Questionnaires and journal entries were completed by all participants, except for two TG fathers who had no journal entries. Fathers' journal entries focused on three concepts: their new roles, thankfulness and feelings. The fathers' first encounter with their newborns was the most significant across all participants.
Before childbirth, many of the fathers relayed ambivalent feel-ings about fetus/infant, with seven fathers wanting see their infants soon and three not feeling at all like becoming a father.
Fathers saw their role as helping choose their infant's name and bringing supplies. The first encounter entries focused on thankful-ness and relief about a safe birth. For example, one father wrote“I was filled with great thankfulness for the safe delivery. Because of Satogaeri Bunben, I thought I might not to be able to attend child-birth, but I think the baby waited for me, so I was in time for T A B L E 4 Cross-sectional comparison of TKHS Scores
TKHS Scores
TG (n=14) CG (n=13)
P
M SD M SD
AP Score
Pregnancy 25.64 6.45 22.08 7.34 .165
1-M. 25.07 6.29 24.92 5.88 .826
6-M. 29.36 6.10 27.23 6.29 .408
12-M. 30.00 5.60 31.00 4.12 .465
AV Score
Pregnancy 7.86 3.37 8.38 5.53 .961
1-M. 6.71 3.93 6.15 3.87 .789
6-M. 7.43 5.14 6.38 3.43 .643
12-M. 11.43 9.54 6.92 5.66 .136
AI
Pregnancy 31.13 13.25 39.19 22.61 .382
1-M. 27.43 13.22 24.56 14.89 .577
6-M. 25.49 18.07 22.72 10.68 .981
12-M. 36.29 22.00 22.76 20.25 .047
Abbreviations: 1-M.: 1-month postnatal; 6-M.: 6-month postnatal; 12-M.:
12-month postnatal; AI: Antagonistic Index; AP Score: Approach Score;
AV Score: Avoidance Score; TKHS: Taiji Kanjyo Hyotei Syakudo.
T A B L E 5 Longitudinal comparison of TKHS Scores
Abbreviations: 1-M.: 1-month postnatal; 6-M.: 6-month postnatal; 12-M.: 12-month postnatal; AI: Antagonistic Index: AP Score: Approach Score; AV Score: Avoidance Score; TKHS: Taiji Kanjyo Hyotei Syakudo.
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it. Give my love to you from now on!! (CG).” For those fathers whose first encounter was not until the day after childbirth, there was also thankfulness, “A lot of hard things happened until the birth, so the pregnancy was not easy. But I really thank for being born safely. You look like a monkey. (CG).” There were also fathers whose first encounters were delayed even longer. One of these fathers shared “Small, cute, fragile, heartwarming (TG).” In contrast, there were two fathers whose first encounter comments reflected apprehension and hesitation; for example,“the baby was small and fragile, so I was little afraid of touching her. After I held her once, I felt intrigued, she was soft and warm and lived. I was surprised.
It did not to seem real to become a father. (TG).” After the first encounter, fathers were encouraged by being able to see their infants, sharing they were developing strong feelings of responsibil-ity as a father and felt happy to become a father.
Fathers in TG also specifically commented about VMC experi-ences in their journals, saying they enjoyed when they could see their infants moving, and complaining if the infant was asleep. They focused on visual cues and even on how seeing their pregnant wives' abdomens grow positively affected their feelings before childbirth.
For example, one father shared,“Her (Wife's) tummy was bigger than the last VMC. A fetus weight was 2700g. It is almost 37 weeks preg-nant, so the birth will come soon.”
After childbirth, one father (TG) shared,“It was the first VMC since the baby was born… I looked at only her pictures, so felt that a baby moving was prettier (than pictures) … I could see diaper changes.” And “I could see the baby's face and that she opened her eyes clearly. I could see breastfeeding three times.This was the first Skype since the baby was born. Although I cannot really touch the baby, it is better than a phone because I can see him move (TG).”
Many fathers also recorded their feelings, such as one father (TG) who shared,“As my work is becoming busy … my fatigue was dis-pelled because I can see my baby's face.” and “My wife looks … a mother's face… I would like to take care of my baby together soon.”
For CG,“The e-mail with pictures is not enough for me, so I down-loaded an application so we could do VMC… Although the screen was small, I happened to see him moving and was impressed by it.”
4 | D I S C U S S I O N
While fathers in this study were similar to first-time fathers in Japan, there were also some differences. They were similar in age (M=32.7 years) and within average years from marriage to first-born child (M=2.41 years) (Japan Ministry of Health, Labour and Welfare, 2017); however, their overall socio-economic status was higher than average for Japanese men (Gender Equality Bureau Cabinet Office, 2017).
As Ferketich and Mercer (1995) described first-time fathers' three developmental processes:“grappling with the reality of the pregnancy and the child, struggling for recognition as a parent from persons in their social interactions and persevering in the role making of involved parenthood” (p. 90), involvement with infants is necessary for fathers
to build a relationship with infants and transition to fatherhood. If fathers do not live with their infants, adequate fathers' involvement in childrearing becomes quite difficult. Therefore, communication that is crucial for building a relationship is important to support father's comprehension about his infant and improve father bonding toward the infant.
