OB NURS 306 Study Guide for Week 4 Content

OB NURS 306 Study Guide for Week 4 Content o Transition to Parenthood o Role Transition to Motherhood/Fatherhood ▪ Motherhood ▪ Fatherhood Mercer describes four stages ■ 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 In general, men do not fantasize about being a father, nor do they role-play being a father during childhood 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 newborn. ■ By friends and family, and by his partner. Factors that influence the man’s transition to fatherhood are: ■ Developmental and emotional age ■ Cultural expectations ■ Relationship with his partner/wife ■ Knowledge and understanding of fatherhood ■ Previous experiences as a father ■ The manner in which he was fathered ■ Financial concerns ■ Support from partner/wife, friends, and family o Special populations: Adolescent parents ▪ Adolescence is the transition between childhood and Adulthood + working through the developmental tasks of being a teenager (Erik Erikson: identity vs role confusion) ▪ Less experiences to none o Signs of normal bonding and attachment ▪ BONDING: directional  baby emotional feelings that begin during pregnancy ▪ ATTACHMENT: bidirectional ↔ emotional connection between both ▪ When to intervene when it is abnormal ■ Expected assessment findings: o ■ Parents hold the infant close. o ■ Parents refer to the infant by name or proper sex. o ■ Parents respond to the infant’s needs. o ■ Parents speak positively about the infant. o ■ Parents appear interested in learning about the infant. o ■ Parents ask appropriate questions about infant care. o ■ Parents appear comfortable holding and caring for the infant. ■ Maladaptive assessment findings: o ■ Parents call the infant “it.” o ■ Parents avoid eye contact with the infant (this can be viewed as adaptive based on culture). o ■ Parents do not respond to the infant’s cries. (ignores the baby) o ■ Parents are emotionally unavailable to the infant. o ■ Parents allow others to care for the infant, showing no interest (this can be viewed as adaptive based on culture). o ■ Parents demonstrate poor feeding techniques such as propping bottles, not burping the infant, or seeming to be uncomfortable and/or irritated when nursing. o Postpartum Blues vs Postpartum Depression Postpartum Blues *aka Baby Blues occur during the first 2 postpartum weeks, last for a few days Occurs or affects a majority of women. *feels sad and cries easily, but she is able to take care of herself and her infant (seek help after 4 weeks) Possible causes of postpartum blues are: ■ Changes in hormonal levels ■ Fatigue ■ Stress from taking on the new role of mother Signs and symptoms of postpartum blues are: ■ Anger ■Anxiety, ■ Mood swings ■ Impatience ■ Sadness ■ Weeping, ■ Crying ■ Difficulty sleeping ■ Difficulty concentrating ■ Difficulty eating ■ Feeling “I’m not myself” ■ Restlessness Postpartum Depression Postpartum depression (PPD) is a mood disorder characterized by severe depression that: -occurs within the first 6–12 months postpartum. - occurs in 14.5% of postpartum women PPD is classified as a major depressive disorder when the woman has a depressed mood or a loss of interest or pleasure in daily activities for at least 2 weeks plus four of the following symptoms: ■ Significant weight loss or gain: a change of more than 5% of body weight in 1 month ■ Insomnia or hypersomnia ■ Changes in psychomotor activity: agitation or retardation ■ Decreased energy or fatigue ■ Feelings of worthlessness or guilt ■ Decreased ability to concentrate; inability to make decisions ■ Recurrent thoughts of death or suicide attempt ■ A major difference between postpartum blues and PPD is that PPD is disabling; the woman is unable to care for herself and/or her baby ■ Requires psychiatric intervention & unable to care for herself and/or her baby • Signs & Symptoms ■ Sleep and appetite disturbance ■ Fatigue greater than expected for caring for a newborn ■ Despondency (low spirit, low hope) Hopelessness ■ Uncontrolled crying ■ Anxiety, fear, and/or panic ■ Inability to concentrate ■ Feelings of guilt, inadequacy, and/or worthlessness ■ Inability to care for self-and/or baby ■ Decreased affectionate contact with the infant ■ Thoughts of harming self-and/or the baby, Postpartum Psychosis Postpartum psychosis (PPP) is a variant of bipolar disorder and is the most serious form of postpartum mood disorders o Onset within first 8 weeks after childbirth & as early as the 3rd day postpartum o Rare postpartum mood disorder that occurs in 1–2 women per 1,000 births (4,000 / year) Distinguishing signs: • hallucinations, • agitation, • confusion, • suicidal/homicidal thoughts, • delusions, • sleep disturbances, • loss of touch with reality ■ Paranoia, grandiose or bizarre delusions usually associated with the baby ■ Mood swings ■ Extreme agitation ■ Depressed or elated moods ■ Distraught feelings about ability to enjoy infant ■ Confused thinking ■ Strange beliefs, such as that she or her infant must die ■ Disorganized behavior o Requires immediate hospitalization & treatment o Newborn Nutrition and Feeding o AWHONN, WHO recommendations for length of breastfeeding ▪ At least for 6 months of breast milk ▪ Better for 12 months or longer o Cultural difference in breastfeeding- refer to table in book on pg 419 o Contraindications to breastfeeding o Maternal and newborn advantages to breastfeeding o Differences in breast milk (colostrum, transitional milk, foremilk, hindmilk) Breast Milk Contains proteins, carbohydrates, and fats that are synthesized in alveolar glands of the breast Stage 1 & 2 Stage 3 (Mature Milk) 20% solids 80% water 22–23 calories per ounce Colostrum present for 2–3 days after birth Transitional Milk consists of colostrum and milk Foremilk milk that is produced and Hindmilk milk produced during the