Module 4 Family Adaptations Flashcards
Define trauma-informed-care
Trauma‐informed care describes an approach to care in which the healthcare provider enters every care relationship with the knowledge that trauma exists in many people and in many forms. Because trauma is often not disclosed until the establishment of a trusting relationship, if it is disclosed at all, the tools of trauma‐informed care are brought to every care encounter. Each woman should be approached with recognition of the power dynamics inherent in a provider–client relationship and of the vulnerability of being pregnant, examined, and evaluated on intimate physical
characteristics and lifestyle choices
Identify the tools for Trauma-Informed Care. Give examples of how you would incorporate these tools into your clinical practice.
Containment—set safe boundaries with respect to her physical and emotional space
Connection—be present with her therapeutically so she feels seen and heard
Compassion—empathetically accept her experience for what she perceives it is
Describe maternal behaviors prenatally that indicate healthy maternal adaptation and attachment.
-Physical caretaking and emotional attentiveness to the baby’s needs.
-Avoiding alcohol, eating nutritiously
-Nicknaming/naming the baby
-Talking to the baby
-Playing music for the baby
Describe maternal behaviors postnatally that indicate healthy maternal adaptation and attachment.
-Holding the baby
**Looking at face to face with the baby (face en face)
-Talking about the baby positively
-Caring for the baby
Describe ways that the CNM can prenatally support the development of maternal-fetal attachment and prepare patients for post birth bonding with their newborn.
- Obtain the services of providers whose labor and birth practices are woman‐centered and baby friendly.
- Attend childbirth education classes.
- Articulate preferences for the conduct of labor, birth, and immediate postpartum in a written birth plan.
- Arrange for continuous labor support with sensitive family, friends, a doula, or a midwife.
- Have baby placed skin to skin with mother immediately postbirth and leave undisturbed for a prolonged period of time.
- Delay non‐urgent procedures, such as cord clamping, injections, newborn measurements, and eye prophylaxis.
- Allow generous amounts of time for the baby to breastfeed and interact with the family
Describe the potential consequences of failure to adapt and attach for the mother and infant and long-term consequences of disorganized attachment on the infant.
Failure to adapt and attach can lead to a variety of disorders after birth; for the mother, these can include postpartum depression,
detached parenting, abusive parenting, social isolation, and deterioration of self‐care practices; for the baby, these can include failure to thrive without organic cause, risk of abuse, and inability to form social bonds with others
Describe Rubin’s four tasks of maternal role development.
1) safe passage: seeking the means to assure a secure and healthy pregnancy and childbirth for herself and her baby
2) acceptance by others: the pregnant woman reflects on her current life, on her past relationships, and role models with respect to parenting and on her current relationships and aspirations for mothering.
3) binding in to the child: establishing a direct form of experience between the mother. Forming a real life relationship.
and her fetus/infant.
4) giving of oneself: physical, emotional, and social changes of pregnancy progressively require more and more modifications in the woman’s lifestyle and choices. And yet, she must embrace these changes willingly and see their purpose in giving to her child for the child’s benefit and well‐being.
Describe the three cognitive processes that assist with attaining Rubin’s four tasks of maternal role development.
1) Replication: the active search by the woman for elements of the maternal role that she wishes to incorporate into her interpretation of becoming mother and that she believes are valued by society
2) Fantasy: a series of mental operations that help the pregnant woman accept the pregnancy and the baby, try on various aspects of the mother role mentally, and deal with the hopes and fears she has for her new life ahead.
3) Dedifferentiation: an exploration of the goodness of fit of prior fantasy work with the woman’s current self‐image
What are helpful ways for the CNM to assist with maternal role development?
Providers should inquire about relationships and behaviors important to the woman’s attachment to the fetus and her attainment of the maternal role. Clear communication can be encouraged within her primary relationships and can be role‐modeled by the prenatal provider. Descriptions of the wide range of normal social and emotional changes she faces can be reassuring to the pregnant woman. Asking about fantasy work and dreams are a chance to engage in discussions that can
lead to exploration of her hopes and fears regarding
impending childbirth and motherhood. Providing information to enhance the woman’s knowledge of her changing needs throughout the course of pregnancy and early postpartum, and of newborn characteristics and behaviors is an essential service. For women who are struggling with serious relationship issues, strategies to assist her include clarifying the problem situation, reviewing steps to conflict resolution, and providing her with appropriate referrals for her psychosocial issues
Define the Fourth Stage of Labor.
The fourth stage of labor is the first hour or two after you deliver.
What factors contribute to an individual’s response to childbirth?
Factors such as a traumatic birth, previous life traumas, or newborn illness can all influence an individual’s response to childbirth, attachment to the newborn and development of identity and role as a mother or primary caretaker.
Describe the 3 key attributes in the mutual relationship between parents and newborns Goulet et al. identified from literature on attachment.
Proximity – Physical closeness allows interaction with multiple senses, facilitates a strong emotional connection and creates an awareness of the infant’s individuality and needs that are different from the parent’s needs.
Reciprocity – Parents and newborns interact in a responsive and adaptive manner. Parents become sensitive to the infant’s cues and body language in their caregiving. The infant contributes to the interaction by reinforcing the parent’s behavior.
Commitment – Feeling and acting responsibly to ensure the safety, growth and development of the infant place the infant in a central position in the family and identify the parenting role as an important part of the adult’s identity.
Is there a specific time period when attachment bonds occur?
Attachment bonds form over time and involve a complex interplay of neural circuitry, hormones such as oxytocin and interactive behavior. Overemphasis on the first hour may be harmful in situations in which it is missed, such as medical condition of the woman or the newborn requires separation of this dyad.
Describe specific care practices that enhance newborn transition and attachment behaviors
- Early skin to skin contact – has been found to improve maternal affectionate behavior, regulate the newborn’s behavior and increase duration of breastfeeding. Early contact also increases maternal sensitivity and the infant’s self- regulation and irritability at 1 year after birth.
- Newborn self-latching – when placed skin to skin, infants frequently crawl and find the areola by themselves and most will initiate suckling spontaneously. May enhance the newborn’s ability to self-regulate his or her behavior over the long term.
- Inclusion of significant others – involvement of the woman’s partner, newborn’s father, or other support persons during the fourth stage of labor has been found to help the woman during the postpartum period, increase the partner’s emotional involvement with the neonate, and increase the sense of security experienced by the partner.
- Early breastfeeding – improves health outcomes for women and their infants.
Identify the period of time following birth that women have an increased risk of health problems.
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