Вы находитесь на странице: 1из 111





Elizabeth Camilleri

A thesis submitted to the

Faculty of Education in
partial fulfilment of the
requirements for the degree

Bachelor of Psychology

University of Malta

April 2005

Forgive me if I do not cry
The day you die
The simplest reason that I know is
Fathers are not supposed to cry
I figured you would expect me
To be strong
To act the way I would have
Taught you
Forgive me, my son, if I do not cry
The day you die…
Forgive me if I do…




By Elizabeth Camilleri

Literature shows that perinatal loss entails parental grief

and despair. The aim of this study was to explore father’s
responses and experiences of this loss. Six men were
interviewed between 1 week and 10 years after the loss.
The interviews were analyzed using phenomenological
methodology. Most fathers experienced shock, disbelief
and disappointment. All men felt the need to support their
partner, often pushing aside their own feelings of grief to
help their wives. Fathers spoke about needing to be alone
at times to get in touch with their thoughts or emotions,
something that their partners, friends, and family often
could not understand. Fathers found hospital support and
tokens of remembrance helped them heal. Religious beliefs
and a scientific cognitive framework were important ways
of meaning making. Fathers said this experience
strengthened their relationship and allowed them better
understanding and empathy for others losses.

Keywords: Fathers, Grief, Loss, Perinatal.

Authors Declaration

I the undersigned do hereby declare that this dissertation is my own

original work and that it does not contain material that has been already
used, except where otherwise acknowledged in the text.


Elizabeth Camilleri
April 2005


To all the children who have died

We remember you
To all the parents, the ones quoted in this dissertation and the
others who have talked with me,
and the millions of others who have experienced the death of a
much loved child.


I would like to thank Mr Pierre Cachia, whose invaluable advice, opened

up my limited view and encouraged me to throw my net as far as possible
while writing this dissertation.

I am also indebted to Ms Marcelle Cipriotte, for her support and expertise

in this area, as well as all the people at S.A.N.D.S ( Stillbirth and Neonatal
Death Society) who made me feel so welcome.

Thanks is also due to all the fathers who participated in this study and
shared their personal accounts in the hope of benefiting others.

Finally, I would also like to thank my parents for their constant belief in
me, and my aunt Chris for giving me her apartment for some peace and
quiet and my friends Nicole, Sam, Keki and Du for their patience and
never ending support. A special mention is also due to Sean who proof
read my final chapters and made sure I went running to clear my mind.

Table of Contents

Chapter 1

Perinatal death is a life event that parents are unprepared for. In one
instant, they are saying “goodbye before saying hello” (Kirk & Schwrebert,
It is rarely discussed in pregnancy, childbirth, and sex education materials

directed towards the lay population, nor is it included in childbirth classes

( Panuthos & Romero, 1987 ). The death of a baby, whether at birth or in

the weeks or months immediately afterwards, is no less a death than any

other. (Kohner & Henley, 1991; Ilse, 2002).

Until the early 1960’s, perinatal loss was not acknowledged by

the medical community as a real bereavement that deserved serious

attention (Hughes, 1998; Radestad, Samuelsson & Segesten, 2001). Right

up to the 1980’s, mothers were advised not to see the dead baby and to

forget what happened, while the father was seen as having the role of

comforting the mother. They were not considered to have any feelings of

distress. (Hughes,1998).

The prevailing hospital policy was that of protecting the parents

from grief by preventing any contact with the child, it was actually

forbidden for fathers to be present at a stillbirth (Hughes, 1998; Radestad et

al., 2000). A Maltese nurse who experienced a miscarriage and stillbirth

herself, confirmed that this was also the adopted policy at St Lukes during

that time (Meachen, 2004, personal interview).

In contrast, by the 1980’s, clinicians began to recognise that

parents go through severe loss. (Condon, 1986; Kirkley, Best & Van

Devere, 1986). Although the community has come a long way in

acknowledging this type of neglected loss, fathers still tend to be

overlooked, the ‘forgotten mourners’ (Kellner & Lake, 1993, Worth ) and

their grief underestimated by society. In a way, men are left ‘on the

sidelines’ when it comes to being recognised as survivors following a

significant loss. (Zinner, 2000, p.181).

The nature and validity of Perinatal bereavement and the effect

it has on a mother has attracted serious study, both by Maltese and

international researchers ( De Maria, 2004; Mander, 1994; Meachen,

2003; Moulder,1990; Peppers & Knapp,1982 ). There is now, wider

acknowledgment that the loss of a pregnancy must be regarded as

potentially traumatic as the loss of a significant adult, and that, for a

successful outcome the stages of bereavement have to be gone through

(Robson, 2002; Seller, Ross, Barby & Cowmeadow, 1993).

The wide range of reaction seen in women such as depression,

disappointment, regret and guilt; have been the focus of many studies

(Mander, 1994; Toediter & Lasker; 2000). However, there is still very little

as regards their partners, the men. In fact, some studies have specifically

made reference to this and our lack of understanding from the man’s


Previously, men were interviewed as part of the couple, but

never the sole focus of a study (Lasker & Toedter,2000; Robson, 2002;

Gray, 2001). Some researchers even report men walking out of the

interview mid- way (Zeanah, Danis, Hirshberg, and Dietz, 1989). Other

researchers have specifically called out for more research on the male

perspective. Black (as cited in Robson , 2002) states that :

The biggest limitation of this study and existing literature is the

lack of information from the men who lose pregnancies. Little has
been heard from them directly, and they undoubtedly have their
own stories to tell. In particular, the persistent sex role stereotypes
about men remaining strong, silent and protective of women at a
time of crisis suggests a special need for caution in drawing any
conclusions about men’s true feelings or preferred coping styles.
In addition, we need to hear men’s own views on how they
perceive their partners emotional needs after pregnancy losses.

Modern medicine has done much to increase the likelihood of

having a healthy baby. The Maltese Islands have seen a decrease in the rate

of stillbirth over the last 50 years. Latest statistics available showed that

stillbirths in Malta, occur once approximately every 300 births

(Demographic review, 2002) compared to around 1 in 50 births, in 1959

(Demographic review, 1959). However, no baby is expected to die. When

a man finds out his partner is pregnant, he goes from adjusting to the idea

of pregnancy, to preparing to being a new parent. When it suddenly all

ends, this sense of aloneness and isolation can be very deep. (Robson,


Focus and Aims

Our culture does not make it easy for grieving individuals.

Normally grief is not talked about and when it is, it’s with an air of

discomfort. When we see people grieve, we often want to hurry them along

so they can put it behind them quickly. If we don’t see any signs of grief

we may breathe a sigh of relief because then we can act as though

everything is back to normal, even if it’s not.

Recent literature in the field of thalantology, the study of death, has

identified that men’s grief responses are different from women’s (Black,

1991; Doka & Martin, 2001; Gray, 2001; Rando, 1993). Peppers & Knapp

(1980), coined the term ‘incongruent grief’, which describes differences in

couples grieving after the death of a baby.

Definitions of miscarriage, pregnancy loss, stillbirth and death.

Lay Language used to describe perinatal death includes

“miscarriage” (infant loss occurring within the first trimester), “pregnancy

loss” (infant lost during late pregnancy), “stillbirth” (infant loss during

birth, and “death” (loss that occurs after the infants birth). Medical

definitions relate to infant viability, with infant losses that occurs prior to

20 weeks being referred to as “foetal wastage” or “spontaneous abortion”.

However, for the fathers I spoke to, regardless of the duration of the

pregnancy or the number of losses, the loss was experienced as a death,

which left them forever changed. I therefore consciously chose to use the

term “perinatal death” or “perinatal loss” to refer to all the losses in this

study regardless of the number of weeks gestation.

This study aims to:

‫ ٭‬Focus on exploring the bereavement process via phenomenology

that a father goes through after losing his child to stillbirth and to:

‫٭‬ Understand how his partner, medical staff, family and friends can

provide support.


A relative of mine lost a child and while his wife managed to move

forward, he found the loss more difficult to accept. Support was offered to

his wife however, his state of well being and how he was coping was

hardly touched upon. He was expected to support his wife and make the

funeral arrangements. After doing some research and contacting experts in

the field of perinatal loss, I was motivated by their encouragement to

explore this area further. Judith Lasker (personal correspondence, 14th

March 2004) stated that it “sounds like a great topic…I am not aware of

any research on pregnancy loss and men in the Mediterranean area, so that

makes your work pioneering.”

Chapter 2
A Literature Review

This literature review provides a broader foundation and context to help

understand how men grieve the loss of a child due to perinatal death. This

will be discussed in the light of the social constructivist perspective, which

views the outer context of society as influencing the individual in

establishing meaning.

This chapter is divided into three sections. The first explores the

psychological processes of pregnancy that men experience when they

learn their they are expecting a child, The second presents various models

and frameworks for understanding grief, specifically male grief and

cultural influences. The third section looks at the bereavement support

systems men and their partners look towards to help resolve or manage

their grief.

2.1 The Psychological Process of Pregnancy

Professional and lay literature demonstrates an increasing focus

on the paternal birth experience and ways of enhancing the quality of this

experience (Draper, 2002).Recent work documents the profound grief

fathers go through by expectant fathers who experience the loss of a much

wanted child ( Radestad et al, 2001).

Three phases have been suggested to describe the psychological

stages a man goes through during pregnancy (May,1982).Phases of

paternal involvement in pregnancy begin with the announcement or

confirming phase in the first trimester which produce feelings of joy if the

father is ready for parenthood. The father attaches his hopes and dreams for

that child.

The second stage is the moratorium phase, which comes about

roughly in the second trimester.This involves the adjustment to the reality

of the pregnancy. The father has to realise he must give up some freedom

due to impending fatherhood, that things will never be quite the same.

May (1982) states that the longer time spent in the moratorium phase

relates to father’s perceptions of their own readiness for pregnancy and

that the shorted and less stressful this stage, the more prepared he feels

about being a father. The final stage is the focusing stage, which is when

a man redefines himself in terms of becoming a father (Draper, 2002).

Therefore when a father experiences the loss of a child due to still birth ,

he has already undergone psychological changes to prepare to become a


Styles of paternal involvement include expressive, in which the

father attempts to experience the pregnancy as much as possible,

instrumental, in which the father is the caregiver and the observer,

in which the father is passive and attached ( Draper,2002)

New research on first time fathers shows attachment to a baby

can intensify as early as the first three months of a pregnancy, there is any

( The Age Newspaper, Australia, Feb 12, 2003). A study by Cherine

Habib ( as presented to the Australian Institute of Family studies and

quoted in The Age Newspaper, 2003 ) found that out of 116 first time

fathers, most felt emotionally and psychologically involved in the very

early stages of their partners pregnancy. Therefore, the loss of a child

before or just after birth often entails great grief and despair on the part of

the fathers as they have formed a bond with the unborn child and do not

expect the baby to die before them (Radstad et al, 2001; Malacrida, 1999).

Fathers are now encouraged to participate early on in pregnancy.

Childbirth education classes help the couple explore how to make the

childbirth experience, and parenting theirs instead of hers alone (Kohner &

Henley, 2001). In a detailed qualitative study of middle-class American

parents; Sandelwski ( as cited in Hughes, 1998) found that parents saw

scans as a pleasurable early meeting between parent and child, an

opportunity to become acquainted with the baby; to appraise and admire

and claim it as their own. Women too, report that the scan makes the

pregnancy seem more real for their partners (Hughes, 1998).Studies by

Puddifoot (as cited in Lasker & Toediter 2000) found higher grief scores

amongst men who had seen the ultrasound image. This was seen to be

related the to issue of attachment and to the meaning prospective parents

give to the pregnancy.

