a stronger, more responsive relationship postpartum.

ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

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Table 1

Individual Characteristics

Characteristic Sample N=22

Age Range (Mean)

Husbands 25-36 (29.5)
Wives 24-34 (28.3)
Race
Caucasian 17
Hispanic/Latino 4
Asian-American 1
Religion
Non-Religious 7
Religious 15
Education
High School 4
Associates 4
Technical 2
Bachelors 9
Advanced 3
ACTIVE HUSBAND INVOLVEMENT DURING PREGNANCY 2

Table 2

Couple Characteristics

Characteristic Sample N=11

Household Income
20K or less 3
20k-50k 0
50k-75k 5
75k-100k 1
100k + 2
Children
1 4
2 2
3 4
4+ 1
Pregnancy Planned
Yes 8
No 3
Baby Delivered
Vaginally 9
C-Section 2