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Contents lists available at SciVerse ScienceDirect

International Journal of Nursing Studies
journal homepage: www.elsevier.com/ijns

Fatherhood and suffering: A qualitative exploration of Swedish men’s
experiences of care after the death of a baby
J. Cacciatore a,*, Kerstin Erlandsson b, Ingela Rådestad c
a

School of Social Work, Arizona State University, AZ, USA
School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
c
Sophiahemmet University College, Stockholm, Sweden
b

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 24 May 2012
Received in revised form 14 October 2012
Accepted 26 October 2012

Background: This study was designed to evaluate fathers’ experiences of stillbirth and
psychosocial care.
Methods: Data were collected between 27 March 2008 and 1 April 2010 via a
questionnaire posted on the homepage of the Swedish National Infant Foundation. The
responses to the following open-ended questions were analyzed using content analysis:
‘‘Are you grateful today for anything that health care professionals did in connection with
the birth of your child?’’ and ‘‘Are you sad, hurt or angry today about something personnel
did in connection with the birth of your baby?’’.
Results: 113/131 (86%) fathers reported feelings of being grateful. Only 22/131 (16%)
fathers reported feeling sad, hurt, or angry. Fathers expressed gratitude when health care
professionals treated their newborn ‘‘with respect and without fear’’, ‘‘with extraordinary
reverence’’, and when their fatherhood was validated by providers. They were also grateful
when providers helped them to create memories of their baby. Fathers also reported
feeling sad, hurt, or angry when providers were nonchalant and indifferent and when they
perceived providers to be uncaring and disrespectful toward their baby.
Conclusion: Bereaved fathers experience overall gratitude for person-centered psychosocial care in the aftermath of stillbirth, particularly when they feel validated as a grieving
father and their child is acknowledged with reverence.
Clinical implications: Health care professionals should support fathers by treating the baby
who died with respect and dignity and by validating and acknowledging both his grief
experiences and his fatherhood just as they would for a grieving mother.
ß 2012 Elsevier Ltd. All rights reserved.

Keywords:
Death of a baby
Grieving fathers
Psychosocial care
Stillbirth

What is already known about the topic?
 Grieving mothers prefer person-centered care in the
aftermath of stillbirth.
 The literature reports differences in mourning outcomes
based on gender of parents.
 Fathers emotions are often overlooked in their grief
experiences, often relegated to being a caretaker for the

* Corresponding author. Tel.: +1 602 496 0073.
E-mail addresses: joanne.cacciatore@asu.edu, jcaccia@me.com
(J. Cacciatore).

mother. This occurs from family members and from
providers. This puts them in a double bind wherein they
feel compelled to remain strong and yet be willing to show
emotional vulnerability in the aftermath of a baby’s death.
What this paper adds
 Most fathers also report feeling grateful for personcentered care provided to them by providers following
perinatal death.
 Only a small percentage of fathers (16%), felt negative
emotions about the ways in which they were treated by
providers following the death of a baby.

0020-7489/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijnurstu.2012.10.014

Please cite this article in press as: Cacciatore, J., et al., Fatherhood and suffering: A qualitative exploration of Swedish
men’s experiences of care after the death of a baby. Int. J. Nurs. Stud. (2012), http://dx.doi.org/10.1016/
j.ijnurstu.2012.10.014

