Revista Portuguesa de Investigação Comportamental e Social 2024 Vol. 10(1): 1–19

Portuguese Journal of Behavioral and Social Research 2024 Vol. 10(1): 1–19

e-ISSN 2183-4938

Departamento de Investigação & Desenvolvimento • Instituto Superior Miguel Torga

 

 

REVIEW ARTICLE

Transition to parenthood: Promotional strategies used by health professionals  

Transição para a parentalidade: Estratégias promotoras utilizadas pelos profissionais de saúde

 

Andrea Victória ^1,2

Catarina Costa ^1,3

Marta Cordeiro ^1,4

Ana Paula Santos ¹

Márcio Tavares ¹

Patrícia Tavares ⁵

¹ Escola Superior de Saúde da Universidade dos Açores, Ponta Delgada, Portugal

² Unidade de Saúde da Ilha de São Miguel, Centro de Saúde da Ribeira Grande, Ponta Delgada, Portugal

³ Hospital do Divino Espírito Santo de Ponta Delgada, Serviço de Obstetrícia, Ponta Delgada, Portugal

⁴ Hospital do Divino Espírito Santo de Ponta Delgada, Serviço de Cirurgia III, Ponta Delgada, Portugal

⁵ Hospital do Divino Espírito Santo de Ponta Delgada, EPER, Portugal

 Received: 03/07/2024; Revised: 04/18/2024; Accepted: 05/04/2024.

https://doi.org/10.31211/rpics.2024.10.1.324

 

 

 

Introduction

The transition to parenthood is a significant milestone, signifying a major change in an individual's life. When a person becomes a parent, they assume new responsibilities and face various challenges, requiring physical, emotional, psychological, and social adjustments. In this context, the transition can be seen as a process unfolding over a specific period, encompassing changes in health, identity, relationships, and/or environment  (Meleis, 2017; Meleis et al., 2000).

Preparing for parenthood involves reorganizing roles that begin well before the baby is born, starting at the beginning of pregnancy or even at conception, when the idea of becoming a mother or father takes shape (Pålsson et al., 2017, 2018). It is unquestionably one of the most profound decisions one can make, seen as irreversible and capable of sparking a period of crisis in the individual or family's life (Mendes et al., 2022).

Numerous factors can impact a woman's health during pregnancy and postpartum, such as her physical and mental well-being, social support system, financial circumstances, and the assistance provided by knowledgeable healthcare professionals (Parlamento Europeu, 2013). The partner also plays a meaningful role in becoming a parent (Daniele, 2021; Gillis et al., 2019). The process of transition and the emotions involved are not explicitly detailed. Nevertheless, the partner plays a crucial role in supporting the woman during self-care and caring for the baby during the postpartum period (Erickson et al., 2020).

In addition to the woman's prenatal period, there is also a prenatal period for men, which refers to their health during the expectation of the child. Empowering the partner in the pregnancy process significantly strengthens the bond between father and child (Alio et al., 2013; Mackert et al., 2018; Santos da Mota et al., 2022).

Given the profound impact of the transition to parenthood on individuals' lives, health professionals need to play a supportive role in facilitating this transition for both partners in a couple. This role entails providing comprehensive support and guidance to both women and men throughout pregnancy, childbirth, and postpartum (Deave & Johnson, 2008; Parfitt & Ayers, 2014; Parlamento Europeu, 2013). Moreover, it is essential for health professionals to recognize the importance of men's involvement in prenatal care and actively encourage their participation in all procedures related to this period (Mackert et al., 2018; Santos da Mota et al., 2022; Sousa et al., 2021).

Multidisciplinary teams can work collaboratively to provide comprehensive prenatal care, offering guidance on pregnancy management, healthy nutrition, appropriate exercise, prenatal appointments, and necessary screenings, all of which contribute to a healthy pregnancy (Parlamento Europeu, 2013; Perreault et al., 2018; Taylor et al., 2017).

During labor and delivery, techniques such as relaxation methods, monitoring the vital signs of both mother and baby, administering necessary medications, and providing emotional support to the couple are employed to promote parenting (Akerman & Dresner, 2009; Nasab et al., 2011; Parlamento Europeu, 2013; Smith et al., 2018). In the postpartum period, healthcare professionals can offer comprehensive support aimed at fostering parenting, empowering the woman, man, or couple in caring for their newborn (Olson et al., 2018). This support may include assistance with breastfeeding, guidance on infant care, and the identification and referral of maternal and infant health issues that may arise (Kuan et al., 1999). Additionally, information on postpartum recovery, parents' emotional well-being, and the creation of a safe and nurturing environment for the newborn’s development may be provided. Overall, healthcare professionals play a crucial role in facilitating the transition to parenthood by offering physical, emotional, and educational support to ensure a positive and healthy experience during pregnancy, childbirth, and postpartum (Meleis et al., 2000). 

The transition to parenthood represents a significant developmental challenge, requiring substantial physical, psychological, and social reorganization. From conception through pregnancy, this adaptation is critical for maternal well-being and overall adjustment, with profound implications for neonatal outcomes, child development, and the emerging attachment relationship (Bellhouse et al., 2022b). This transition is influenced by multiple contextual factors, including life circumstances, social environment, psychosocial stress, levels of support from the partner and family, whether the pregnancy was planned, previous gestational loss, and the physical health of both the mother and baby (Bellhouse et al., 2021). The shift to parenthood significantly changes couples’ lives (Eddy & Fife, 2021; Erickson et al., 2020; Meleis et al., 2000). Whereas many experience joy and happiness during this time, others face heightened stress and anxiety, along with decreased intimacy and marital satisfaction. Many couples feel unprepared to navigate this transition effectively, which may negatively impact the family and individual life cycle (Eddy & Fife, 2021).

Despite the importance of the transition to parenthood, there is a notable scarcity of studies examining the process of a man becoming a father (Genesoni & Tallandini, 2009; Höfner et al., 2011; Segal, 2005). The prevailing notion that a father's role is limited solely to supporting his partner continues to persist (Finn & Henwood, 2009). Although this role is undeniably important, it does not preclude fathers from taking on other equally valuable responsibilities, such as directly caring for the baby and actively participating in the child's education (Pellai et al., 2013). It is important to acknowledge that becoming a father is a journey of personal growth that involves inner reorientation and adaptation to the new role (Berg & Wynne-Edwards, 2001; Finn & Henwood, 2009; Saxbe et al., 2018; Silva et al., 2021; Vidaurreta et al., 2021).

