Chapter 22: Transition to Parenthood

After giving birth to a healthy infant boy, a primiparous woman, 16, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is "risk for impaired parenting related to deficient knowledge of newborn care." In planning for the woman's discharge, what should the nurse be certain to include in the plan of care?

A. Tell the woman how to feed and bathe her infant

B. Give the woman written information on bathing her infant

C. Advise the woman that all mothers instinctively know how to care for their infants

D. Provide time for the woman to bathe her infant after she views an infant bath demonstration

D

A. Incorrect: Although verbalizing how to care for the infant is a form of client education, it is not the most developmentally appropriate teaching for a teenage mother.

B. Incorrect: Although providing written information is useful, it is not the most developmentally appropriate teaching for a teenage mother.

C. Incorrect: This statement is inappropriate; it is belittling and false.

D. Correct: Having the mother demonstrate infant care is a valuable method of assessing the client's understanding of her newly acquired knowledge, especially in this age group, because she may inadvertently neglect her child.

p. 625

A 30-year-old multiparous woman has a boy who is 2 1/2 years old and now an infant girl. She tells the nurse, "I don't know how I'll ever manage both children when I get home." Which suggestion would best help this woman alleviate sibling rivalry?

A. Tell the older child that he is a big boy now and should love his new sister

B. Let the older child stay with his grandparents for the first 6 weeks to allow him to adjust to the newborn

C. Ask friends and relatives not to bring gifts to the older sibling because you do not want to spoil him

D. Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time

D

A. Incorrect: This strategy is a negative approach to facilitating sibling acceptance of the new infant.

B. Incorrect: Reactions of siblings may result from temporary separation from the mother. Removing the older child from the home when the new infant arrives may enhance negative behaviors from the older child caused by separation from the mother.

C. Incorrect: Providing small gifts from the infant to the older child is a strategy for facilitating sibling acceptance of the new infant.

D. Correct: The older child may regress in habits or behaviors (e.g., toileting and sleep habits) as a method of seeking attention. Parents need to distribute their attention in an equitable manner.

p. 629

The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?

A. Talks and coos to her son

B. Seldom makes eye contact with her son

C. Cuddles her son close to her

D. Tells visitors how well her son is feeding

B

A. Incorrect: This is a normal infant-parent interaction.

B. Correct: The woman should be encouraged to hold her infant in the en face position and make eye contact with the infant.

C. Incorrect: This is a normal infant-parent interaction.

D. Incorrect: This is a normal infant-parent interaction.

p. 625

The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is:

A. Tell the mother she must pay attention to her infant

B. Show the mother how the infant initiates interaction and attends to her

C. Demonstrate for the mother different positions for holding her infant while feeding

D. Arrange for the mother to watch a video on parent-infant interaction

B

A. Incorrect: A statement of this kind may be perceived as derogatory and is not appropriate.

B. Correct: Pointing out the responsiveness of the infant is a positive strategy for facilitating parent-infant attachment.

C. Incorrect: Educating the young mother in infant care is important, but pointing out the responsiveness of her baby is a better tool for facilitating mother-infant attachment.

D. Incorrect: Videos are an educational tool that can demonstrate parent-infant attachment, but encouraging the mother to recognize the infant's responsiveness is more appropriate.

p. 624

The nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad's chin. This woman's statement reflects:

A. Mutuality

B. Synchrony

C. Claiming

D. Reciprocity

C

A. Incorrect: Mutuality occurs when the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics.

B. Incorrect: Synchrony refers to the "fit" between the infant's cues and the parent's responses.

C. Correct: Claiming refers to the process by which the child is identified in terms of likeness to other family members.

D. Incorrect: Reciprocity is a type of body movement or behavior that provides the observer with cues.

p. 613

New parents express concern that because of the mother's emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth. The nurse's response should convey to the parents that:

A. Attachment, or bonding, is a process that occurs over time and does not require early contact.

B. The time immediately after birth is a critical period for humans.

C. Early contact is essential for optimum parent-infant relationships.

D. They should just be happy that the infant is healthy.

A

A. Correct: This statement is accurate.

B. Incorrect: The formerly accepted definition of bonding held that the period immediately after birth was a critical time for bonding to occur. Research since has indicated that parent-infant attachment occurs over time. A delay does not inhibit the process.

C. Incorrect: Parent-infant attachment involves activities such as touching, holding, and gazing; it is not exclusively eye contact.

D. Incorrect: This response is inappropriate because it is derogatory and belittling.

pp. 612-613

During a phone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!" The nurse would recognize that the woman is experiencing:

A. Taking-in

B. Postpartum depression (PPD)

C. Postpartum blues

D. Attachment difficulty

C

A. Incorrect: The taking-in phase is the period after birth when the mother focuses on her own psychologic needs. Typically, this period lasts 24 hours.