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 Fathers feel deep grief upon the death of a baby, and they
experience a lack of regard or callousness toward their
grief and their babies as disrespectful.
 Conversely, when providers treated the baby with the
same ‘‘reverence’’ as a live-born child, men reported
feeling validated and experienced gratitude for the
compassion and professionalism of providers.
Each of us has his own rhythm of suffering.
-Roland Barthes
1. Introduction
While grief in general has been widely studied in
psychological research, much less is known about the ways
in which men, as fathers specifically, experience loss, grief,
and social support.
Because mothers gestate and give birth, much of the
literature on perinatal death has focused on maternal grief
and morbidity, while some studies have been comparative
along gender lines. Specific to perinatal death, when
compared to mothers, fathers consistently report fewer
grief symptoms and less anxiety (Barr, 2004), however,
trauma symptomatology in the aftermath of a baby’s death
is a risk identified in the literature for both genders
(Badenhorst and Hughes, 2007). Littlefield and Rushton
(1986) evaluated the reaction of parents to the death of a
child through the perspective of sociobiology. In their
study of 263 bereaved parents, they concluded that
mothers express more grief than fathers, maternal grandmothers grieved more than maternal grandfathers, and
paternal grandmothers grieved more than paternal grandfathers. Mothers seem to have more intense emotional
reactions with the exception of avoidance and meaningmaking (Wing et al., 2001), and this has implications for
grieving fathers.
1.1. Fathers as invisible protectors
Perhaps as a consequence of mothers’ tendency toward
emotional expression, fathers reported both peripheral
and endogenous pressure as protector, feeling neglected in
their own experiences of grief. In general, grieving fathers
experience a ‘‘double bind’’: social pressure to remain
‘‘strong’’ as caregivers for their partners while they also felt
pressured to be more emotionally expressive. Fathers
reported avoidance tendencies, blocking negative
thoughts, task centered coping, and solitary grieving,
allowing emotional expression only in private settings
(Cook, 1988). Cook (1998) recommends a model of father’s
grief which is not based on an emotioncentric, feminine
style.
Yet, this tendency to focus on the feminine expression
of grief is apparent in the small body of academic research
on fathers and, also, in hospital practices where men often
cite feeling that their experiences of loss were overlooked,
invisible, or invalidated (Kavanaugh et al., 2004; Lang et
al., 2011; Weaver-Hightower, 2011). Fathers report feeling
neglected by providers, reporting that others, namely
nurses, family, and friends, tended to view the father in a
primarily supportive role for the benefit of the mother

(McCreight, 2004). Because they are perceived to have
lesser grief than mothers, these perceptions often result in
minimal support directed toward fathers or, perhaps,
diminished understanding about the ways in which men
experience a baby’s death. In turn, this may exacerbate
already salient relational stressors between partners
(Wing et al., 2001).
1.2. Discordant grieving styles
Indeed, gender differences in the expression of grief and
thus the perceived need for support, beginning with
hospital provider care, may contribute to marital disharmony and discordant grieving. These risks can be better
managed with the aid of healthcare providers through
early interventions such as naming and holding the baby,
psychoeducation, support groups, and rituals that bring
parents together toward shared goals of remembering the
baby who died (Lang et al., 2011; Wing et al., 2001).
Zeanah et al. (1995) found that family support and ego
strength were the most salient predictors of symptoms,
and in about 25% of the families, fathers expressed more
grief than their partners. Additionally, defensiveness was
the best predictor of difficulty in coping for fathers.
Yet, some research on paternal grief tells a more
nuanced story than merely difference in the expression of
grief based on gender. Because the mother endures birth
and a physical recovery process, a father’s emotional
reaction may be delayed due to external demands such as
caring for surviving children, hospital protocol, funeral
arrangements, and the need to protect his partner (Callan
and Murray, 1989). The responsibility to maintain family
income may cause some fathers to overwork and become
preoccupied with work as a means of distraction from their
grief. Additionally, fathers may experience a need to
remain strong, so as not to burden their partner with their
own distress. And, because some bereaved fathers are
reluctant to join a support group and report that peers
were not open to helping them grieve (O’Leary and
Thorwick, 2006), they may end up bearing much of the
burden of their grief alone. As such, fathers also report
diminished cognition which may affect their ability to
work, as well as emotional states of guilt, shame, anger,
and death avoidance (Barr, 2004; Callan and Murray,
1989). In response to these considerations, Callan and
Murray (1989) assert the need for doctors to shift roles
from providers of medical care to highly person-centered
counseling following the death of a child, noting that
consistent findings support the idea that grief reactions are
influenced by their interactions with parents.
1.3. A father’s pain and provider responses
Fathers indeed do suffer after the death of a baby, albeit
sometimes expressed differently than mothers. Fathers’
expressions of loss after perinatal death can be divided into
discrete categories: their visual images and memories of
the baby’s death, self-blame, identity and/or role confusion, the desire for social recognition and validation of their
fatherhood, playing a supportive role to their partners,
and their perception of hospital provider’s practices