Parenthood represents a significant change in individuals' life cycles and is one of the most common triggers of crises. This transition, marked by numerous challenges and adjustments, begins during pregnancy and extends into the postpartum period (Parfitt & Ayers, 2014; Saxbe et al., 2018; Tavares et al., 2019). Becoming a mother or father is frequently a stressful transition (Gutiérrez-Zotes et al., 2016; Meleis, 2017; Perren et al., 2005), involving long-term processes that reshape both cognitions and behaviors (Hoekzema et al., 2016; Mendes et al., 2022; Workman et al., 2012), making new mothers more susceptible to new circumstances and challenges (Gutiérrez-Zotes et al., 2016; Parlamento Europeu, 2013). A growing body of evidence suggests that perinatal stress and depression are symbolic expressions of powerlessness, negatively impacting the personal and social lives of new mothers, leading to difficulties bonding with their babies and reduced interpersonal interactions. These factors have short- and long-term adverse effects on mothers and newborns (Gutiérrez-Zotes et al., 2016; Thiel et al., 2020). Similarly, inadequate preparation for this transition among men can affect the couple's relationship, the father-child bond, and the overall development of the baby and family (Philpott et al., 2017; Silva et al., 2021; Vismara et al., 2016).

Pregnancy is recognized as an opportune time to recommend health interventions that promote both interpersonal and intrapersonal changes necessary for parenthood (Bellhouse et al., 2022a, 2022b; Parfitt et al., 2013; Saxbe et al., 2018). During this period, individuals face the dual challenge of caring for themselves while preparing to care for a child (Gutiérrez-Zotes et al., 2016; Philpott et al., 2017). Research has shown that men's involvement from the beginning of pregnancy enhances the psychological well-being of both parents (Parfitt et al., 2013; Silva et al., 2021; Vismara et al., 2016). This transitional period, therefore, requires a complex balance of adjustments. In this regard, the Swedish National Board of Health and Welfare has emphasized the importance of parenting groups and programs that provide peer support, underscoring the need to prioritize such initiatives in the care of pregnant women and new parents (Ekelöf et al., 2023).

Supporting mental health during the transition to parenthood involves providing appropriate resources and creating peaceful environments for expectant mothers, fathers, and couples. Research emphasizes the importance of promoting health at multiple levels, strengthening individuals' resources, and fostering social support systems and communities. The contemporary variation of the African proverb "It takes a village to raise a child; it takes a network to raise a mother" emphasizes the need for a comprehensive support system. Close collaboration across all levels of healthcare is vital for identifying women needing additional support and for collectively promoting their physical and psychological well-being during pregnancy (Ekelöf et al., 2023).

Accordingly, this scoping review aimed to identify and analyze the strategies employed by healthcare professionals to facilitate the transition to parenthood, intending to develop interventions that ease this process.

Method                            

Study Design

A scoping review was used to achieve the research objective, designed to comprehensively identify the existing literature on a specific topic and provide a comprehensive overview of an emerging area (Munn et al., 2018).  This review adhered to the guidelines of the Joanna Briggs Institute Reviewer’s Manual (2020) and followed the recommendations of Tricco et al. (2018), using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) tool.

Research Question

The starting question was: "What strategies do health professionals use to transition to parenthood?" Key concepts (Transition to parenthood, Pregnancy, and Strategies) were identified as integral components of the PCC framework (Participants, Concept, and Context).

Concept Identification and Research Strategy

After defining the key concepts and translating them into English, synonyms were identified using terms from the DeCS/MeSH vocabulary (Health Sciences Descriptors). These terms were combined using Boolean operators and truncation symbols (* and AND) to formulate the search expression. The finalized search string included the following terms: "Parenthood transition" or "Parenthood adaptation," or "Parenthood adjustment" and "Pregnan*" and "Strategies" or "Methods" or "Techniques" or "Interventions" or "Best practices" or "Approaches." All concepts were explicitly searched in the Abstract section.

Study Selection and Analysis Process

Three independent reviewers conducted the critical evaluation, extraction, and synthesis of the data to analyze and select the studies. Two additional reviewers were available to resolve any disagreement, although their involvement was not required. The process is illustrated in detail in Figure 1 of the PRISMA flowchart.

Inclusion and Exclusion Criteria

Inclusion criteria: Empirical studies and studies focusing on the transition to parenthood during pregnancy, published between 2018 and 2023 and written in Portuguese, English, or Spanish.

Exclusion criteria: Non-peer-reviewed publications (grey literature), studies on subsequent pregnancies with a history of miscarriage, studies involving minors, studies on parents with children from previous relationships, studies focused on pregnancy complications, and studies on premature infants.

Data Sources

Articles were selected from the EBSCO host search platform (CINAHL Complete, MEDLINE Complete, Nursing & Allied Health Collection: Comprehensive, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Library, Information Science & Technology Abstracts, MedicLatina, Cochrane Clinical Answers), a reliable analytical tool that allows quick access peer-reviewed, relevant research.

Search Period

The search was conducted from November to December 2023, targeting studies published between 2018 and 2023. This time frame was selected to encompass the latest and most relevant studies, providing a comprehensive overview of the approaches employed by healthcare professionals during the transition to parenthood.

Results

Identification and Selection of Studies

Upon entering the search expression into the EBSCO platform's fields, 308 articles were retrieved. An analysis of keyword co-occurrence, as depicted in Figure 1, revealed a connection between the term "Parenthood" and the key term "Pregnan*." Whereas the term "Strategies" was not directly identified as a co-occurring keyword, related terms such as "Intervention" and "Support" emerged, which are linked to strategies employed during the transition to parenthood.

 

Figure 1

Visualization of Key Concepts Related to Parenthood

 Note. Visualization of the network of concepts using the VOSviewer program (v. 1.6.18). Parenthood; Pregnancy; Intervention; Support.

