Transition to parenthood ch13 Flashcards
TRANSITION TO PARENTHOOD
The transition to parenthood is a dynamic developmental process that begins with the knowledge of pregnancy and continues throughout the postpartum period as the couple takes on their new or expanded roles of mother and father. Whether this is the first child or tenth child, this transition is a major life event that is both exciting and stressful, producing developmental challenges for the individual, the couple’s relationship, and family members. It is common for new parents to experience
● Increased stress related to learning the role of mother or father, childcare tasks, financial concerns, work-family conflict, and chronic fatigue.
● Decreased satisfaction within their couple relationship.
● Decrease in sexual and intimate activities.
Factors affecting transition to parenthood
Each individual deals with the growth, realization, and preparation of becoming a parent in different ways. Personal values, societal expectations, and cultural beliefs influence how an individual takes on the role of parent. Transition to parenthood is fostered or hampered by many factors, some of which include:
● Previous life experiences: Previous experiences caring for infants and children can foster a smoother transition to parenthood.
● How they were parented: A positive feeling of how they were parented can enhance the transition to parenthood.
● Length and strength of the relationship between partners: A strong relationship between the couple can foster a smoother transition to parenthood.
● Financial considerations: Financial concerns can cause stress and hamper the transition to parenting.
● Educational levels: Decreased ability to read and comprehend information regarding child care may hamper the couple’s ability to gain knowledge in the care of the infant.
● Support systems: A lack of positive support in the care of the woman and infant can increase stress and hamper the transition to parenting.
● Desire to be a parent: A lack of desire to be a parent can hamper the transition to parenting.
● Age of parents: Adolescent parents may have a more difficult transition to parenthood.
The transition to parenthood involves taking on the role of mother or father, viewing the child as an individual with his or her own personality, and incorporating the new child into the family system.
Evidence-Based Practice: Maternal and Paternal Fatigue
The sample consisted of 108 cohabitating mother–father couples expecting their first child. Data were collected during the third trimester and at 1, 3, and 6 months postbirth.
Results:
● High levels of prenatal fatigue were associated with higher levels of postpartum fatigue for both the mother and father.
● Maternal and paternal fatigue increased following the birth and remained consistent over 6 months.
● Mothers were more fatigued than fathers.
● Poor sleep quality was associated with fatigue for both mothers and fathers.
● Poor sleep quality in mothers was associated with higher levels of stress and depressive symptoms.
● Poor quality of sleep for fathers was associated with shorter duration of infant sleep.
● Age was not associated with postpartum fatigue for either mother or father.
● Younger mothers reported high levels of stress and depressive symptoms than older mother
● Neither family income nor length of couple relationship was associated with fatigue.
Nursing actions:
● Assess levels of fatigue for both the mother and father during the postpartum period.
● Promote rest by providing uninterrupted time during the postpartum hospitalization.
● Promote resting during postpartum hospitalization by clustering nursing care to allow for periods of uninterrupted times for resting.
● Provide information on strategies to decrease fatigue during the prenatal period and postnatal periods.
● Assist mothers in managing stress and depressive symptoms. This is more beneficial to improving their sleep quality than focusing on infant sleep patterns.
Parental roles
The role of mother or father evolves and changes over time as the child grows and additional children are added to the family. Each new role has expectations and responsibilities that the individual must learn in order to be successful in the role.
Couples are given the title of mother and father with the birth of their child but must learn the expectations and responsibilities of these roles.
● Examples of parental role expectations are that others will acknowledge the person as being a parent or that the child will obey the parents.
● Examples of responsibilities are that the parents will love and protect their child.
Knowledge of parental roles
Knowledge of these expectations and responsibilities is acquired through intentional learning (formal instructions) and incidental learning (observing others in the role). Most individuals have little intentional/instructional learning regarding the role of mother or father and must rely on incidental learning of these expectations and responsibilities. Examples of incidental learning of the parental role are:
● Observing other individuals who are mothers and fathers.
