Thinking for Three: Mothers’ and Fathers’ Narratives on Transition to Parenthood

Department of Education, Languages, Intercultures, Literatures and Psychology Laboratory of Methods and Analysis Techniques of Illness Experiences, University of Florence, Florence, Italy Department of Health Sciences Laboratory of Methods and Analysis Techniques of Illness Experiences, University of Florence, Florence, Italy Department of Human, Philosophical and Educational Sciences (DISUFF) University of Salerno, Salerno, Italy


INTRODUCTION
Transition to parenthood is a crucial moment in a person's life [1 -5]. Unlike other moments of transition (e.g. leaving the parents' home, getting married, starting the first job), parent-drastically and the new parents have to cope with new demands and concerns, such as the constant care and attention required by the newborn, different management of disposable income, reduced availability of free time, physical tiredness, and reorganization of housework and lifestyle [11]. Taken together, these additional tasks reflect some of the reasons why almost all new parents live this moment with a set of overwhelming and ambivalent emotions, fluctuating between happiness and fear, and reporting a high level of stress [12 -16]. Literature highlights how mothers and fathers deal with this transition in different ways [10]. During pregnancy, fathers often show disengaged representations of the ideal child more than mothers do because fathers have fewer opportunities to interact with their unborn child [17]. The birth of the first child particularly represents an event that brings out gender disparities in workload and labor division between the two members of the couple, which were not always present prebirth. In other words, after childbirth, new parents perceive a decline in the sharing of housework which, in turn, leads to greater dissatisfaction [18]. In particular, mothers, compared to fathers, report a significant increase in the time spent on housework, highlighting that they take over the bulk of responsibilities for these activities [18]. Moreover, mothers note a marked decrease in the time spent at their jobs than fathers [10,18]. Literature also highlights a gender gap regarding childcare. Given that, before childbirth, parents expected a fair distribution of these activities, after delivery, new mothers experience unmet expectations, with new fathers doing less than expected. Conversely, new fathers experience over-met expectations, with new mothers doing more than expected [19]. In the postpartum period, new mothers spend more time managing and caring for the newborn, such as feeding him/her, changing his/her diapers or clothes, soothing him/her and waking up during the night, than new fathers [10,19,20].
Overall, in the first months of the baby's life, new mothers must deal with an upset sleep-wake rhythm and the difficulty of programming time, as a result of the newborn's unpredictable behavior. Furthermore, new mothers must use a new time plan, because of breastfeeding rhythms and reorganization of their daily activities, in order to tune in to the child's sleep-wake patterns, given that the newborn is essentially physically dependent on them. Conversely, the new fathers play an especially supportive role of the mother-child dyad, and their lives continue to include a prevalence of time away from home [21].
Although there is consistent evidence regarding these different parenthood experiences, most studies carried out so far have focused on prenatal versus postnatal experience or on specific issues related to parenthood, without considering the broader normative transition and the developmental challenge due to difficulties in starting to think for three. Furthermore, literature has used principally quantitative approaches. Our study starts from a different theoretical and methodological viewpoint, than the narrative medicine approach [22]. As outlined by Donzelli and Mc Greevy [23], nowadays, narrative medicine and personalized medicine are beginning to cooperate in both the diagnostic and the therapeutic fields, to help the health system tune in with individual needs. In particular, regarding perinatal research, this means considering the subjective experience a useful stance both for clinicians and patients, in order to tailor healthcare services starting from the patient's own story [24,25].
Starting with these considerations, the first aim of this study was to explore autobiographical narratives of first-time new parents a few weeks after childbirth, in order to examine the meaning they construct of this life transition process, which constitutes a significant developmental crisis, which influences both the parent's life as a couple member and the newborn's well-being. The second aim of the study was to investigate the differences between the experience of new mothers and new fathers.

Participants
Thirteen couples (women M age = 34.69, SD = 3.33; men M age = 36.58, SD = 5.77) were recruited for the present study. Inclusion criteria: Italian natives; women at first pregnancy; age >18 years; singleton and no-risk pregnancy; in all couples, the birth took place in the presence of the father.

