Paternal experience during the child ’ s first year of life : integrative review of qualitative research

Social transformations have raised reflection about the paternal role and pointed to new fatherhoods, characterized by more effective involvement of the father in the family routine and in childcare. The present integrative review of qualitative studies aimed to synthetize the literature evidence about fatherhood experience throughout the first year of the child’s life, attentive to gender questions. Twenty three studies integrated this review. It was observed that fathers had positive experience with their babies and, still, craved for more time and space to dedicate to the family. However, inequality between genders, continuous requirement of financial provision at home and their inaptitude for breastfeeding moment impeded more paternal involvement. We concluded that new fatherhoods movement is present in the father experience and contemporary gender tendencies are challenges for parenting support. Descriptors: Paternity; Father-Child Relations; Gender Identity; Pediatric Nursing; Men's Health


INTRODUCTION
In contemporary times, new family models different from traditional, are resulted from social movements, especially feminism, with transformations in gender relationships and ways of being family.Thus, temporal coexistence of these models and predominance of the traditional family collective imaginary became a challenge (1) .
Parental roles suffered consequences from this process and childcare, which is a family role, becomes in the dependency of subjects involved in them and in its particularities attributed to gender questions and its praxis (2) .In this context, pregnancy and childcare was always attributed to the woman, with the tendency to push the man away from those (2)(3) .This fact reinforce Elisabeth Badinter (4) thoughts when questioning the myth of maternal love as innate of women, and referring it as a social construction of the being natural and instinctive, while paternal love is optional, being concretized or not (5) .
This scenario have broadened discussions about inclusion of men in health questions, sexuality and reproduction, looking at gender equality (5)(6)(7) .In parallel, homosexual groups and pro-feminist men started to question the reproduction of traditional manhood and hegemonic model, as well as promoting reflections about the male identity formation, proposing new ways of being man, new masculinities (5,8) .Following this tendency, advances in the debate about new fatherhoods are identified, understood as an effective participation of men in family routine, including childcare (9) .
In front of these notes and considering questions about the traditional manhood model and paternity, the new family structures, and the need to welcome new fatherhoods, this study aimed to synthetize evidence in the literature about paternal experience during the child's first year of life, attentive to gender questions.

Qualitative evidence brings dense and deep
descriptions contributing to the study's aim that is centered in the research question: what repercussions gender relations brought to fatherhood?Thus, a integrative review of qualitative studies was chosen, as it is a method that aggregates knowledge produced by primary qualitative research (10)(11) , followed by the steps preconized by Whittemore and Knalf (10) . The

RESULTS AND DISCUSSION
The process of search and selection of articles can be observed in Chart 1.
Although 32 articles were selected, nine of them were The organization, summary, critical and integrative information analysis allowed to establish three themes translating fatherhood experience during the first year of their child's life: care and positive interactions; paternal work, division of tasks and responsibilities; and breastfeeding and fatherhood.

Care and positive interactions
The establishment of interactions with the child supports paternal experience, as it generated positive feelings, approximating father and child (12)(13)(14)(15)(16)(17)(18) and build the counterpoint to the abandonment sensation experienced before the child's birth (19)(20) .These interactions are promoted by opportunities of fathers to: participate in the childcare; receive social support; have responsiveness of the child; feel affinity with the child and desire to be reference of values for the child.
Brazilian fathers experienced feelings of intense pleasure and realization with concretization of fatherhood (12,14,17,(19)(20) , they felt it as personal concretization and experienced strong connection with the child (14,17) .Those feelings meet the happiness verbalization of Swedish (19) and Asian (16) fathers and give proud to British (18) fathers.Some Brazilian men could not perceive themselves as fathers until their child's birth by understanding the pregnancy as a biological process and of female responsibility and others, they processed this feeling during the pregnancy (20) .There were those who affirmed that being a father is easier than imagined (20) -in relation to the previous unprepared feeling -, as the contributions of family members, friends (12,15,(21)(22) and coworkers (19) and the facilitation of the wife in the interaction of them with the baby was meaningful (12,14,17,20) .Fathers from Singapore also mentioned health professionals, besides friends and family members, as source of support and information (16) .
Brazilian fathers highlighted the previous affinity with children (12) and the positive reaction of the baby with them (12,14,17,20) in this father-child relationship.Still for Brazilian and English fathers, the accompaniment of the child's routines and development and, the learning opportunities of childcare after birth were promoters of paternal sense (12,14,(17)(18) .In this conjunct, Swedish fathers added personal maturity to higher involvement in the paternal role (19) .
Regarding healthcare, fathers showed preoccupation with physical alterations in the child's body (15,21) , they got closer from their vaccine's calendar (20) and participated in appointments related to their health (13) .
Research showed the father-child relationship being based in differences between genders and female and male roles (14)(15)17,19) . In thi sense, the Swedish father attributed a more gentle role to the mother and to him, something of more determination (19) .On the other hand, the Brazilian father related differences in his behavior in front of the child, when he associates the son to tranquility and daughter to worries, especially in relation to rape (15) .
Nevertheless, fathers expressed worries in being good fathers, with efforts to get closer to what they wished (17) and to reach insertion and participation in the child care (14,(16)(17)(18)(19)23) , elements of the new fatherhood (23) .