2.1.1 Conclusion

The work above shows that men do go through psychological

change and development in preparation for fatherhood. The father forms an

attachment to his child by engaging in behaviours such as going to

antenatal classes, looking at early scans, feeling, and singing to the bump.

According to Layne (1992) new technologies such as pregnancy tests,

ultrasounds and amniocenteses offer:

the scientific experience of pregnancy, before the sensations of

foetal movement which facilitates earlier and earlier parent-infant

bonding by opening the womb to visual connection and providing

knowledge of such infant particulars such as sex and size, long

before the child is born. (p34)

Findings in literature have shown that when a stillbirth occurs, a

baby’s death is a profound loss (Toediter & Lasker, 2000; Malacrida,

Peppers & Knapp, 1998).Attachment can begin even before conception;

therefore fathers also experience a profound sense of loss and distress

when their child dies. This is due to their preparation for fatherhood, and

attachment to their unborn child as well as their expectations of a

successful pregnancy.

2.2 The Bereavement Process

Stillbirth and neonatal death have been linked to mourning and

feelings of grief in both fathers and mothers, (Peppers & Knapp, 1987;

Lasker & Toedter, 2000; Radsted et al, 2001).Thus, the bereavement

process has been directly linked to fathers who have experienced a

stillbirth. Bereavement theories and models are a useful framework for

understanding the process a man may go through.

2.2.1. Basic Definitions of Grief, Loss, Mourning and Bereavement

Literature often overlaps in it’s definitions of grief and mourning

(Nadeau, 1998; Rando, 1993; Kastenbaum, 1998). One distinction that can

be made is that grief represents the internal experiences and external

behaviours. This results in a response to loss conditions surrounding that

loss. Mourning is the process one goes through to accommodate that loss.

Loss can be seen in a much broader context as being deprived of or ceasing

to have something that one formerly possessed or to which one was


There are different types of loss. Rando’s (1993) work builds up

on Freud’s (1957) definition of “mourning” and contends that death

involves a physical loss as well as a psychological loss. Perinatal loss, in

this light can be seen as a physical loss of a child as well as a psychological

loss of what that child could have been.

Kastenbaum (1998) offers the explanation that Bereavement is

the idea that something of value has been taken away against our will.

Grief is a painful, internal, subjective response to bereavement and

Mourning is the culturally patterned expression of the bereaved person’s

thoughts and feelings.

2.2.2 The Bereavement Process

Here I will examine some of the better known models of

bereavement grief and mourning and then I will look at the Stages theories

of bereavement. These give us an insight and help provide a basic

framework for understanding.

The first person to focus attention, in a sensitive way on the pain

of the bereaved was Sigmund Freud, as set out in his book ‘Mourning and

Melancholia’ (1917). In it, he laid the blueprint for what would later be

known as ‘Griefwork’. Noting that emotional attachments are created

(cathexis) that hold individuals such as parent and child together, Freud

presents the work of grief, or griefwork as the process of letting go of

attachments to the bereaved (decathexis). Freud suggested we must work

hard to establish a new identity in which the deceased is not present, and

that failure to complete griefwork may result in dysfunction.

John Bowlby (1980) building on Freud, redirected the attention

from the intrapsychic dynamics described by Freud and looked instead to

how grief influences our interpersonal relationships. According to Bowlby,

when the bereaved observes that the object of their affection or attachment

no longer exists, the result is grief.

However, grief work models fail to take into account the vast

array of human responses to loss and assume that love objects can be

replaced. Several theorists have also proposed that grief takes the form of a

number of stages. The best known is probably that of Elizabeth Kubler-

Ross (1970). Through her work with the dying, she came up with five

stages that have entered the folklore of thanatological, (also known as

death studies) literature. These are Denial and Isolation, Anger,

Bargaining, Depression, and finally, Acceptance. The stage theory has

come under a lot of scrutiny in recent years especially the sequence and

universality of the stages however as Kastenbaum, (1998) points out:

Nevertheless, several valuable contributions of Kubler- Ross’s
approach, including the stage theory should be kept in mind. The
value of her work in awakening societies sensitivity…has not
been called into question. Accepting the stage theory is not
essential for appreciation of her many useful insights. (p.69)

William Worden (1982) advanced on the notion that the

bereaved have a specific set of tasks or processes in order to reconcile their

grief. This is known as griefwork. The bereaved are seen as active rather

than passive participants. Unlike earlier theories, the continued presence of

the deceased in the lives of the bereaved is allowed. There is recognition,

although the relationship with the bereaved has changed, it is nonetheless a

relationship. The tasks he proposed are:

1. Accepting the reality of the loss.

2. Experiencing the pain of grief.

3. Adjusting to an environment in which the deceased is missing;

4. Withdrawing emotional energy and reinvesting it into another


Doka (1993) as cited in Martin & Doka 2000 proposes a further

task, that of a spiritual nature “to reconstruct faith or philosophical systems

challenged by the loss.” (p24)

Malta is largely, made up of practicing Catholics. Abela (1994)

notes that “The Maltese have retained their traditional value system”

(p.251). It is an island where abortion is still illegal and where the church is

given much importance in every day life. Mitchell (1996) writes that one

of the most important things for men in Malta is to be married with

children. This is to prove both their sexuality and responsibility for the

family which is the possibly the most important of all institutions on the

island. Therefore, the loss of a child to stillbirth may challenge and test

Maltese men’s identity and faith in God.

A new wave of contemporary literature (Doka & Martin, 2000;

Neimeyer, 2003; Rando, 1999; Zinner, 2000) challenges the previously

held notion that grief depicts a journey moving from the acknowledgement

of loss to the re-establishment of a new life. Many grievers seem to fall

short on account of the requisite periods of intense emotional and physical

pain in response to loss. Worden’s (1991) widely used text, Grief

Counselling and Grief Therapy, “highlights ethnical and cultural

differences in grieving , however it is silent when it comes to gender

patterns of bereavement” (Thompson, as cited in Zinner , 2000).

Martin & Doka, (2000) have provided a new paradigm for grief.

Rando ( as cited in Martin & Doka, 2000) states that they “have challenged

traditionally held, yet empirically unsupported notions that have cause a

high level of harm to a significant proportion of bereaved individuals and

loved ones” (p.xi). The emphasis is as much on the mourners, as on the

death and grief and the mourning it generates.

Literature on paternal responses to perinatal loss seem to support

the notion that research has shown that fathers reaction’s were less intense

and they grief was resolved over a shorter period of time when compared

to the mothers (Peppers & Knapp, 1987; Lasker & Toediter ,2000; Radstad

et al , 2001). Zinner (2000) also states that:

The assumption that bereavement will be visibly painful may be

based on selective anecdotal observation or on research based
predominantly on widows and female survivors. Research
outcomes using grief assessment instruments that score responses
based on characteristics that fit contemporary and relatively
feminine-based profile of grieving may also bias the expected
view of bereavement. Thus if one grieves as we have come to
expect and demand, then one is awarded survivorship status. If
one grieves less conventionally and therefore less visibly, then
one is not (p.182).

Men and women who grieve in a different manner have been

marginalised, as they do not grieve like the norm. Several writers such as

Cullberg and Kennell et al (as cited in Hughs, 1998) considered the

absence of grief after a perinatal loss as maladaptive. In their studies, a

quarter of the mothers and a third of the fathers were deemed to have

muted responses to the loss. They were said to suffer less severe

weepiness, less insomnia, anorexia and self-blame and perceived

themselves as coping fairly well. Hughes (1998) states that this is “clearly

a common way to cope with loss and grief and deserves more research”

(p.153). The challenge to the griefwork hypothesis is part of a larger

rethinking of the paradigms of grief (Wortman & Silver, 1989, Bonanno,

1997, Doka & Martin 2000). Doka & Martin (2000) state that:

Ultimately, the griefwork hypothesis identifies grief solely as an

affective response to loss and posits one adaptive strategy as the
only effective response. Such an approach ignores the multifaceted
manifestations of grief. It denies that individuals experience,
express and adapt to loss in highly individual ways. (p28)

In the light of these ideas, the next section will be outlining

Kenneth Doka and Terry Martin’s theory on specific patterns of grieving

which are related to but not constrained by gender and relate it

specifically to findings in literature on perinatal loss literature.

2.2.3 Disenfranchised grief, Intuitive and Instrumental grieving

The idea of disenfranchised grief, instrumental and intuitive

grieving is put forward by Martin & Doka, 1998; 1999 ; 2000.) and is

explained below:

Disenfranchised grief is when a loss cannot be openly acknowledged

or publicly shared, and the griever is not recognised. When a baby dies

before birth, the loss can be devastating for the fathers and very often, the

world that surrounds them tends to discount their loss (McCreight, 2004).

According to Doka and Martin (2000), there are two specific

patterns of grieving, as well as a possible third blended type, which uses a

mix of the two styles. Each type has an experience of grief that is different

and uses different coping strategies. The first style is called Intuitive

grieving and is stereotyped, but not necessarily as female related grief.

Features related to Intuitive grievers are:

1. Feelings are intensely experienced.

2. Expressions such as crying and lamenting mirror inner experience.

3. Successful adaptive strategies facilitate the experience and expression of


4. There are prolonged periods of confusion, inability to concentrate,

disorganization and disorientation.

5. Physical exhaustion and or anxiety may result.

Other features include tears, depressed mood, anxiety, loss of

appetite, anger and irritability. Intuitive grievers want to and need to talk

about his or her experience and find the retelling of the story necessary as

part of their grieving process (Martin & Doka, 2000).

Studies on perinatal loss and miscarriage, including local studies

by De Maria (2004) and Meachen (2003) have primarily focused

on maternal responses. Their studies, like foreign literature on the

subject show that most women, rather than most fathers exhibit

features such as crying, denial, depression and anxiety which are

features associated with this style. An example of this intuitive

style of grieving is given by De Maria (2004) “I cried and cried and

cried. And I think that’s what helped me at the time because you

feel really useless” (p50).

One of the themes that emerged from the above study was that

all the mothers spoke of the need to talk about the death, and how they

perceived distinct differences in the way they and their husbands grieved.

Zeanah et al (as cited in Lasker & Toediter 2000) noted that although in

their sample mothers on average scored higher on grief than fathers. A full

one- quarter of the families found that the fathers grief exceeded that of the

mother. This suggests that some of the men in these studies also showed

intuitive styles of grieving, although they were a minority. On the other

hand, Instrumental grievers, differ in three key elements that function

together as a system:

1. Their focus on cognition/moderated affect. Thinking is predominant to

feeling; feelings are less intense.

2. Their desire to master their feelings. Mastery of oneself and the

environment are important. A general reluctance to talk about feelings.

3. Using problem- solving strategies to enable mastery of feelings and


Instrumental grievers are more comfortable in dealing

intellectually with their losses and use thoughts, rather than affect cues.

They may also experience impaired cognitive activity. Instrumental

grievers, still experience sadness, anxiety, loneliness and yearning

(Worden, 1991) but what is different is the strength of these feelings.

Men’s responses to loss as a father, is in general different from a

woman’s response to being a mother (Radstad et al, 2001) Studies in

literature support the idea of a difference in strength of affect. One

participant in the local study by De Maria (2004) speaks of the difference

in feelings between herself and her husband who she describes as a

“complete ice block” (p.56).

Often a father feels he must be strong and set his grief aside.

Conventionally, men are expected to take on the supportive role and to

show their feelings less (Henley & Kohner, 1991).