 

Following the PRISMA model (Figure 2), established filters were applied, including time frame, language, publication type, and removal of duplicate records, resulting in the exclusion of 109 articles. Subsequently, the remaining articles were screened by title and abstract to assess compliance with the pre-defined inclusion and exclusion criteria. Finally, after a full reading of the remaining articles, six were selected for inclusion in the final review.

 

 

Note. PT = Portuguese; EN = English; SP = Spanish; FR = French.

 

Characteristics of the Included Studies

This scoping review identified six studies (Table 1) that examined various strategies employed by healthcare professionals during the transition to parenthood. The studies were conducted in Sweden, Taiwan, Australia, Denmark, and the United States, encompassing a diverse range of participants and methodologies.

The qualitative studies (Bellhouse et al., 2022b; Eddy & Fife, 2021; Ekelöf et al., 2023) used interviews and inductive data analysis, primarily exploring the mental well-being of women during the perinatal period and the factors perceived by healthcare professionals as promoting this well-being. The findings underscored the importance of internal resources, trust during the transition, and the community support network.

 

Table 1 Identification and Characterization of the Selected Studies for Analysis
#	Authors (Year)	Country	Participants	Method	Study Type	Objective	Results	Conclusions
1	Ekelöf et al. (2023)	Sweden	16 healthcare professionals (midwives, obstetricians, psychologists, and child health nurses)	Interviews	Qualitative, inductive analysis	Explore women's mental well-being in the perinatal period and promoting factors	Promoting factors: internal resources, confidence in transition, support network	Focus on internal resources and support structures
2	Pan et al. (2019)	Taiwan	74 pregnant women (39 intervention, 35 control)	Mindfulness intervention program	Quantitative, single-blind randomized clinical trial	Assess the efficacy of mindfulness on psychological health during pregnancy and early motherhood	Significant improvement in stress and depression; no differences in mindfulness	Mindfulness reduces postpartum stress and depression; useful in the transition to parenthood
3	Trillingsgaard et al. (2021)	Australia and Denmark	1,255 families (659 intervention, 596 control)	FSP Intervention Program with mothers and partners expecting their first child	Quantitative, randomized clinical trial	Assess the effects of a universal parenting program	Program satisfaction; no significant differences in parental competence, stress, or depression	Program participation did not significantly influence the indicators
4	Eddy & Fife (2021)	USA	11 heterosexual couples	Separate interviews	Qualitative, grounded theory	Develop a theory on the impact of husband involvement on the couple's relationship during pregnancy	Active husband involvement strengthens the relationship; barriers include overload, discussions, gender differences, and disinterest	Active husband involvement leads to strengthened postpartum relationships
5	Bellhouse et al. (2022a)	Australia	16 parents with risk factors	STAR MUMS Program (5 sessions, 1.5h/5 weeks during pregnancy)	Qualitative and exploratory	Explore experiences and acceptability of the STAR MUMS program	Program deemed acceptable, facilitates reflection, reduces isolation and anxiety, improves bonding with infants	High levels of participation and adjustment; program is acceptable and facilitates reflection
6	Bellhouse et al. (2021)	Australia	13 publications selected from 6,829 identified	Systematic review	Systematic literature review	Describe the effects of psychological interventions during pregnancy for early parenthood	Interventions included mindfulness, stress management, cognitive-behavioral therapy, among others	More research is needed to determine effective prenatal interventions
Note. FSP = Family Startup Program. STAR MUMS = Supporting Transitions and Relationships (based on psychoanalytic and attachment theory, including approaches such as mindfulness and mentalization).

 

 

Findings from quantitative studies (Pan et al., 2019; Trillingsgaard et al., 2021), encompassing randomized controlled trials, examined the efficacy of intervention programs such as mindfulness and the Family Startup Program. These programs aimed to alleviate stress and depression and gauge parental competence. The results suggested that mindfulness may have positive effects in reducing postpartum anxiety and depression. However, satisfaction with general parenting programs did not consistently lead to significant improvements in the measured variables.

One specific study employed grounded theory to develop a theory on the influence of the husband's involvement during pregnancy on the couple's relationship. The results indicated that the husband's proactive involvement strengthens the relationship in the postpartum period despite overwhelming responsibilities and gender disparities. Another qualitative study delved into the experiences and acceptability of the Supporting Transitions and Relationships program, which targets fathers with risk factors. The findings revealed high acceptance that the program was well received, facilitated self-reflection, reduced feelings of isolation and anxiety, and improved bonding with their babies. Additionally, a scoping review of psychological interventions during pregnancy underscored the wide range of approaches available, such as mindfulness programs, stress management techniques, and cognitive-behavioral therapy.

Categories of Strategies Identified

Based on this review's findings, various strategies employed by healthcare professionals to facilitate the transition to parenthood were identified. The study results were categorized into four groups (Table 2): Personal Resources (Studies 1, 4, 6), Support Programs for Prospective Parents (Studies 2, 3, 5, 6), Supportive Psychological Interventions during the Transition to Parenthood (Study 6), and Spousal Support for Pregnant Women (Study 4).

 

Table 2

Grouping Strategies by Category 

Categories	Strategies	Studies
Personal Resources	Women's ability to trust their pregnancy process.	1
	Using the family and community support network.	1, 4, 6
Support Programs for Parents-to-be	Mindfulness programs for stress and anxiety management. Intervention programs organized by healthcare professionals for couples to share experiences. Use of stress scales (PSS) and postpartum depression scales (EPDS) by healthcare professionals. Follow-up sessions during a first pregnancy.	2, 5 5, 6
		2
		3, 5
Supportive Psychological Interventions	Organizing various programs, including mindfulness-based therapies for parenting and cognitive-behavioral therapy.	6
Spousal Support for Pregnant Women	Health professionals encourage husbands to participate actively in the pregnancy process by sharing tasks and providing emotional support, empowering them with knowledge.	4
Note. PSS = Perceived Stress Scale; EPDS= Edinburgh Postnatal Depression Scale.