Paternal work, division of tasks and responsibilities
Facing fatherhood, the sense of responsibility for the child is strongly triggered (14,17,(21)(22) and there is participation in their care decisions (17) .Fathers demonstrated preoccupation with the children and dedicated themselves to them (14,15,17,(21)(22) .Thus, within the responsibilities adopted by fathers, Brazilians as well as English and Swedish, are: physical and emotional protection, prevention of accidents and violence, inclusive sexual 21) ; education, limits imposition and teaching good manners (15,(17)(18)(19)(20)(21)(23)(24) ; and prepare for adult life (17) . Fathersalso worried with them going to childcare, overall regarding mistreatment, incipience of care and emotional impact, and referred to feel jealousy, missing the child and insecurity (17) .
In relation to educating children, fathers expected that passed on to the child would be repassed to the next generation (14)(15)21,18) , however, they explicitly choose what to pass on to the child, within what they learned from their fathers, excluding what they considered negative aspects (14,20) .
English fathers highlighted the social pressure as a provider role, what determined limits to new fatherhoods (18,27) .A comparative study of fatherhood between Sweden and Poland pointed that Polish fathers defined themselves more intensively as providers, while Swedish refuted the exclusiveness of this role.Swedish fathers understood that gender equality would not be reached without an involvement of men in the domestic sphere (27) .
Still referring to gender questions, fathers pointed that attribute the child care to the woman, restricted the fatherhood (14)(15)17,19,23,25) . Yet, there ae those who reproduced such standard and conceived to be natural for woman do care for the child (12,(14)(15)17,21,25,28) and to have more responsibility for the child (14,17) .These put themselves as secondary/helpers in newborn care (15,25) or did not divide equally domestic (12) and care (14,17) tasks.
British fathers reported to follow and do what the wife determines in relation to the child, as the mother has more knowledge about the care, seen that they spend more time with the baby (27) .Yet, they defended that care should be shared (18,27) , a fact also sustained by Swedish fathers (19) .There are still those who pointed the mother as having instincts to care for girls and the father, for boys (15) and others that cared for the wife, as understanding that could be contributing to care for the son (25) .Asian fathers, on the other hand, mentioned to change their behavior to protect his wife and child (16) .
Concomitant to it, fathers reported worries with physical and emotional distress and of the partner when caring for the baby (17) .Some were available to assume the care during the mother's absence, as in cases of issues during the birth (19) , in situations where mothers worked (25) or in situations where the father worked less time than the mother (14,20) .There were also those who were not available by their own initiative and performed punctual tasks when asked, as diaper changes, give baths, to hold and feed the baby (17) .
Brazilian studies listed activities of care not enjoyed by the fathers, as: change diapers and/or clothes, to calm the child when crying and give him a bath (12,14,17) .Some felt unprepared to care for the child when there are fears and insecurities or perceptions of incompetency (12,14,17) .
Regarding work, it integrates, regulates and affects fatherhood.Within the worries with the child wellbeing, maintenance and protection are guaranteed, in a way that some fathers perceived fatherhood more as a social role than a space of affection involvement (25) .In this perspective, work was presented as a factor that pushed away the father from fatherhood (14)(15)(17)(18)(21)(22)(23)(24)(26)(27)(28)(29) , as it decreased his opportunities of care and involvement (14)(15)18,23,27) and restricted physical contact with the child (14- 15,17,28) . Regarding work,fathers affirmed to have only night time and weekends to invest in the relationship with the child and participate in his/her care, but they report tiredness of this dynamic (14)(15)17,28) , especially for the interference in the sleep quality (14) .
On the other hand, financial matters made it impossible for some English fathers to use fatherhood leave (seen that in the country there is a smaller payment during this period) and the return to work emerges his identity as provider (18) .Still in what is referred to this question, the fatherhood leave time for Brazilian fathers was considered insufficient (24) , as well as for Swedish fathers who used ten days of fatherhood leave (19) .Yet, the understanding of fatherhood as effective and affective involvement, for beyond the conception of provider was present in studies with Brazilian, English and Swedish fathers (17)(18)(19)20,25,27,29) .
Cultural questions appeared in a study about migrant African fathers in England, they pointed limited time with the child imposed by habits of the local society, counterpointing fatherhood in rural African villages in comparison with the experienced in urban English centers (22) .
Another question in the fatherhood experience are the changes in family dynamics (14,17) and in the couple relationship (12,14,17,19,21) , overall in order to prioritize childcare (17) .Sometimes, there are more approximation between the couple (12,19) and in others, the limitations in terms of freedom, time and social activities comes out (14) .
In this aspect, Swedish fathers were surprised because they were guided in the prenatal service about the risk of the couple's separation (19) .And, there were situations in which the father was jealous of the baby, by understanding their wife's involvement with the baby, and putting him in a second plan (21) , especially with the decrease of couples' moments (12) .