In 2000, Lasker & Toediter, reviewed results using the Perinatal

Grief Scale. (Potvin, Lasker, & Toediter 1989). Lower grief scores were

still consistent with the male gender, though “ findings of high scores in

some samples of men reinforces a caution against assuming that fathers

grieve less than mothers, despite considerable evidence of gender

differences, particularly since the use of statistical means can obscure

individual suffering” (p366 ).

This supports Doka & Martin’s (2000) opinion that a large

proportion of men may be instrumental grievers and may score lower due

to the way they express their grief. Strategies for dealing with perinatal loss

differed between mothers and fathers. Mothers were more likely to seek

outside support and vent feelings (Kavanaugh, 1997; Conway& Freeny as

cited in Doka & Martin 2000).Fathers used problem focused strategies

more, as well as controlled affective expression and intellectualized grief

( Lang & Gottleib as cited in Doka & Martin 2000).

2.3.1 Masculinity and grief – Culture as a shaping agent

Cultural norms not only influence the experience of grief but the

expression of grief as well. Hochschild (as cited in Martin and Doka,

2001), states that every society has ‘feeling rules’ that govern the

expression of emotions. Just as norms regulate behaviour, feeling rules

attempt to regulate the experience and expression of emotion. Martin and

Doka (2001) state that a subset of these feeling rules may be caused by

grieving rules that define who and what one may grieve, and how one’s

grief is expressed.

Kholberg (1966) suggests that male and female gender patterns

of thinking and feeling are differentiated at an early age through gender

specific processes of socialization. Because of their socialization into sex

roles men and women are likely to exhibit differential grieving patterns

(Martin & Doka, 2001). Hence, for men, masculinity becomes a filter

through which experiences pass.

One of the costs of masculinity is what is more commonly

known as ‘emotional inexpressiveness’ (Thompson, 2001). Thompson

argues that men are not discouraged from expressing all emotions, only

those that are seen as unmanly. “Unfortunately, grief is an emotion that

tends not to be associated with masculinity, and this can present a dilemma

for men when feelings of grief clash with societies deeply ingrained

expectations” (p.32)

Therefore, a father experiencing a perinatal loss may find

himself at odds with himself. On the one hand he is expected to show some

emotion, and on the other hand he is expected to take on the role of the

strong care giver and support for his wife (Henley & Kohner, 1991). A

father explained the unspoken rules of masculinity and grief:

Fathers are just as upset when a baby dies. They get involved,

they feel the baby growing in its mother’s stomach, feel it kicking.

It’s their child too. Yet, men are supposed to be able to get on

with things. We aren’t supposed to sit at our desks and cry. Other

men may come up and say, “If you need to talk, I’m here,” but

they don’t mean it. Men don’t like listening to other men’s

problems. (p.69)

Many men have been trained to think with their heads and

respond cognitively to their loss, due to the masculine socialization process

to which they have been exposed to growing up (Thompson, 2001; Zinner,

2000). When men approach grief, they often engage in intellectual or work

related activities as this allows them to work their minds in a way they are

accustomed to (Doka & Martin, 2001). Men need to be supported and

acknowledged when they respond cognitively to their loss. Grief cannot be

quantified in terms of affect.

2.4 Support Systems

Men who grieve the loss of a child do not do so in a vacuum.

Therefore, it is important to look at the social sphere that surrounds him

after the loss. Support will be viewed in the light of Vaux’s theory on

social support (1988). This has been defined as a process in which persons

manage their social resources to meet social needs. A support network is a

person’s social network, which he or she turns to, or can ask for assistance

in dealing with life’s challenges. Supportive behaviours include emotional,

advice/guidance, practical, financial/material, and socializing. Timing and

the mode in which this support is given can influence whether this support

is perceived as positive or negative (Kavanaugh et al, 2004). The father’s

partner, who is also going through her own feelings of despair and grief, as

well as family, friends, people in the work place and in the medical

profession can all give social support. This is vital in assisting him and his

partner to move forward together.

Studies have shown that a lack of social support delays the

process of grieving (Lasker & Toediter, 2000; Friedrichs, Daly &

Kavanaugh 2000). This can be especially true if the loss is trivialised or not

acknowledged by the people around him.

2.4.1 Support from the mother.

When a baby dies during pregnancy, a mother is overwhelmed

by feelings of sadness and emptiness (Kohner & Henley, 1991). Her hopes

and dreams for the future have been shattered. Fathers are expected to

support and are often the ones who have to hold it in emotionally and break

the news to family and friends as well as making the funeral arraignments.

This is often the first major life crisis that a couple have faced

together, and it can bring parents closer together or isolate them and push

them further apart. Factors that influence the marital relationship are the

couples ability to share their grief, accept each others different grief

responses, sensitivity to each others needs, flexibility in role responsibility

and spending time together (Gilbert, as cited in Wheeler 2000).

Because men’s reactions to a stillbirth are often different from

the mothers, it is vital that they acknowledge and validate each others

mourning styles and try to accommodate each other. Studies such as those

by Lasker & Toediter (2000) and Kavanaugh, Trier & Korzec (2004) have

shown that couples who support each other, come out of this tragic event

with a much stronger bond and ultimately have a stronger marriage. It is

those couples who grieve apart that often encounter difficulties later on.

Mothers should also be sensitive to their partners needs and understand the

fact that some fathers may react in different ways.

2.4.2 Family and Friends Support

Parents who experience a perinatal loss often seek support of

family and friends (Kavanaugh et al, 2004; Malacrida, 1999). The way

family and friends assist men during this difficult time can have lasting

effects. Clyman, Green, Rowe, Mikkelsen & Ataide (as cited in

Kavanaugh et al, 2004) as well as Malacrida (1999) , have found that if

fathers perceive they are unsupported they often feel isolated and

misunderstood in their grief. Furthermore, a lack of social support has been

linked to complicated or chronic grief (Lasker & Toediter, 2000).Perinatal

loss is affected by the quality and quantity of social networks.

A study by Cecile (also cited in Kavanaugh, Trier & Krozec,

2004) found that men felt that their feelings were discounted. This lead to

feelings of anger, resentment and disappointment towards others

(Malacrida, 1999). A father (as cited in Weaver, 1996) elaborated on his

experiences after a stillbirth:

“How is your wife doing?’ was the question. “ I know you’ll

take good care of her.” It became clear that I was a sideline

observer to the loss of our daughter. Be strong. She needs you.

This was the message unmistakable. Friends expect her to grieve,

they didn’t have the same expectations of me. My job was only to

be there for her, so she could grieve.” (p.6).

Both fathers and mothers need to be given support from family,

friends to prevent feelings of isolation and potentially complicated grief.

2.4.3 Hospital Support

Professional’s behaviour towards the rituals surrounding the

dead baby and their attitudes to the bereaved parents has come a long way

(Henley& Kohner, 1991). Medical staff is slowly becoming aware that

there is a need to support and follow up parents who have lost a child and

to be more sensitive to their physical and psychological needs. Support

tends to vary, depending on the resources allocated in the areas and the

training given to professionals (Henley & Kohner, 1991).

Fathers are often perceived by the medical profession as taking

on the supportive role but not being a bereaved person in their own right

(Weaver, 1996).Tokens of remembrance such as pictures, locks of hair,

clothing and foot prints are now offered to the parents as a way of

remembering and validating the child. These practices also occur in Malta.

(M. Mechean, personal communication, February 2005).Hospitals need to

be sensitive to both parents following the loss of their child, and perhaps

anticipate their needs, offering guidance and literature on loss and where to

go for support (Gardner, 1999).

2.4.4 Workplace support

Overall literature shows that men experiencing the loss of a child

found the work environment to be unsupportive (Friedrichs et al, 2000,

Malacrida, 1999). Men are often the main breadwinners and still expected

to perform to the same level at work even though they have suffered a

major loss (Henley & Kohner, 1991)). Companies need to move

forward in their thinking and offer fathers time off if they choose to, or at

least offer a choice of diminishing the workload.

2.4.5 Conclusion

Chapter 2 has examined literature that supports the idea that men

bond with their baby during pregnancy and experience feelings of grief

that are often different from their partners when a baby is lost due to

stillbirth. It has presented various frameworks and introduced emerging

new paradigms of grief. It has also looked at how social support is an

important factor in helping fathers who are experiencing a perinatal loss.

The forthcoming chapter will clarify the methodology behind my study.

Chapter 3

Design and Methodology

3.1 Introduction

In this chapter, I will describe the selection process of my co-

researchers and give a brief overview of their experience. I will also

discuss the methods of preparation, data collection and organization of this

study. Finally, I will describe the methods used to analyze the data.

3.2 The Preparation for data collection

3.2.1 Selection of the Co-Researchers

The co-researchers for this study were selected if they had

experienced a late miscarriage or stillbirth. That is a pregnancy lost after 16

weeks. The co-researchers were in a stable relationship from the beginning

of the pregnancy until after the late miscarriage or stillbirth occurred. The

co-researchers age was not considered a variable for the outcome of this

study, neither was the length of time that had passed between the event and

the time of the interview, as long as the co-researcher could clearly

remember the details of the experience and feelings, thoughts and actions

during that time.

3.3.2 Sample Size and Recruitment

The sample size of men that participated in the study was 6. The

reasons were two fold. First, to be able to study the phenomenon of

paternal grief in depth, a smaller sample is considered optimal. Qualitative

research is usually limited to small numbers due to practical reasons such

as time. It is best used to elicit the depth of an experience such as perinatal

loss. This research is aimed at generating hypothesis and tentative

explanations for further studies. It’s value lies in the possibility of

generating significant ideas.

Secondly, it proved difficult to identify men, who had been

through perinatal loss and were willing to participate in such a study. In

fact, like findings in some of the published studies abroad (McCreight

2004; Radstad et al., 2001) there was a high attrition rate. Several fathers

when contacted were initially willing to be interviewed, only to drop out at

the last minute.

The men were recruited via an intermediary nurse at St Luke’s

hospital who organises a Stillbirth and Neonatal Death (S.A.N.D.S)

support group for bereaved parents. After an explanation of the criteria

needed for selection, the nurse contacted several suitable bereaved parents

and explained the nature of the research study. She explained the issues of

confidentiality and how this interview was on a voluntary basis and that

subjects could drop out should they feel the need to. The men were

therefore not chosen at random, but carefully selected due to the relatively

rare nature of the phenomenon they experienced. Once consent had been

given, the researcher contacted the fathers via telephone, and answered any

questions they had. The researcher explained that the interview would be

taped and then transcribed and given back to the fathers to review as co-

researchers for approval should they so wish. Once the researcher felt sure

that the subject understood and agreed to the nature of the interview an

appointment was fixed. Four fathers chose to be interviewed in hospital,

one father was interviewed at his home and one father was interviewed at

his workplace.

3.4 Design

A descriptive design using phenomenological methods was used

for this exploratory study. In depth, open- ended interviews of bereaved

fathers were conducted to obtain comprehensive descriptions of reactions

to perinatal loss. These interviews provided the raw data for analysis, so

that the descriptions of grief, originating from the lived experience of these

men could be “the basis for the reflective structural analysis that portrays

the essences of the experience” (Moustakas, 1994, p.13).