Please cite this article in press as: Cacciatore, J., et al., Fatherhood and suffering: A qualitative exploration of Swedish
men’s experiences of care after the death of a baby. Int. J. Nurs. Stud. (2012), http://dx.doi.org/10.1016/
j.ijnurstu.2012.10.014

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(McCreight, 2004). Using in-depth interviews conducted
within five years of the death to address the father’s
perspective of stillbirth, Worth (1997) found fathers to be
preoccupied with their transition into fatherhood and the
implications of a stillbirth on their fatherhood. Some
expressed a willingness to sacrifice their own life for their
child. Fathers reported many moments of affection and
attachment behaviors such as counting toes, looking for
facial and other physiological similarities, and/or comparing their stillborn child to their living children. However,
fathers also reported that the administrative details, often
related to final disposition and autopsy forms, felt
inappropriate and untimely, often shifting their perception
of provider care toward the negative. This can have lasting
effects on a man’s bereavement trajectory. Like mothers,
fathers report that negative hospital care often influenced
their grief reactions and processes.
Another significant source of distress for men is the
ambiguity of fatherhood when a baby dies (McCreight,
2004). Bereaved men questioned whether or not they
should consider themselves fathers, and when they were
treated by providers as such, they reported feeling
satisfaction and validation. Some reported satisfaction in
the opportunity to discuss their experiences and to take
the lead in tangible rituals such as funeral services for their
child. Similar to other studies, McCreight (2004) found that
both parents appreciated the opportunity to interact with
their dead child. However, unlike other studies, which have
emphasized gender differences in grief expressions men
and women, this study found more similarities for both
sexes. Similarly, O’Leary and Thorwick (2006) found that
fathers felt overlooked by providers’ verbal (i.e. asking how
the mother is doing) and non-verbal cues. Research is thus
mixed and many are asserting that father’s grief is not less,
rather qualitatively different, from mother’s grief (Stinson
et al., 1992; Wing et al., 2001), an important point for
healthcare providers to recall when considering the ways
in which bereaved parents, both mother and father, should
be care for while in the hospital. This applies to the
expression of grief, social support, and bonding rituals with
the baby who died. However, there exists only a few, small
studies which explore the effect of social support and ritual
particularly with fathers.
Samuelsson et
al. (2001) found that fathers do
appreciate an opportunity to actively mourn their child,
including holding and seeing the baby and collecting
mementos. They also expressed a general feeling of
frustration and helplessness while unable to protect their
partner from emotional pain. In addition, they felt reliant
on providers to make decisions and expressed a general
sentiment that their emotional needs were ignored. In a
small pilot study of grieving fathers, Aho et al. (2011)
found that supportive psychosocial care, peer contact, and
resource provision yielded positive outcomes over a
control group. This collaborative approach was perceived
positively by fathers in the study in helping them cope
with their motional experiences.
This study was designed to explore the experiences of
grieving fathers in relation to their healthcare providers
and the birth and death of their babies. This research
focuses on psychosocial care during the first decade of the

3

21st century, and it is important to note that no significant
changes in such practices have occurred during this period
in Sweden.
2. Methods
2.1. Study design, data collection and participants
We made information about the study available at the
website of the Swedish National Infant Foundation, an
organization providing support to parents. A questionnaire
was available online at this site. The data were obtained
electronically, and inclusion criteria were fathers who had
experienced the death of a baby to stillbirth after the 22nd
week of gestation at some time from the year 2000 until 1
April 2010. The participating fathers gave their informed
consent at the webpage and participated anonymously.
The Regional Ethics Committee, Lund, approved the study,
Dnr. 467/2006.
2.2. Questionnaire
The web questionnaire was driven by clinical experiences and a thorough review of relevant literature and
consisted of 82 items covering demographic information
and topics related to the birth of a stillborn baby. These
outcomes helped to determine inclusion criteria for
analyses of the primary, open-ended questions used for
this paper. For example, one question inquired as to whether
or not the father present at birth. Another question asked
specifically about his contact with the baby. Yet, another
asked about the baby’s gestational age. The questionnaire
took an average of 20 min to complete. The questions
posited were both open-ended and multiple choice, and
fathers could from multiple answers. They were encouraged
to write fluently about their experiences with healthcare
providers in two open-ended questions. This analysis was
conducted on the only two open-ended questions.
2.3. Analysis
Data were derived from the original Excel questionnaire. Qualitative, inductive manifest content analysis was
used for analyzing the text from these specific questions:
‘‘Are you grateful today for anything that the health care
professionals did for you in connection with the birth of your
child?’’ and ‘‘Are you sad, hurt or angry today about
something personnel did in connection with the birth of your
baby?’’ (Elo and Kyngäs, 2008). Among the fathers who
fulfilled the inclusion criteria for this study, there were a
total 135 responses to the two questions. The responses for
each question were read and re-read several times (i.e. 113
responses to the question about ‘‘gratefulness’’ and 22
responses to the question about being ‘‘sad, hurt or angry’’,
for what health care professionals did in connection to the
stillbirth). Thereafter, the manifest content of a sentence or
a longer paragraph was labeled with one of the codes/
statements that emerged inductively during the process of
analyses of all text for respective question. The codes/
statements were discussed by two of the authors to ensure
consistency and thereafter formed into six categories,

