postpartal psycho logic adaptations

8/4/2019 Postpartal Psycho Logic Adaptations

1/56

V A R Q U E Z , K A R E N D .

V E R G A R A , C A N D A C E B .

V I C E N T E C H A R M A I N E S .

2 - 1 0

Postpartal Psychologic

Adaptations(p.788-793)


2/56

Postpartal Period

Time of readjustment and adaptation for the entire

childbearing family, especially for the mother.


3/56

Postpartal Period

The woman experiences a variety of responses as sheadjust to the ff.:

A new family member

Postpartal discomfort

Changes in her body image

The reality that she is no longer pregnant


4/56

Taking-In and Taking-Hold

Taking-In Period

During the first day or two after birth

The woman tends to be

passive and somewhat dependent.

Follows suggestions.

Hesitates to make decisions

Preoccupied with her needs


5/56


Taking-In Period

Foodand sleep are her major needs.

Nursing role:

Emotional support like talking to the mother about herperceptions of her labor and birth

Sort out the reality from her fantasized experience

Clarify anything that she did not understand


6/56


Taking-Hold Period

Second or third day after birth

Ready to resume control over her life

Concerned about:

controlling her bodily functions (eg. Elimination)

If breastfeeding, she may worry about the quality of her milk

Her ability to nurse her baby


7/56


Taking-Hold Period

Might also feel that the nurse handles her baby moreproficiently than she does

Nursing Role:

Provide assurance that she is doing well as a mother

Emotional support


8/56

Maternal Role Attainment

A process by which a woman learns motheringbehaviors and becomes comfortable with her

identity as a mother.

In most cases, maternal role attainment occurswithin 3 to 10 months after birth.


9/56


Factors that influence the womans success inattaining the maternal role:

Social support

Womans age and personality traits

Marital relationship

Presence of underlying anxiety or depression

Previous childcare skills

Temperament of her infant

The familys socioeconomic status


10/56


Four Stages:1. Anticipatory Stage

- During pregnancy

- The woman looks to role models, especially her own mother.

2. Formal Stage

- When the child is born

- Still influenced by the guidance of others- Tries to act as she believes others expect her to act.


11/56


3. Informal Stage

- When the mother begins to make her own choices aboutmothering

- Begins to develop he own style of mothering

- Find ways of functioning that work well for her.

4. Personal Stage

- Final stage of maternal role attainment

- The woman is comfortable with the notion of herself asmother


12/56


Challenges of a woman as she adjust to her new role:

Finding time for themselves

Feelings of incompetence

Fatigue from sleep deprivation

The feeling of responsibility

For women with older children, finding time for them is achallenge

Infantsbehavior


13/56


Nursing Role:

Needs to be aware of the long-term adjustments and thestresses that the childbearing family faces.

Providing anticipatory guidance about the reality of being a

parent

Giving postpartal family parenting literature for reference athome

Provide ongoing parenting groups.


14/56

Postpartum Blues

Transient period ofdepression.

Occurs during first few days of the puerperiumin 70% of all postpartal women.


15/56

Postpartum Blues

Frequently occurs while the woman ishospitalized, but it may occur at home as

well.

Usuallyresolve naturally within10 to 14days.


16/56

Postpartum Blues

Factors:

Changing hormone levels

Psychologic adjustments

Unsupportive environments

Insecurity

Fatigue, discomfort and overstimulation


17/56

Postpartum Blues

Manifestations:

Tearfulness

Anorexia

Difficulty in sleeping

Feeling of letdown


18/56

Importance of Social Support

Family relationships

Source of stress

Contact with parents of small children; decreasewith coworkers

Great concern: No family or friends to form a socialnetwork

- isolation at a time where the woman needssupport can cause tremendous stress

- postpartum depression, child neglect, abuse

- New mother support groups


19/56

Development of Family Attachment

Mothers first interaction with her infant is influenced bymany factors(i.e. family of origin, degree of nurturing shereceived as a child,etc)

Personal Characteristics:

- Level of Trust- Level of self-esteem

- Capacity for enjoying herself

- Adequacy of knowledge about childbearing and childrearing

- Her prevailing mood or usual feeling tone

- Reactions to the present pregnancy

Based on these factors the mother has developed some kind ofemotional orientation


20/56

Initial Maternal Attachment Behavior

New mother demonstrates a regular pattern ofmaternal behaviors at first contact with a normalnewborn

From fingertip exploration-extremities, to palmarcontact with larger body areas, and finallyenfolding infant with whole hand and arms