 

Discussion 

The transition to parenthood is a critical and transformative moment in individuals' lives, involving significant restructuring across multiple dimensions, including health, identity, relationships, and the environment (Meleis, 2017; Meleis et al., 2000). The arrival of a new life represents a significant event that requires substantial adjustments and transformations for both the individual and the family. This reconfiguration process can begin before birth or even during the contemplation of parenthood, and it is considered one of the most pivotal and demanding decisions a person can face. This phase demands effective communication, understanding, and support (Mendes et al., 2022).

Within this framework, this scoping review aimed to ascertain the strategies employed by healthcare professionals to facilitate a smooth transition to parenthood, acknowledging the intricate and varied nature of parenting experiences.

Multifaced Approach to Promoting Mental Health and Well-Being

The findings of this review underscore the significance of employing a comprehensive approach to promote the mental health and well-being of expectant parents. The qualitative studies included in the review (Bellhouse et al., 2022b; Eddy & Fife, 2021; Ekelöf et al., 2023) emphasized the importance of internal resources such as confidence and resilience, as well as the necessity of a robust social support system. Healthcare professionals play a crucial role by providing emotional and educational support, contributing to the development of a community-based support network, which is essential for mental well-being during the perinatal period. Recent quantitative studies (Pan et al., 2019; Trillingsgaard et al., 2021) have provided evidence of the effectiveness of targeted programs, such as mindfulness and the Family Startup Program, in reducing postpartum stress and depression. These programs have demonstrated significant benefits for the psychological well-being of pregnant women and new parents, underscoring the need for structured, evidence-based interventions to support the transition to parenthood.

Personal Resources

Confidence in the pregnancy process and using family and community support networks are crucial for the well-being of expectant mothers. Confidence in the pregnancy involves embracing impending motherhood and gaining valuable knowledge (Silva et al., 2021). As individuals transition into parenthood, this confidence becomes essential, grounded in the belief that they exist within a psychological and social environment that allows them to perceive life from a new perspective and reassess personal values and priorities (Parfitt et al., 2013; Philpott et al., 2017; Silva et al., 2021).

Sharing a safe environment with a partner, alongside dividing tasks and responsibilities, fosters a shared relationship that promotes fairness and equity in marriage (Oliveira et al., 2022; Philpott et al., 2017). Being part of a community support and care network provides pregnant women with the chance to share experiences, promote positive mental health and safety behaviors, and alleviate the physical stress associated with pregnancy. This sense of belonging to peer groups allows expectant mothers to exchange concerns, form friendships, and gain insights into how other couples navigate the pregnancy journey. These elements are vital for cultivating strong mental well-being (Ekelöf et al., 2023). Positive emotional well-being encourages safe behaviors and diminishes the physiological stress linked to pregnancy, thus enhancing the overall health, confidence, and ability of parents to navigate the various challenges that arise during the transition to parenthood (Alves et al., 2019; Parfitt et al., 2013).

Support Programs for Prospective Parents

Prospective Parent Support Programs are important in addressing perinatal stress and depression, which negatively affect mothers' intimate and social lives (Pan et al., 2019). Postpartum depression has received increasing attention in recent years due to its rising global prevalence (Hahn-Holbrook et al., 2018). This rising prevalence may be attributed to women’s involvement with a variety of parenting roles alongside work, social, and family demands, which can lead to significant mental distress (Gutiérrez-Zotes et al., 2016).

Pregnancy is an opportune time to promote health interventions (Ekelöf et al., 2023). In this sense, healthcare professionals use assessment scales to identify issues that may compromise a healthy transition to parenthood, especially in terms of mental health. Early identification and intervention for mental health problems during pregnancy and postpartum favors the well-being of the mother-father-baby triad (Oliveira et al., 2022; Philpott et al., 2017).

Randomized studies with intervention and control groups have demonstrated that mindfulness programs can reduce postpartum anxiety and depression. The results indicate that intervention groups have significantly lower levels of anxiety and depression compared to control groups, suggesting that participation in these programs benefits the mental health of pregnant women. Emotional responses observed through these programs were positive, intense, and varied, indicating a stronger psycho-emotional balance (Silva et al., 2021).

Trillingsgaard et al. (2021) found that while parental support during the transition to parenthood leads to satisfaction, there is no conclusive evidence of its effectiveness in reducing anxiety and stress. Becoming a parent is often challenging, requiring reorganizing thoughts and behaviors (Pan et al., 2019). Supporting parents through this transition is a critical global public health initiative, empowering them with knowledge and support programs to adapt to their new roles (Meleis et al., 2000).

Supporting Psychological Interventions in the Transition to Parenthood

Programs such as the Supporting Transitions and Relationships (STAR Mums) program support normal psychological processes during pregnancy, preparing for the relationship with the baby and reducing risk factors (Bellhouse et al., 2022a). The program, which is grounded in psychoanalytic theory and attachment concepts, incorporates mentalization techniques to facilitate self-reflection. Participants in the program reported a decrease in stress and anxiety levels, underscoring the importance of mentalization exercises in promoting a positive transition.

Mental health is particularly relevant to marital stability. A more stable marital relationship lowers the likelihood of developing maternal or paternal depressive symptoms (Oliveira et al., 2022; Philpott et al., 2017). Investing in intervention and healthcare programs for fathers can yield significant long-term benefits for society. Children raised in stable and nurturing environments are more likely to develop into healthy and productive adults, thereby contributing to a more resilient and equitable society (Erickson et al., 2020; Parfitt et al., 2013). In this context, the importance of family-oriented education programs must be emphasized, prioritizing fathers' involvement to ensure their inclusion throughout the process. Health services and professionals should provide specialized support to fathers and actively create more opportunities for their engagement (Santos da Mota et al., 2022; Vismara et al., 2016).

According to  Bellhouse et al. (2021), the transition to parenthood is a critical period for mental health, requiring significant psychological adjustments to embrace the parental role. Early intervention programs, coordinated by healthcare professionals, are important to facilitate a smooth transition. Despite the importance of these interventions, there is a scarcity of evidence-based programs that can be implemented during the prenatal period. Further research is necessary to identify effective interventions that prepare first-time parents for parenthood and prevent attachment difficulties (Bellhouse et al., 2021).   