● Recalling how they were parented.
● Watching movies or television programs that have mothers and/or fathers as characters.
The process of learning and developing parental roles should start during the pregnancy. Partners who learn together during the pregnancy have better outcomes when they take on the role of parents. Providing couples with written information regarding different styles of parenting roles allows the expectant couple to learn about parenting behaviors. The expectant couple can then discuss parenting issues and mutually agree on expectations and responsibilities for their new roles.
Expected Findings in parental roles
● Parents identify changing roles and are willing to make lifestyle changes to accommodate the changes.
● Parents identify with the parental roles.
● Parents discuss what the roles mean to them.
● Couples incorporate a third person, the infant, into their relationship.
● Couples support each other in mutual caregiving tasks.
Nursing actions
Nursing actions are directed at supporting the couple as they take on their role of mother or father. Nursing actions include:
● Providing an environment that is conducive to rest, such as uninterrupted periods of time so that parents can sleep.
● Adequate rest can increase the couple’s ability to take in new information and develop new skills.
● Providing culturally sensitive care.
● Mother and father role expectations and responsibilities vary based on cultural backgrounds.
● Active listening; encourage the parents to talk about their expectations of each other in their respective role of mother or father.
● Having realistic and mutually agreed upon expectations decreases the level of stress within the relationship.
● Providing parental education on infant care with a variety of educational strategies such as handouts, videos, and demonstrations of procedures (burping, swaddling, entertaining, and stimulating the infant).
● Information needs to be appropriate and relevant for the couple.
● Providing positive feedback for parents’ infant care behaviors.
● New parents are insecure regarding infant care and need to know they are correctly interacting with and caring for their infant.
● Providing information on community parenting classes and support groups.
● This will provide parents opportunities for both intentional and incidental learning.
Motherhood & mercer’s 4 stages in “becoming a mother”
Mercer describes four stages through which women progress in “becoming a mother”:
● Commitment, attachment, and preparation for an infant during pregnancy
● Acquaintance with and increasing attachment to the infant, learning how to care for the infant, and physical restoration during the early weeks after birth
● Moving toward a new normal during the first 4 months
● Achievement of a maternal identity around 4 months
The process of becoming a mother begins during pregnancy but can occur before pregnancy. Some women begin preparing for this role as children when they fantasize about being mothers and role-play motherhood with dolls. Others actively improve their health in preparation for the pregnancy before conceiving
The process of “becoming a mother” is influenced by:
● How the woman was parented.
● Her life experiences.
● Her unique characteristics.
● Her cultural beliefs.
● The pregnancy experience.
● The birth experience.
● Support from partner, family, and friends.
● The woman’s willingness to assume the role of mother.
● The infant’s characteristics such as appearance and temperament
Nursing actions
● Review prenatal and labor records for risk factors such as complications during pregnancy and labor and birth.
● Pregnancy and birth experiences can either enhance or impede the process of becoming a mother.
● Assess the stages of “becoming a mother.”
● Assessment data assists in developing individualized nursing actions.
● Expected assessment findings:
● Positive feelings toward being pregnant
● Positive health behaviors
● Nurturing behaviors toward the infant
● Protective feelings toward the infant
● Increasing confidence in knowing and caring for the infant
● Establishment of new family routines (Mercer, 2006)
● Provide rooming-in or couplet care to facilitate bonding and attachment.
● Provide private time for the parents to interact with their infant.
● Provide comfort measures for the woman to promote rest and healing.
● Listen to the woman’s concerns in order for her to process the incorporation of the infant into her life.
● Provide information on the care of infants.
● Praise the woman for the care she provides her infant.
Evidence-Based Practice: Maternal Adaptation During the Early Postpartum Period
In the 1960s, Reba Rubin conducted qualitative research studies focusing on maternal adaptation during the early postpartum weeks. Her research is the foundation of our understanding of the psychosocial experience of women during the postpartum period.