- minutes to days


21/56


En face- mother arrangesherself of the newborn soshe has direct face-to-face and eye-to-eye

contact


22/56


Infants eyes open Greets the newborn and

talks in a high-pitchedtone

Sight, touch and hearing;smell may be involved

Responds to verbal cues


23/56


Shock, disbelief, or denial

- I cant believe shes finally here

- I feel like he is a stranger

Feelings of connectedness between the newborn andfamily- expressed negatively or positively

- Shes got your cute nose, Daddy

Facial expressions, questions asked and itsfrequency- concerns about the infants generalcondition or normality


24/56

Initial Maternal Attachment Behavoir

Acquaintance phase

Getting to know her baby

Infant gives clear behavioral cues, infants responses

to mothering will be predictable- Mother feel effective and competent

-smile

-grasping a finger


25/56


Phase of mutual regulation Mother and infant seek to deal with the issue of the

degree of control to be exerted byeach partner inthe relationship

Balance between mothers needs and infants needs Each should obtain a good measure of

enjoyment from the interaction. Negative feelings may surface or intensify

- Nurse should be supportive when the

mother vocalizes these feeling


26/56


Reciprocity An interactional cycle that occurs simultaneously

between mother and infant

Mother and infant enjoy each others company

Cuing behaviors, expectancy, rhythmicity, andsynchrony

Synchronous- interaction between mother and infantare gratifying, sought and initiated by both parents

Find pleasure and delight in each others company andgrow in mutual love.


27/56

Father-Infant Interactions

In Western cultures, commitment to family-centeredmaternity care has fostered interest inunderstanding the feelings and experiences of thenew father.

Father has a strong attraction to his newborn similarto the mothers feelings of attachment.


28/56

Father-Infant Interactions

Engrossment-the characteristic sense of absorption,preoccupation, and interest in the infantdemonstrated by fathers during early contact.

-strong feelings of

attraction.


29/56

Siblings and Others

Infants are capable of maintaining strongattachments within the family.

siblings, grandparents,

aunts and uncles.


30/56

Siblings and Others

The social setting and personality of an individualseem to be factors in developing attachments.

Visiting hours and rooming in

Permits siblings in the attachment process


31/56

Cultural Influences in the postpartal period

New mothers cultural and personal valuesinfluences her :

Postpartal care Expectations about food and fluids

Rest

Hygiene

Medications

Relief measures

Support and advice


32/56


It is important that nurses should recognize thatsometimes they are approaching their clients carefrom their own perspective.

They need to offer and support individual choices.


33/56


It is helpful for nurses to understand that there arereally differences in beliefs and practices of culturalgroups.

European

Eat a full meal and large amounts of fluids

Want to ambulate shortly after birth

Shower, wash her hair and put on a fresh gown

May or may not be interested in educational classes


34/56


Some cultures emphasize postpartal routines orrituals for mother and baby:

To restore harmony

Hot-cold balance of the body


35/56


Hispanic, African and Asian May avoid cold after birth (cold air, wind and water)

Mexican Avoid eating hot foods such as pork

Considered birth of a baby as a hot experience


36/56


In many cultures, the extended family plays anessential role during the puerperium.

The grandmother- the primary helper to mother andnewborn

Brings wisdom and experience, allowing the new mother torest

Visiting hours may be expanded to allow familymembers additional access.


37/56

D I D Y O U K N O W

T H E R A T E O F A D M I S S I O N O F W O M E N I N T O A P S Y C H I A T R I C H O S P I T A L I S G R E A T E R

D U R I N G T H E Y E A R A F T E R C H I L D B I R T HT H A N A N Y O T H E R T I M E I N A W O M A N S L I F E

Care of the Woman with a

Postpartum Psychiatric Disorder


38/56

Types of Postpartum Psychiatric Disorders

Diagnostic and Statistical Manuarl of MentalDisorders (APA, 2000)

One diagnosable syndrome with three subclasses:1. Adjustment reaction with depressed mood

2. Postpartal Psychosis

3. Postpartum major mood disorder.


39/56

Adjustment Reaction with Depressed Mood

Aka Postpartum blues, maternal or baby blues

50%-80%

Mild depression interspersed with happier feelings

Few days after birth, self limiting, few hours to10days or longer

Severe in primiparas; rapid alterations of estrogen,progesterone, and prolactin levels after birth


40/56


Overwhelmed

Unable to cope

Fatigue Anxious

Irritable

Oversensitive Key feature: Episodic tearfulness oftenwithout

identifiable reason


41/56


Validate existence

Label as real but normal

Provide reassurance

Encourage partner to watch for and report signs thatmother is becoming more depressed.