Partner as a Supporting Element for Pregnant Women

The partner’s active involvement during pregnancy is essential for strengthening the couple's relationship in the postpartum period. Research indicates that the husband's active engagement during pregnancy enhances the ties in the postpartum period through four key components: a positive attitude, instrumental support, emotional support, and responsiveness during significant moments (Eddy & Fife, 2021). Providing support with a positive attitude entails the husband's willingness to assist his partner without resentment or a sense of obligation, completing tasks with love and compassion. Instrumental support refers to efforts to help with daily tasks, while emotional support involves being emotionally available and responding empathetically to the woman's needs. These components empower the couple, fostering increased confidence, maturity, love, communication, and ongoing support (Eddy & Fife, 2021).

Similarly, Oliveira et al. (2022) highlight the concept of conjugality, which refers to the bond between two individuals, not necessarily formalized by a contract, characterized by affective and sexual relations in which partners share or negotiate responsibilities to maintain family cohesion. Cowan et al. (2018) highlight that the couple's experience of the changes involved in the parenting process depends on the harmony between the romantic aspects of their relationship, the division of tasks, and communication patterns. Moreover, the more support the partner provides and the greater the satisfaction in the marital relationship, the lower the likelihood of the woman developing depressive symptoms (Oliveira et al., 2022). However, challenges such as fatigue, interpersonal conflicts, gender issues, and disengagement may arise, negatively impacting this dynamic (Eddy & Fife, 2021; Parfitt et al., 2013; Philpott et al., 2017). Excluding men from the preparation process for parenthood can lead to feelings of insecurity. A confident man exhibits lower levels of fear and higher resilience, facilitating a more positive transition (Silva et al., 2021). Encouraging men's involvement in pregnancy and childbirth strengthens the father-infant emotional bond and helps reduce gender stereotypes (Santos da Mota et al., 2022; Vismara et al., 2016).

Strategies such as establishing new routines, sharing feelings and responsibilities, and forming a cooperative team during the transition to parenthood promote stronger attachment and parental adjustment (Alves et al., 2019; Parfitt et al., 2013; Philpott et al., 2017). The comprehensive restructuring of parental rights in Portugal, including the extension of parental leave to fathers, has promoted the sharing of parental responsibilities, acknowledging the father’s active role in supporting the mother and caring for the baby (Leitão, 2019; Rocha, 2020).

Emotional and practical support and open communication between partners are crucial for the well-being and healthy development of the future baby. Supportive and understanding attitudes can help individuals recognize that they have the personal resources to manage their new role effectively (Erickson et al., 2020).

Integration of Strategies and the Role of Health Professionals

The transition to parenthood is often accompanied by a range of emotions, including joy, excitement, as well as anxiety, stress, and depression (Hughes et al., 2020; Parfitt et al., 2013). During this critical period, timely intervention can have a substantial impact. Support programs not only provide essential information, guidance, and emotional support to parents-to-be but also facilitate appropriate parental adjustment by guiding them through the forthcoming changes (Alves et al., 2019; Philpott et al., 2017; Vismara et al., 2016).

Similarly, Trillingsgaard et al. (2021) argue that bringing together women, men, and couples who share similar experiences creates a space for understanding, discussion of challenges, sharing of successes, and solidarity, thereby establishing a reliable support network. These programs also offer practical strategies for managing stress and promoting mental and emotional well-being during the transition to parenthood.

Healthcare professionals play a pivotal role in this process by providing specialized knowledge and personalized care, promoting healthy parenting practices, and addressing the emotional and physical challenges faced by parents (Barimani & Vikström, 2015; Gjerdingen et al., 1991). Healthcare professionals serve as facilitators and advocates for strategies that empower parents to gain confidence in their new roles and reinforce family bonds. Their contribution to supporting parenting extends beyond their technical expertise to include educational guidance, emotional support, and practical care. A comprehensive intervention from healthcare professionals is essential to ensure a seamless transition to parenthood while promoting the overall health and well-being of the entire family.

Limitations

Although this scoping review has provided a comprehensive overview of the strategies used by healthcare professionals in facilitating the transition to parenthood, several limitations must be acknowledged.

Data Sources and Temporal Scope. The search was limited to a select number of databases, potentially resulting in the exclusion of relevant studies available from other sources. Including additional databases, such as PubMed, Scopus, Web of Science, Embase, and PsycINFO, could have widened the scope of the review. Furthermore, restricting the search to studies published between 2018 and 2023 may have limited the inclusion of earlier research, which might offer valuable insights into long-term trends and developments in parenting support strategies.

Inclusion and Exclusion Criteria. The inclusion and exclusion criteria were designed to focus on general factors influencing the transition to parenthood. However, by excluding studies addressing specific conditions, such as maternal or neonatal health issues, preterm birth, maternal depression, and teenage motherhood, this review may have overlooked crucial contextual factors that impact parenting. The omission of these specific aspects may limit the generalizability and applicability of the findings to various parenting contexts.

Linguistic Bias. The review only included Portuguese, English, French, and Spanish studies. This selection criterion may have introduced a linguistic bias, potentially excluding relevant studies published in other languages and limiting the diversity and representativeness of the findings.

Search Strategies. Using specific keywords and Boolean operators might have limited the scope of the search results. Although the DeCS/MeSH vocabulary was employed to identify synonyms, more advanced search strategies, such as combining free-text terms with controlled vocabulary, could have enhanced the comprehensiveness and accuracy of the search. The implementation of more sensitive search tools might have captured a broader spectrum of pertinent studies.

Quality Assessment of Studies. Scoping reviews do not systematically evaluate the quality of the included studies; instead, they focus on identifying and mapping the existing literature. Consequently, the results of this review should be interpreted with an awareness that the methodological quality of the studies was not assessed. This limitation affects the ability to make practical recommendations based on the robustness of individual studies.

Diversity of Studies. The variety in study designs, geographical contexts, and populations included in this review may restrict the generalizability of the results. This heterogeneity suggests that the findings may not be universally applicable. Conducting subgroup analyses could offer valuable insights into how different factors influence the transition to parenthood in specific contexts, thereby enabling a more precise and contextually relevant interpretation of the data.