Please cite this article in press as: Cacciatore, J., et al., Fatherhood and suffering: A qualitative exploration of Swedish
men’s experiences of care after the death of a baby. Int. J. Nurs. Stud. (2012), http://dx.doi.org/10.1016/
j.ijnurstu.2012.10.014

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Table 1
Statements sorted into categories and number of fathers in each category.a
Category
Gratitude
Providers supported fatherhood
n = 104
Confirmation and consideration of the child
n = 34
Preservation of the memory of the baby
n = 31
Sad, hurt, or angry
Being met with nonchalance or coldness
n = 12
Unsympathetic and insensitive
n=9
Disrespect toward the baby
n=6
a

Statements
The really invited me to take part as a father and treated me with consideration.
They took the time to pay attention to me alone when I was out in the hallway for a moment.
They showed tenderness and used the baby’s name.
The footprint is worth a lot to us now. The same is true for the little cuddly animal that she
had with her during the time we were together in the hospital.
The physician who delivered the baby was appalling and behaved inhumanely.
The physician who reported the death did so in a very cold way.
A staff member who went by the baby without seeing him.

One father can be in more than one category.

three for each question. These categories emerged during
the process of analysis according to similarities and
differences in the text (Table 1).
3. Results
In all, 159 fathers who had lost a child sometime
between 1970 and 2010 completed the web questionnaire.
Of those, 131 fathers fulfilled the inclusion criteria as they
had experienced a stillbirth after the 22nd week of
gestation at some time from the year 2000 until 1 April
2010. The majority of the fathers answered the questionnaire within two years after their loss, with 76%
experiencing the death of a baby between 2006 and
2010 (n = 99). The remaining 24% (n = 32) experienced the
loss between 2000 and 2005. Almost all fathers (95%) were
present during the birth of their baby, all of them saw their
child within 30 min after birth, and 102 (78%) held their
child. A total of 14% (n = 18) fathers did not report feeling
grateful for anything that the health care professionals had
done in connection with the birth, and 86% (n = 113)
reported feelings of gratitude. In total, 109 (84%) of fathers
did not report feeling sad, hurt, or angry for something
personnel did in connection with the birth of their baby.
Only 16% of fathers conveyed that they felt sadness, anger,
or being hurt by something a provider had done in
connection with the birth of their child. There were no
significant differences in the data based solely on time
since loss.
3.1. Gratefulness for something that the health care
professionals did in connection with the birth of the child
Of the 86% of fathers who expressed gratitude for
provider care, the dominant recognition was around the
degree of provider compassion and professionalism. These
statements were often accompanied by descriptions of the
providers as ‘‘professional, accustomed to providing help,
well prepared, calm, unafraid, considerate, displayed presence
of mind and were not stressed, attentive and gave of their
time, and prepared’’. Personnel were described as ‘‘empathic, fantastic, supportive, gentle, understanding, wonderful,
tender, compassionate, warm, respectful, kind, attentive,