Two concepts identified through her research are “maternal phases” and “maternal touch.” Rubin (1984) refined and modified the process as more evidence was linked to maternal adjustments and behaviors and identified areas of development that women progress through to “becoming a mother.”
Mercer (1995) developed the theory of “maternal role attainment,” which describes and explains the process women progress through as they become a mother. Based on her previous research and the research of others, Mercer (2004) supports replacing the term maternal role attainment with becoming a mother. The term becoming a mother reflects that the process is not stagnant but continually evolving as the woman and her child are changing and growing.
The theories generated by Rubin’s and Mercer’s research agendas are the cornerstone of evidence-based knowledge used in establishing nursing guidelines for the care of postpartum women and families.
Maternal phases-factors afffecting transition thru the maternal phases
As defined by Rubin (1963b, 1967), a three-phase maternal process occurs during the first few weeks of the postpartum period (Table 13–1). A delay in transitioning through the phases may indicate that the woman is experiencing difficulty in becoming a mother. Factors that can affect the woman’s transition through the maternal phases are:
● Medications (e.g., magnesium sulfate or analgesics) that depress the central nervous system (CNS), leading to tiredness and a slow response to stimuli.
● Complications during pregnancy, labor and birth, and/or postpartum (e.g., preterm labor, chronic illness, difficult birth, or cesarean birth) can cause the woman’s focus to shift to her health and well-being, and/or to resolving feelings of disappointment.
● Cesarean births can cause increased discomfort that interferes with the woman’s ability to care for her infant.
● Pain causes a shift of maternal attention from focusing on caring for baby to seeking pain relief for self.
● Preterm infants or infants who experience complications can cause additional stress on the woman and delay her transition through the phases.
● Mood disorders such as depression cause the woman’s focus to be more on self and less on the infant.
● Lack of support from the partner and/or support system may lead to maternal exhaustion.
● Adolescent mothers, who are more focused inwardly and on peer relationships than on care of the infant.
● Lack of financial resources, which forces the woman to focus on obtaining basic needs rather than on her infant.
● Cultural beliefs, which can influence the woman’s behavior and the amount of time she spends in each phase. In some cultures, for example, women are expected to rest rather than be actively involved in care or decision making during the first few months of the infant’s life.
Nursing Actions- maternal phases
● Review prenatal and labor records for factors that might delay progression through the maternal phases.
● Assess for maternal phases.
● Assessment data assists in developing individualized nursing actions.
● Expected assessment findings:
● Taking-in behaviors during the first 24 to 48 hours
● Taking-hold behaviors from 24 to 48 hours through the first few weeks after birth
● Nursing care during the taking-in phase is directed by the nurse because the woman is more dependent during this phase and has difficulty making decisions.
● Nursing care during the taking-hold phase is directed more by the woman, as she is becoming more independent and has an increased ability to make decisions.
● Provide comfort measures such as backrubs, uninterrupted periods of rest, and analgesics.
● Adapt teaching to reflect the maternal phase.
● During the taking-in phase, teaching is directed to immediate learning needs and is provided in short sessions, as the woman’s focus is on self versus learning about the care of the infant.
● During the taking-hold phase, praise the woman for her learning, as she is eager to learn but can become frustrated with not being able to master a new task quickly.
Taking in phase
The taking-in phase, a period of dependent behaviors, occurs during the first 24 to 48 hours after birth and includes the following maternal behaviors:
- The woman is focused on her personal comfort and physical changes.
- The woman relives and speaks of the birth experience.
- The woman adjusts to psychological changes.
- The woman is dependent on others for her and her infant’s immediate needs.
- The woman has a decreased ability to make decisions.
- The woman concentrates on personal physical healing (Rubin, 1963b, 1967).
Taking-hold phase
The taking-hold phase, the movement between dependent and independent behaviors, follows the taking-in phase. It can last weeks and includes the following maternal behaviors:
- The focus moves from self to the infant.
- The woman begins to be independent.
- The woman has an increased ability to make decisions.