B. Incorrect: PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is more serious and persistent than the PP blues.

C. Correct: During the PP blues, women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth PP day.

D. Incorrect: Crying is not a maladaptive attachment response; it indicates PP blues.

p. 620

The nurse can help a father in his transition to parenthood by:

A. Pointing out that the infant turned at the sound of his voice

B. Encouraging him to go home to get some sleep

C. Telling him to tape the infant's diaper a different way

D. Suggesting that he let the infant sleep in the bassinet

A

A. Correct: Infants respond to the sound of voices. Because attachment involves a reciprocal interchange, observing the interaction between parent and infant is very important.

B. Incorrect: Separation of the parent and infant does not encourage parent-infant attachment.

C. Incorrect: Educating the parent in infant care techniques is important, but the manner in which a diaper is taped is not relevant and does not enhance parent-infant interactions.

D. Incorrect: Parent-infant attachment involves touching, holding, and cuddling. It is appropriate for a father to want to hold the infant as the baby sleeps.

p. 623

The nurse notes that a Vietnamese woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. In evaluating the woman's behavior with her infant, the nurse realizes that:

A. What appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits.

B. The woman is inexperienced in caring for newborns.

C. The woman needs a referral to a social worker for further evaluation of her parenting behaviors once she goes home with the newborn.

D. Extra time needs to be planned for assisting the woman in bonding with her newborn.

A

A. Correct: The nurse may observe a Vietnamese woman who gives minimal care to her infant and refuses to cuddle or interact with her infant. The apparent lack of interest in the newborn is this cultural group's attempt to ward off evil spirits and actually reflects an intense love and concern for the infant.

B. Incorrect: Cultural beliefs are important determinates of parenting behaviors. The woman's "lack of interest" is a Vietnamese cultural behavior.

C. Incorrect: Cultural beliefs are important determinates of parenting behaviors. The woman's "lack of interest" is a Vietnamese cultural behavior. The lack of infant interaction is not a form of infant neglect, but rather a demonstration of love and concern for the infant.

D. Incorrect: The nurse may observe the woman and may be concerned by the apparent lack of interest in the newborn when, in fact, this is a cultural display of love and concern for the infant. It is important to educate the woman in infant care, but it is equally important to acknowledge her cultural beliefs and practices.

p. 627

Many first-time parents do not plan on their parents' help immediately after the newborn arrives. What statement by the nurse is the most appropriate when counseling new parents about the involvement of grandparents?

A. "You should tell your parents to leave you alone."

B. "Grandparents can help you with parenting skills and also help preserve family traditions."

C. "Grandparent involvement can be very disruptive to the family."

D. "They are getting old. You should let them be involved while they can."

B

A. Incorrect: Intergenerational help may be perceived as interference, but a statement of this sort is not therapeutic to the adaptation of the family.

B. Correct: This is the most appropriate response.

C. Incorrect: Not only is this statement invalid, it also is not an appropriate nursing response.

D. Incorrect: Regardless of age, grandparents can help with parenting skills and preserve family traditions. This is not the most appropriate statement, and it does not demonstrate sensitivity on the part of the nurse.

p. 631

When the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called:

A. Mutuality

B. Bonding

C. Claiming

D. Acquaintance

A

A. Correct: Mutuality extends the concept of attachment to include this shared set of behaviors.

B. Incorrect: Bonding is the process over time of parents forming an emotional attachment to their infant. Mutuality refers to a shared set of behaviors that is a part of the bonding process.

C. Incorrect: Claiming is the process by which parents identify their new baby in terms of likeness to other family members, their differences and uniqueness. Mutuality refers to a shared set of behaviors that is part of the bonding process.

D. Incorrect: Like mutuality, acquaintance is part of attachment. It describes how parents get to know their baby during the immediate postpartum period through eye contact, touching, and talking.

p. 613

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. What is a facilitating behavior?

A. The parents have difficulty naming the infant.

B. The parents hover around the infant, directing attention to and pointing at the infant.

C. The parents make no effort to interpret the actions or needs of the infant.

D. The parents do not move from fingertip touch to palmar contact and holding.

B

A. Incorrect: This would be an inhibiting behavior.

B. Correct: Hovering over the infant, as well as obviously paying attention to the baby, is a facilitating behavior.

C. Incorrect: This would be an inhibiting behavior.

D. Incorrect: This would be an inhibiting behavior.

p. 614

In follow-up appointments or visits with parents and their new baby, it is useful if the nurse can identify infant behaviors that can either facilitate or inhibit attachment. What is an inhibiting behavior?