helpful, understanding, proficient super, good listeners, and
willing to help’’. An overriding theme was formulated:
Gratitude for the compassionate professionalism of
providers with the subcategories: (1) supported fatherhood, (2) confirmation of and consideration for the child,
and (3) acquisition and preservation of memories related
to the loss.
3.2. Health care professionals supported fatherhood
The category ‘‘Health care professionals supported
fatherhood’’ consisted of statements from 104 fathers.
Health care professionals supported fatherhood by facilitating postmortem rituals such as seeing the birth of baby
who died as the birth of a real child, worthy of dignity and
respect, and they legitimized his fatherhood as if the baby
had been born alive.
They invited me in as father and also thought about me.
They took the time to think only of me when I was
momentarily in the corridor in their presence (Loss in
2009).
They really were there to help and always available to do
so. I was just as pampered as my wife was. The staff made
us feel as though we were exactly like all the other couples
having a baby (Loss in 2010).
3.3. Confirmation and consideration of the child
The category ‘‘Health care confirmation of and consideration for the child’’ consisted of statements from 34
fathers. Fathers were thankful that health care providers
treated their baby as if she or he were alive. This was
demonstrated by the positive comments made by the
providers about the baby to the parents.
I appreciate that the nurse who was with us at the delivery
treated our little girl with respect and without fear (Loss in
2008).
They showed tenderness and used the baby’s name (Loss
in 2010).

Please cite this article in press as: Cacciatore, J., et al., Fatherhood and suffering: A qualitative exploration of Swedish
men’s experiences of care after the death of a baby. Int. J. Nurs. Stud. (2012), http://dx.doi.org/10.1016/
j.ijnurstu.2012.10.014

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They spoke of him as they might speak about any of the
babies. They put a diaper on him (Loss in 2008).
They treated our daughter with extraordinary reverence.
(Loss in 2008).
3.4. Preservation of the memory of the baby
The category ‘‘Acquisition and preservation of memories related to the loss.’’ consisted of statements from 31
fathers. Fathers were thankful that health care providers
allowed and encouraged memories through hand and foot
prints, photographs, and locks of hair.
The footprint is worth a great deal now. The same is true
for the little cuddly animal she had with her during our
time in the hospital (Loss in 2010).

5

health care providers were insensitive in the death
notification process.
The reception we got when we were confronted by the
delivery and the staff said that he was dead. A physician
showing no feelings, who just left us alone in the room
without giving us any answers about what would happen
next. We were alone, not knowing if we should go home,
remain there, complete the delivery or if an incision was to
be made (Loss in 2010).
The staff member who had done the ultrasound examination and said that the baby was dead. They were
unbelievably clumsy and insensitive and did not give us
any information or guidance. You can go home now and
come back tomorrow morning. Goodbye! (Loss in 2010)
3.8. Disrespect toward the baby

Footprints and handprints, a lock of hair, a card. That they
saw to it that the baby was photographed. We ourselves
never thought of this, but the cards are now our most
treasured mementos (Loss in 2010).
3.5. Sad, hurt, or angry about something personnel did in
connection with the birth
Of the 16% of fathers who conveyed that they felt
sadness, anger, or being hurt, the dominant theme stated in
their comments was they felt their fatherhood went
unrecognized or invalidated with the categories: (1) being
met with nonchalance or coldness, (2) unsympathetic and
insensitive confirmation of the baby’s death, and (3)
disrespect toward the baby (Loss in 2010).
3.6. Being met with nonchalance or coldness
The category ‘‘Being met with nonchalance or coldness’’
consisted of statements from 12 fathers. The fathers were
sad, hurt, or angry when health care professionals did not
recognize and validate them as a father or did not show
sensitivity during their traumatic loss.
In contrast with the midwife, the physician we overall had
the most contact with did not listen to me. Feels typical,
they (caregivers) say that they think it is really important
that the fathers take part, but then they completely fail to
show any interest, except when they respond with
sarcastic remarks or humiliate us (Loss in 2009).
A female physician met me with the attitude that the loss
was not as sorrowful for me as for my wife (Loss in 2010).
The first physician was totally cold and said to my wife that
she should stop acting like a baby (Loss in 2008).
3.7. Unsympathetic and insensitive confirmation of the
baby’s death
The category ‘‘Unsympathetic and insensitive confirmation of the baby’s death’’ consisted of statements from
nine fathers. The fathers were sad, hurt, or angry that

