Maternity - Postpartum, part 3: Maternal Role Attainment, Parental-Infant Bonding, Sibling Adaptation
by Meris Shuwarger BSN, RN, CEN, TCRN November 30, 2021 Updated: June 16, 2022 8 min read
Hi, I'm Meris with Level Up RN, and today, I'm going to be talking to you about some postpartum patient education. We're going to be talking about maternal role attainment, parental and infant bonding, sibling adaptation, and important patient teaching for sexual intercourse in the postpartum period. I'm going to be following along using our maternity flashcards. These are available on our website, leveluprn.com, if you want to grab your own deck, and if you already have a set of your own, I would invite you to follow along with us. Okay, let's go ahead and get started. So, first up, we are talking about the three phases of maternal role attainment, and this kind of describes the different phases that a new parent, a new mother, may go through in the immediate postpartum period. So let's talk about it a little bit. The first phase is sometimes called the dependent phase or the taking-in phase, and this is for the first 24 to up to 48 hours following birth. It's called the dependent phase because the mother is often dependent on others for her own care. So think about the fact that, after delivery, yes, you have this great new baby, but also, I just went through something really significant, and I am trying to get my own body back to homeostasis. I can't just jump up and start being super mom because I need to fix my own self first, right? So that's the dependent phase.
So I think of this also with the taking in; I'm taking it all in. I'm reflecting on what just happened to me, the fact that there's this new baby, that sort of a thing. So we do have here in bold and red that the mom may be eager to discuss her birth experience. So, every time you go in the room, mom might really want to tell you about what it was like hearing that baby's cry for the first time or what it was like when her water broke. That's normal. That would indicate that she is really in that taking-in phase. Now, beginning on day two or three, we have the dependent independent or the taking-hold phase. Now, this is where mom is going to transition from being pretty dependent on other people to being more independent. And also, she's going to begin to be excited to learn how to care for her baby. So, maybe at first, it was a lot of her partner changing the baby, maybe the nurse helping her to recognize when the baby needs to feed. But now that she's in that taking hold phase, she's like, "All right, let's figure it out. I'm a mom now. I'm going to take care of this baby, and I'm going to be involved in the care of this baby, especially now that my own body is doing a little bit better," right? So, first, we take it all in, and then I think of taking hold of a baby is how I remember that that is kind of what's happening in that phase. This is where I'm going to be more hands-on in the care of this infant.
And then the interdependent or the letting-go phase. So this is where we kind of figure out how this new baby is going to fit into our lives. So it says here, "Mother re-establishes her relationships with others, including her partner, and adjusts to a lifestyle that includes the infant, and may return to work." So this is sort of the, "Okay, now, I've got this baby. How does it fit into my life? How do I make my life fit around the new baby?" So that is maternal role attainment. Now, moving on to parental infant bonding, so we can have good, normal bonding, and we can have impaired bonding. So let's talk about signs of good, normal bonding first. So holding the infant, talking to her, singing to the infant, gazing at the infant, pointing out the distinct features that you see, saying that it's the best baby in the world, the most beautiful baby in the world, all of that is going to be signs of bonding. With both of my children, I did not sleep for the first 24 hours because I-- and this wasn't something that I could really control. I just held my babies in my laps and just stared at them, right? I stared at them for 24 hours. And we've talked about this before in previous videos, but having had eight miscarriages myself, I just remember thinking, "Wow, they're here. This baby is finally here." So I was really all-in on that bonding, so much so that I sacrificed my own sleep, right? I don't recommend that, but that is what my experience was.
Now, signs of impaired bonding, signs that maybe things are not going very well and maybe we need to work on that a little bit. So, ignoring the infant. So if the infant is crying or something like that apathy when the infant cries, sort of just not-- apathy means a lack of caring or lack of interest. That is going to be a sign of impaired bonding. Disgust with diapers or spit-up. I mean, they are super gross, but if a parent is routinely verbalizing or showing facial features of extreme disgust, that would be a sign of impaired bonding. And then expressing disappointment in the infant. So, on one hand, it's totally normal to say you have the best baby, the most beautiful baby, the whatever. But if you're expressing disappointment in the infant, that can also be a sign of impaired bonding.