- The woman is interested in the infant’s cues and needs.
- The woman gives up the pregnancy role and initiates taking on the maternal role.
- The woman is eager to learn; it is an excellent time to initiate postpartum teaching.
- The woman begins to like the role of “mother.”
- The woman may have feelings of inadequacy and being overwhelmed.
- The woman needs verbal reassurance that she is meeting her infant’s needs.
- The woman may show signs and symptoms of baby blues and fatigue.
- The woman begins to let more of the outside world in (Rubin, 1963b, 1967)
Letting-go phase
In the letting-go phase, the movement from independence to the new role of mother is fluid and interchangeable with the taking-hold phase. Maternal characteristics during this phase are:
- Grieving and letting go of old relationship behaviors in favor of new ones.
- Incorporating the infant into her life whereby the baby becomes a separate entity from her.
- Accepting the infant as he or she really is.
- Giving up the fantasy of what it would/could have been.
- Independence returns; may go back to work or school.
- May have feelings of grief, guilt, or anxiety.
- Reconnection/growth in relationship with partner (Rubin, 1963b, 1967).
Fatherhood
Men’s preparation for the role of father is vastly different from women’s preparation for motherhood. In general, men do not fantasize about being a father, nor do they role-play being a father during childhood. During pregnancy, men mentally evaluate how they were fathered and how they want to father, but the reality of becoming a father may not occur until the child is born (May, 1982). Additionally, expectant fathers often picture themselves parenting older children rather than infants
Evidence-Based Practice: Expectant Fathers’ Beliefs and Expectations
The purpose of this qualitative study was to gain a deeper understanding of expectant fathers’ experiences as they prepared to parent a new infant-
Five major themes emerged from the data:
- Being there: Men talked about the importance of being present in their child’s life.
- Fathering older children: Men talked more frequently about parenting older children versus infants. They focused on father roles with children beyond infant and toddler periods.
- Preparation for life in society: Men talked about the importance of fathers preparing their children to be successful in their community and society. They identified their father roles as educator and life coach, providing emotional support to their children in dealing with life’s challenges, serving as a positive role model, and facilitating their children’s engagement within the community.
- Heaviness of the fathering role: Men described fathering as an extremely difficult task that included being responsible for another life and the importance of providing financial and concrete support to their children,
- Parenting support: Men indicated that they relied on women versus men for support in their role as father. The women were usually their partner, their mother, or other female relatives.
Implications -fatherhood
Implications:
- Providing opportunities for expectant fathers to talk about their preparation and feelings regarding their new and emerging role of father.
- Father involvement that begins in pregnancy is associated with positive maternal and infant outcomes. The provision of prenatal and postpartum education interventions can assist men in understanding the importance of early father involvement in the care of their infant and its effect on the infant’s development. Early parenting behaviors include rocking, soothing and carrying their infant.
Influences of a mans interpretation of what it mean to be a father
The meaning of “father” varies based on the man’s interpretation of the role and its expectations and responsibilities. This is influenced by:
● How he was fathered.
● How his culture defines the role.
● In some cultures, men are not expected to be involved in the birthing process and/or care of the infant.
● By friends and family, and by his partner.
Factors affecting a mans transition to fatherhood
The man’s partner has a major influence on the degree of the man’s involvement in infant and child care. For the man to be an involved father, his partner needs to share this desire and to be supportive. Becoming a father evolves over time as the man has increasing contact with his infant, increasing knowledge of infant and infant care, and increasing experiences in infant care. Factors that influence the man’s transition to fatherhood are:
● Developmental and emotional age.
● Cultural expectations.
● Relationship with his partner.
● Knowledge and understanding of fatherhood.
● Previous experiences as a father.
● The way he was fathered.
● Financial concerns. ● Support from partner, friends, and family.
Nursing actions-fathers
● Provide information on infant care and infant behavior.
● Demonstrate infant care such as diapering, feeding, and holding.
● Providing information and demonstrating infant care skills enhances the father’s comfort in caring for his infant.