The category ‘‘Disrespect toward the baby’’ consisted of
statements from six fathers. The fathers were sad, hurt or
angry when health care professionals did not treat their
baby with respect as a person.
They did not call the baby ‘‘baby’’, but rather ‘‘fetus’’, and
that was clearly exact but on the wrong side of the
‘‘boundary;’’ for me the baby was a baby and would
therefore I would have preferred that the baby had been
called that, whatever the correct medical terms were (Loss
in 2010).
Some staff member who went by the baby without looking
at him (Loss in 2008).
3.9. Summary of the analysis of the replies to the two open
questions
Insensitive treatment was the primary reason for
fathers perceived transgressions and subsequent psychological distress. Frequently, it was a single individual’s
behavior that was described as ‘‘unfeeling’’ and lacking in
empathy. The majority of the fathers expressed their
gratitude for something that the provider had done in
connection with the birth of their child. This gratitude
primarily had to do with the fact that providers helped
fathers feel like fathers, acknowledging their parental role
for a longed-for baby. They also appreciated when
providers treated their stillborn babies with the same
dignity and respect as a live-born baby. The result may be
summarized in the following quotation by one of the
participants:
They treated him as a real baby, smiled at him,
complimented his appearance, patted his cheek, and
talked about him. They took him rather soon to the
photographer so we got a life-long pictorial memory. They
gave us hand and footprints. The talked with us and guided
us through difficult questions, for example concerning
autopsy, about talking with a medical social worker and
minister, about how we were going to feel later. We got an
information brochure and a book about losing a child. We

Please cite this article in press as: Cacciatore, J., et al., Fatherhood and suffering: A qualitative exploration of Swedish
men’s experiences of care after the death of a baby. Int. J. Nurs. Stud. (2012), http://dx.doi.org/10.1016/
j.ijnurstu.2012.10.014

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were able to borrow a digital camera and we got
everything on a CD. I am extremely grateful for all of
this. Most of all that the midwife who had the greatest
responsibility for taking care of us saw me as a father and
talked just as much with me (as with my wife) and about
being father of a son (Loss in 2008).
4. Discussion
Consistent with previous research, several men in this
study clearly experienced ‘‘feeling ignored and unacknowledged as a legitimately grieving’’ father (Lang et al., 2011,
p. 191). Yet, they consistently expressed their gratitude for
highly person-centered psychosocial care and when they
felt supported and validated in their fatherhood. They were
also grateful when providers treated their baby as any livenewborn, helping them to create memories with their
baby. Further, when met with perceived nonchalant and
detached psychosocial care, and when providers were
deemed uncaring and disrespectful toward the baby who
died, fathers reported feelings of sadness, hurt, and anger.
Defey (1995) analyzes the particular difficulty facing
health care providers when caring for parents experiencing
perinatal death. Often times medical providers are
insufficiently prepared to deal with death, inciting
experiential avoidance. This, in turn, may result in actually
avoiding, not only merely the experience, but also the
bereaved parents themselves. She attributes perceived
transgressions to the medical provider’s own difficulty and
discomfort facing the death of a baby. Malacrida (1997)
found that parents reported providers as ‘‘insensitive’’ to
their needs and that they felt both rushed in their time
with the baby and pressured by providers to make
important end-of-life decisions.
Mothers and fathers may have more in common than
previously thought. Consistent with the findings in this
research on fathers, a recent study by Rådestad et al.
(2011) found that most mothers who gave birth to a
stillborn baby were grateful when the health care
providers facilitated postmortem rituals such as holding
and seeing the baby, photographs, and locks of hair.
Further, health care providers who validated and
supported bereaved mothers in their motherhood, despite the death of their babies, incited deep feeling of
gratitude for the mothers and may help alleviate
negative, long-term psychological outcomes (Rådestad
et al., 2011). Murray and Callan (1988) indeed found
higher self-esteem, lower depression, and improved
psychological well-being in bereaved parents associated
with satisfactory provider interactions. Satisfaction with
hospital interaction was the only predictor of lower
depressive symptoms, and higher levels of reported
happiness were correlated to the greater amount of time
since perinatal death. Cacciatore (2010) suggests that
humility, mindfulness, and nuance are immutable
aspects of person-centered care likely to benefit both
mothers and fathers. It is important, thus, to remember
that fathers may look to providers to recognize them as
such, and health professionals need to be aware of a
father’s experience of grief through validation, empathy,
and psychosocial care (Worth, 1997).