So, parental teaching, we want to include and encourage the parents to have a hands-on approach. So especially as the nurse, this is all your day-to-day life. This is very normal to you. This is just your job. So it can be easy to go in and just change a diaper, swaddle the baby, do whatever it is. But we really want to include the parents and encourage them to take ownership of the care of the baby and really be hands-on. Then we also want to provide education on infant hunger cues. You can go watch that video that I did in-depth on that, and then provide information on community resources as well. So does the parent need a resource like WIC, Women, Infant, and Children? Is there a need for a benefit like SNAP so that they can have assistance with food? Do we need help finding daycare, a pediatrician, all kinds of those things? It's a lot of work to locate those resources on your own, so we do want to provide that to the family.
Now, talking about sibling adaptation, this is something I was very worried about when my son was born. My daughter was-- let's see, she was two years old, very newly two years old, so I was really worried about introducing her to a new baby and kind of rocking her world with that big change. So we have a few things here that we suggest that can be done to help promote that sibling adaptation. One is letting the sibling be one of the first people to see the new baby makes them feel really special, involved, and included. This one bold in red - it's so important and so helpful - provide a gift from the infant to the sibling. So when my son came home from the hospital, he got my daughter a gift, right? He had gotten her a baby doll that looked kind of like him for her to take care of so that she could practice taking care of a baby and be a big helper for Mommy and Daddy. So giving a gift from the infant to the sibling is very helpful. And this one goes hand-in-hand with giving the younger siblings a doll to care for or giving the older siblings the opportunity to provide care for the baby. Obviously, my two-year-old was not going to be changing a diaper, right? But if I had an older child, I could say, "Hey, would you mind holding him while I get that bottle ready?" or something like that is going to help to make them feel involved.
Plan individual time with each child, so try to make them feel special. And remember that regression is normal. So, for instance, if you have a toilet-trained child who suddenly starts having accidents or wetting the bed, that's normal. If your older child starts kind of talking more in a baby speech sort of manner, that's normal as well. Regression is normal when a new baby is brought into the household. And monitor the behavior of older children. So just be aware of what's going on when that child is around the infant and be sure to look out for any sort of aggressive behavior. Now, switching gears entirely, let's talk about patient-teaching as it relates to sexual intercourse in the postpartum period. So the biggest thing here is going to be do not have intercourse until you are cleared to do so by your provider. That is going to be very individual based on who your provider is, what their kind of standards and practices are, and then also about you, about the patient. Did you have a C-section versus a vaginal delivery? Did you need an episiotomy? Those sort of things are going to change. But in general, it's going to be about two to four weeks after delivery. And again, it's going to be based on the individual and the provider.
This is a guideline. You can also educate your patients not to have intercourse until they themselves feel ready as well. We don't want them to push themselves in any sort of capacity, whether that be physically, emotionally, or intimately with their partner. They've just had a big change, so we're going to tell our patients, "The guideline, your provider says four weeks," or whatever it may be. "However, don't return to having intercourse until you yourself feel ready." Lubricant should be used to prevent discomfort. Again, lots of changes internally and externally associated with pregnancy and delivery, so we would want to encourage them to use an external lubricant. Contraception needs to be discussed, typically before they even leave the hospital, or at least at their postpartum visit. People think of breastfeeding as being a contraceptive option, and it is not. Breastfeeding may suppress ovulation sometimes, but also may not. And even if your menstruation has not returned, you cannot count on breastfeeding to have suppressed your ovulation, so it is not a reliable form of contraception, and we would want to talk about options.
There are options for patients that involve hormones, even if they are breastfeeding. Most notably would be the mini-pill, a progestin-only IUD, or subdermal implant, Depo-Provera. All of those sorts of things would be options for a breastfeeding patient. And then, of course, if your patient is not breastfeeding, they can pursue any of the options that have estrogen as well. So just really important to educate your patients that breastfeeding is not contraception. I hope that review was helpful. I'm going to give you some quiz questions to help you test your knowledge of some key facts I provided in this video.
Okay, so let's test your knowledge. So, first up, we have a patient who is 36 hours postpartum and they are expressing interest in learning how to bathe their new baby. What phase of the maternal role attainment is this patient in? And there's two names for it, so either name would be okay. Next up, the nurse observes a new parent holding their new infant and gazing at it silently. Is this a sign of normal bonding or impaired bonding? And lastly, a parent tells the nurse that, after bringing their newborn home, they're fully toilet-trained four-year-old began having accidents and wetting the bed. How should the nurse respond? Let me know how you did in the comments. I can't wait to hear. Thanks so much, and happy studying.
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