A. The infant cries only when hungry or wet.

B. The infant's activity is somewhat predictable.

C. The infant clings to the parents.

D. The infant seeks attention from any adult in the room.

D

A. Incorrect: These are facilitating behaviors. Facilitating and inhibiting behaviors are behaviors that build or discourage bonding (attitudes); they do not reflect any value judgments on what might be healthy or unhealthy.

B. Incorrect: These are facilitating behaviors. Facilitating and inhibiting behaviors are behaviors that build or discourage bonding (attitudes); they do not reflect any value judgments on what might be healthy or unhealthy.

C. Incorrect: These are facilitating behaviors. Facilitating and inhibiting behaviors are behaviors that build or discourage bonding (attitudes); they do not reflect any value judgments on what might be healthy or unhealthy.

D. Correct: Parents want to be the focus of the infant's existence, just as the infant is the focus of their existence. Facilitating and inhibiting behaviors are behaviors that build or discourage bonding (attitudes); they do not reflect any value judgments on what might be healthy or unhealthy.

p. 613

With regard to parents' early and extended contact with their infant and the relationships built, nurses should be aware that:

A. Immediate contact is essential for the parent-child relationship.

B. Skin-to-skin contact is preferable to contact with the body totally wrapped in a blanket.

C. Extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies.

D. Mothers need to take precedence over their partners and other family matters.

C

A. Incorrect: Immediate contact facilitates the attachment process but is not essential; otherwise, adopted infants would not establish the affectionate ties they do.

B. Incorrect: The mode of infant-mother contact does not appear to have any important effect.

C. Correct: Nurses should encourage any activity that optimizes family extended contact.

D. Incorrect: Mothers and their partners are considered equally important.

p. 616

In the United States, the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except:

A. Washing both the infant's face and the mother's face

B. Placing the infant on the mother's abdomen or breast with their heads on the same plane

C. Dimming the lights

D. Delaying the instillation of prophylactic antibiotic ointment in the infant's eyes

A

A. Correct: To facilitate the position in which the parent's and infant's faces are approximately 8 inches apart on the same plane, allowing them to make eye contact, the nurse can place the infant at the proper height on the mother's body, dim the light so that the infant's eyes open, and delay putting ointment in the infant's eyes.

B. Incorrect: To facilitate the position in which the parent's and infant's faces are approximately 8 inches apart on the same plane, allowing them to make eye contact, the nurse can place the infant at the proper height on the mother's body, dim the light so that the infant's eyes open, and delay putting ointment in the infant's eyes.

C. Incorrect: To facilitate the position in which the parent's and infant's faces are approximately 8 inches apart on the same plane, allowing them to make eye contact, the nurse can place the infant at the proper height on the mother's body, dim the light so that the infant's eyes open, and delay putting ointment in the infant's eyes.

D. Incorrect: To facilitate the position in which the parent's and infant's faces are approximately 8 inches apart on the same plane, allowing them to make eye contact, the nurse can place the infant at the proper height on the mother's body, dim the light so that the infant's eyes open, and delay putting ointment in the infant's eyes.

p. 617

Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that despite what folk wisdom might say:

A. High-pitched voices irritate newborns.

B. Infants can learn to distinguish their mother's voice from others soon after birth.

C. All babies in the hospital smell alike.

D. A mother's breast milk has no distinctive odor.

B

A. Incorrect: Infants respond positively to high-pitched voices.

B. Correct: Infants know the sound of their mother's voice early.

C. Incorrect: Each infant has a unique odor.

D. Incorrect: Infants quickly learn to distinguish the odor of their mother's breast milk.

p. 617

After birth, a crying infant may be soothed by being held in a position in which the newborn can hear the mother's heartbeat. This phenomenon is known as:

A. Entrainment

B. Reciprocity

C. Synchrony

D. Biorhythmicity

D

A. Incorrect: Entrainment is the movement of newborns in time to the structure of adult speech.

B. Incorrect: Reciprocity is body movement or behavior that gives cues to the person's desires. These take several weeks to develop with a new baby.

C. Incorrect: Synchrony is the fit between the infant's behavioral cues and the parent's responses.

D. Correct: The newborn is in rhythm with the mother. The infant develops a personal biorhythm with the parents' help over time.

p. 617

Of the many factors that influence parental responses, nurses should be aware that all of these statements regarding age are true except:

A. An adolescent mother's egocentricity and unmet developmental needs interfere with her ability to parent effectively.

B. An adolescent mother is likely to use less verbal instruction, be less responsive, and interact less positively than other mothers.

