Chapter 18: Postpartum Psychosocial Adaptations

Question 1

what are Rubin’s process of maternal adaptation?

Answer 1

• taking in
• taking hold
• letting go

Question 2

Taking In Phase

Answer 2

• mother is focused primarily on her own need for fluid, food, and sleep
• May try to take in every detail of the baby but be content to let others make decisions
• Major task: to integrate birth experience into reality
  
  • Discusses labor and delivery and attempts to piece all the pieces together
  • Allows mom to realize that the pregnancy is over and newborn is now a separate individual
• Lasts a day or less
  
  • May be prolonged in a cesarean delivery b/c the woman may have difficulty in assimilating the procedures that occurred

Question 3

Taking Hold Phase

Answer 3

• mother becomes more independent
• Exhibits concern about managing her own body functions and assumes responsibility for her own care
• When she is more confident in her own care, she can shift attention to the infant
• Often compares her infant with others to validate wellness and wholeness
• Mother may verbalize anxiety
• As a nurse: encourage mother to care for the infant as well as the father
• Lasts for several days
  
  • Good time to review material and provide instructions

Question 4

Letting Go Phase

Answer 4

• time of relinquishment for the mother and often for the father
• If the first child, couple must give up role as a childless couple
  
  • So have to relinquish this freedom
• Some parents are disappointed by size, gender, or characteristics of the infant, so must give this us and accept reality
• May have feelings of grief, so it is helpful to be able to discuss these
• Mother may refocus on relationship with partner and return to work

Question 5

Mercer’s Maternal Role Attainment

Answer 5

• anticipatory stage: begins during pregnancy when mother chooses a physician and location for birth
  
  • childbirth classes help mom gain control
• formal stage: begins with birth and continues for 4-6 weeks
  
  • behaviors are largely guided by others
  • major task: to become acquinted with the infant so parent can mesh caregiving with infant cues
• informal stage: may overlap with formal stage
  
  • begins when mom learns appropriate responses to infants’ cues
  • mother begins to respond according to unique needs of infant
• personal stage: attained when mother feels a sense of harmony in the role, enjoys infant, sees infant as central
  
  • mother feels comfortable and competent
  • usually occurs by about 4th month

Question 6

3 parts of Heading Toward a New Normal

Answer 6

• appreciating the body: centers on the way a woman feels physically
  
  • must cope with discomfort and sleep interrupted
  • changes in body function
• settling in: involves becoming competent, developing confidence, and accommodating and integrating infants into the parents’ lives
  
  • mother more secure and competent with infant
  • mother glad to have help
• becoming a new family: modify relationships with partner and other family members

Question 7

redefined roles

Answer 7

• Mother is particularly concerned about redefining roles and focuses on maintaining a strong, adaptive relationship with her partner
  
  • Observes him for changes in behavior and is acutely aware of interaction with the infant
• The father feels pressure to succeed in his new role
• New parents may need to agree on a division of tasks and responsibilities that was not necessary before birth
  
  • Process can be simple, easy, and quick or may be difficult is role assignment is inflexible
• role conflict may occur

Question 8

what are the major maternal concerns after childbirth?

Answer 8

• body image: concerned with regaining normal figures
  
  • nurses hsould teach that weight loss should be gradual and should teach the importance of safe activities to regain muscle
• smoking: many will restart w/in 6 mos
• postpartum bles

Question 9

Fatherhood

Answer 9

• facilitated by engrossment: intense fascination and face to face observation b/w father and child
  
  • characterized by father’s intense interest in how the infant looks and responds and a desire to touch and hold the baby
• may be unsure of new role
  
  • many fathers lack confidence in providing infant care and may feel that others expect them only to provide support to the mother
    
    • nurse can assist the new father by involving him in child care activities

Question 10

Siblings

Answer 10

• response to a new baby depends on their age and developmental level
  
  • adjustment depends on age
• may be aggressive
• may be regressive: go back to infantile behavior
• need to be taught appropriate interaction w/ infant
• siblings often need extra attention and reassurance
  
  • parents can emphasize the advantages of being the older sibling and can allow siblings to participate in age appropriate aspects of infant care

Question 11

Grandparents

Answer 11

• Involvement of grandparents may depend on proximity
  
  • If close: can develop a strong bond, and be a source of unconditional love and an added sense of security
  • If further away, may have sporadic contact
• Degree of grandparent involvement should be a comfortable arrangement for both families
• Often a major support system for new parents

Question 12

factors that affect family adaptation

Answer 12

• discomfort and fatigue
• knowledge of infant needs
• previous experience: multiparas are more comfortable with infants and exhibit attachment sooner
• expectations about newborn
• maternal age
• maternal temperament
• temperament of infant
• availability of a strong support system
• cesarean delivery: longer recovery, additional discomfort, inc stress, financial strain
• preterm or ill infant
• birth of multiple infants

Question 13

how does the birth of multiple infants affect family adaptation?