Procedure
The study was conducted in accordance with the guidelines for the ethical treatment of human participants of the Italian Psychological Association. The Ethical Committee of the Local Health Authorities (CEAVNO) approved the study (n. 12749/2018). Participants were recruited during delivery preparation courses. Mothers were informed about the study goals and invited to inform their partners. Then, the first meeting with interested couples was organized and participants signed a written informed consent form. They could withdraw from participation at any time and no monetary reward was given. Thirteen couples contacted accepted to participate. At the first meeting, a short questionnaire on sociodemographic (age, educational, professional and relational status) and pregnancy data (biological or pathological aspects) was administered.
One month after childbirth, both parents were met again in our laboratory to individually participate in an open-ended interview. The interview, conducted by a psychologist expert in clinical research, started with the question "We are interested in collecting your personal experience of becoming a parent. Please, would you narrate how you have faced this transition and how you felt upon the encounter with your baby". Participants were free to narrate their experiences without any limits of time. If necessary, the interviewer intervened only for clarification requests or to encourage the parent to better express what he/she wanted to say.
Firstly, interviews were audio-recorded and transcribed verbatim. The mothers' and fathers' narratives were then separately analyzed by T-Lab software [26], aiming to explore similarities and differences between them. Specifically, we used a thematic analysis to perform unsupervised clustering of narrations to highlight the themes that emerged from the text, and we evaluated the elementary contexts of the narratives. Subsequently, we wanted to deepen the analysis of those parts of the narratives concerning the birth of the child. This was in view of the fact that all fathers had actively participated in the birth, and we, therefore, considered that this moment was revealing to highlight the attitudes of the parents towards this new dimension of their lives. The analysis was carried out using the Italian version of the Language Inquiry and Word Count (LIWC) software . Unlike the T-LAB, which conducts an analysis of common factors to the words used, LIWC has an internal vocabulary that makes it possible to recognize about 70% of the words. Words are then grouped into language categories such as pronouns, articles, verbs indicating mental states etc. This software has proven to be particularly suitable for exploring the revealing language dimensions of the meaning that the speaker attributes to the experience he or she has experienced [27,28]. For our analysis, we have evaluated the importance of variables related to pronouns, feelings, social relations, emotions and cognitive states.