Breastfeeding and fatherhood
The breastfeeding process is presented as of dual elements, and it can be a promoting or limiting aspect of paternal experience.
Reinforcing the sociocultural history that determined the breastfeeding act as exclusively female, breastfeeding were one of the events of higher impact in the feeling of paternal exclusion (15,17,20-21,30-31)   or insignificance (19) , especially on the first two years of the child's life (30,32) .
However, fathers supported and incentivized the mother to breastfeed, because they identified breastfeeding as needed for the child's good health (13,19,28,(30)(31)(32) .They acted as: helping with the child's head position (19,29) ; obtaining knowledge (19,28,(30)(31)33) from the midwives and pediatrics nurses, in the Swedish case (19) ; the permanence by the woman's side creating a favorable emotional environment (24) ; attention to the woman and child (13) ; and/or the division of domestic tasks and care for the other children (24,27,32) , especially in the first months after the birth (24) . Als, Brazilian fathers affirmed that seeing the child being breastfed by the woman intensified his love for the him/her (30)(31) .
The lack of space for his actions in the breastfeeding process motivated the search for other mechanisms of participation that not the child's feeding (32)(33) .However, they felt closer to the child and with more space to care for him/her when weaning the baby, the introduction of bottles and the insertion of the child in other social environments (beyond the family) (19,30,34) .Swedish fathers affirmed that when using the bottles, they felt to be nursing, as they were equally feeding the baby (19) .
In addition, during breastfeeding moment, the breast were conceived as source of nutrition for the baby, suppressing the image as sexual and sensual organs and, as consequence, contributing for early weaning and father exclusion (30) .
Other elements that limited the paternal participation on breastfeeding were the interference from grandmothers (13) , the lack of information about breastfeeding (33) and the devaluation of the father's opinion about it, which contributed to remove him from this setting (28,32) .At the same time, the lack of information and actions directed to Swedish fathers in prenatal consultations and during the birth, brought uncertainties and conducted them to a tension (alarm) position (19) .
The fatherhood experience during the first year of life is permeated by social gender constructions.Gender socialization is understood as the process by which men and women go through life and direct the male and female (sex) to their respective male and female (genders).From biological characteristics, each society in a determined historical moment, builds understandings (models) that are proper to each gender (35) .
It is noteworthy that, by itself, this socialization is not problematic, but is starts to represent the base of actual discussions when the female and male rigid models are used to justify inequalities (36) .In this study's context, it is noted that social constructions imprison men and women inside traditional patterns of father and mother (35) .Thus, the same social mechanisms that enable woman for domestic activities and care for the child, for the man, it results in feelings of fear and not being prepared, experienced by the father when manipulating the baby.
That is, different from the woman, the man is socialized, affectively distant from the child to meet his responsibilities that are strongly based in financial provision, authority and family guardian (5) .
The woman started to integrate the workforce, to study and have financial independence, however, changes in the domestic environment did not follow those transformations and she still performs her socialized role, even in situations where there is double income (where both man and woman work), bringing repercussions in the physical and emotional health (36) .
Impelled to the public and work environment, the man does not perceive the domestic environment as his acting place and also he is not familiarized with the care for the child and domestic tasks (35) .Thus, to find his place in the family dynamics, the father needs to be interested and search for information, with friends, family members and coworkers.In the same way, his actions depend on the woman's permission or her unavailability to have such role.
Besides, the society appeal for the man to supply for the house and the need to spend time at work, as well as the inexistence of public policies allowing fathers to enjoy the time with the child after the birth, marks the work as a priority element in the regulation of the paternal involvement with the family and child.The conception of providers follows the present in all contexts found in this review, supporting the universal character of this understanding.
The father's exclusion also happen during breastfeeding, when he experiences feelings of undervalue or insignificance.In first instance, the breastfeeding is understood by the father, mother and others as a physiological act and exclusively feminine and, however, permeated by a sociocultural construction that does not provision the competencies and needed abilities to the father to participate in breastfeeding.
Competencies socially attributed to women, yet, does not mean that breastfeeding is an innate act from her, a question clearly discussed by other authors (37)(38) .Another aspect analyzed is the value romanticized of the motherbaby bond during breastfeeding, at the same time that the man does not received the same value (38) .
It is still important to note in this context that the father can be anxious for the end of breastfeeding and introduction of the bottle -bringing consequences for the duration of the breastfeeding phase -, the arrival of the verbal phase or the introduction of the child in public spaces, so the father can occupy more spaces in the child's life.
The assumption of the father's responsibility as a social role is expressively present with the concretization of fatherhood and demands for material support.
However, many fathers demonstrate dissatisfaction with this unique and exclusive relationship with fatherhood and they have experienced it in a more broad and participative way.This fact can be found by the expression of positive feelings regarding fatherhood, by the interest of the father for the child and his/her care, by the division of domestic tasks and childcare and by his approximation to breastfeeding, when supporting the mother.Thus, the father's action scope is broad, allowing opportunities to (co)act domestic and child care and create abilities needed for that (38)(39) .
However, this process occur under a history and persistency of traditional male patterns, referring him to revisit this model, emerging and reemerging the different understandings of being a father, concepts sometimes extended and sometimes connected to the social ideal of a provider.It is also perceived that understandings are dynamic and are depending on distinct aspects.Thus, coexistence is understood by multiple father models, in Brazil as well as in other countries, where the studies included in this review.