The choice and usage of the appropriate communication methods are challenging for fathers who cannot share the same physical space with their infants. In this study, father's frequency of visitation and VMC use frequency were increased after childbirth and infants attended these interactions with mothers. Regarding the effect on father bonding toward the infant during and after perinatal separation, we found many variations, most notably that fathers in the TG with VMC equipment actually had fewer visitations. This finding may be due to the feeling of connection created through VMC. In the fathers' journals, fathers who used VMC specifically noted positive comments about visual cues and moving images, reflecting a sense of“virtual co-presence” created by sharing the same time and experience with infants. This observation also parallels the recent findings of Stefana et al. (2020), (who describe) fathers' voices played the central role in evoking their preterm infant's gaze and the likelihood of affectionate paternal communication. Moreover, these fathers expressed their strong eagerness for meeting/living with their infants. These observa-tions validate earlier findings (Baldassar et al., 2016) that VMC actu-ally makes people desire for more and actuactu-ally increase the incidence of visits. These observations are also important as a previous study noted that nonresident fathers were more likely to exclude them-selves and/or be excluded from their children's lives (Astone & Peters, 2014). It may well be that VMC supports father bonding toward the infant by increasing fathers' involvement in infant's life, even though the involvement is virtual. Our findings support the importance of cre-ating father-specific interventions designed to improve and sustain fathers' positive engagement.
Almost all of fathers expressed thankfulness and relief at the first encounter. With a few exceptions, all of the TG Approach, Avoidance and the Antagonistic Index Scores were higher than those in CG. The longitudinal comparisons of TKHS scores also seemed to show a posi-tive pattern of responses for the treatment over the CG; however, the pattern seemed to evolve more slowly, suggesting that those in the CG may transition earlier, but not as well. For instance, while CG showed that Approach Scores was lowest at pregnancy and gradually increased, TG showed that Approach Scores was lowest at 1-month postnatal and gradually increased. The Antagonistic Index showed a different direction by group, but Avoidance Scores showed the same direction by group that Avoidance Scores declined and rebound at 1-month postnatal. These results may suggest that the CG might tran-sition to fatherhood faster than the TG, as the CG engaged in actual visitations more often than the TG, who had virtual contacts. It is important to note that VMC is not a complete substitute for face-to-face communication (Baldassar et al., 2016; Epstein et al., 2017), espe-cially since all of the senses, such as smell and/or touch, are not engaged in VMC (King O'Riain, 2014). However, VMC does provide additional context with visual cues, which can create a greater sense
FURUKAWAET AL. 7 of 9
of presence and may support communication for fathers who are sep-arated from their infants during the early transition to fatherhood.
One concern for both father bonding toward the infant and tran-sition to fatherhood was the fathers' feelings to their infants at child-birth. In this study, approximately a half of fathers (n=13, 48.1%) were present at the birth of their infants, while the others (n=13, 48.1%) met their infants later, mostly on the day or next day of childbirth.
Despite their presence or absence at childbirth, all of the fathers expressed similar comments at the first encounters with their infants. Childbirth remains integral to both father bonding toward the infant and transition to fatherhood, and the presence at childbirth is encouraged. When attendance at birth is not an option, ongoing inter-action within the larger family context has long been encouraged (Palkovitz, 1992).
One of the challenges in this study was the ongoing technical issues and concerns when using VMC. These challenges have been noted in other publications (Furukawa & Driessnack, 2013; Rhoads et al., 2015).
4.1 | Limitations
One limitation was our inability to control for the use of VMC in either group, as it turned out some participants in the CG used VMC.
Another limitation was the sample size, which was not adequate for a valid experimental study, but it was almost too large for the qualita-tive data, as data saturation from journal entries was established early.
Recruitment during the perinatal period is always challenging, as there are many competing demands. Most notably, the final sample being of higher socioeconomic status may not reflect experiences of those from more challenging financial contexts.
5 | C O N C L U S I O N
Sharing the same space, time and experience with their infants and children is important for fathers and children to develop early father bonding toward the infant, identity as a father and ongoing father-child relationships. Accordingly, separation in the perinatal period should be avoided; however, when families are separated geographi-cally, there are now more options to maintain contact, albeit virtually.
The use of VMC appears to provide a sense of virtual co-presence to support fathers who were separated from their wives and infants during the perinatal period. Although it does not completely substitute for being in person, this study advanced the idea that this alternative to face-to-face presence may be ideally suited when fami-lies are separated geographically as it provides contextualized visual and auditory cues.
For family nurses and midwives, it is not only important to include fathers during the perinatal period, no matter where they are, but also increase our awareness of families who are living apart, whatever the circumstance. The family unit has always been, and family remains a key focus for all nurses.
A C K N O W L E D G E M E N T
We would like to thank all of the fathers for sharing their experiences by responses of the questionnaire and writing journals such a busy time in their lives. This work was supported by JSPS KAKENHI (grant number 2466000).
C O N F L I C T O F I N T E R E S T
The authors declare that there is no conflict of interest.
A U T H O R S H I P S T A T E M E N T
Authorship statement confirming that all listed authors meet the authorship criteria and that all authors are in agreement with the con-tent of the manuscript.
• RF and MD designed the study.
• RF collected the data.
• RF, MD and EK analysed the data.
• RF, MD and EK prepared the manuscript.
O R C I D
Ryoko Furukawa https://orcid.org/0000-0002-2200-7815
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How to cite this article: Furukawa R, Driessnack M, Kobori E.
The effect of video-mediated communication on father-infant bonding and transition to fatherhood during and after Satogaeri Bunben. Int J Nurs Pract. 2020;e12828.https://doi.
org/10.1111/ijn.12828
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