It is important to consider these limitations when interpreting this review's findings and outlining future research on the transition to parenthood. Subsequent studies should encompass a broader spectrum of research, contexts, and demographics to ensure a comprehensive and inclusive understanding of successful approaches to promoting successful parenting.

Conclusion

This scoping review identified that most studies emphasize the importance of support directed at women and couples during the transition to parenthood, with a noticeable lack of focus on men. The journey to parenthood is a complex and transformative experience that requires careful attention and appropriate support to ensure the well-being of all involved—the woman, man, couple, and baby. This transitional period is a significant and challenging phase in the lives of those involved, characterized by substantial physical, emotional, and social changes.

Importance of Support in the Transition to Parenthood

The results of this review emphasize the importance of using a multifaceted approach to support the mental health and well-being of expectant parents. The studies underscore the significance of internal resources, an effective social support system, and structured, evidence-based interventions.

Identified Strategies and Interventions

Healthcare professionals are instrumental in promoting a positive and healthy transition to parenthood by providing emotional and educational support and assisting in building community support networks. Research has shown that supportive psychological interventions effectively prepare couples for their relationship with the baby and reduce risk factors. Additionally, the active participation of the supportive partner has been identified as essential in strengthening the couple's relationship during the postpartum period.

Research Gaps

Despite the significance of the findings, there is a noticeable lack of studies investigating the process of men's transition to parenthood. This gap indicates the need for future research that specifically examines the role and experiences of men during this critical phase to develop a more comprehensive and cohesive understanding of the parenting process.

Implications for Clinical Practice

The findings of this review can be applied to real-world clinical settings, encouraging the implementation of diverse programs that consider individuals' personal resources and their close emotional bonds. Strategies such as education, emotional support, and the active involvement of parents should be incorporated to ease the transition to parenthood, thereby enhancing the well-being of couples and strengthening family connections. This insight is essential for crafting interventions that empower parents to embrace their new roles confidently.

In conclusion, this scoping review addressed the research question and met the stated objective by identifying strategies healthcare professionals employ to facilitate the transition to parenthood. Acknowledging the significance of a comprehensive and inclusive approach is essential for ensuring a smooth and positive transition, thereby establishing a solid foundation for future generations.

 

Acknowledgments and Authorship

Conflict of interest: The authors have declared no conflicts of interest.

Funding: This study did not receive any specific financial support.

Contributes: AV: Conceptualization, methodology, formal analysis, drafting the original manuscript, writing (review & editing). CC: Methodology, formal analysis, drafting the original manuscript. MC: Methodology, formal analysis, drafting the original manuscript. AS: Conceptualization, methodology, formal analysis, revision. MT: Conceptualization, methodology, formal analysis, revision.

 

References

Akerman, N., & Dresner, M. (2009). The management of breakthrough pain during labour. CNS Drugs, 23(8), 669–679. https://doi.org/c2vmdx

Alio, A., Lewis, C. A., Scarborough, K., Harris, K., & Fiscella, K. (2013). A community perspective on the role of fathers during pregnancy: A qualitative study. BMC Pregnancy and Childbirth, 13(1), Article 60. https://doi.org/gbcr42

Alves, S., Milek, A., Bodenmann, G., Fonseca, A., Canavarro, M. C., & Pereira, M. (2019). Romantic attachment, dyadic coping, and parental adjustment across the transition to parenthood. Personal Relationships, 26(2), 286–309. https://doi.org/gqhbtn

Barimani, M., & Vikström, A. (2015). Successful early postpartum support linked to management, informational, and relational continuity. Midwifery, 31(8), 811–817. https://doi.org/f3gxjg

Bellhouse, C., Bilardi, J., Temple-Smith, M., & Newman, L. (2022a). Subjective experiences of participating in the Supporting Transitions, Attachment and Relationships (STAR Mums) program, a psychological group intervention for high-risk pregnant women. SSM - Mental Health, 2, Article 100065. https://doi.org/mxrq

Bellhouse, C., Komiti, A., Temple-Smith, M., Bilardi, J., & Newman, L. (2022b). A psychological group intervention for high-risk pregnant women: A protocol of a feasibility and acceptability study of the STAR Mums program. Journal of Reproductive & Infant Psychology, 40(4), 342–351. https://doi.org/nhrn

Bellhouse, C., Newman, L., Bilardi, J. E., & Temple-Smith, M. (2021). A systematic narrative review of psychological interventions available in the antenatal period to prepare parents for parenting. Current Psychology, 42(11), 8733–8746. https://doi.org/mk43

Berg, S. J., & Wynne-Edwards, K. (2001). Changes in testosterone, cortisol, and estradiol levels in men becoming fathers. Mayo Clinic Proceedings, 76(6), 582–592. https://doi.org/fgbvtz

Cowan, C. P., & Cowan, P. A. (2018). Enhancing parenting effectiveness, fathers' involvement, couple relationship quality, and children's development: Breaking down silos in family policy making and service delivery. Journal of Family Theory & Review, 11(1), 92–111. https://doi.org/gk6jv8

Daniele, M. (2021). Male partner participation in maternity care and social support for childbearing women: A discussion paper. Philosophical Transactions of the Royal Society B, 376(1827), 1–9. https://doi.org/mw3p

Deave, T., & Johnson, D. (2008). The transition to parenthood: what does it mean for fathers? Journal of Advanced Nursing, 63(6), 626–633. https://doi.org/cwxj9c https://doi.org/f54ttm

Eddy, B. P., & Fife, S. T. (2021). Active husband involvement during pregnancy: A grounded theory. Family Relations, 70(4), 1222–1237. https://doi.org/mxsr

Ekelöf, K., Thomas, K., Almquist-Tangen, G., Nyström, C. D., & Löf, M. (2023). Well-being during pregnancy and the transition to motherhood: An explorative study through the lens of healthcare professionals [Preprint]. BMC Pregnancy and Childbirth. https://doi.org/mxrr