This qualitative design has several advantages in meeting the

stated purpose of this dissertation and in overcoming some of the

limitations found in qualitative methods. When one attempts to understand

complex, and often ambiguous, personal experiences such as grieving, we

may risk losing sight of what is theoretically and clinically important,

when we focus solely on quantative methods. Qualitative methods offer

alternatives to the positivist paradigm of Western science, and provide the

opportunity to capture the meaning of the experiences we are attempting to


The philosophy of phenomenology is the theoretical tradition

from which the qualitative methods used in this study have emerged. First

described by Husserl (1859-1938), phenomenology is the study of how

people describe the things and experiences they come to know through

their senses. It asserts that one can only know what one experiences, and

that sensory experience, interpretation and meaning are intertwined.

Thus, phenomenology focuses on how we interpret and put together the

phenomena we experience in such a way as to make sense of the world and

in doing so develop a worldview. There is no separate or objective reality

for people. There is only what they know the experience means to them.

The subjective experience incorporates the objective thing and the person’s

reality (Patton, 1990, p.69).

3. Instruments, Tools and Materials

The primary instrument in studies relying on in-depth interviews

for data collection is the researcher. As a result, the success of this method

of collecting important and useful data is directly related to the skill of the

interviewer. It is therefore fundamental that the interviewer develops a

rapport with a diverse number of individuals, and be adept at hearing the

subtleties and nuances of what is being expressed (Patton, 1990).

As the researcher in this study, I aimed to not only develop a

good relationship with the men I interviewed, but to make sure I actively

listened and understood the experience as much as possible from their

perspective, asking for clarification where necessary. The participants

were made co-researchers in this study. This was to make sure the research

findings were valid for the co-researchers as well as the readers of this


I questioned my own practices throughout, particularly in

relation to the interpretations I drew up from the data. Marshall (as cited in

Pyette, 2003) stresses that, quality in research is dependant on honest and

forthright investigations and on the importance of searching for alternative

explanations. A self-critical attitude is imperative. I therefore thought

carefully and deeply about my own possible biases and about how, my

being a female may influence my co-researchers type and level of


Verbatim transcription and notation of non-verbal behaviour has

been shown as critical to the reliability of any qualitative study (Seale &

Silverman as cited in Chase, Mandel & Whittemore, 2001). Therefore, a

tape recorder was used to record the interviews. These were transcribed,

including pauses, sighs, changes in tone and relevant body language so that

any reoccurring themes could be looked at and analysed further.

3.3 Organization and Examination of Data

The subsequent methods were used in organizing and analysing

the data. The progression selected is that by Colazzi (as cited in Creswell,

1998) and the procedural steps were as follows:

1. The descriptions of the co-researchers were read in order to acquire a

general feeling for them.

2. Significant statements that were seen to be of relevance to the study of

the phenomenon were extracted. The aim here was to isolate the pertinent

data so as to bring the phenomenon to life.

3. Meanings were formulated by spelling out the meaning of each

significant statement .In this delicate step, the meanings arrived at were

carefully re examined, so as not to lose their connection with the original

description. This was in order to bring out those meanings hidden in the

various contexts of the phenomena.

4. Clusters of themes were organised into different emerging meanings.

These clusters were again re evaluated to make sure that nothing was

unaccounted for in the original text. At this point, any discrepancies were

noted among the different clusters which contradicted others or appeared

totally unrelated. I then proceeded to examine the solid conviction that,

what was logically inexplicable may be real and valid.

5. An exhaustive description of the phenomenon resulted from the

integration of these results

6. Finally, I returned to the co-researchers to ask if this description

formulated validated their original experience or not.

3.5 Pilot Study

A pilot interview was held with one of the fathers in the study.

This allowed the researcher to rephrase a few questions to explore in more

depth the phenomenon under investigation.

Open ended questions were noted to be the best as men tended to

elaborate and give a richer understanding of the phenomenon explored than

giving simple yes and no answers. After conducting the pilot study it was

noted that only four or five questions were actually needed. As a result, the

questions were used more as a checklist to make sure all areas were

covered. The opening question was often all that was needed to allow the

co-researchers to elaborate on their experience. This was followed up with

probes and questions used to clarify the co-researchers stories so it was

sure that the phenomenon has been understood and captured.

This pilot study was included in the data analysis, as it was felt

that it gave a valuable contribution to studying the phenomenon.

3.5 The interviews

In total 5 interviews, along with 1 pilot study were carried out.

The interviews lasted on average around 50 minutes, four were conducted

in English and one was conducted in Maltese. This depended on the

language the co-researchers felt most at ease in. Two of the six men

interviewed spoke in English and one in Maltese.

Prior to conducting the interview, a consent form was presented,

(See Appendix A) and read out to the co-researchers to ensure that each

participant understood the nature of the study. Once again, they were

reminded that they could drop out at any moment if they felt

uncomfortable and that a copy of what they had said would be made

available to them should they so wish. A short questionnaire was then

handed out (See Appendix B), to collect demographic data regarding age,

level of education, number of children and their age to help the interviewer

understand their social context.

Next, a semi-structured interview was used to capture the

experience (See Appendix B). A number of the questions were prepared

beforehand, as a guide to help participants expand their answers.The first

questions dealt with the co-researchers ideas and expectations during the

pregnancy. Then the researcher explored their reactions, feelings and

experiences upon finding out that their child was going to die. Next, the co-

researchers were asked about their cognitions, feelings and behaviours

during this time. The researcher asked about support given by friends,

family and the work place, what helped them with their loss and what

hindered them. Finally, the co-researchers were asked about any

recommendations they may have for other parents, especially other men

going through a similar experience.

Approximately three weeks after the interviews were held the

fathers were contacted and any parts of their interviews which needed

further elaboration were clarified. Here, the co researchers were reminded

that they could be provided with information on their interview and the


3.6 Ethical Considerations

The researcher made sure she was up to date on the ethical

standards for reporting and publishing as printed in The fifth edition of

The Publication Manual of the American Psychological Association

(2001). The men who were recruited had been briefed on the voluntary

nature of the study. All the co-researchers had received some form of

counselling around the time of the perinatal loss. This was seen as

important as the researcher did not want to cause any additional distress by

interviewing them. Names and additional identifying information was

changed to mask identity .They were also informed that, since they were

talking about an experience that may bring about distress, they could be

referred to a trained counsellor should they feel it necessary.

3.7 Conclusion

This chapter presented an outline of the research design and the

methods of data collection and analysis. The next chapter will give a

detailed discussion of the findings that emerged from the interviews.

Chapter 4

Presentation, Analysis and Interpretation

of Data

4.1 Introduction

In this chapter, I will explore the data in the study: ‘Born

Sleeping: Paternal grief responses in relation to a perinatal loss’. First, I

provide a brief description of the co-researchers. I will then list the themes

extracted from the interview transcriptions. Next, I will offer an analysis

and interpretation of the data. Finally, I will give recommendations for

further study.

4.2 Description of the Co-Researchers


Matthew is a 33 year old who has had experience within a hospital setting.

His wife had noticed that the baby had not grown since their last visit to

the doctors and that it was not moving as much. They, as well as their son

found out during a routine examination that the baby had died. His wife

delivered their baby girl two days later at 28 weeks. The cause of death

was still unknown as the interview took place only a week later. So far he

has felt is too early to go to a S.A.N.D.S support group but keeps in contact

with one of the groups key members.


Mark is a 38 year old foreigner married to a Maltese. His only son was

born at 17 weeks. His wife started bleeding and they quickly went to the

hospital for an ultrasound, after two days under observation they lost their

baby. There was no reason given for the death of their son last November.

He and his wife both attended a S.A.N.D.S course recently.


Luke is a 23 year old and lost his daughter at 34 weeks. His wife called

him up and told him she was not feeling the baby and was going to hospital

to have a check up. He arrived to find her crying as they waited for an

ultrasound. The nurse failed to find a heartbeat. She gave birth two days

later. Their baby’s death was ruled accidental as the baby had a knot in the

chord as well as the chord wrapped around her neck. They lost their

daughter in December of last year. They both attended a S.A.N.D.S course.


John is 38 years old. He and his wife experienced both a miscarriage and a

stillbirth. The miscarriage, ten years ago was their second pregnancy and

the stillbirth, a son was six years ago. After their first loss, John was

apprehensive about the third pregnancy and said he had misgivings about it

from the onset. When his wife started spotting he was not as shocked as the

first time. He and his wife decided not to have any more children. They

have one son who is eleven. There were no support groups available at the

time although John was offered the possibility of counselling by the

researcher, he declined.


David is 30 years old and he and his wife have suffered two miscarriages

and two stillbirths. The first two losses were early miscarriages after which

they sought professional help. It was determined that his wife would need

medical supervision and had to be administered drugs. The third pregnancy

progressed smoothly up to the 19-week mark last March, when his wife

started spotting; she was then rushed to a private hospital where they tried

to stop her waters from breaking. After keeping her elevated for two days,

their baby girl was born alive. She died shortly after. Their last pregnancy

sadly ended with a stillbirth, last November after 23 weeks of full bed rest,

this time the child was a boy. David and his wife remain hopeful that they

will become pregnant as soon as feasibly possible and are willing to do

whatever it takes to start their family. They also recently completed a

S.A.N.D.S course.


Ian is 47 years old and has a vast medical background. Ten years ago, he

and his wife had to go overseas for the final stages of pregnancy due to a

blood group incompatibility. The pregnancy has been trouble free apart

from all his family, except himself, contracting chickenpox. The doctor

assured them that there was nothing to worry about and even prolonged

inducing the birth since everything seemed normal. A few days later, his

wife could no longer feel the baby and she rushed alone to hospital while

he looked after their other two children. He found out over the phone that

his baby was going to be a stillbirth. An autopsy of their daughter was

inconclusive although the doctor suspected it may have been caused by the

chicken pox or unsuccessful administration or treatment of the blood

rhesus incompatibility injections. The care and attention they received at

the hospital by the trained staff and S.A.N.D.S overseas, prompted Ian and

his wife to set up a support group locally. His wife now helps run support

groups while he remains behind the scenes helping others who face similar

life changing experiences.

4.3 Phenomenological Reduction

The following is a list of common experiences extracted from

the interview transcripts. They have been grouped into clusters that

represent the synergy of a number of phenomena:

Initial reactions

‫٭‬ Shock , Disbelief and Disappointment

‫ ٭‬Providing support

‫٭‬ Hope

‫٭‬ The need to re-gain control and remain strong to support

Incongruent grief

‫ ٭‬Solitude and Company

‫ ٭‬Talk and Silence

‫٭‬ Action and weaker affect

‫٭‬ Somatization of grief

Coping strategies

‫٭‬ Cognitive Focus: Rationalizing religion and

scientific worldviews.

‫ ٭‬Emotional focus

Social Sanctions of Pregnancy Loss

‫ ٭‬Partners support

‫ ٭‬Discounted loss

‫٭‬ The need for private time to grieve as a couple


The Pathway to moving forward

‫٭‬Acknowledging the baby as ‘real’

‫ ٭‬Tokens of remembrance

‫ ٭‬Generativity and looking for the silver lining

‫٭‬Weaving the experience and memory into the fabric of the


4.3 Initial Reactions

Hoping against all odds

All of the fathers (6) knew that their unborn baby was going to

die or was dead before the actual delivery. This time span ranged from one

to four days. During this time, all of the fathers (6) spoke about how they

hoped against all odds that the baby would somehow be all right. Mark

said, “We still had a little hope then”. Ian recalled that he “hoped she

would come back with good news, I was praying, really praying. Myself

and the kids.” Luke said he “didn’t give up hope immediately... I said

maybe the baby will be born alive”. (ma qtajtx qalbi mill- ewwel...ghedt

forsi tohrog hajja il- bejbi ). David spoke about having hope right up to the

birth and said that the doctor gave him “ courage and hope” ( kuragg u )

even though the doctor had told him that there was only a slight chance

that the baby would survive.