RESULTS
Regarding socio-demographical characteristics, more than 75% of participants were of a middle-high socio-educational level, with 11 women and 9 men having a university degree or more. Twelve women and 13 men had a job. Twelve couples lived together at the time of data collection, and 5 couples were married. All deliveries were natural, lasting less than 8 hours, and the Apgar Index of all newborns was equal to or greater than 9.
Concerning the interviews, no significant differences emerged between mothers and fathers regarding the duration of narratives ( For both mothers and fathers, results of T-Lab thematic analyses highlighted a four-factor model (cosine index average of the semantic quality of mothers' narratives = .096; cosine index average of the semantic quality of fathers' narratives = 0.095). Table 1 shows different emerged themes of mothers' narratives and the most significant words that saturate them. Table 1. T-Lab Thematic analysis: Themes of mothers' narratives and the most significant words that saturate them.
As the table shows, in mothers' narratives, the first emerged theme, named "Reorganization of couple relation", saturated by 28% of words, refers to the transition from couple to triad. This theme contains words such as our, relationship, crisis, anxiety, underlining the transition from couple partners to parents in a new family nucleus. The elementary context analysis confirmed this cluster as it is exemplified by the following excerpt: "Our relationship has changed. He often goes out and I stay home alone with the baby, and there are problems and anxiety because [...] sometimes he cannot come back from work and I go into crisis" (mother #2).
The second theme, saturated by 27% of words, identifies the "Management of the baby". This theme includes terms that refer to childcare. In particular, mothers use verbs referring to actions performed on the baby, such as breastfeeding, wake up, sleep, and words such as hungry, bottle. This theme is confirmed by elementary context analysis in which the baby's management is expressed through phrases like: "He stopped breastfeeding. So that's why he cried too, because he was hungry, but he didn't attach to the nipples. So I tried, tried again, insisted, in the nights we were awake, while I tried. Finally, he wanted the breast and attached to it" (mother #3).
The third theme, saturated by 26% of words, is labeled "Emotional aspects of childbirth". It contains terms such as fear, strange, intimacy and describes the experience of childbirth from an emotional point of view. The elementary context analysis confirmed this cluster, with phrases like: "Everything together, everything came out in a single push and well, it is good, it is a strange experience […] you really have an unforgettable sensation even physically because you feel a liberation, at a certain point you feel an incredible intimacy and you see this little grey body" (mother #12).
Finally, the fourth theme, saturated by 19% of words, identifies the "Physical aspects of childbirth". In this case, lemmas are associated with the procedural and medical aspects of childbirth, such as centimeters, hospital, push, labor. The emerging theme is confirmed by analyzing the elementary contexts, in which the physical aspects of childbirth are expressed with phrases such as: "I arrived at the hospital having a 5 centimeters dilation, which is enough for a person at the first birth. It was a fast labor […] an hour and forty for the pushes it was a short time, but I was dead tired." (mother #5). Table 2 shows the different emerged themes from the fathers's narratives and the most significant words that saturate each cluster. Love (amore) 9 9 Nursery (asilo nido) 9 9 To hope (sperare) 10 10 To improve (migliorare) 9 9 To organize (organizzare) 9 9 Lucky (fortunato) 9 9 Doctor (dottore) 8 8 Before (prima) 9 9 Pregnant (in cinta) 8 8 To learn (imparare) 8 8 Activity ( In the fathers' narratives, the first emerging theme, saturated by 29% of words, concerns the experience of "To take part in childbirth" narrated through words such as amazing, head, birth, to be worried and to take part. This theme underlines the father's participation in the physical and emotional childbirth experience, claiming their co-protagonist role and narrating their first contact with the baby through sentences like:"I lived the childbirth from the first to the last minute, they made me take part in everything, I saw the head came out, I saw it all and I wasn't worried, nothing, it was an emotion, an amazing experience" (father #13).
The second theme, saturated by 28% of words, refers to the "Daily routine reorganization" in the couple becoming a triad. In fathers' narratives, this change is expressed by terms such as before, to work, to arrange. The elementary context analysis confirmed this result with sentences like: "You have to start thinking for three, now we are not just two of us, and now you have to devote time to the baby after work […] now we have arrange differently" (father #8). The third theme, saturated by 26% of words, labeled "Transition to fatherhood" as a significant role change, implying the attempt to compare life before childbirth with the present experience and future expectations. This theme involves words such as different, question, expectations, children and role, to describe this transition as something complex. The elementary context analysis pointed out these data with sentences like: "I always have many expectations about having children and stuff like that […] but it was a difficult question because you'll never feel ready for this role. It's a big discovery, everything changes, absolutely everything" (father #3).
The fourth of the emergent themes, saturated by 17% of words, refers to the "Night management of the baby", through words such as : to wake up, feeding time, to rest and disaster. This theme was narrated in terms of night time and sleep/wake rhythms, as emerging from the elementary context in sentences, such as: "My terror is to wake up often during the night. Because if I don't sleep, it's a disaster [...] I have to be mentally rested at work" (father #7).
Parents narrated the experience of childbirth in a not dissimilar way from a quantitative point of view. The part of the text occupied by these experiences accounts for 25% for mothers and 22% for fathers.
With regard to the linguistic characteristics of childbirth's narratives, means and standard deviations are shown in Table  3.
Mothers and fathers used a non-significantly different number of words to describe their experience of childbirth. The LIWC analysis was carried out on the number of correctly recognised words, which are 68% for fathers and 66% for mothers. Significant differences emerged between mothers and fathers in the use of pronouns "I" (W=-2.026; p<.05) and "we" (W=-2.385; p<.01) that provide information about the way in which the narrator posits her/himself in the text. In particular, mothers use more "I", compared to fathers, to narrate their childbirth experience, as evidenced by these excerpts: "I gave birth in two hours, delivery was really fast. I went directly to the delivery room without even labor because I arrived in the morning at the hospital and I went directly to the delivery room. I did the tracing and they took me to the delivery room at 9.30 and at 11.30 he was born" (Mother # 4); "it was a little easier than I thought. I was a bit scared but when I got there so dilated, they encouraged me to have a natural birth, so I managed myself. I arrived at 9.30 am and the delivery was completed around 1:00 pm. [...] At a certain point I felt an incredible release, a strong emotion and finally I saw it" (mother #13).
On the contrary, in the narration of the fathers, a greater use of "We" was observed: "At the beginning we were a bit hesitant about the fact that I was present but then, talking about it among ourselves, we decided that it was beautiful as an experience. Actually, we can say in retrospect that it is a beautiful and intense situation to live" (father # 4). Furthermore, "We were gratified, let's say, by this experience, because in any case we did everything as they told us to do, and we had an important strength in facing the moment" (father # 9).
Finally, the narratives also differed significantly in terms of the use of references to the social relations. Fathers reported greater use of reference to "others" (W=-2.924; p<.01) and "social" (-2.518, p<.01) categories than mothers. For instance, a father narrated: "When I saw her that she was so small I was almost afraid to touch her and so I asked the doctors and they told me to stay calm. First the midwives gave the baby to my wife and then later the midwives took her and gave her in my arms "(father #5). Similarly, father#1 reported: I tried to talk to the midwife for clarification, but she said that the protocol was that. At the same time, I was walking around the corridors and I saw another woman who had arrived after us who had already given birth. So I got worried but the medical staff told me to rest assured".
Differences close to significance (p <.06) have been found for the positive feelings and optimism about which fathers have used words indicating positive and optimistic feelings more than mothers.
Differently, no differences emerged between fathers and mothers regarding the other variables analyzed (all p> .05).