CONCLUSIONS
Fatherhood during the child's first year of life is experienced by the father in a paradox way, in the measure that a new status is reached in society and he desires to be closer to the child, he needs to be opposed to a context of impositions and demands restricted to financial provider and family guardian role.
Thus, to experience new fatherhoods' demands a shock between the father's desires and social values, in a counterpoint that also questions the manhood model, the modern family requirements and the inter generation characteristics.Thus, the up rise of a new father needs a sensitive mother to her partner's needs and proactive to stimulate his participation in childcare.
The findings presented here contribute to broaden references about fatherhood and gender theme, aiming to consolidate the crossing to new fatherhoods.It is also pointed the need to develop Health studies aimed to new fatherhoods, once this review used a very specific cut.
Many gaps still need to be studied to move forward the knowledge building about this theme, for example, the nuances of paternal care in cases where the father does not live with the child; relationships affected by contexts of violence, illness, imprisonment, elitism and others.
Also, there is a need to broaden discussions for successful health education strategies to approximate the father from the domestic scenario and to overcome gender patterns that permeate in the social imaginary.
first step was the selection of databases, SocINDEX; and Education Resources Information Center(ERIC).These platforms convey studies related to the problem in focus and are periodically updated.The adopted descriptors were: father, paternity, father-son relationship, health, gender identity and education, with its respective versions in Portuguese.They were combined in trios based on Boolean logic "and" and "or", fixing the first two terms linked by the logic or and the third by the logic and.For example: father or paternity and education.The following selection criteria were set: to be an original scientific article exclusively with qualitative approach; to have an abstract available online; to be fully available for free; to be written in English, Portuguese or Spanish; published between January of 2003 and December of 2004; to contain knowledge about fatherhood during the child's birth and the first year of life; and have the father as the study's subject.Initial selection occurred from the reading of titles and abstracts and, when apparently meeting the study criteria, being read in full by two researchers, sustained in

Database Descriptors Number of obtained references Number of articles read Number of selected articles
Synthesis of articles integrating the review by author(s)/year and country, study focus, subjects and methods in chronological order of publication.São Carlos, SP, Brazil, 2015.

Author(s)/ Year/ Study's Country Study's focus Subjects Method
Six Brazilian fathers who experienced paternity in a participative way.Exploratory study, focus group, analysis of discursive practices, social constructionism.Fägerskiöld/ 2008/ Sweden Experiences of primiparous fathers during their children's first infancy.20 Brazilian primiparous fathers.Theory based on the data.Pontes; Alexandrino; Osório/ 2008/ Brazil Father's experiences, knowledge, behaviors and feelings about the breastfeeding process.17 Brazilian fathers whose children were between six and eight months.Descriptive study, Bardin thematic content analysis.Freitas et al./ 2009/ Brazil Meanings attributed to fatherhood by men who are fathers.Ten Brazilian fathers whose children were attended at a school hospital.The father's perception about going back home with his baby and the implications of this phenomenon in the family's life.Four Brazilian primiparous fathers.Semi-structured interview.