4.3.1. The experience of Shock, Disbelief and Disappointment

Many of the fathers (5) talked about immediate feelings of shock

and a sense of disbelief. John explained that, “everything was normal, so

you wouldn’t be expecting it… so you would never be thinking of a shock

like that. How could it happen? What happened? ”. Luke described himself

as “paralysed” and said that it felt like he had been dreaming and “fallen

off a cliff”. David recalled that he “was shocked, at that moment I didn’t

even hear what he (the doctor) was saying I was so shocked”.

Mark’s first reactions were of shock as well as what he described as a

“feeling of emptiness”. A few fathers (2) also mentioned immediate

physical reactions such as “dizziness” and feeling like a “black out”” or

“the feeling that I was going to be sick”. All fathers (6) reported strong

feelings of sadness. David who had multiple losses explained that:

You can’t even describe what you start feeling at that moment.

Overwhelming sadness, like you wish you were dying at the time,

because you already have an awful memory of the last time and at

that time, I began to bring back that vision from last time.”

All fathers spoke (6) about feeling great disappointment when all

the dreams and expectations for the awaited baby were thwarted. For

example Mark spoke of the shock as well as what he described as “a

hurting disappointment. A few fathers (2) also spoke about feelings of

anger. Luke said that immediately after the delivery he punched a wall

and broke his hand “blood everywhere but I didn’t feel it” David turned his

anger towards his religion and almost smashed a statue of the virgin Mary

in his garden in a fit of rage.

All the fathers (6) had bonded with their child during the pregnancy and

were looking forward to the new addition to their families. Mark stated that

he and his wife “ had started bonding with the baby”, John spoke about

putting his hand on his wife’s tummy and feeling “ the kid go round and

round” Matthew explained that he and his family:

Had shadows of this baby in clothes. We had shadows of this

baby in music… This baby we had never seen. I used to play with
her and she used to play with me back. I used to call her, Juliet,
and touch her mother’s tummy and then I would feel a foot or a
hand, and I used to catch it or grab it and say “caught you!” and
you feel that the baby is getting excited…so yes, for me I had
established a definite relationship with the baby. For me I lost a
child in my hands.

Since all fathers had begun to develop a bond with their unborn child, they

experienced reactions of shock, disbelief and disappointment when they

realised they were going to lose it.

4.3.2 Providing Support

Most fathers (6) described their initial reaction to the news of the

death of their baby was to forget their own pain and think of their wife and

how they could help her. Mark said “I was more concerned about her than

about the baby in the beginning ...it’s like, what am I going to do. You

don’t think about the baby in the first few seconds”. John recalled that “At

the time you will be too worried about (your wife) and the whole

situation… and support your wife as much as possible, she is the one with

the baby inside her”. David immediately thought of his wife and that “we

were going to go through what we had been through before.” ( konna se

naddu min dak li ghaddejna qabel). Ian explained that “ she didn’t know

what was going on around her because she was so shocked. I was very

much in control. I took over one hundred percent”

4.3.4 The need to re-gain control and remain strong to support their


All fathers (6) discussed how important it was for them to feel in

control of their feelings and the situation. They all (6) felt that somehow

they needed to gain control of a situation where there were helpless. It was

important for them to feel like they had a certain amount of control to be

able to provide support for their partners. They felt that, remaining strong

and dealing with the doctors, funeral arrangements (6) and children (3) was

a way of re-gaining some control on such a traumatic experience.

Ian recalled that he was “in control of everything, of what is happening.

The problem is, this is something which you cannot control”. Matthew

words resonated with most of the other fathers “I was trying not to make

things worse, you know, at least I didn’t want them to worry about me...I

wasn’t taking care of myself, absolutely. I was worrying times three”

David also spoke about gaining mastery by hiding his feelings from his

wife behind a mask and joking as a way of being perceived as being in

control. He stated:

Understand me, I am talking openly like this to you, but I would

not with my wife. I don’t show her, I don’t want to worry her… if I am
down I usually laugh, but I am only laughing on the outside.”

( ifimni, hekk ed nidkellem hekk imam mal-mara ma nuriex li,

marridx ninquitahha …J’hekk inkun bid-dwejjaq gieli nidhaq,
imam barra inkun ed nidhaq biss, minn gewwa man kunx ed

4.4 Incongruent grieving style and reaction time.

Most (5) of the fathers spoke about the differences in the way

they and their partner grieved. Their wives, in their opinion were more

emotional and felt the need to talk about it more .Only (1) father felt that

they “grieved in the same way”. All the fathers (6) felt that although they

had suffered greatly, their wives had in fact suffered more. Luke recalled

that “she was much, much worse than me” and Ian found that “she took it

much worse”. Many of the fathers (5) felt that they were misunderstood by

their partner, especially after the initial period of grieving when they were

ready to move forward before their wives. David recalled that “ Mark, on

the other hand found comfort in grieving with his wife although they found

themselves supporting each other at different times: “I had difficult

moments, mostly we were not at the same time.” Ian spoke of how his

medical exposure was beneficial:

My background is as part of the technical hospital staff, I used

to work in theatre so deaths, I’ve seen many, even children so you
build up a barrier, I mean you feel the shock but you control
yourself… my medical background switched on, the reaction I
had if I had not been a nurse I would have definitely had different

4.4.1 Solitude and Company

The majority of fathers (5) spoke of the need to be alone at

times, to be with their thoughts (5) or to cry away from people (3). Luke

spoke about how it was difficult to be left alone “I went out alone and I

find them (my wife and friends) there. I love them, don’t get me wrong but

I love to have moments alone, it’s better alone sometimes”. Matthew spoke

about the first time he felt he could release his emotions “I think I had

more water coming out of my eyes than out of the shower, I broke down,

this was the first instance when I was completely alone and I could break

down without worrying anybody.” Ian recalled that on his way to break the

news to his children, he spent over an hour on a train, travelling alone

which “made me sort out everything in my mind, what happened, how it

happened, thinking about her, thinking about the baby, everything”

A few fathers (2) spoke of the need to seek the comfort from

their wives to grieve together. Mark explained that:

When you are alone, it is difficult to grieve and now, with my

wife, you have someone to talk to about these things and you can
grieve together…I don’t think you can comfort your wife if you
don’t grieve…when I was alone I was really sad, but the moment
I could hold my wife in my arms I felt much better.

David said that he often “didn’t feel like his family” even though

they meant well. He didn’t want to “be pitied, even if at that

moment you are.” (Ma ridx inkun il miskin ankhe jehekk )

4.4.2 Silence sometimes better than talk

All ( 6) of the fathers said that although they found it useful to

talk about the experience with their wives in the early days that followed

the loss but unlike their wives, many fathers (3) stated that they preferred

not to bring up the subject and discuss it after the initial period of

mourning. David was the only father who expressed that he had mixed

feelings, and said that although he wanted to talk with his wife he didn’t

feel that it was healing, this was because he held back and did not

completely let go when talking to his wife so he felt he could not open up

and talk to anyone, even though he wanted to . Luke had similar feelings:

“I wanted to be alone, alone, alone, I didn’t want to talk and be around my

wife or my mother, no one, and it was these moments that helped me.

Some (2) fathers found that talking about it with their partners

and family actually helped them. John said that talking to friends and

family about the experience helped even though “people may not like it to

show, but I talk about it and I’m sure it helped.” Mark explained that

although his family lived in Belgium, he found comfort in talking to them

“especially my sister, because with her I can really talk about these

things… she, her first baby was a miscarriage and she had miscarried a

twin also.”

Most fathers (5) found that at times, talking to well-intentioned

family and friends to ease the pain often backfired. Matthew expressed

surprise at his colleagues reactions: They told me ‘We are so sorry that you

did so much for this baby and then you lost it.’ That had not even crossed

my mind. It hadn’t even entered my head. I’m not feeling sorry because of

that. I’m sorry because I lost a future with the baby…and I couldn’t

understand that. It wasn’t good.” Luke found that “a lot of people you

think are friends come over, not to support you but to find out how and

what really happened, typical Maltese. In a way we found out who our real

friends were.” John and Luke mentioned one close male friend each who

they found they could confide in and helped them

Many fathers (4) found going to support groups useful as it helped them

realise they are not alone as well as provide information. Many (4) saw it

as a way of giving additional support their wives. Ian found going to group

meetings was a way of helping his wife: “I just go there to support my wife

and the other men” They could around people who understood their grief

as they had passed through a similar experience. Luke explained that “It

helped us a little, by talking, listening to other peoples experiences”, Mark

felt it was useful and necessary to go together: “Because, then one is trying

to solve the problem, while the other is sitting at home. You make the baby

together so you should go together when they die to solve your problems

together” A few fathers (2) felt very strongly that they found support

groups would not help them. One father even went as far as to state that

although he encouraged other men to go to support groups, had he gone he

would have “probably broken down as I don’t like hearing everyone

talking about it. I don’t like doing it, me personally. It wouldn’t have

healed me. It would have broken me down.”

4.4.3 Action and Affect

All the fathers (6) spoke about their need to do things to keep themselves

busy after the loss. Some were more active cognitively (3) thinking and

researching things on the internet, focusing on details and prices or setting

up groups while others were active more active physically (3) doing things

such running, hitting, building and going out. Many fathers (5) felt this

helped heal their loss significantly. Luke explained that “emotions helped

me a lot, not crying though, how do you say, kicking things, physical

release, that helped me.”

Most fathers (5) cried, although rarely in public. Many (4)

wanted to be perceived as coping well and usually (5) they had weaker

affect and shed fewer tears than their wives. Ian said that, “she never asks,

but she tells me sometimes ‘You’ve got no feelings’. I do have feelings. I

rationalize them. I have to control them. It’s my way of coping.” Matthew

on the other had felt the need to express himself in an emotional way and

said, “I still break down every now and then and fall into a pot hole.” One

father spoke about his need to use alcohol during the early days to help him

get in touch with his emotions and cry. He said

I started drinking a lot of whisky. That’s how I grieve, even. And

my wife was afraid that I would become an alcoholic, but it
helped me. I did not drink to get happy or chilled out. I drink to
get sad and sadder, to feel that pain.

4.4.5 Somatization of grief

Most fathers (5) spoke about feeling physical pain and

heaviness around the chest area as a symptom of their grief. Matthew

described it like a “stone on my chest” as well as being tense all over “ I

was all worked up, I was so tense that my muscles were aching and

literally tense” while John touched his chest and spoke of “a pain in here.

Mark spoke of a “heaviness on the chest”.

A number of fathers (3) had problems sleeping properly and one

father found that in the week leading up to the anniversary of his baby

girl’s death he could not sleep and his appetite became non-existent.

Some fathers (3) said they had vivid flashes of their child that sometimes

popped up. David spoke about how he had vivid dreams about his

daughter. He explained:

I used to dream a lot. I used to see a little girl, her being born as I
had seen her being born. But she was growing and going to school
in her uniform with pigtails and I see her, always got further and
further away. And, I dreamt this for a long time and I never told
my wife because she was crying everyday.

4.5 Coping Strategies

The fathers who faced a perinatal loss used two main adaptive strategies.

4.5.1 Cognitive Focus: Rationalizing religion and scientific


Most of the fathers (4) used cognitive strategies to cope with the

experience. This is not to say that they did not feel anything, only that their

feelings were less intense than their partners. They could separate their

feelings from their thoughts. Ian, reflecting on what might have been

showed how he could separate his feelings of grief from his thoughts “I

miss her, even when I am in the car with the two kids, and I am taking

them to school I think, she would be over here, I think about it for a few

seconds, that’s all.”

