1. Psychological/behavioral changes Achievement of developmental tasks-progress in assuming maternal role.
    1. Assessment:
      1. Taking-in phase-1-3 days following birth.
        1. Talkative; verbally relives labor/birth experience.
        2. Passive, dependent, concerned with own needs (eating, sleeping, elimination).
      2. Taking-hold-3 to 2 weeks.
        1. Impatient to control own bodily functions, care for self.
        2. Expresses interest/concern in learning how to care for baby (desire to assume “mothering” role).
        3. Responds to positive reinforcement.
      3. Letting-go-mother “lets go” of former selfconcept, role, lifestyle; begins to integrate new role and self-concept as “mother.”
        1. Feelings of insecurity, inadequacy.
        2. Hesitancy in approaching infant care tasks.
      4. “Baby blues”-may appear on day 4 or (Note: Often, father/partner experiences same feelings.)
        1. Thought to result from fatigue (sleep deprivation), realization of need for role change, recognition of new responsibilities, hormonal change.
        2. Mild depression, cries without provocation.
        3. Frightened-intimidated by own perceptions of responsibilities, hormonal changes.
      5. Lag in experiencing “maternal feelings”- usually resolved within 6 weeks.
        1. May contribute to “baby blues.”
        2. Guilt regarding lack of “maternal feelings.”
        3. Diminished by prompt bonding experience.
    2. Analysis/nursing diagnosis:
      1. Ineffective family coping: compromised, related to achieving developmental tasks.
      2. Situational low self-esteem related to perceived inadequacy in acceptance of maternal role.
      3. Ineffective individual coping related to “baby blues,” lag in experiencing maternal feelings.
    3. Nursing care plan/implementation:
      1. Taking-in. Goal: emotional support.
        1. Encourage verbalization of labor/birth experiences; compliment parents on “how well” they did.
        2. Explore feelings of disappointment, if any.
        3. Meet dependency needs; comment on appearance, hair, personal gowns.
        4. Encourage rooming in.
      2. Taking-hold. Goal: health teaching.
        1. Discuss self-care, postpartal physiological/psychological changes.
        2. Demonstrate infant care; mother returns demonstration.
    4. Evaluation/outcome criteria:
      1. Woman demonstrates beginning comfort in maternal role.
      2. Woman develops confidence and competence in infant care.
      3. Woman expresses satisfaction with self, infant; eager to return home.
      4. Woman succeeds in breastfeedin(Tension inhibits let-down reflex; baby nurses poorly.)
  1. Breastfeeding and lactation
    1. Biological foundations:
      1. Antepartal alterations:
        1. High estrogen/progesterone levels-stimulate proliferation and development of breast ducts.
        2. High progesterone levels-also-development of mammary lobules and alveoli.
      2. Postpartum alterations:
        1. Rapid drop in estrogen/progesterone levels.
        2. Increased secretion of prolactin-stimulates alveolar cells-milk.
        3. Suckling-stimulates release of oxytocin-contraction of ducts-milk ejection (let-down reflex).
        4. Engorgement-due to venous and lymphatic stasis.
          1. Immediately precedes lactation.
          2. Lasts about 24 hours
          3. Frequent feeding reduces engorgement.
    2. Assessment:
      1. Colostrum (yellowish fluid)-continues for first 2-3 days; has some antibiotic, immunologic, and nutritive value.
      2. Milk (bluish-white, thin) -secreted on about third day.
    3. Analysis/nursing diagnosis:
      1. Knowledge deficit related to breastfeeding techniques.