Erickson, N. L., Neumann, A. A., Hancock, G. R., & Gartstein, M. A. (2020). Baby preparation and worry scale (Baby-PAWS): Instrument development and psychometric evaluation. Early Human Development, 147, Article 105080, https://doi.org/mxss

Finn, M., & Henwood, K. (2009). Exploring masculinities within men's identificatory imaginings of first-time fatherhood. The British Journal of Social Psychology, 48(Pt 3), 547–562. https://doi.org/bjg65f

Genesoni, L., & Tallandini, M. (2009). Men's psychological transition to fatherhood: An analysis of the literature, 1989–2008. Birth, 36(4), 305–318. https://doi.org/f9jc4p

Gillis, A., Gabriel, B., Galdiolo, S., & Roskam, I. (2019). Partner support as a protection against distress during the transition to parenthood. Journal of Family Issues, 40(8), 1107–1125. https://doi.org/mw3n

Gjerdingen, D., Froberg, D., & Fontaine, P. (1991). The effects of social support on women's health during pregnancy, labor and delivery, and the postpartum period. Family Medicine, 23(5), 370–375.

Gutiérrez-Zotes, A., Labad, J., Martín-Santos, R., García-Esteve, L., Gelabert, E., Jover, M., Guillamat, R., Mayoral, F., Gornemann, I., Canellas, F., Gratacós, M., Guitart, M., Roca, M., Costas, J., Ivorra, J. L., Navinés, R., de Diego-Otero, Y., Vilella, E., & Sanjuán, J. (2016). Coping strategies for postpartum depression: A multi-centric study of 1626 women. Archives of Women's Mental Health, 19, 455–461. https://doi.org/mxdn

Hahn-Holbrook, J., Cornwell-Hinrichs, T., & Anaya, I. (2018). Economic and health predictors of national postpartum depression prevalence: A systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Frontiers in Psychiatry, 8. https://doi.org/gcxhzd

Hoekzema, E., Barba-Müller, E., Pozzobon, C., Picado, M., Lucco, F., García‐García, D., Soliva, J., Tobeña, A., Desco, M., Crone, E., Ballesteros, A., Carmona, S., & Vilarroya, Ó. (2016). Pregnancy leads to long-lasting changes in human brain structure. Nature Neuroscience, 20, 287–296. https://doi.org/f9jc4p

Höfner, C., Schadler, C., & Richter, R. (2011). When men become fathers: men’s identity at the transition to parenthood. Journal of Comparative Family Studies, 42, 669-686. https://doi.org/gj2ssz

Hughes, C., Devine, R. T., Foley, S., Ribner, A. D., Mesman, J., & Blair, C. (2020). Couples becoming parents: Trajectories for psychological distress and buffering effects of social support. Journal of Affective Disorders, 265, 372–380. https://doi.org/gnctjx

Joanna Briggs Institute. (2020). JBI manual for evidence synthesis. Joanna Briggs Institute. https://synthesismanual.jbi.global

Kuan, L., Britto, M., Decolongon, J., Schoettker, P., Atherton, H., & Kotagal, U. (1999). Health system factors contributing to breastfeeding success. Pediatrics, 104, Article e28. https://doi.org/bm3jj5

Laureij, L. T., Breunis, L. J., Steegers-Theunissen, R., & Rosman, A. (2020). Identifying the needs for a web-based postpartum platform among parents of newborns and health care professionals: Qualitative focus group study. JMIR Formative Research, 4(5), Article e16202. https://doi.org/mxrs

Leitão, M. (2019). Time-sharing in parental leave: Why and how fathers assess their time to care home alone. Portuguese Journal of Social Science, 18(3), 265–282. https://doi.org/mxq8

Mackert, M., Guadagno, M., Lazard, A., Donovan, E. E., Rochlen, A., García, A. A., & Damásio, M. (2018). Engaging men in prenatal health via ehealth: Findings from a national survey. JMIR Pediatrics and Parenting, 1(1), Article e9513. https://doi.org/mw3s

Meleis, A. I. (2017). Theoretical nursing: Development and progress (6^th ed.). Lippincott Wolters, Kluwer.

Meleis, A. I., Sawyer, L. M., Im, E.-O., Hilfinger Messias, D. K., & Schumacher, K. (2000). Experiencing transitions: An emerging middle-range theory. Advances in Nursing Science, 23(1), 12–28. https://doi.org/gfzq2w

Mendes, J., Sousa Santos, A. P., & Tavares, M. (2022). Perceções da violência obstétrica pelas parturientes e profissionais de saúde: Uma revisão scoping. Revista Portuguesa de Investigação Comportamental e Social, 8(2), 1–15. https://doi.org/mxrt

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(1), Article 143. https://doi.org/gfq8w2

Nasab, L., Shahoie, R., Zaheri, F., & Ranaie, F. (2011). Emotional and physical support during labor for primiparouse women. European Psychiatry, 26, 1102–1102. https://doi.org/c94vws

Olson, T., Bowen, A., Smith-Fehr, J., & Ghosh, S. (2018). Going home with baby: Innovative and comprehensive support for new mothers. Primary Health Care Research & Development, 20, Article e18. https://doi.org/mw87

Oliveira, J. M. D., Alvarenga, P., & Soares, Z. F. (2022). Relações entre a saúde mental e a conjugalidade de gestantes primíparas. Psico, 53(1), Article e38230. https://doi.org/mxrp

Pålsson, P., Kvist, L., Ekelin, M., Hallström, I., & Persson, E. (2018). “I Didn’t Know What to Ask About”: First-Time Mothers’ Conceptions of Prenatal Preparation for the Early Parenthood Period. The Journal of Perinatal Education, 27(3), 163–174. https://doi.org/gjcp7j

Pålsson, P., Persson, E., Ekelin, M., Hallström, I. K., & Kvist, L. (2017). First-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period: Implications for early parenthood preparation. Midwifery, 50, 86–92. https://doi.org/f97rvc

Pan, W.-L., Chang, C.-W., Chen, S.-M., & Gau, M.-L. (2019). Assessing the effectiveness of mindfulness-based programs on mental health during pregnancy and early motherhood: A randomized control trial. BMC Pregnancy & Childbirth, 19(1), 2–8. https://doi.org/gg9kc8