There was a general reluctance to talk about deep feelings with

others, with most men (4) preferring to deal with their loss by thinking of it

and trying to come to terms with the loss by spending time alone and with

their wives. “I realised I am down to earth, things happen, no body is

special. I have rationalized it in a way, with my thoughts, for each problem,

there is a solution, some how or another” Ian said. Immersing themselves

into work and doing other things to stop them from ruminating over the

loss was also found to be helpful. Mark spoke about focusing on the house

he was building and how it helped, as well as “searching the internet so I

had my mind calculating, making spreadsheets so I had my mind really

busy” and Luke explained that:

Keeping myself busy helped me a lot. My grandma has a house
and it’s being demolished to make three flats and she told me to take care
of these things and that helped me a lot, it gets me out, going to the notary,
but I still keep a part thinking of the baby, I don’t want to forget.

Not all the men had been given a reason for the loss but all stated that it

would have been helpful to know, especially if there was something they

could do about it to prevent it from happening again. All the men spoke

about how they felt that perinatal loss was a terrible experience but that

they accepted it as one of those things; something that happens and part of

life, although the loss had changed them forever. John said that he felt “it’s

not meant to be” and Ian felt that “…nothing just happens, there is always

a reason for things to happen”. Two fathers used their medical knowledge

to help them cope with the loss and build up a protective barrier. Ian stated,

“I was very solid, we had a medical background so we knew what could

have happened but for the lay person, who knows how they will take it”.

There were mixed feelings about whether their faith in God helped. Some

fathers (2) found it useful, Mark who found it helped, though his wife felt

differently, he said that he felt “…you cannot blame God about it, about

why he took out child.” Matthew used it to explain to his son that his sister

was now an angel with Jesus. Luke however felt, “Not at all” (Xejn affatt).

David found that first, he found comfort in God, even naming two of his

children after religious figures, however after multiple losses he took it

against the church for several months. He recalled that:

After the last loss I took it very much against the church…I
didn’t want to know about anything .I didn’t want to see Santi
cards or even The Pope, poor man who has nothing to do with it, I
used to change the channel. Now I let it all go, it’s passed, but I
spent two if not three months, because I used to say “Four times!
You see women who don’t look after themselves at all and she
goes out and puts them in an institution and because you’d love
and you want to have a family, it’s like he is kicking you”
Maltese translation-?

4.5.2 Emotional Focus

All fathers used a blend of both emotional and cognitive styles

however; a few fathers (2) found that sharing their feelings of grief to be

predominantly the most beneficial way to cope. Being listened to was

especially important for these fathers as Matthew explained that he talked a

lot and “ had the opportunity to express my feelings” The pain of the loss

was expressed with tears that even emerged during the interview and re-

telling the story as a way to make sense of it and get in touch with their

feelings. They found that talking to their wives was the most beneficial

way of coping. Mark gave his opinion on how to cope:

Don’t hide your feelings from your wife and don’t stay alone

with them because you will not cope with it. You push your

feelings away, but you are not really solving the problem…I know

that if you push it away even years after, it will come back and


Luke was the only father who mentioned that he used alcohol as a

means to get in touch with his emotions and be able to cry. He

sighed and said “ I wanted to be alone, alone alone, I didn’t want

to be around my wife or my mother, no one, and it was these

moments that helped me

4.6 The Pathway to healing

4.6.1 Discounted Loss – Disenfranchised Grief


Most fathers (5) expressed their wish for more privacy during

the birth and just after. One father explained that “we were surrounded by

people I meet everyday because I am a hospital worker, and we even had

couples there we knew who were going to deliver.” Half the fathers (3)

said it would have been beneficial to have a separate room perhaps in a

different area from the labour ward full of expectant parents. Matthew

stated “We even had staff come in to say ‘Congratulations, we are really

happy for you’ and I have to speak up and say listen, we have nothing to be

happy about because we have a dead baby inside.” Overall however

almost all (5) of the men were extremely satisfied with the immediate after

care they received in Hospital.

Matthew praised the staff “they were remarkable, I really have

nothing to complain about, and I will be grateful to them for my life”. Ian

who was in hospital in London said the staff were incredibly professional.

One midwife came in on her day off to make sure his wife did not deliver

in a hospital amongst strangers .They also put him in touch with a

specialized midwife who had psychological training to help parents who

have experiences a loss of this nature. This midwife steered him through

situations, like registering the birth, which could have caused more trauma

and to which, being a visitor in the country, he was unaware of at the time.

Their professionalism helped him heal. The one father who found it

traumatic experienced his loss ten years ago, well before any standards of

care were implemented at the local hospital. The person who delivered the

news of his child’s death ignored John and spoke only to his wife, the

doctor told him the sex of his baby and “that it was best if I did not tell (my

wife) and…till this day I didn’t tell her”. The level of the support these

fathers received had a huge impact on how the men felt about the whole


Outside the Hospital

All fathers, spoke of various degrees of disappointment in the

way they were treated outside the hospital. A few fathers (2) expressed

anger at the way shop owners did not acknowledge the loss when asking to

return baby things. Luke recounted that:

She phoned where we had got the cot and everything from

(name of shop), he’s very, I don’t want to use bad words but he asked us

for the death certificate before he would give us a voucher. Can you

believe it? These sort of people exist.”

All men (6) found their family and friends gave good support, however at

times they were insensitive to their loss. Mark explained that it was hard

for him and his wife to talk openly in the family about their loss since his

sister-in-law was also pregnant at the time of their loss. “It makes you

wonder how it would have been even seeing her sister pregnant, now she is

really showing… because it would have been only two weeks difference.

John spoke about the fact that he felt “totally forgotten, you are there to

support your wife, that is something that is defiantly lacking, that they give

all the attention to the wife.”, however he did find that his family and one

close friend in particular could understand him. Matthew found it hard that

people expected him to remain strong:

They can’t go up to her, I mean especially the older generation,

they don’t actually go up to the mother and tell her “listen how do

you feel? What is it? How are you feeling? Do you need any help?

No, they ask me and to some extent, they take me for granted. At

one point, they were discussing the funeral, when we had not even

delivered the baby yet and they expect me to be strong enough to

cope. I told them I don’t want to think about that now, I’m not

capable at the moment.


People at the workplace were generally seen as expressing their

sympathy, although most (5) men felt they did not want to go into the

details of their loss with them. John for example said that, “over there I

didn’t express my feelings that much over there…I had spoken to them

about it but I didn’t go deep into in. They work for us, so, I didn’t, it was

our own business”

Partners support

All fathers felt that their wives had offered them various levels

of support once they themselves received support from their husbands.

Matthew felt that now his wife realises what he did for him and is a lot

more tactile with him, whereas before his wife and son were taking him for

granted “…now they are not taking me for granted absolutely. She is

asking me when I come home from work “Listen, do you need some rest?”

Not like before, you know, assuming I was available… she is going out of

her way to spoil me.

4.6.2 The need for private time to grieve as a couple

A few fathers (3) expressed a strong desire to be let alone with

their wives and children, if they had any, during the first few weeks. They

felt it was important to grieve privately and talk about it within the family

to make sense of what had happened together, before letting other people

in. Ian and his wife found themselves in a different country and he


When I called home, my mother wanted to come up. Her sister

wanted to come up, the Maltese way. I said “No, we are on our
own and we will work on our own and try and reason it out
ourselves for the first couple of weeks over there and then we
could return at our leisure. This is our issue, we will control it
ourselves. I was happy that we did that because we were just the
four of us, we spoke about Rebecca and everything.

4.7 The Pathway to moving forward

Men found several ways that helped them move forward and look to the


4.7.1 Acknowledging the baby as ‘real’

All the fathers had seen their baby on the advice of the hospital

staff. Most men were apprehensive at first, as they did not know what to

expect. All the fathers were happy that they had done this even though they

may have initially expressed otherwise. Seeing and holding the baby made

the experience more tangible. Mark explained:

I was afraid in the beginning. I didn’t know what to do. I was

really afraid of it. But when you hold the baby, it was a really
good but sad feeling, that you could at least hold it, you could see
it, you have a photo in your mind and you will never forget it…
you could see details of its hand, it was completely formed at that
stage…and then you see it red and small and you are surprised by
how warm it is and what a weight it had.

David was extremely impressed at the sight of his children as one

was pink and born alive and the other was born dead. He

described the little girl as “perfect” and “pretty and fair”. The fact

that she was born alive and lived for a few moments made it

especially traumatic for him as when he held her she seemed to be

asking him why he couldn’t help her. His son was born dead, but

he felt that at least he did not suffer as much and he did not regret

seeing him. David and Mark’s partners did not see one of their

children after they were born as they felt it would make things


4.7.2 Tokens of remembrance

Most fathers (5) were given photographs, hand prints, foot prints

and locks of hair as a way of remembering their lost children. They all

expressed that these were a positive thing in retrospect although one father

still found it hard to look at them. Another father had his daughter

cremated and her urn had a special place in his bedroom so in a sense “she

is still with us”. Half of the fathers carried a picture of their child in their

wallet which they took out to show people. They found this helped them

and a source of comfort. The father who did not have any physical

evidence said that he was not given the option of keeping or recording the

event but expressed his hope that practices had changed and that this was a

good idea as it may have helped him and his wife if it had been available.

4.7.3 Looking for the silver lining and Generativity.

All fathers (6) initially found nothing positive about the whole experience

of stillbirth. However, they went on to mention that one positive thing to

emerge was that they were closer to their wives, both physically and

emotionally and felt that their marriage was now stronger. Half the fathers

(3) wondered about the future and what they could do to keep their child’s

memory alive. One father set up a support group as a way of keeping his

daughters memory alive. Another positive thing that emerged was the

fathers understanding of others losses. All the fathers (6) felt that now they

were better able to provide support to others who have lost someone.

4.7.4 Weaving the experience and memory into the fabric of the


All fathers stressed that their lost children were indeed a member

of the family even if he or she did not survive. Most fathers (5) included

their dead babies when counting the number of children they had and liked

it when others acknowledged their lost children. Fathers who’s losses had

occurred more than a year ago found ways of remembering the child on

their anniversary, especially in the first two years after the loss. Most just

spent the day alone with their wives or visiting the cemetery. Ian went as

far as to introduced a system where every year he and his family celebrate

his daughter by going out for a meal with the rest of the family. He

explained, “She hasn’t left us, she is still with us and that has helped me

cure myself.”

Discussing the findings


This study focused on the experience of father’s grief after a

perinatal loss. In doing this, various themes with different textures and

structures emerged. Here I will discuss the findings that were consistent

with the literature as well as looking at findings which seem to be

specifically relevant to fathers interviewed.

This study confirmed that men do go through psychological

change and development in preparation for fatherhood. All the fathers

formed an attachment to their children by engaging in behaviours such as

looking at early scans, feeling, and talking to the baby.

Fathers in the study reported a profound sense shock at the loss as well as

disbelief and disappointment .Literature has shown that when a stillbirth

occurs, a baby’s death is a profound loss and shock as nowadays everyone

expects a positive outcome from pregnancy. (Toediter & Lasker, 2000;

Malacrida, Peppers & Knapp, 1998).

Most fathers in this study agreed with literature (Peppers &

Knapp, 1987; Lasker & Toediter ,2000; Radstad et al , 2001).

that showed fathers reaction’s to be less intense and their grief resolved

over a shorter period of time when compared to the partners.

