Postpartum Part 1 Flashcards
What are the 6 periods of Perinatal Continuum of care?
Occurs over 12-14 month period
- Preconception
- 1st Trimester (Antepartum)
- 2nd Trimester (Antepartum)
- 3rd Trimester (Antepartum)
- Labour and Birth (Intrapartum)
- Postpartum/Newborn
- Partum = preganancy
- Postpartum = after pregnancy
- Intrapartum = during pregnancy
Describe the locus of care for each period of the perinatal continuum of care?
- Locus of care between preconception and 3rd trimester can be in the home/community setting
- Locus of care during labour and birth occurs in a hospital/birthing centre or at home
- Locus of care postpartum can occur in the home/community setting
Describe the Intensity of care for each period of the perinatal continuum of care?
- Independent self-care can is the intensity of care from pre-conception to 2nd trimester where there is low risk
- From the second trimester to third trimester home care can be considered for high-risk pregnancies and independent care can be considered for low-risk pregnancies
- During labour and birth, the intensity of care can range from low-risk hospitalization, high-risk hospitalization and neonatal intensive care
- The postpartum intensity of care can range from independent self-care in low-risk pregnancies and home care in high-risk pregnancies
Define puerperium
Puerperium: birth to the return of the reproductive system to the pre-pregnant state (also known as 4th trimester)
What is the duration of 4th trimester?
From birth to 6-8 weeks after birth
What type of healthcare model do we use in postpartum care?
- Health-focused model (try not to use the word patient, focused on health)
- Wellness-oriented (focused on bringing the client back to optimal health and wellness after pregnancy)
Describe the factors in the transition to parenthood
- Parenthood is thought of now as a developmental transition rather than a major life crisis
- Emotional, psychological, sociocultural and economic transitions continue well beyond physical recovery, 4th trimester and perinatal period (1 year)
List the factors that affect postpartum psychosocial adaptation
- Pregnancy/birth experiences
- Physical recovery
- Role attainment
- Bonding and attachments behaviours (ex. making eye contact with the baby, calling baby by name, etc.)
- Newborn/infant characteristics (ex. illnesses, temperament, etc.)
- Fatigue
- Ability to meet needs
- Emotional responses
- Socioeconomics
- Social supports
- Family dynamics
- Cultural considerations
In a postpartum setting, what are some cultural influences and/or considerations to keep in mind?
- Beliefs and values
- Health, self-care and newborn care practices
- Interactions with health care providers and family members (family dynamics)
- Newborn and infant feeding practices
What are the 2 theories of parental psychosocial adaptation?
- Rubin’s “Phases of Maternal Postpartum Adjustment” theory
- Mercer’s “Becoming a Mother” theory
Describe Rubin’s theory?
- Taking in (dependent)
- Taking hold (dependent-independent)
- Letting go (interdependent)
Describe the “Taking in” phase in Rubin’s theory?
- Mother is passive and willing to let others do things for her
- Focuses on food, fluids and restorative sleep
Describe the “Taking hold” phase in Rubin’s theory?
- Mother becomes interested in caring for the infant
- May be critical about her care-giving abilities
- Interested in learning about caring for her baby and herself
Describe the “Letting Go” phase in Rubin’s theory?
- Giving up old life to accommodate new infant
- Coming to terms with the reality of the birthing experience
- Giving up the fantasy of what their ideal child would be
Describe Mercer’s theory
• Commitment and attachment in pregnancy • Acquaintance and attachment to newborn • Moving toward a new normal • Achievement of maternal identity, redefinition of self, integration of motherhood
Describe the parental developmental tasks for fathers
Starts during pregnancy • New expectations and priorities • Striking a balance between work, own needs, needs of partner and baby • Redefinition of role • Reaping rewards
Describe the challenges of parental developmental tasks for members of the LGBTQ+ community in parenthood
• Similar challenges: attachment in pregnancy and to newborn; new priorities; new normal; striking a
balance; achievement of identity as a parent, redefinition of self, integration of parenthood
• Added challenges: lack of family acceptance, public/provider ignorance and judgement; social
invisibility and more
According to Fahey and Shenssa (2013) reading, what are some of the learning needs of a postpartum client
Physical recovery, meeting own needs, parental role attainment, effective mobilization of support, self-efficacy, positive coping strategies, and realistic expectations
What are some considerations to keep in mind when educating a postpartum patient?