DISCUSSION
The main purpose of the present study was to explore narratives of transition to parenthood in the early time after childbirth. In particular, we investigated the meaning parents construct on this significant life event, considering the differences between mothers and fathers.
Overall, our results show that, even when the transition to parenthood is an "easy" and normative experience, it still implies a developmental crisis that involves a great deal of sensation and feeling in the couple.
In line with the literature [21,29], our data provide broader elements in showing that mothers and fathers live this process not only with different roles, but also referring to different contexts. Indeed, mothers and fathers seem to house two different spaces: one mental and one physical. Mothers' narratives focus on the intimacy of the domestic setting (see the "Management of the baby" theme), while fathers' also include the external environment, characterized by work and other activities unrelated to the home (see the "Daily routine reorganization" theme).
Concerning childbirth, mothers narrate their experience through two themes, the first related to emotional aspects of this event, and the second referring to corporeal and procedural. Both these aspects concern childbirth as a complex and intimate experience. In fathers, the childbirth experience is connected to the first meeting with their baby (see the "To take part in childbirth" theme) and to the acquisition of a paternal role (see the "Transition to fatherhood" theme). This first encounter marks the beginning of a new significant relationship: fathers claim an active role in childbirth, sharing emotional and sensory issues in narratives. This is not consistent with Page's results [30], who pointed out a greater and stereotyped gender difference, with mothers mainly focused on emotional issues and fathers on informative ones, such as organizational and medical features of the birth.
Moreover, the new parents also differ regarding the management of the baby. Mothers' narratives are characterized by a strong agency through a wide use of words that refer to actions that they perform on and with the child, emphasizing their active part in the baby's management. The baby's rhythms are followed by them through a daily adaptation, which marks the everyday routine. In the fathers' narratives, the management of the baby focuses on the night and sleep issues, which suggests a lesser sense of agency towards the baby, who is often experienced as an element of interference with the opportunity to sleep and rest. In other words, fathers seem to manage the newborn with difficulty, an observation that enriches literature that explains how mothers and fathers pay different kinds of attention to the baby [10,18,19].
The transition from couple to the triad is also addressed by both parents but in different ways. Mothers focus on the need to reorganize the couple relationship more than fathers, given the new family structure. The narratives of mothers are focused on the need to look for and find a balance in the relationship with the father of the baby, called "dad" and not "partner" or "husband". The words "crisis" and "life" underline that the new mothers recognize a turning point opportunity in the transition from the couple to the triad. In contrast, fathers are more focused than mothers on aspects related to the reorganization of everyday life, where the separation between home and work, day and night, is clear. The words used suggest how fathers tend to live in two disconnected dimensions: domestic and work.
Mothers and fathers focus on different issues, also regarding the transition process: while for mothers, two of the four themes are related to the memory of delivery, fathers refer their experience more to the difficulty of building confidence in their new role and of thinking for three.
The further analysis carried out by LIWC on the theme of childbirth is consistent with these results. It highlighted a different role played by mothers and fathers in this complex event. Specifically, while in the maternal narratives, the protagonist role of the woman emerges, underlined by greater use of the "I" (see "agency" in the previous T-Lab's analysis), different and interesting appears to be the role played by the father that has to face and manage two important tasks at the time of delivery. In fact, if on the one hand, the father acts as a guarantor of the context, assuming a role of filtering of the information between the mother-child's dyad and the outside world (obstetricians, gynecologists and, more generally, the environment), on the other hand, he assumes the important role of serving as an emotional container for the "We", acting as a bridge between the "We" as a couple and the "We" as a triad. Moreover, the fact that fathers have referred more than mothers to the relational ("other" and "social") dimensions underlines the importance of this role. The father in telling about the birth not only focused on "We" but also on other partners confirming his role as mediator with the world outside the couple (Compare in this respect what had emerged from the analysis with the T-LAB) Therefore, the results of this study highlight an interesting aspect. While the role of the mother seems to be in line with what is reported in the literature, in which she is the protagonist at the time of the birth of the child [9,21], the role of the father is of particular importance for the way in which it favors the development and evolution of the "three-way thinking" process by bringing the "We" and the "others" components into the couple.

