maternal adaptation in the postpartum period part 2

cultural considerations - balance of hot and cold

Latin American, Asian, African American

cultural considerations - confinement after childbirth

rest, recuperation, avoid illness

cultural considerations - ask cultural preferences

support preferences as able

psychological adaptations

immediate post-delivery period

attachment

begins before birth, acceptance, and nurturing fetus

bonding

describes attachment felt by parents, enhanced in first 30-60 min after birth

deterrents to bonding

hospital routines, eye meds

nurses encourage attachment by...

early parent newborn interactions, skin to skin, newborn care

maternal touch initially

touch is fingertip in an enface position progresses to full hand touch and the mom draws the infant closer - strokes baby,

binding in

mother identifies specific features about baby, looks like, claiming behavior

verbal behavior in relation to maternal touch

most mothers speak to infants in a high pitched voice, progress to using the baby's name

Reva Rubin's 3 phases adaptation to the maternal role

taking in, hold, and letting go phase

taking in phase

the time immediately after birth when the client needs sleep, depends on others to meet her needs and relives the events of birth process

characteristics of taking in phase

passive and dependent; preoccupied with self. reviews/relives birth experience. interacts with newborn; identifies specific characteristics. (lasts 1-2 days)

taking hold phase

dependent and independent maternal behavior. preoccupied with baby. (day 2-3 to day 10 or can lasts several weeks)

taking hold phase characteristics

resumes control over her life; concerned about self-care. gains self-confidence. becomes preoccupied with present. takes care of self and infant but needs reassurance.

letting go phase

occurring later in the pp. period as the woman reestablishes relationship with other people (2-4 wks)

letting go phase characteristics

maternal role attainment and relationship adjustment

Usefulness of Framework

used to monitor progress. absence or inability to progress through phases may impede maternal role development.

is length of phase necessarily accurate?

no

speed through phases increased with today's contemporary women d/t...

knowing fetal sex, classes, readings

paternal/partner adaptations influenced by

participation in childbirth. relationship with s/o. competence in childcare. family role organizations. culture. method of infant feeding.

paternal/partner adaptations develop bond

intense absorption, preoccupation, interest = engrossment

7 behaviors of engrossment

visual and tactile awareness of the newborn. perception of newborn as perfect. strong attraction to newborn. awareness of distinct features of the newborn. extreme elation by the father. increased sense of self-esteem.

stage 1 (expectations) of role development process for fathers/partners

preconceptions about what home life will be like with a newborn

stage 2 (reality) of role development process for fathers/partners

occurs when father or partners realizes that their expectations are not realistic. feelings change (elation, sadness, ambivalence, jealousy, frustration)

stage 3 (transition to mastery) of role development process for fathers/partners

father or partner makes a conscious decision to take control and be at the center of his newborn's life regardless of his preparedness

Stages in the Transition to Parenthood

anticipatory, formal, informal, and personal

anticipatory stage

allows parents to seek out other role models

formal stage

allows parents to become acquainted with the infant and begin to take cues from the infant

informal stage

encourages parents to respond to the infant as a unique individual

personal stage

attained when the parents feel a sense of harmony in their roles

critical attributes of attachment

proximity, reciprocity, and commitment

proximity

physical and psychological experience of the parents being close to their infant

proximity characteristics

contact by touching/holding. emotional state. individualization by differentiating needs from own.

reciprocity

process by which the infants' capabilities and behavioral characteristics elicit parental response

reciprocity characteristics

complementary behavior (infant stares, parent stares). sensitivity, recognize and response to infant communication

commitment

enduring nature of the attachment relationship

commitment characteristics

centrality, infant is placed in center of lives. parent role exploration, find their own way; integrate new identity.

factors influencing pscyho/social

support systems. single parenting. lingering discomfort/fatigue. knowledge of infant needs. previous experience. expectations of the newborn. maternal age. maternal/infant temp. unanticipated events, multiple fetuses. cultural influences.

single parenting

emotional and financial support, often live below poverty level, increased LBW

previous experiences

multiparity brings more responsibility than 1st baby, extended family less excited, guilt about extending love.

maternal age

teenagers must cope with conflicting developmental tasks, trying to become comfortable with self and can't really be expected to give self, body changes are difficult.

cultural influences

how a women's social group views the feminine role can make the women lean toward motherhood vs career, married vs single, or independent vs dependent roles in life

nursing interventions

identify positives and negative attachment behaviors. recognize cultural diversity. limited time in hospital to address concerns.

don't forget extended family

sibling roles and grandparent's roles