**Background:** The transition to parenthood is often accompanied by anxiety, but when a pregnancy is classified as high-risk—due to obstetric or medical complications that threaten the life of the mother, fetus, or both—the experience becomes markedly more stressful for both parents. While research on maternal experiences of high-risk pregnancy is growing, fathers' perspectives remain understudied. This scoping review aimed to map the existing literature on fathers' experiences of high-risk pregnancy, focusing on their well-being, interactions with healthcare, and support needs.
**Methods:** The review followed Arksey and O'Malley's five-step framework. Nine databases were searched via EBSCOHost: Academic Search Complete, APA PsychArticles, CINAHL Plus with full-text, Health Source: Nursing/Academic Edition, MasterFILE Premier, MasterFILE Reference eBook Collection, MEDLINE, SocINDEX with full-text, and eBook Collection. Search terms included "Father" OR "Dad" OR "Paternal" AND "High risk pregnancy" OR "Complicated pregnancy" OR "Medical high-risk pregnancy" OR "Birth complications" OR "Pregnancy complications." No date restrictions were applied (results spanned 1948–2022). Inclusion criteria were: studies focusing on fatherhood and high-risk pregnancy, peer-reviewed English-language articles with full-text access, and no limitations on cause of high-risk pregnancy or study design. Exclusion criteria included studies on absent fathers, those not specifically addressing high-risk pregnancy, and those reporting only mothers' perceptions of fathers' experiences. A four-pronged screening process (title, abstract, full-text, and reference mining) was conducted independently by all three authors. Data were charted using Microsoft Excel under headings: Authors, Aim, Research Context, Research Design, Sample Characteristics, and Key Findings. Narrative synthesis followed Popay et al.'s three-step approach: developing a preliminary synthesis, exploring relationships within and between studies, and assessing robustness.
**Key Results:** The initial search yielded 2190 hits; after removing 149 duplicates, 2041 titles were screened. 2007 articles were excluded, leaving 34 abstracts for review; 15 were excluded, leaving 19 full-text articles. Seven were excluded, and reference mining of the remaining 12 identified 2 additional articles; a second round of mining on those 2 yielded 1 more, for a total of 15 included studies. Of these, 11 were from high-income countries (4 from the US, 3 from Sweden, 2 from the UK, 1 from Germany, 1 from Taiwan) and 4 from low-middle-income countries (2 from Uganda, 1 from Malawi, 1 from Thailand). Study designs included 11 individual interview studies (one also included a focus group), 1 cross-sectional survey, 1 retrospective chart review, and 1 secondary data analysis of interviews. Sample sizes ranged from 4 to 788 fathers. Four themes emerged: (1) The father versus the healthcare professional and the hospital environment—fathers reported lack of communication, feelings of neglect, and exclusion from healthcare staff, leading to increased anxiety, powerlessness, and role ambiguity. The hospital environment was described as unwelcoming, with lack of privacy and facilities for men. (2) The impact of high-risk pregnancies on fathers—fathers experienced extreme stress, exhaustion, and mental health problems. Cole et al. found that 14% of fathers were at risk of Major Depressive Disorder, and 8.1% had elevated symptoms of both traumatic stress and depression. May reported that 30% of fathers had clinical levels of depression. Fathers often hid their emotions to appear strong, leading to burnout and long-term psychological scarring. (3) Redefining the role of 'father' after experiencing high-risk pregnancy—fathers reconstructed their identities, balancing roles as breadwinner, caregiver, and emotional supporter, often at the expense of their own needs. Hegemonic masculinity was a central theme, with fathers feeling pressure to remain strong and not seek help. (4) Focus on fathers: Recommendations for support during high-risk pregnancies—fathers emphasized the need for improved communication, honest updates, and inclusion in care decisions. They valued being invited to cesarean sections and receiving status updates. Some interviews occurred years after the experience, highlighting long-lasting trauma and isolation. Fathers requested stronger male networks and educational support.
**Clinical Implications:** The findings underscore the critical need for a family-centred approach that actively includes fathers in high-risk pregnancy care. Healthcare professionals should improve communication with fathers, provide clear information, and acknowledge their trauma and support needs. Hospitals should create welcoming environments with facilities for fathers and implement policies that facilitate their involvement. Mental health screening and support services for fathers should be integrated into prenatal and postnatal care, given the high rates of depression and traumatic stress. Interventions should address hegemonic masculinity norms that discourage help-seeking and promote emotional expression. The review also highlights the dissonance between policies supporting male involvement and actual practice, indicating a need for systemic change. Future research should evaluate policies and interventions that support fathers, examine cultural and contextual influences, and include both parents' perspectives.