42/56

Postpartum Psychosis

Symptoms- Agitation

- Hyperactivity

- Insomnia

- Mood lability

- Confusion

- Irrationality

- Difficulty remembering orconcentrating

- Poor judgment- Delusions

- Hallucinations

1 to 2 per 1000 First 3months postpartum

Improvement- 95% womenin 2 to 3 months

Increase risk in next

pregnancy


43/56

Postpartum Major Mood Disorder

Postpartum depression 7%-30% postpartumwoman in North American

Anytime during firstpostpartum year

- Four weeks (before onsetof menses and uponweaning)

NOT associated withdepression duringpregnancy

Risk factors1. Primiparity2. Ambivalence3. History of postpartum

depression or bipolar

illness4. Lack of social support5. Lack of stable and

supportive relationship6. Lack of supportive

relationship7. Dissatisfaction withherself.


44/56

Postpartum Major Mood Disorder


45/56

Clinical Therapy

Women with history of postpartum psychosis ordepression or other high risks:

Should be referred to a mental health professional forcounseling

Biweekly visits between the second and sixth week postpartumfor evaluation

Common treatment measures Medication

Individual or group psychotherapy

Practical assistance with child care


46/56

Clinical Therapy

Treatment for postpartum psychosis: Lithium

Antipsychotics or electroconvulsive therapy withpsychotherapy

Removal of the infant

Social support

Treatment for postpartum depression:

Psychotherapy

Antidepression medications(serotonin reuptake inhibitors)


47/56

Clinical Therapy

If social support is not available, the woman and herfamily may encouraged to contact Depression afterDelivery (DAD).

DAD is a national support network that provides literature and

volunteers.

Many of the drugs in treating postpartum psychiatricconditions are contraindicated in breastfeeding

women.


48/56

Nursing Assessment and Diagnosis

Ideally a depression assessment should be completedeach trimester to update a pregnant womans riskstatus. The Eidenburgh Postnatal Depression Scale

Score above 12- suffers from postpartum depression

Becks revised Postpartum Depression Predictors Inventory

(PDPI-Revised)


49/56


Objective signs of depression

Anxiety

Irritability

Poor concentration

Forgetfulness

Sleep difficulties

Appetite change

Fatigue

Tearfulness


50/56


Ineffective Individual Coping related to postpartum

depression

Risk for Altered related to postpartal mental illness


51/56

Nursing Plan and Implementation

Teaching for Self-Care Offer realistic information and anticipatory guidance

Debunking myths about the perfect mother or perfect newborn

Social support

The nurse should also alert the mother, spouse and otherfamily members to the possibility of postpartum blues in earlydays of birth.

Symptoms of postpartum depression should be described and

encouraged her to call her health provider if symptoms becomesevere.


52/56

Nursing Plan and Implementation

Community-Based Nursing Care

Home visits.

Telephone follow-up at 3 weeks postpartum.

If a woman presents symptoms of depression, refer to a mentalhealth professional immediately.

Providing information and emotional support.

Assistance in providing care for the infant.

Postpartum follow-up, as well as visits from a psychiatric homehealth nurse.

Primary Prevention Strategies for Postpartum


53/56

Primary Prevention Strategies for PostpartumDepression

1. Celebrate childbirth but appreciate that it is a life-changingtransition that can be stressful.

2. Consider keeping a journal where you write down yourfeelings.

3. Appreciate that you do not have to know everything to be agood parent.

4. Connect to others who are parents.

5. Set a daily schedule and follow it even if you dont like it.

6.

Prioritize daily tasks.7. Remember that you do not have to entertain or care for

everyone who drops by.

Primary Prevention Strategies for Postpartum


54/56

Primary Prevention Strategies for PostpartumDepression (contd)

8. If someone volunteers to help you with tasks or baby care,take them up on it.

9. Maintain outside interests.

10. Eat a healthful diet. Limit alcohol. Quit smoking. Get some

exercise.11. Get as much sleep as possible.

12. Limit major changes the first year insofar as possible.

13. Spent time with others.

14. If things get overwhelming, and you feel yourself slippinginto depression, reach out someone for help.

15. Attend a postpartum support group if someone is available.


55/56

Evaluation

The womans signs of depression are identified andshe receives therapy quickly.

The newborn is cared for effectively by the father oranother support person until the mother is able to

participate more fully.


56/56

END.Thank you!

postpartal psycho logic adaptations

Documents