LIMITATION
Despite the undeniable interest in the results, this study presents some limitations. First, it is possible that there are some methodological problems related to the nature of the small and culture-specific sample. The second limitation is the inclusion criteria. In particular, we selected only primiparous women with singleton and no-risk pregnancy. Moreover, our sample included only women who experience a natural delivery. Therefore, it would be interesting to include a more heterogeneous sample of couples, in order to give greater validity to our results.
Despite these limitations, this study provides a contribution to the knowledge of the representation of transition to parenthood of new parents. In particular, the present study highlights the connections and the differences in the points of views of mothers and fathers on this crucial life-challenging moment. The narrative design of the present study is in line with the narrative task of new parents, characterized by the need to reconstruct the story of their transition to parenthood and to give it meaning [31 -35].

CONCLUSION
In conclusion, our results highlight that childbirth represents an important turning point that requires continuity from thinking for two to thinking for three. In this process, both parents have to face three crucial issues concerning: giving meaning to the childbirth experience, reorganizing family life, and managing the newborn. Our results have relevant clinical and social implications, emphasizing the importance of supporting new parents during the entire perinatal period, helping them to connect their pre-and postnatal experience, and supporting them, starting from a personalized evaluation of their specific needs as they emerge, using a narrative medical approach.

ETHICS APPROVAL AND CONSENT TO PARTI-CIPATE
The Ethical Committee of the Local Health Authorities (CEAVNO) Florence, Italy approved the study under ethical approval no. (n.12749/2018).

HUMAN AND ANIMAL RIGHTS
No Animals were used in this research. All human research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2013.

CONSENT FOR PUBLICATION
Informed consent was obtained from all individual participants included in the study.

AVAILABILITY OF DATA AND MATERIALS
The data that support the findings of this study is available from the Laboratory of Methods and Techniques of Illness Experience Analysis (MeTA-Es), Department of Psychology -University of Florence, Italy.

CONFLICT OF INTEREST
Dr. Andrea Smorti is the Editorial Board Member of The Open Pyschology Journal.