● Praise the father for his interactions with his infant.
● Praising can encourage continued interactions with his infant.
● Provide opportunities for the father to talk about the meaning of fathering.
● Talking about the meaning of fathering assists in identifying his beliefs regarding the role.
● Facilitate a discussion with the father and his partner to identify mutual expectations of the fathering role.
● Mutually agreed-upon expectations can decrease the level of stress within the relationship.
Adolescent parents
Adolescent parenting is a stressful life experience in that the adolescent is taking on the role responsibilities of being a mother or father while at the same time working through the developmental tasks of being a teenager. Additionally, adolescent parents have few life experiences that prepare them for the role conflicts and strain experienced by first-time parents.
Adolescent mothers often live with their parents or other relatives following the birth of their child, while adolescent fathers tend to not live with the adolescent mother and their child. Adolescent parents, due to having fewer life experiences and coping skills, are more likely to use harsher parenting practices such as yelling and screaming (Urban Child Institute, 2014). The children of adolescent parents have more difficulty in acquiring cognitive and language skills and social and emotional skills
Nursing actions -adolescent parents
● Assess level of knowledge.
● Information needs to be appropriate and relevant for the individual and/or couple for learning to occur.
● Present information at an age-appropriate level.
● Learning styles and teaching strategies are different for young teens and older teens. Information needs to be provided in a manner that will engage the adolescent parent in the learning process.
● Include the adolescent father in infant care teaching sessions.
● Adolescent fathers need information and encouragement in developing care behaviors.
● Involve the maternal grandparent in teaching sessions focused on infant care.
● Grandparents need a review of infant care since most teen mothers live with their parents during the first year.
● Discuss with the adolescent parents their expectations of each other regarding child care and support.
● Realistic and mutually agreed-upon expectations decrease the level of stress within the relationship.
● Involve adolescent fathers in prenatal care based on adolescent mother’s comfort level.
● Adolescent fathers who are involved during the prenatal period have greater involvement with infants following the birth.
Evidence-Based Practice: Adolescent Parents
Implications for nursing care: Public health programs that include home visits can lower risky behaviors in adolescent mothers and increase their likelihood of attending and completing college.
Same sex parents
Once the couple has decided who will conceive, they must decide how they will conceive. Most lesbian couples use artificial insemination (AI) and thus must decide whether they want a known or unknown sperm donor. They will gather information about sperm banks and obtaining sperm. Lesbian couples share similar feelings as heterosexual couples who are using AI. They often find the process to be stressful due to the monitoring of ovulation and the timing of insemination, and the process becomes more stressful when pregnancy does not occur within the first few months of AI
During the postpartum hospitalization, the couple needs information regarding care of their infant and of the postpartum woman. The postpartum couple views themselves as coparents and plans to equally share in the care of their child. It is important to include both women in teaching sessions regarding infant care. Most lesbian mothers breastfeed their infants and it is not uncommon for both mothers to breastfeed their infant (see Critical Component below). It is important for nurses to ask the mothers if they both plan to breastfeed and if so, assist both in breastfeeding and provide information on induction of lactation and use of lactation supplementation.
Induction of Lactation
Several methods can be used to induce lactation for nonbirthing mothers. These include hormonal therapy, manual and/or electric pumping of the breast, use of an at-breast supplementation device, or a combination of these methods. The nonbirthing mother should begin preparing her breasts for lactation several months before the birth of the baby.
Roles of mother in lesbian couples
Lesbian couples take on the role of birth mother and co-mother during their transition to parenting. They will experience similar stress-producing issues as heterosexual couples as they take on their new roles, but research findings indicate that lesbian parents report less parental stress than heterosexual couples
Lesbian couples report lower parental stress related to feelings of incompetence as a parent and social isolation compared to heterosexual couples
lesbian couples are egalitarian in their roles and equally share in the care of their infant (Borneskog et al., 2014). These relationship traits might influence the lower levels of parental stress.