Father Trials: Video Feedback and Prenatal and Postnatal Parenting

We propose to conduct a randomized controlled trial (RCT) with a
between-subject design in a critical phase of parenthood: the transition to
having the first baby. We focus on the 50% of parents who have been neglected
in parenting research and *until recently- in family policies: fathers. In most
western countries fathers have increased their participation in parenting over
the past decades. And even though in most families the participation of fathers
in child rearing is modest, the parental role of fathers is highly relevant for
child development (e.g., Kok et al., 2015; Ramnchandani et al., 2005). We will
test the effects of a prenatal version of the Video Feedback Intervention to
promote Positive Parenting (VIPP, Juffer et al., 2008) on fathers* hormonal
levels, on their processing of infant signals, and on their parenting behavior,
including the quantity (involvement) and quality (sensitivity) of father-child
interaction. The proposed study tests whether exposure to and interaction with
the unborn infant increase the father*s involvement during pregnancy and after
birth. A special focus is on a dimension of parenting that has received
considerable attention in animal research but, despite its evolutionary
importance, not in studies on humans: the role of the parent as protector.

In this RCT the following hypotheses will be tested:
1. The Prenatal Video Feedback Intervention to promote Positive Parenting
(VIPP-PRE) results in different hormonal, neural, and behavioral responses to
infant stimuli and video clips designed to elicit protective parenting
2. VIPP-PRE promotes fathers* parenting in terms of quantity (involvement) and
quality (sensitive interaction)
3. VIPP-PRE affects fathers* basal hormonal levels (i.e. oxytocin, vasopressin,
cortisol, estradiol, and testosterone), which in turn may mediate neural and
behavioral effects.

Secondary objective
We will examine the extent to which effects of the VIPP-PRE intervention are
moderated by fathers* early childhood experiences. Although fathers* early
childhood experiences are known to moderate the effects of nasally
administered oxytocin, it is not yet clear whether this also holds for
endogenously produced oxytocin.

The RCT includes an experimental group and a control group, and will be
conducted during pregnancy (i.e. gestational age 20-30 weeks). The
interventions start 1-2 weeks after the pretest. The first posttest is
administered 1-2 weeks after the intervention, and a follow-up 5-6 months later
(i.e. infant is 8 weeks old).

The VIPP-PRE consists of three sessions between the 21th and 30th week of
pregnancy. Parents are seen by an intervener and a prenatal ultrasound
professional. The sessions take place every 1-2 weeks and last for
approximately one hour. Fathers will be invited to interact with the fetus both
verbally and by touching and softly massaging the infant through the mother*s
abdominal wall. The baby*s behavior will be made visible through ultrasound.

There are no risks associated with the assessments used in this study. No
adverse effects have been reported in participants/patients undergoing MRI at
the currently available field strengths. The burden associated with
participation (producing ten saliva samples, three visits to the LUMC, three
intervention sessions, online and app questions) has been approved by the
Toetsingscommisie Ethiek Pedagogische Wetenschappen (see ECPW2017-170). The use
of non-medical prenatal ultrasound in this study is strictly regulated and
considered safe.
Once we understand the neurobiological underpinnings of good-enough and
poor parental sensitivity and protection, better attempts can be made to
improve parenting and reduce the adverse effects of poor parenting. Thus, the
importance of the benefits gained from this research outweighs the minimal
risks involved.