Postpartum Care Fundamentals (1) Flashcards
Puerperium
Birth to the return of reproductive systems to pre-pregnant state
- Birth to 6 weeks
Factors Affecting Postpartum Psychosocial Adaptation
- Pregnancy/birth experiences
- Physical recovery
- Role attainment
- Bonding and attachment behaviours
- Newborn/infant characteristics
- Fatigue
- Ability to meet needs
- Emotional responses
- Socioeconomics
- Social support
- Family dynamics
- Cultural considerations
Cultural Considerations and influences in Postpartum
- Beliefs and values
- Health, self-care and newborn care practices
- Interactions with health care providers
- Family dynamics
- Newborn and infant feeding practices
Parental Psychosocial Adaptations to Postpartum
Rubin - Phases of maternal postpartum adjustment
- Taking in (dependent)
- Taking hold (dependent-independent)
- Letting go (interdependent)
Mercer - Becoming a mother
- Acquaintance and attachment to newborn
- Moving toward a new normal
- Achievement of maternal identity, redefinition of self, integration of motherhood
Rubin; Taking in (Phases of maternal postpartum adjustment)
- First 24 hours client in taking in phase (at this point still in hospital); observe and perceive them as fulfilling their own basic needs
- More passive, more indecisive, rely on others to have their needs met, sense of wonderment about baby, excitedness
Rubin; Taking hold (Phases of maternal postpartum adjustment)
- Day 1-3 to 10 days- several weeks
- As the stay in hospital shortens move faster through phases
- Take change of baby, more responsibility, still some lack of confidence, more active decision making, eagerness to learn and practice
- For most have already gone home
- Prime opportunity to start learning and absorb information
- Community supports are key
Rubin; Letting go (Phases of maternal postpartum adjustment)
- Forward movement in family movement, changes of roles within family
- Reassert relationship with partner, back to sexual activity, parent division of labour
Mercer; Becoming a mother
- Maternal identity not reflects in Rubin’s work
- The process of becoming a birth parent and growing into identity of parent requires commitment and attachment that begins in pregnancy
- For those who do not meet that pregnancy tasks may have challenges and face mental difficulties
- First stage is accepting we are pregnant
- Then attachment to newborn when baby is born
- Then moving towards a new normal within the family
- Redefining one’s self
Father’s parental developmental tasks
- New expectations and priorities
- Striking balance between work, own needs, needs of partner and baby
- Redefinition of role
- Reaping rewards
LGBTQ+ parental developmental tasks
- Similar challenges: attachment in pregnancy and newborn; new priorities; new normal; striking a balance; achievement of identity as parent, redefinition of self, integration of parenthood
- Added challenges: lack of family acceptance, public/provider ignorance and judgement; social invisibility and more
Fahey and Shenassa: Learning Needs
- physical recovery
- meet own needs
- parental role attainment
- effective mobilization of support
- self-efficacy
- positive coping strategy
- realistic expectations
Learning needs in the postpartum period
- “readiness to learn” considerations
- Nurses; teaching priorities can differ from client learning priorities
- Change over time
- Common needs vs individual needs
- Individualized care; client satisfaction; client behaviours and health outcomes
Examples of Postpartum community resources
- Community Health Centres
- Hospital outpatient clinics
- Health Care Providers’ (HCP) offices
- Online resources (MotHERS program, OMama)
- Ontario Early Years Centres
- Private organizations
- Public Health (telephone, clinic, home, infant hearing, parenting classes, HARP)
- HBCB (Healthy Babies Healthy Children)
Postpartum Nurse’s Role
- Assess, monitor, support adaptations (psychosocial, emotional, physical)
- Identify and build on strengths
- Identify and meet leaning needs
- Care coordination
- Health promotion
- Illness prevention
- Teaching and facilitating client learning
G/P (2 digit) system
G = gravidity; total number of pregnancies for that person's body (uterus or abnormal) P= parity; the number of pregnancies beyond 20 weeks that have completed regardless of outcome
GTPAL system
G = gravidity; total number of pregnancies for that person's body T = term births; a birth of a fetus who is born at 37 weeks gestation or more P = pre-term birth; from 20 weeks to under 37 week (36 weeks and 6 days) A = abortion/miscarriage; losses of pregnancies under 20 weeks gestation L = living; number of children that are currently living
Guiding Principles of Family-Centred Maternity and Newborn Care (17 principles)
1) Is optimal
2) Pregnancy and birth are normal, health processes
3) Early parent-infant attachment is critical for newborn and child development and the growth of healthy families
4) Applies to all care environments
5) Is informed by research evidence
6) Requires a holistic approach
7) Involves collaboration among care providers
8) Culturally appropriate care is important in a multicultural society
9) Indigenous peoples have distinctive needs during pregnancy and birth
10) Care as close to home as possible is ideal
11) Individualized maternal and newborn care is recommended
12) To make informed choices, women and their families require knowledge about their care
13) Women and their families play and integral role in decision making
14) Health cafe providers’ attitudes and language have an impact on family experience
15) Respect reproductive rights
16) Occurs within a system the requires ongoing evaluation
17) Best practices from global settings may offer valuable options for Canadian considerations
Questions to ask to explore cultural expectations about child-bearing
1) What do you think you and your family believe that you should do to remain healthy during pregnancy
2) What are the things you can or cannot do to improve you health and the health of your baby
3) Tell me about any special dietary needs or foods you cannot eat
4) Tell me about any beliefs you have about pregnancy, birthing, and the postpartum period that would be important for me to know
5) Tell me about any concerns or fears you and your family have about hospitalization for childbirth
6) Who fo you want with you during the labour
7) What actions are important for you and your family to take after the baby’s birth
8) Tell me about your expectations from the nurse(s) caring for you
9) How will family members participate in your pregnancy, childbirth, and parenting
Personal reflection for nurses and maternity care providers
- Recognize the influence of own ethnicity and culture and their effects on your life
- Recognize the diversity of needs and experiences of those you serve
- Obtain details based on personal information actually given by the woman of family members rather than making assumptions
- Use simple language when discussing procedures
- Explore what is acceptable and suited to the woman for her care
- Involve family members with the consent of the patient
- Work out a mutually acceptable schedule of caring for the woman or newborn
Values and guiding principles for perinatal nursing in Canada
- Caring
- Health and well-being
- Informed decision making
- Dignity
- Confidentiality
- Justice
- Accountability
- Quality practice environment
Gravida
A woman who is pregnant
Gravidity
Pregnancy
Multigravida
A woman who has had two or more pregnancies
Nulligravida
A woman who has never been pregnant and is not currently pregnant