This study identified two main patterns used for grieving as a

means of coping, one more cognitive in style and one more affective in

style. These findings are consistent with Martin and Doka’s (2000) theory

of Intuitive and Instrumental grief. Fathers who primarily used affective

style strategies to cope exhibited tears, expression of feelings and the need

to talk and retell their story. In fact, during the interviews, fathers who

were later identified as being more affective in style, shed tears and

experienced physical reactions while retelling their story. This seemed to

have been beneficial and cathartic. Most fathers in the study used thinking

as predominant to feeling and noted that their feelings were less intense

than their wives were. This reflects Martin and Doka’s (2000) ideas on

Instrumental grievers, where the person deals intellectually with their

losses and use thoughts, rather than through emotional expression.

Fathers also supported the literature findings on the need to be

strong and set one’s grief aside (Henley & Kohner, 1991). The fathers in

the study felt a need to take on the supportive role and to show their

feelings less. They felt the need to control themselves and their

environment to offer support This supports Doka & Martin’s (2000)

opinion that a large proportion of men may be instrumental grievers and

that men may score lower due to the way they express their grief.

Cultural norms were highly influential on the fathers the

experience and reactions to grief. This supported Hochschild’s (as cited in

Martin and Doka, 2001), ideas about society norms that regulate behaviour

and experience. Men exhibited severe reactions during the labour were

offered pills to calm them down but declined as they wanted to calm

themselves down and take it like a man and be strong. Grief is an emotion

that is usually not associated with masculinity. Those men whose feelings

of grief clashed with Maltese societies expectations tended to exhibit

stronger feelings of anger than the other men. For example, one father

unleashed the intensity of his emotions by destroying a niche. Eventually,

he stopped himself, but only out of fear of repercussions from God.

Perhaps a direct result of suppressing affective emotions, lead them to be

expressed through the more socially acceptable masculine emotions of

anger and rage.

Another strong theme to emerge from this study was the heavy

reliance on religion for support and blame.Literature on perinatal loss

speaks about fathers finding comfort and sometimes blaming and showing

anger towards God. This study revealed what a powerful social agent the

Roman Catholic Church is on this island and how all the Maltese fathers

subscribed to a “traditional value system” which Abela (1994) spoke

about. The three top priorities Abela speaks about are : family, work and

religion. Religious rituals associated with death were usually adhered to,

funerals or some kind of ceremony to commemorate the loss were often

chosen, even though a perinatal loss was not considered a proper death in

terms of the law or the church.Those fathers who chose to have a burial or

ceremony were usually afforded dignity and recognition of the loss. Many

fathers spoke of the strong family presence at these ceremonies, possibly

due to Malta’s strong family ties ( Sultana & Baldacchino, 1994), which

they did not always find helpful, as they wanted to be alone. The church

performed some sort of ceremony, which was not the case in other findings

(Malacrida , 1999). There is also talk of having a plot in the largest

cemetery on the island specifically for perinatal losses. This is in stark

contrast to other countries. The religious element could also be seen in the

use of Santi (cards with a picture of a saint) which were often placed in the

casket with the child. Several fathers still visited their child’s grave

regularly and one father had plans to build a religious shrine to place the

baby’s urn in. God was also used as a way of justifying and rationalizing

the loss. The only person who did not bring up religion until probed, and

had reactions consistent with literature, was the only father in the study

was foreign. This leads one to believe that Maltese men use and rely more

heavily on religion than men in the United Kingdom, North America and

Sweden as a way of understanding and coming to terms with their loss.

The fathers interviewed confirmed findings of studies such as

those by Lasker & Toediter (2000) and Kavanaugh, Trier & Korzec (2004)

which have shown that couples who support each other, come out of this

tragic even with a much stronger bond and ultimately have a stronger

marriage. Although fathers did not seem to encounter difficulties. It would

be interesting to follow up the fathers whose loss is still relatively new in

six months time to see whether this had changed or not

Family members who tried to support the parents by being

physically present and talking about the loss only made it harder for the

fathers in the study who needed to be alone to grieve. Those fathers who

specifically told their family to back off and give them time alone with

their partner first, claimed that this made them heal faster.

Intimacy is, according to Sultana and Baldacchino (1994), one of

the most prominent aspects of Maltese society. Due to Malta’s size it is

almost impossible not to bump into people you know on the bus or at the

supermarket for example and since many people belong to many networks,

it is almost impossible to keep confidentiality and anonymity. Fathers in

Malta are therefore afforded even less privacy and time alone than abroad.

Family members lived a stones throw away and often dropped in

unannounced. While this was beneficial for men who found speaking about

the loss useful, those who didn’t, found it even harder to find the space

they required to grieve. The need for others to find out the finer details of

the loss is especially typical of small tightly knit communities. This was

found to be hurtful especially when this was all that was asked about.

Only one father supported the literature that states fathers are

perceived by the medical profession as taking on the supportive role but

not being a bereaved person in their own right (Weaver, 1996). The

majority of fathers spoke highly of the hospital staff that treated them as

mourners in their own right. They also confirmed the findings in literature

(Radstad et al, 2001) which noted that fathers often needed to be

encouraged by staff to hold the baby for the first time but once they did

they looked upon the experience as positive. This shows what a long way

the Maltese medical profession has come within the last ten years when

dealing with standards of care and perinatal loss. This study highlighted the

usefulness of hospital staff and how they helped in resolving in the fathers

grief faster than those who didn’t receive adequate support.

Father’s views on support groups was consistent with literature in this area.

In also highlighted the need of partners and support group leaders to be

aware that some men may not be comfortable disclosing their emotions

and should not be pushed, as this may do more harm than good.

This study showed that fathers in Malta are generally offered

better recognition of their loss by their work colleagues. Literature found

men experiencing the loss of a child, found the work environment to be

unsupportive (Friedrichs et al, 2000, Malacrida, 1999) .Those fathers who

did work, were openly acknowledged as grievers and generally offered

support, even though they preferred not to go into details of the death with

colleagues. Many fathers also though the type of support was not always


Fathers spoke about tokens of remembrance and how they found

them beneficial and this was consistent with recent literature on the subject

(Lane, 2000). Keeping the child’s memory alive by helping others and

weaving his or her story into the fabric of the family was also backed up

the literature (Johnson & Puddifoot,1996; Kavanaugh,2001; Radstad et al,


Chapter 5

Conclusions and Implications

Limitations of this study

This study is limited in size and scope. The biggest setback was

the limited length of this project. I found that the more engrossed I became

in the subject matter, the more I felt it impossible to limit or summarise the

experience. I believe that being able to explore fully each part of this

phenomenon is necessary to capture the full experience of my co-


Due to the sample size, it is not possible to generalize results to

all fathers who experience a loss of this type. The results are therefore

merely suggestive and are only indicative of the particular participants in

this study. Since five out of the six interviews were carried out primarily in

English, the interviews may not be an accurate sample of the Maltese

population at large. The Maltese interview was translated as accurately as

possible, however it may be somewhat imprecise due to the differences in

the two languages. Finally, due to the sensitivity of the topic, the co-

researchers may have omitted certain information so as to provide more

socially desirable responses to some of the questions..

Recommendations for future research

A larger sample of men could be used to determine if the

findings in this study are consistent with a larger proportion of men. The

study could also look at the differences between fathers who are still

childless and those who are not. It may also be useful to determine if

multiple losses effect paternal grief reactions or not. Another issue which

emerged and was not touched upon by the researcher was the issue of grief

in the siblings of the families going through a perinatal loss. Several fathers

in this study spoke of their concern for their sons and daughters reactions

to the loss. Future research may want to focus on the children or family as

a whole and how it is affected.

Most fathers in this study received support through S.A.N.D.S. It

would be useful to compare these men to fathers who were not given the

same level of hospital and group support. Finally, future research may find

it useful to further explore the role of local culture and how this colours

and changes the way fathers experience grief.


The co-researcher’s stories revealed that the death of a child is a

life changing event The hopes and expectations of a new member coming
into the family turns into great sadness, despair and disappointment.
Fathers need to be acknowledged as grievers and given the space they need
to grieve. Their partners need to be made aware that while some fathers
will exhibit similar grief responses to their own, many fathers will not.
Although many of the co-researchers in this study appear to have moved
on with their lives, they will forever hold a special place in their heart for
that lost child who came into this world sleeping.


Abela, A. M. (1994).Values for Malta’s future: social change, values and

social policy. In R.G. Sultana & G. Baldacchino (Eds.), Maltese Society: A
sociological review (pp. 253-270).Malta: Mireva Publications.

Beck Black, R. (1991). A 1 and 6 month follow up of prenatal diagnosis

patients who lost pregnancies. Prenatal Diagnosis, 9, 795-804.

Bowlby, J. (1980). Attachment and Loss, vol.3 .Loss: sadness and

depression. Hogarth Press, London.

Chase, S. K., Mandel, C. L, & Whittemore, R. (2001). Validity in

Qualitative Research . Qualitative Health Research, 11 (4), 522-537.

Doka, K .A. & Martin, T. (2001). Take It Like a Man: Masculine Response
to Loss. In Dale A. Lund (Ed.), Men Coping with Grief. (pp. 37-47). NY:
Baywood Publishing Company, Inc.

Draper, J. (2002). ‘It’s the first scientific evidence’: men’s experience of

pregnant confirmation. Journal of Advanced Nursing. 39 (6), 563-70.

Fathers Bond With Their Unborn Babies, Study Finds. (2003, February
12). The Age, Australia.

Friedrichs, J., Daly, M. I., & Kavanaugh, K. (2000). Follow-Up of Parents

Who Experience a Perinatal Loss: Facilitating Grief and Assessing Grief
Complicated by depression. Illness, Crisis & Loss, 8 (3), 296-209. Sage
Publications Inc.

Gardner, J., M. (1999). Perinatal Death: Uncovering the Needs of

Midwives and Nurses and Exploring Helpful Interventions in the United
States, England and Japan. Journal of Transcultural Nursing. 10 (2), 120-

Hughes, P. (1998). Psychological effects of stillbirth and neonatal loss. In

S.Clement (Ed.), Psychological perspectives on pregnancy and childbirth.
(pp. 145-165). London: Churchill Livingstone.

Husserl, E. (1931). Ideas: General introduction to pure phenomenology

( Translated by W.R.B. Gibson). London: George Allen & Unwin, Ltd.

Ilse, S. (2002). Empty Arms: Coping with miscarriage, stillbirth and infant
death. Burnsville, NC: Compassion Books, Inc.

Johnson, M .P., and J. E. Puddifoot.(1996). The grief response in the
partners of women who miscarry. British Journal of Medical Psychology
69, 313-27.

Kastenbaum ,R. J. (1998). Death, Society and Human Experience, 6th

edition. Allyn and Bacon, Boston.

Kavanaugh, K. (2001). Communicating with Parents Who Experience a

Perinatal Loss. Illness, Crisis & Loss, 9(4), 369-380.

Kavanaugh, K., Trier, D., Korzec M.( 2004). Social Support Following A
PerinatalLoss. Journal of Family Nursing, 10(1), 70-92. Sage Publications

Kholberg, L .A . (1966). A Cognitive-Developmental Analysis of

Children’s Sex-Role Concepts and Attitudes. In The Development of Sex
Differences, E. E. Maccoby (Ed.), California: Stanford University Press.

Kirkley Best, E.,& VanDever, C.(1986). The hidden family grief: an

overview of grief in the family following perinatal death. International
Journal of FamilyPsychiatry, 7(4), 419-437.

