Nursing Care of the Newborn and Family

Psychosocial changes during the postpartum period include various adjustments and changes that occur during the first 6 weeks after giving birth.

The most important psychosocial changes include bonding, attachment, maternal touch and verbal behaviors, as well as adaptation and maternal role attainment.

During this period, the nurse should provide support for the new family and intervene to promote a healthy outcome during the postpartum period.

First, let’s start with bonding. Simply said, bonding refers to the intense connection that parents develop for their baby.

Important methods to promote maternal bonding include promoting skin-to-skin contact and breastfeeding. On the other hand, paternal bonding can be enhanced with methods including presence during labor and delivery, bathing the baby, changing diapers, and bottle feedings.

Sometimes, the bonding process can be delayed due to neonatal complications that might require admission to the neonatal intensive care unit.

When this happens, nursing care involves providing information, encouraging bedside visitation and involvement in their baby’s care, and coordinating resources to support the family.Now, bonding should not be confused with attachment, which refers to an enduring linkage between the parents and their child.

It is a reciprocal relationship where the baby receives food, warmth, cuddling, and gentle interaction, and develops feelings of security and trust.

In other words, babies can anticipate that their parents or caregivers will be available to support them in times of need.

In turn, the baby demonstrates reciprocal attachment behaviors, including making eye contact, tracking their parent’s face or grasping their finger.Okay, let’s switch gears and move on to maternal touch.

Right after delivery, mothers usually use their fingertips to touch their baby. But, as time passes, they typically feel more comfortable and start to stroke their baby’s hair or chest with the palm of their hands.

Additionally, they hold their baby close, rub the nose against their baby’s nose, or rub their cheek against their baby’s cheek.

While interacting with their babies, mothers typically use a high-pitched voice.Next up is adaptation, which can be divided into three main phases.

First is the taking-in phase, which provides time for the mother to recover from the labor, regain strength, and reorganize their thoughts.

During this phase, clients are focused on their own physical needs like sleep and nourishment. They are often passive, often preferring to rely on a partner or healthcare providers for decision-making.

Second is the taking-hold phase, where the client becomes more active, takes more responsibility for her own care, and does not rely on others for decision-making.

Clients gradually adapt and begin focusing on the baby. At first, clients might be insecure about their skills and competence as a parent.

This is an ideal time for the nurse to provide positive reinforcement for caregiving activities, and to encourage the partner’s participation.

Finally, the last phase is the letting go phase. That’s when they “let go” of the previous life, embrace their new role and responsibility, as well as the life changes that come with a new baby.Adaptation also applies to other family members, such as the client’s partner and other children.

Regarding the partner, the arrival of the baby can change the relationship dynamics, and they also need to adapt and settle into their new role as a parent.

Greater partner involvement with caregiving, such as diaper changes or feeding, indicates a greater acceptance of their new role.

The baby’s siblings also need to adapt, and they may show different reactions. Some children may experience fear of replacement, acting out, or regression, while others may have an easier time accepting the baby’s arrival.

It’s important to assess their reaction and help them adapt by accepting their feelings, and teaching them to interact with the baby.Now, important factors that can affect adaptation during the postpartum period include maternal age, previous experiences, as well as maternal and infant temperament.

Additionally, adaptation might be different in clients who undergo cesarean birth than those who have had a vaginal delivery.

Finally, neonatal complications might slow down the process of adaptation, but the family can catch up with the adjustments and changes over the next several months.Switching gears and moving on to maternal role attainment, this is a 4-stage process where confidence in the maternal role is achieved.

The first stage, called the anticipatory stage, begins during the pregnancy and includes seeking role models, fantasizing about the future maternal role, and attending childbirth classes.

The second stage, also known as the formal stage, begins after delivery. During this stage, the client recovers from the labor, learns more about her baby’s unique features, cues, and ways of communicating.

It is also a time to learn from others about the maternal role, replicate the behavior of healthcare professionals, and gain caregiving competence.

The third stage is called the informal stage. That’s when the client has learned the baby’s cues, and develops their unique mothering methods that fit the baby’s needs.

Finally, there’s the fourth or personal stage, which involves development of competence and internalizing the new maternal role.Finally, let’s cover the most common maternal concerns during the postpartum period.

First, clients might experience concern about their body image due to unrealistic expectations about weight loss after pregnancy.

It’s important to educate clients that there should be no rigid diets during this period, since a deficiency of nutrients can decrease their energy levels and impair their body’s ability to return to its pre-pregnant state.

Instead, a balanced diet and light daily exercises and walks should be encouraged. Now, some clients might experience postpartum blues, also known as baby blues or maternal blues, which begin several days after delivery and usually resolve within 14 days.

The exact cause remains unknown, but some sources suggest that it might be associated with emotional letdown after delivery, postpartum discomfort, body image concerns, and anxiety about the ability to take care of their baby.

Common symptoms of postpartum blues include fatigue, as well as mood swings that can range from irritability to anxiety and crying outbursts.

The nurse should validate the significant change in life that comes with having a new baby, and provide reassurance that ambivalence, as well as having emotional ups and downs are normal at this time.

Postpartum blues should be differentiated from perinatal depression, which is way less common, but causes more severe symptoms, such as extreme sadness, hopelessness, irritability, and anhedonia, which means a diminished interest in everyday activities that used to be pleasurable.

These symptoms last for at least two weeks, significantly impair daily functioning, and may negatively affect both parents, the baby, and the process of attachment and bonding.

Families should be educated about these symptoms and instructed to seek help immediately if they occur. Alright, as a quick recap… Psychosocial changes during the postpartum period include various maternal adjustments and changes that occur during the first 6 weeks after giving birth.

During this period, the nurse should support the client and their partner and help promote a healthy outcome. The most important psychosocial changes include bonding, attachment, maternal touch and verbal behaviors, as well as adaptation and maternal role attainment.

Bonding refers to the intense connection that parents develop for their baby, while attachment refers to the reciprocal relationship that develops between the parents and their baby.

Adaptation applies to the whole family, and refers to the adjustment to their new roles and responsibilities, as well as the life changes that come with a new baby.

Finally, during maternal role attainment, the client learns from others about the maternal role, gains competence, and eventually learns the baby’s cues and develops