Answer 13

• Often follows a high risk pregnancy in which mother was confined to bed rest
• Infants may be preterm or unhealthy
• Financial strain may occur bc mother has had to stop working
• Problems of attachment may occur b/c of more than one infant
• Parents have to attach to each infant separately and get to know each as an individual with individual personality traits

Question 14

bonding

Answer 14

• rapid initial attraction felt by parents for their infant
• Unidirectional: from parent to child
• Enhanced when parents and infants are permitted to touch and interact during first 30-60 min after birth
• Infants are placed skin to skin for bonding time
• delay procedures if possible
• all is not lost if delayed

Question 15

attachment

Answer 15

• process by which an enduring bond between a parent and child is developed through pleasurable, satisfying interaction
• Begins in pregnancy and extends for months after childbirth
• Infant receives warmth, food, and security and mother receives enjoyment and establishes identity as mother
• Rarely instantaneous
• Reciprocal–bidirectional b/c parent and child

Question 16

initial attachment w/ maternal touch

Answer 16

• fingertipping: occurs during early minutes
  
  • Mother gently explores the infant’s face, fingers, toes with fingertips
• Palmar Contact: She then progresses to stroke the baby’s chest and legs with her palm
• Enfolding Infant: Then uses her entire hand and arms to enfold the infant and to bring her baby close to her body
• Increasing time in en face position: She holds the newborn closer, strokes the baby’s hair, and presses her cheek against the infant’s cheek
  
  • Then will begin to identify specific features of the newborn

Question 17

verbal behaviors of new parents

Answer 17

• Often speak in a high pitched voice
• She may start by calling the baby “it” to “he/she” to using its chosen name
• May provide clues to a mother’s early psychological relationship with the infant

Question 18

reciprocal attachment behaviors of the infant

Answer 18

• Make eye contact and engage in gazing
• Move their eyes and attempt to track the parent’s face
• Grasp and hold parent’s finger
• Move synchronously in response to patterns of parent’s voice (entrainment)
• Root, latch onto breast, suckle

Question 19

how to promote attachment

Answer 19

• early, unlimited contact
  
  • prolonged contact–>more touching
  • more time to learn newborn’s needs
    
    • inc confidence
    • praise and encouragement
• assist parents to inspect infant
• position infant in an en face position
• point out positive characteristics of infant
• mother the mother

Question 20

Mother the Mother

Answer 20

• “Mother” the mother: early, taking in phase is a time to “mother” the mother to help her transition to more complex tasks of maternal adjustment
  
  • During the first few hours after childbirth, she has a great need for physical care and comfort
  • Provide ample fluids and favorite foods
  • Keep linens dry and keep mom warm
  • remind her to void
  • assess level of comfort
  • encourage sleep

Question 21

clinical manifestations of postpartum blues

Answer 21

• anxious
• moody
• irritable
• overwhelmed
• fatigue
• oversensitive
• episodic tearfulness
• insomnia

Question 22

postpartum blues

Answer 22

• mild depression interspersed with happier feelings
  
  • self limiting
  • early onset: begins during first week
    
    • peaks around day 5
    • ends w/in 2 weeks
  • doesn’t usually affecta mom’s ability to care for infant
• may be a result of emotional letdown that occurs after birth, postpartum discomforts, fatigue, anxiety about her ability to care for infant, body image concerns

Question 23

how can a nurse care for a woman with postpartum blues

Answer 23

• validate feelings
  
  • let them know it it is normal
  • label it as a real and normal reaction
• offer emotional support and encouragement
• family support
• teach partner

Question 24

postpartum depression

Answer 24

• onset during pregnancy or within 4 weeks after birth lasting at least 2 weeks
• loss of interest in almost all activities
• at least 4 symptoms:
  
  • changes in appetite or weight
  • change in sleep
  • changes in activity
  • decreased energy
  • feelings of worthlessness or guilt
  • difficulty with focus or decision making
  • recurrent thoughts of death or suicide

Question 25

incidence of postpartum depression

Answer 25

• anytime during 1st year
• all ethnicities, educational levels
• more intense and persistent than blues
• impacts entire family and infant

Question 26

management of PPD

Answer 26

• psychotherapy
• medication:
  
  • SSRIs, TCAs
  • takes 4 weeks to become effective
  • continue for 9-12 mos after remission
  • if used during breastfeeding, caution by doctor is important

Question 27

postpartum psychosis

Answer 27

• ability to recognize reality, communicate, and relate to others is impaired
• rare (1-2/1000 births)
• usually no history of mental illness
• can occur as early as few days after birth
• agitation, confusion, rapidly shifting moods, disorientation, delusions, hallucinations
• psychiatric emergency and usually requires hospitalization
  
  • antidepressants/antipsychotics

Question 28

Bipolar II Disorder

Answer 28

• PPD imposter w/ wild swings of emotion
• may be unsafe with infant