Kohner, N., & Henley, A. (1991). When a baby dies: The experience of
late miscarriage, stillbirth and neonatal death. London: Pandora Press.

Lasker, J. N. , & Toedter, L.J. (2000). Predicting Outcomes after a

Pregnancy Loss: Results from Studies Using the Perinatal Grief Scale.
Illness, Crisis & Loss, 8 (4), 350-372. Sage Publications.

Layne, L.L. (1992). Of Fetuses and Angels: Fragmentation and Integration
in Narratives of Pregnancy Loss in D. Hess and Linda L. Layne (Eds)
Knowledge and Society, 9:29-58.Hartford, CT: JAI Press.

Layne, L.L. (2000). He Was A Real Baby With Baby Things: A Material
Cultural Analysis of Personhood, Parenthood and Pregnancy Loss. Journal
of Material Culture. Vol 5(3): 321-345. Sage Publications Inc.

Malacrida, C. (1999). Complicated Mourning: The Social Economy of

Perinatal Death. Qualitative Health Research. 9, 504-519. Sage
Publications Inc.

Mander, R. ( 1994). Loss and bereavement in childbearing. London:


Martin, T. L., & Doka, K (2000). Men don’t cry... women do:
Transcending gender stereotypes of grief. Philadelphia, PA:

May, K.A. (1982) Three Phases of father involvement in pregnancy.

Nursing Research 31(6): 337-342.

Moulder, C. (1998). Understanding pregnancy loss: Perspectives and

issues in care. London: Macmillian Press.

Moustakas, C.(1994).Phenomenological research methods. London: Sage


McCreight. B .S. (2004). A grief ignored : narratives of pregnancy loss

from a male perspective. Social Health Illness, 26930, 326-50.

Miller, J.E., & Golden, T. R. (1998). A Man You Know Is Grieving.
Indiana: Willowgreen Publishing.

Mitchell, J .P. (1996). Gender politics and ritual in the construction of

social identities: The case of San Pawl Valletta, Malta. Unpublished PhD
thesis, University of Edinburgh.

Nadeau, J.W. (1998). Families making sense of death. London: Sage.

National Statistics Office. (1959). Demographic review of the Maltese

Islands. Malta: National Statistics Office.

National Statistics Office. (2002). Demographic review. Malta: National

Statistics Office.

Panuthos .C., & Romero, K.(1987). Ended beginnings: Healing

childbearing losses. South Hadley, MA: Bergen and Garvey.

Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd

edition ).London : Sage .

Peppers, L.G., & Knapp, R. (1982). Motherhood and mourning. New

York: Praeger.

Pyett, P.M. (2003). Validation of Qualitative Research in the “Real

World”. Qualitative Health Research, 13 (8), 1170-1179. Sage

Radstad, I.,Samuelsson, M., & Stegesten, K. (2001). A Waste of Life:
Fathers Experience of Losing a Child before Birth. Birth. 28, 124-130.
Blackwell Science, Inc.

Rankin, E. A. D, Campbell, N. D, Soeken , K. L. (1985) Adaptation to

parenthood: differing expectations of social supports for mothers versus the
fathers. Journal of Primary Prevention 5, 145-153.

Rich, D. E. (2000). The impact of Postpregnancy Loss Services on Grief

Outcome: Integrating Research and Practice in the design of Perinatal
Bereavement Programs. Illness, Crisis & Loss, 8 (3), 244-264. Sage
Publications, 2000.

Rando, T (1993). Treatment of complicated mourning. Champagne, IL:

Research Press.

Robson, F, M. (2002). ‘Yes!- A Chance to Tell My Side of the Story’:A

Case Study of a Male Partner of a Woman Undergoing Termination of
Pregnancy for Foetal Abnormality. Journal of Health Psychology. 7(2),
183-193. London: Sage Publications.

Sultana, R. G. & Baldacchino, G. (Eds.).(1994). Maltese Society: A

Sociological Review. Malta: Mireva Publications.

Thompson, N. (2001). The Ontology of Masculinity- The Roots of

Manhood. In D. A. Lund (Ed.), Men Coping With Grief (pp 27-36). New
York: Baywood Publishing Company, Inc.

Vaux, A. (1998). Social support: Theory, research, and intervention. New

York: Praeger.

Weaver, J. (1996). What’s a Father to do? In P. Schwiebert (Ed.), Strong
and Tender (pp. 9-15). Burnsville, N C: Compassion Books.

Zeanah, C., Danis, B., Hirshberg L, & Dietz, L. (1989). Initial adaptation
in mothers and fathers following a perinatal loss. Infant Mental Health
Journal 16(2), 80-93. Sage Publications, Inc.

Zinner, E. S. (2000). Being a Man about It : The Marginalization of Men in

Grief. Illness, Crisis & Loss 8(2), 181-188. Sage Publications, Inc.

Appendix A
Consent Forms

Consent Form English Version

Elizabeth Camilleri
Flat 4
15, G. Howard st
Sliema, SLM 09
Tel: 21320473

Consent Form

Dear Mr_________
I am currently following a Bachelor of Psychology Honours course at the
University of Malta. As part of the course requirement I am conducting a
research study on the experience of stillbirth on fathers. The results of this
study will contribute to the understanding of those who work with
bereaved parents.

This study would involve an interview of approximately forty five minutes

during which I will ask you about your own experiences of the still birth
and the nature of your grief. The interview will be recorded on audiotape
and transcribed fully. A copy of this, as well as a copy of my dissertation
will be made available to you at your request. I assure you that all
information provided will used soley by the researcher for this study.
Names and any personal details which may give away your true identity
will be changed to preserve anonymity.

At any point during the interview you may withdraw from the study should
you feel the need to.

I would like to thank you for considering my request

I_____________________________( sign please) hereby willingly agree

to participate in the research project described above

( Initials only)_________


Yours Sincerely

Elizabeth Camilleri

Consent Form Maltese Version

Elizabeth Camilleri
Flat 4
15, G. Howard st
Sliema, SLM 09
Tel: 21320473
Ittra ta’ Kunsens

Ghaziz ______
Qieghda nsegwi kors tal- Bacellerat fil - Psikologija fl- Universita ta’
Malta. Bhala parti essenjali mill- kors qieghda naghmel ricerka dwar l-
esperjeza ta’ ‘stillbirth’ fuq il-missier. Ir-rizultati ta’ dan l- istudju ser
jghinu lil dawk li jahdmu ma’ genituri li telfu tarbija.
Din il- ricerka tikkonsisti f’intervista ta madwar hamsa u erbghin minuta
fejn nitolbok titkellem fuq l - esperienza tieghek ta’ l - istillbirth’ u fuq in-
niket li garrabt wara din it- telfa. L- intervista ser tigi rrekordjata u mnizzla
kelma b’kelma bil-miktub. Kopja ta’ l - intervista u tat- tezi shiha jigu
mibghut lilekh. Nassigurak li l-materjal kollu ser jibqa kunfidenzjali u
jintuza biss minni ghall din ir- ricerca.Ismijiet u d- dettalji personali ser
jinbidlu biex tinzamm il-kunfidenzjalita.

Fi kwalunkwe him waqt din l – intervista tista tirtira minn dan l- istudju
jekk tixtieq.

Nixtieq nirringrazzjak talli ikkunsidrajt it-talba tieghi.

Jien __________,(firma) naghti l- kunsens tieghi minn jeddi sabiex niehu
sehem f ’dan l – istudju hawn fuq deskritt.

(Inizzjali biss)


Dejjem Tieghek,

Elizabeth Camilleri

Appendix B
Interview Guide

Demographic details

Participant number 123456

Age of Participant at present

Level of education Primary Secondary Tertiary MA/other

Death of child Gender: M / F

Age: weeks
How many years ago
Cause of death if known
Birth order: 1st 2nd 3rd

Other children Yes / No

Number of Children

Questions in English

1 Can you describe in your own words your experience of this event?
‫ ٭‬How did you react initially to the news?

2 Can you describe in detail your thoughts, feelings and reactions through
this time ?
In what ways did you grieve the loss?‫٭‬

3 How were your reactions to the loss similar or different to your

‫ ٭‬What were their initial concerns?
‫ ٭‬Did they express their feelings differently?

4 What are your ideas on fatherhood?

‫ ٭‬How did you feel when you found out your partner was carrying your
‫٭‬What were your major concerns or worries?

5 What was your behaviour like during the pregnancy?

‫ ٭‬How was this different or similar to your partners feelings, thoughts
behaviours during this time?

6 How important are emotions while grieving?

‫ ٭‬What kind of emotions did you feel?
‫٭‬How did thinking help in all this?

7 Did you feel the support of your partner during all this?

8 What about you supporting your partner?

9 Did you feel supported throught this difficult time?

By who? ‫٭‬
‫ ٭‬How did they provide support?

10 Did your family and friends help?

‫ ٭‬In what ways?
‫ ٭‬How did they hinder?

11 What about the work place?

‫٭‬Was your boss supportive?
‫ ٭‬What about colleagues?

12 Looking back, is there anything you wish you had done differently ?

13 What advice would you give fathers passing through a similar


14 Is there anything you feel would have helped you during this time?

15 Is there anything else in regard to this experience that you would like to

Questions in Maltese

1 Tista’ tiddeskrivi, fi kliemek l- esperjena tieghek ta dak li gara?

‫٭‬ Kif irragixxejt ghall-ahbar ?

2 Tista’ tiddeskrivi fid- dettall, hsibijietek , dak li hassejt u r- reazzjonijiet

tiejhek matul dan iz- zmien ?
‫ ٭‬Kif ghaddejt minn din it- telfa ?

3 Ir - reazzjonijiet tieghek, kif kienu bhal, jew differenti minn dawk tal-
partner tieghek?
‫٭‬ X’ kien l- ewwel inkwiet taghom ?
‫ ٭‬Esprimew ruhhom differenti minnek ?

4 X’ inhuma l- ideat tieghek fuq li tkun missier ?

‫ ٭‬Kif hassejtek meta skoprejt li l- partner tieghek kienet tqila b’tarbija
minn tieghek ?
‫ ٭‬X’ kienu l- preokkupazzjonijiet principali tieghek ?

5 Kif gibt ruhek matul it-tqala ?

‫٭‬ Kif kienu differenti jew simili l- imgieba, hsibijiet u emozzjonijiet
ghall- partner tieghek matul dan iz- zmien ?

6 Kemm huma importanti l- emozzjonijiet waqt il- luttu ?

‫ ٭‬X’tip ta’emozzjonijiet hassejt ?
‫ ٭‬Il – fatt li qghadt tahseb dwar dan, kif ghen f’dan kollu ?

7 Hassejt is- support tal- partner tieghek waqt dan kollu ?

8 Int urejt support lejn il- partner tieghek? Kif ?

‫ ٭‬X’ghidt jew ghamilt ?

9 Hassejtek is- support f’dan iz- zmien difficli ? Minn min ?

‫ ٭‬Kif ipprovdew dan is- support ?

10 Eghnewk il – qraba u l- hbieb ?

‫ ٭‬B’liema mod ?
‫ ٭‬Kif fixxklu ?

11 U fuq il – post tax- xoghol ?
‫٭‬ L’ imghallem eghnek, u l- kollegi tieghek ?

12 Meta thares lura, hemm xi haga li xtaqt ghamilt differenti ?

13 X’ parir taghti lil missirijiet li ghaddejin minn esperjenza simili ?

14 Hemm xi haja li thoss li kieku kienet tghinek matul dan iz- zmien ?

15 Tixtieq izzid xi haga ohra rigward din l- esperjenza ?

Appendix C