Parfitt, Y., & Ayers, S. (2014). Transition to parenthood and mental health in first-time parents. Infant Mental Health Journal, 35(3), 263–273. https://doi.org/f54ttm

Parlamento Europeu. (2013). Diretiva 2013/55/UE do Parlamento Europeu e do Conselho de 20 de novembro de 2013 que altera a Diretiva 2005/36/CE relativa ao reconhecimento das qualificações profissionais e o Regulamento (UE) n.o 1024/2012 relativo à cooperação administrativa através do Sistema de Informação do Mercado Interno («Regulamento IMI»). Parlamento Europeu. https://shre.ink/8dGO

Pellai, A., Festa, F., Cilento, F., Grossi, L., Grassino, E., Zaffaroni, M., Guidi, C., Bona, G., Bonomi, A., Visentin, R., Angellotti, P., & Guala, A. (2013). [What new fathers know, think and do: a survey about fathering's attitudes, beliefs and behaviors in a sample of 570 men just after the birth of their newborn]. Minerva Pediatrica, 65(5), 531–540. https://bit.ly/4buOZ28

Perreault, M., Atkinson, S., Mottola, M., Phillips, S. M., Bracken, K., Hutton, E., Xie, F., Meyre, D., Morassut, R. E., Prapavessis, H., & Thabane, L. (2018). Structured diet and exercise guidance in pregnancy to improve health in women and their offspring: study protocol for the Be Healthy in Pregnancy (BHIP) randomized controlled trial. Trials, 19, Article 691. https://doi.org/dsg7

Perren, S., von Wyl, A., Bürgin, D., Simoni, H., & von Klitzing, K. (2005). Depressive symptoms and psychosocial stress across the transition to parenthood: Associations with parental psychopathology and child difficulty. Journal of Psychosomatic Obstetrics & Gynecology, 26(3), 173–183. https://doi.org/fgwcx3

Philpott, L., Leahy-Warren, P., FitzGerald, S., & Savage, E. (2017). Stress in fathers in the perinatal period: A systematic review. Midwifery, 55, 113-127. https://doi.org/gr3c9v

Rocha, M. (2020). Promoting gender equality through regulation: The case of parental leave. The Theory and Practice of Legislation, 9(1), 35–57. https://doi.org/grg6jd

Santos da Mota, D. M. dos., Oliveira, F. V. N., & Alves de Sousa, V. M. (2022). Participação paterna no pré-natal: Revisão integrativa. RECIMA21 - Revista Científica Multidisciplinar, 3(1), Article e3112340. https://doi.org/mxrv

Saxbe, D., Rossin-Slater, M., & Goldenberg, D. (2018). The transition to parenthood as a critical window for adult health. American Psychologist, 73, 1190-1200. https://doi.org/gjhd3r

Segal, S. C. (2005). Birthing fathers-the transformation of men in American rites of birth. Rutgers University Press. https://www.jstor.org/stable/j.ctt5hj64k

Silva, C., Pinto, C., & Martins, C. (2021). Transição para a paternidade no período pré-natal: Um estudo qualitativo. Ciência & Saúde Coletiva, 26(2), 465–474. https://doi.org/mxrw

Smith, C., Levett, K. M., Collins, C. T., Armour, M., Dahlen, H., & Suganuma, M. (2018). Relaxation techniques for pain management in labour. The Cochrane Database of Systematic Reviews, 3, Article CD009514. https://doi.org/gdf8rv

Sousa, B. S. A., Almeida, C. A. P. L., Santos, J. R., Lago, E. C., Oliveira, J. F., Cruz, T. A., Lima, S., & Camargo, E. L. S. (2021). Meanings assigned by primary care professionals to male prenatal care: A qualitative study. The Open Nursing Journal, 15(Supl. 1, M8), 351–357. https://doi.org/mw3t

Tavares, I., Schlagintweit, H. E., Nobre, P., & Rosen, N. (2019). Sexual well-being and perceived stress in couples transitioning to parenthood: A dyadic analysis. International Journal of Clinical and Health Psychology, 19, 198–208. https://doi.org/f5d6

Taylor, C., McCance, D., Chappell, L., Nelson-Piercy, C., Thorne, S., Ismail, K., Green, J. S. A., & Bick, D. (2017). Implementation of guidelines for multidisciplinary team management of pregnancy in women with pre-existing diabetes or cardiac conditions: Results from a UK national survey. BMC Pregnancy and Childbirth, 17, Article 434. https://doi.org/gcrrf3

Thiel, F., Eberhard-Gran, M., & Garthus-Niegel, S. (2020). The impact of perinatal life stress on infant temperament and child development: A 2-year follow-up cohort study. Journal of Developmental & Behavioral Pediatrics, 42(4), 299–306. https://doi.org/mxdp

Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., … Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/gfd8vk

Trillingsgaard, T. L., Maimburg, R. D., & Simonsen, M. (2021). Group-based parent support during the transition to parenthood: Primary outcomes from a randomised controlled trial. Social Science & Medicine, 287, Article 114340. https://doi.org/gmzkmg

Vidaurreta, M., López-Dicastillo, O., Serrano, I., Belintxon, M., Bermejo-Martins, E., & Mujika, A. (2021). Placing myself in a new normalized life: The process of becoming a first-time father. A grounded theory study. Nursing & Health Sciences, 24(1), 152–162. https://doi.org/mxch

Vismara, L., Rollé, L., Agostini, F., Sechi, C., Fenaroli, V., Molgora, S., Neri, E., Prino, L. E., Odorisio, F., Trovato, A., Polizzi, C., Brustia, P., Lucarelli, L., Monti, F., Saita, E., & Tambelli, R. (2016). Perinatal parenting stress, anxiety, and depression outcomes in first-time mothers and fathers: A 3- to 6-months postpartum follow-up study. Frontiers in Psychology, 7. https://doi.org/gfzgp8

Workman, J., Barha, C., & Galea, L. (2012). Endocrine substrates of cognitive and affective changes during pregnancy and postpartum. Behavioral Neuroscience, 126(1), 54–72. https://doi.org/d2j5tj