- Consider the client’s “readiness to learn” (ex. if patient is not coping well, will not be ready to learn)
- Nurse’s teaching priorities can differ from the client’s learning priorities
- Needs will change over time, must learn how to mobilize social supports
Describe common needs vs individual needs
4 categories of common needs
- Need for information
- Needs to share experience
- Need for psychological support
- Need for tactical/emotional support (Cleaning, cooking etc.)
Individual needs
- Feeding plan
- Carseat
What are the benefits of individualized care in regards to learning needs?*
Individualized care leads to client satisfaction which in turn results in positive client behaviours and health outcomes
What is the “Healthy Babies Healthy Children (HBHC) Screen Tool” Used for?
- To determine child/family’s risk level and needs
What are the two systems to document antenatal history?
G/P = 2 digit system
Gravidity (Gravida) / Parity (Parida)
Pregnancies / Live births
GTPAL= 5 digit sytem
Gravidity: # of times a woman has conceived, including any current pregnancy
Term Births: # of times a woman has carried a pregnancy to at least 37 weeks gestation and delivered
Preterm births: # of times a woman has delivered before 37 weeks gestation but after 20 weeks gestation
Abortion/Miscarriage: # of times a woman has lost a pregnancy, whether it was elective or spontaneous (miscarriage), before 20 weeks gestation
Living - Living children
Where is a stillbirth categorized in the GTPAL?
If baby died after 20 weeks it is added under preterm or term, not abortion, however it is not included in the living category
A 30 year old female is 25 weeks pregnant with twins. She has 5 living children. Four of the 5 children were born at 39 weeks gestation and one child was born at 27 weeks gestation. Two years ago she had a miscarriage at 10 weeks gestation. What is her GTPAL?
G=7, T=4, P=1, A=1, L=5
A 31 year old female is currently 16 weeks pregnant. She has 2 year-old twins that were born at 39 weeks gestation and a 5 year-old who was born at 40 weeks gestation. She had a stillbirth 7 years ago at 27 weeks. What is her GTPAL?
G=4, T=2, P=1, A=0, L=3
A 20 year old female is currently 8 weeks pregnant. She had a miscarriage at 12 weeks gestation two years ago. She has no living children. What is her GTPAL?
G=2, T=0, P=0, A=1, L=0
A 26 year old female is currently 26 weeks pregnant. She had a miscarriage at 10 weeks gestation five years ago. She has a three year old who was born at 39 weeks. What is her GTPAL?
G=3, T=1, P=0, A=1, L=1
A 35 year old female is currently pregnant with twins. She has 10 year old triplets who were born at 32 weeks gestation, and a 16 year old who was born at 41 week gestation. Twelve years ago she had a miscarriage at 19 weeks gestation. What is her GTPAL?
G=4, T=1, P=1, A=1, L=4
A 39 year old female is currently 18 weeks pregnant. She has two sets of twin daughters that were born at 38 and 39 weeks gestation and an 11 year-old son who was born at 32 weeks gestation. She has no history of miscarriage or abortion. What is her GTPAL?
G=4, T=2, P=1, A=0, L=5
A 29 year old female is currently 9 weeks pregnant. She has no living children. Two years ago she had 2 miscarriages at 10 and 12 weeks gestation. What is her GTPAL?
G=3, T=0, P=0, A=2, L=0
A 30 year old female is 20 weeks pregnant with twins. She has a 6 year-old who was born at 40 weeks gestation. She had a still birth at 38 weeks gestation 3 years ago. What is her GTPAL?
G=3, T=2, P=0, A=0, L=1