C. Adolescent mothers have a higher documented incidence of child abuse.

D. Mothers older than 35 often deal with more stress related to work and career issues, as well as decreasing libido.

C

A. Incorrect: Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling, but a higher incidence of child abuse is not one of them.

B. Incorrect: Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling, but a higher incidence of child abuse is not one of them.

C. Correct: Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling, but a higher incidence of child abuse is not one of them.

D. Incorrect: Midlife mothers have many competencies but are more likely to have to deal with career and sexual issues than are younger mothers.

p. 625

When dealing with parents who have some form of sensory impairment, nurses should realize that all of these statements are true except:

A. One of the major difficulties visually impaired parents experience is the skepticism of health care professionals.

B. Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact.

C. The best approach for the nurse is to assess the parents' capabilities rather than focusing on their disabilities.

D. Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information.

B

A. Incorrect: The skepticism, open or hidden, of health care professionals throws up an additional and unneeded hurdle for the parents.

B. Correct: Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used.

C. Incorrect: After the parents' capabilities have been assessed (including some the nurse may not have expected), the nurse can help find ways to assist the parents that play to their strengths.

D. Incorrect: The Internet affords an extra teaching tool for the deaf, as do videos with subtitles or nurses signing. A number of electronic devices can turn sound into light flashes to help pick up a child's cry. Sign language is acquired readily by young children.

p. 628

With regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn, nurses should be aware that:

A. Sibling rivalry cannot be dismissed as overblown psychobabble; negative feelings and behaviors can take a long time to blow over.

B. Participation in preparation classes helps both siblings and grandparents.

C. In the United States, paternal and maternal grandparents consider themselves of equal importance and status.

D. Since 1990, the number of grandparents providing permanent care to their grandchildren has been declining.

B

A. Incorrect: Sibling rivalry should be expected initially, but the negative behaviors associated with it have been overemphasized and stop in a comparatively short time.

B. Correct: Preparing older siblings, as well as grandparents, helps with everyone's adaptation.

C. Incorrect: In the United States, in contrast to other cultures, paternal grandparents frequently consider themselves secondary to maternal grandparents.

D. Incorrect: The number of grandparents providing permanent child care has been rising.

pp. 629-630

Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is the management of the environment. While providing routine mother-baby care, the nurse should ensure that:

A. The baby is able to return to the nursery at night so that the new mother can sleep

B. Routine times for care are established to reassure the parents

C. The father should be encouraged to go home at night to prepare for mother-baby discharge

D. An environment that fosters as much privacy as possible should be created

D

A. Incorrect: Once the baby has demonstrated adjustment to extrauterine life (either in the mother's room or the transitional nursery), all care should be provided in one location. This important principle of family-centered maternity care fosters attachment by giving parents the opportunity to learn about their infant 24 hours a day. One nurse should provide care to both mother and baby in this couplet care or rooming-in model. It is not necessary for the baby to return to the nursery at night. In fact, the mother will sleep better with the infant close by.

B. Incorrect: Care should be individualized to meet the parents' needs, not the routines of the staff. Teaching goals should be developed in collaboration with the parents.

C. Incorrect: The father or other significant other should be permitted to sleep in the room with the mother. The maternity unit should develop policies that allow for the presence of significant others as much as the new mother desires.

D. Correct: Care providers need to knock before gaining entry. Nursing care activities should be grouped.

pp. 614-616

The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, about one-half million women in America experience a more severe syndrome known as postpartum depression. Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis?

A. PPD symptoms are consistently severe

B. This syndrome affects only new mothers

C. PPD can easily go undetected

D. Only mental health professionals should teach new parents about this condition

C

A. Incorrect: PPD symptoms range from mild to severe, with women having both good day and bad days.

B. Incorrect: Screening should be done for both mothers and fathers. PPD in new fathers ranges from 1% to 26%.

C. Correct: PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt.

D. Incorrect: The nurse should include information on PPD and how to differentiate this from the baby blues for all clients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if they occur.

pp. 621, 622

What concerns about parenthood are often expressed by visually impaired mothers? Choose all that apply.

A. Infant safety

B. Transportation

C. The ability to care for the infant

D. Missing out visually

E. Needing extra time for parenting activities to accommodate the visual limitations

A, B, D, E

Correct: Concerns expressed by visually impaired mothers include infant safety, extra time needed for parenting activities, transportation, handling other people's reactions, providing proper discipline, and missing out visually.

Incorrect: Blind people sense reluctance on the part of others to acknowledge that they have a right to be parents. However, blind parents are fully capable of caring for their infants.

p. 628

____________________ is the process by which the parent and infant come to love and accept each other.

Attachment

p. 612