Illustration by Abigail Goh Photography by Gregg Goldman

“It was a lonely experience.” That’s how Dave Barylski remembers the long hours at his babies’ bedsides. Twins, the girls were born in April 2019 weighing just more than 1 pound each after birth at 22 weeks of gestation. Barylski and his partner, Bethany Watkins, practically lived in the newborn intensive care unit (NICU) at St. Louis Children’s Hospital for seven months—and he was often the only father in the unit. “I was lucky that my job offered paternity leave and extended family leave so I could be there, but being a dad in that situation, I had to piggyback off the services that are usually focused on moms,” he says. “I was the only father there during lunches and in the support groups that were clearly aimed at moms’ needs.”

Jesse Davis, MD, neonatal hospitalist at the Women & Infants Center, a partnership by Barnes-Jewish Hospital, St. Louis Children’s Hospital and Washington University Physicians, noticed Barylski’s situation. “In my work with families of critically ill babies, it’s the moms who are usually there all the time, and there’s a lot of direct engagement with those mothers, which is absolutely necessary. But what about the fathers?” he asks. “I had noticed that we tended to see the dads only when we moved the babies to the NICU after delivery, and in many cases that was our only real engagement with the fathers. I decided to change that because these dads deserve to be seen.”

Creating a Community

Davis began considering new ways to approach and involve fathers who were helping to care for infants in the NICU. He wanted to provide them with paternal services in the hospital setting, as well as connect them with valuable community resources. The result of Davis’ intentions was a small pilot program called the Fathers First Initiative. Fathers participating in the initial program responded so positively that Davis is now seeking grant funding and working with colleagues at the Brown School at Washington University in St. Louis to quantify results and expand the project.

Fathers First helps promote equity and equal access to support services, Davis notes. And when dads are involved in newborn care, infant development is positively affected. “Improving engagement with fathers allows them to share in the experience and increases the odds that their babies will have good outcomes,” he says. Paternal involvement also helps decrease the incidence of maternal depression and anxiety.

Yet for many fathers of newborns in the NICU, where premature or critically ill babies often stay for months while they receive life-saving care, being present is a luxury they can’t afford. Unlike Barylski, many fathers cannot take time off work and are needed to assist with household duties and care for older children. Recognizing these challenges and barriers spurred Davis to create partnerships with community organizations that offer father-focused services.

Davis first identified St. Louis Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) as a Fathers First partner organization. This nonprofit is one of several collaborative programs working with umbrella organization Vision for Children at Risk, which “promotes the well-being of children, youth and their families.”

Davis began the collaboration by attending Project LAUNCH’s Fathers’ Cafe, a monthly event taking place online. “It brings dads together to talk about parenting, to consider ways they can take better care of their children and themselves,” he says. “I worked with the event team to find speakers for Father’s Cafe, and we began inviting NICU dads to participate. It’s a safe space for them to share their struggles and offer advice. As I watched these events and the participants, I knew that connecting NICU and community dads would be beneficial.”

Davis then identified additional community partners, including Raising St. Louis, a St. Louis Children’s Hospital program that connects families with community resources and educational programs; Fathers & Families Support Center, which helps noncustodial fathers become involved and supportive parents; and Generate Health, which works to advance racial equity in pregnancy outcomes, family well-being and community health.

“Each community partner brings a specific service to Fathers First and our NICU dads. Our goal with these partnerships is to develop a program that provides fathers with knowledge and support,” Davis says.

Making connections

Jessee Davis, MD, of Fathers First, chats via Zoom with Dave Barylski, a Fathers First mentor, and one of Barylski’s daughters.

Barylski’s daughters had “graduated” from the NICU by the time Davis began developing the Fathers First Initiative. However, recognizing that peer support would be a valuable resource, Davis asked Barylski to work as a mentor, or “dad champion,” for fathers in situations similar to what he had experienced. “The girls had been home for about a year when Jesse called me, and I thought he was onto a great idea,” Barylski says. “He brought me in because I had been on the inside of the NICU experience, so we started by talking about what I felt was needed for other dads.”

Barylski had participated in “pretty much everything the NICU offered” while his daughters were being treated. But given the focus on mothers, he says, “we needed to change the mindset, to include dads in the equation, too,” he says. “There are a lot of practical things that a father needs help with when the mom is with the newborn.” For example, fathers may need guidance in managing unfamiliar household tasks, coping with potential loss of income, navigating insurance issues, and arranging for and providing childcare for older children at home.

After discussing the program with Davis, Barylski began calling NICU dads to offer his support and learn more about their needs. Those initial conversations created a baseline of information that helped identify priorities and trends. “One of the important things that we confirmed was that dads really do want to talk to other dads who have been in their shoes. It helps ease the sense of isolation—and feeling alone is the most common thing other dads in that situation experience,” he says.

Tailoring services

Once Davis had established relationships with community partners, NICU dads and clinical colleagues—including bedside nurses, social workers and other specialists—he was ready to build a menu of services. “We created a monthly ‘Dad Club,’” he says, “and are getting assistance from our BJC HealthCare mental health providers and those from Generate Health to plan self-care days for dads.” One of the key messages these events offer is that self-care enhances personal health, as well as the family’s. Other Fathers First events have included virtual Super Bowl and NBA playoff watch parties, during which Washington University Perinatal Behavioral Health Service providers are available to answer questions and encourage conversation—all in a low-pressure, social setting.

As the Fathers First Initiative took off, community partners and others involved in the early planning began encouraging more dads to participate. The initiative was gaining momentum, which led Davis to the next phase of program development. “In science, if you want to grow a project, you need to document the results,” he says. “The second phase of Fathers First is focused on gathering data and evaluating it.”

Tyriesa Howell, assistant professor at the Brown School at Washington University, began collaborating with Davis on the research component of the project in March 2021. Howell notes that she is particularly interested in work that addresses health-care disparities. “I was looking for opportunities to address those issues. When I learned about the Fathers First Initiative and its efforts to expand, I felt a connection with its goals.”

Currently, Davis and Howell are pursuing grants and other funding sources that will allow them to formalize the initiative’s design and delivery, document measurable outcomes and develop long-term goals. ““We’ve submitted a proposal to Washington University’s Institutional Research Board to begin data collection, initially through focus groups,” Howell says.

Offering more

Thanks to the initiative’s positive, anecdotal feedback and early success, Davis and Howell envision creating a program that can be instituted within hospital NICUs throughout the U.S. “I’d like to see the program grow into a service that can support and serve parents, their families and NICU staff,” Howell says.

Davis adds that the initiative “feeds itself,” as fathers whose babies leave the NICU choose to work as peer mentors. “The primary outcome we’re looking for is improved mental health for moms and dads,” he says. “This is an important issue within children’s hospitals—beyond the NICU— and within communities.”

Once phase-two documentation is complete, Davis plans to focus the initiative’s third phase on advocacy, shining an ever-brighter spotlight on fathers’ needs in various health-care and community settings. “It’s rewarding to support fathers the way we do, to see the emotion on their faces as they make connections within the program and receive the support they need from their communities.” And he adds: “Fathers First allows caregivers, dads, community services and families to collaborate and make a real difference.”

Barylski’s twin daughters, Everlei and Rylei, are almost 3 years old now. “They’re doing great,” he says. “But I’ll never forget what those first months were like. I want other dads in that situation to know that support is there for them. This program brings a lot of warm hearts together to create a healing community.”