In the autoethnography, Waltzing Matilda, a father’s
story about the death of his baby to stillbirth, WeaverHightower (2011) sensitively describes his profound
sadness and awe:
Her body was not disgusting, as we feared, but instead
miraculous, strange and wonderful. . . Seeing and
holding her brought both intense pain and great joy
at once. Perhaps this and other stark dualities—the body
as beautiful and horrible, simultaneously saying hello
and goodbye, giving birth but leaving with empty
arms—best define the experience of stillbirth (p. 9).
He goes on to describe the importance of mementos:
Matilda’s hair, the yellow comb used for her hair, a small,
silver ring ‘‘worn only for a few hours’’, a cast of her right
hand, and more and more ‘‘proof’’ that she existed and of
his fatherhood to her (p. 14). He closes the article with
Matilda’s legacies: perspective, courage, and other things
for which he expresses gratitude. But mostly, it appears, for
just ‘‘becoming her father’’ (p. 24).
4.1. Limitations
The web questionnaire completed by the fathers was
posted on the homepage of the Swedish National Infant
Foundation, and the fathers were thus self-recruited. The
anonymity of an Internet questionnaire increased participation rates and gave respondents an opportunity to
openly express their feelings and experiences without fear
of judgment or reprisal. It is also important to note that
Sweden has a long tradition in the provision of psychosocial care, clinical practice, and research in this area. This
trend is likely to have influenced the outcomes of this
study and may not represent global perspectives on
psychosocial care after stillbirth. The results in this study
are from a single selected group of fathers from one
country and results may be different in countries where
maternity care routines and guidelines differ from those in
Sweden. Thus, this is a non-generalizable sample. In
addition, cultural variation related to death and dying
rituals needs to be considered. Still, through the process of
careful data collection and qualitative analyses, this study
adds to the small but growing body of literature on
grieving fathers after the death of a baby or child.
5. Conclusion
Though much more is known about grieving mothers, it
seems that in many ways, grieving fathers desire the same
degree of psychosocial care as mothers. While most fathers
report feeling grateful for person-centered care provided
to them by providers following perinatal death, a small
percentage of fathers (16%) felt negative emotions about
the ways in which they were treated by providers,
particularly when they felt invalidated, ignored, and
overlooked in the grief experience. More importantly,
they resented when providers did not treat their baby with
dignity and reverence. Fathers experience deep grief upon
the death of a baby, and they perceived a lack of regard or
callousness toward their grief and their babies as

Please cite this article in press as: Cacciatore, J., et al., Fatherhood and suffering: A qualitative exploration of Swedish
men’s experiences of care after the death of a baby. Int. J. Nurs. Stud. (2012), http://dx.doi.org/10.1016/
j.ijnurstu.2012.10.014

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J. Cacciatore et al. / International Journal of Nursing Studies xxx (2012) xxx–xxx

disrespectful. Conversely, when providers treated the baby
with the same ‘‘reverence’’ as a live-born child, they
reported feeling validated and experienced gratitude for
the compassion and professionalism of their healthcare
providers.
6. Clinical implications
Healthcare providers should support both parents after
the stillbirth of a baby. They can focus on validating a
grieving man’s fatherhood by treating the stillborn baby
with the same respect and dignity as they would a liveborn baby. Ways to do this might be through important
rituals such as seeing and holding the baby, allowing and
encouraging the father to participate in making decisions,
using the baby’s name and treating the baby tenderly, and
referring to him as a father.
Conflict of interest
None declared.
Funding
None declared.
Ethical approval
The Regional Ethics Committee, Lund, approved the
study, Dnr. 467/2006.
Acknowledgement
We would like to express our thanks to the fathers who
participated in this study.
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Please cite this article in press as: Cacciatore, J., et al., Fatherhood and suffering: A qualitative exploration of Swedish
men’s experiences of care after the death of a baby. Int. J. Nurs. Stud. (2012), http://dx.doi.org/10.1016/
j.ijnurstu.2012.10.014