Psychosocial Assessment

Coping and Stress Tolerance

Many new mothers feel overwhelmed by the responsibility of motherhood. They may be intimidated by the nurses’ capability and skill with the newborn. They often feel inept and may not wish to ask questions that might be viewed as unintelligent. Establishing rapport, listening, and anticipating fears and anxieties are important nursing measures. False reassurances are not helpful; thorough teaching and encouragement are far more beneficial.

Often women experience a period of depression after delivery that is triggered by rapid hormonal shifts. This so-called postpartum depression, or “baby blues,” may be mild or severe. It often appears between 2 and 7 days postpartum. Prepare the woman for the possibility of this and plan a course of action if it occurs.

Signs of Potential Problems

No assessment of psychosocial needs is complete without an assessment for signs of potential problems. Not all potential psychosocial problems are easily identified. However, some signs may indicate a need for further evaluation by a caregiver skilled in that area (Box 27-11). The presence of one or more of these signs

Box 27-11 Signs of Potential Psychosocial Problems

• • Inability or refusal to discuss labor and birth experience
• • Refusal to interact with or care for baby (e.g., does not name baby, does not want to hold or feed baby)
• • Refusal to attend infant care (including breastfeeding) classes
• • Refusal to discuss contraception
• • References to self as ugly and useless
• • Excessive preoccupation with self (body image)
• • Marked depression
• • Lack of support system
• • Partner or other family members reacting negatively to baby
• • Expression of disappointment over baby’s sex
• • View of baby as messy or unattractive
• • Baby reminding mother of family member or friend she does not like

does not prove that a problem exists but may indicate a need for further assessment (see Chapter 28).

Roles and Relationships

The addition of a new family member has a major effect on roles and relationships. These changes are most obvious when the first child is born, but adjustments take place whenever another child joins a family. Time, money, and both environmental and emotional resources must be divided to include the new member.

In our society, the mother still fills the role of the child’s primary caregiver and faces the greatest number of changes. The responsibility of this role, 24 hours a day, 7 days a week, is overwhelming to many women. Today, because many women are independent wage earners, the loss of freedom is a difficult adjustment. The transition to motherhood can lead to feelings of guilt and confusion. Be sensitive to the mother’s concerns.

The responsibilities of fatherhood often become a reality when the father actually sees his child. The realization that a totally dependent individual needs him is frightening to many men. The financial concerns of feeding, clothing, and sheltering his family take on new significance. A two-income family may have only the father’s wages, at least temporarily. Even if the mother returns to work, there are new expenses for child care. Both parents find that the child’s needs take priority over their own needs or wishes. Freedom and spontaneity give way to a life circumscribed by feeding schedules, diaper bags, and babysitters.

Some men have little knowledge or experience in caring for infants; simple things, such as feeding, changing diapers, or even carrying a baby, may be intimidating. Help alleviate these fears by including the father in teaching whenever possible and by allowing him to verbalize his fears and concerns. Fathers go through a predictable three-stage process during the first 3 weeks of their transition to parenthood (Table 27-4).

Additional role adjustments relate to friends and the extended family. Friendships and socialization may take lower priority. Siblings assume a new position in the family order. Parents now become grandparents, and in-laws share grandchildren. These situations are all dynamic, and each family makes a variety of accommodations in incorporating their new roles.

Self-Perception

The new mother commonly wishes to discuss her perception of the labor and delivery. The new mother may spend considerable time with friends or in telephone conversation relating her experiences of labor and delivery. Allow time for her to verbalize and work through her experiences. Reality may differ greatly from her expectations. She may need explanations to clarify things in her mind.

Table 27-4 Transition to Fatherhood: A Three-Stage Process

The new mother may be passive for the first day or two. This is called the taking-in stage (see Box 27-9). During this time, the mother needs supportive care. Her primary focus may be on herself and on personal needs such as sleep, food, and attention. She may defer to the nurses and let others care for the baby. This is followed by the taking-hold stage, when the woman is ready to assume greater authority and responsibility for herself and her baby.

Mood swings are common early in the postpartum period, related to recent stresses, fatigue, and rapid hormonal changes. Explain this to the new mother so that she does not become unduly concerned.

New mothers, particularly primiparas, commonly expect that they will regain their prepregnancy figures quickly after delivery. Many bring clothes that they hoped to wear home, only to be sadly disappointed. Be supportive and explain that it takes time for the body to regain the prepregnancy tone and shape.

Cognitive and Perceptual Issues

Control of discomfort during the postpartum period is necessary for the woman to resume a normal activity level and get adequate rest. The most common discomforts experienced are perineal pain from the episiotomy and afterbirth pains. Afterbirth pains are cramping sensations that result from the contraction of the uterus. They are more common and may be more severe in multiparas and breastfeeding mothers.

Most physicians prescribe analgesics for these discomforts. Acetaminophen is commonly used, with or without codeine. Codeine is generally effective but is a controlled substance and also has side effects, such as constipation and vertigo, that may be undesirable in the postpartum patient (see Table 27-3). Salicylates, such as aspirin, are usually avoided because they may 

interfere with clotting mechanisms. Recently ibuprofen (Motrin) has been popular. Ibuprofen is an analgesic, an anti-inflammatory, and a prostaglandin inhibitor. It is often effective in reducing the severity of the cramping without altering the contraction of the uterine muscle. CAUTION: Ibuprofen is to be used with caution in people with kidney or heart disease or those taking diuretics.

Another major challenge of the postpartum period for the mother involves learning how to care for herself and the newborn. This can be overwhelming for the first-time mother. The nurse has limited time to teach all the necessary information. Most hospitals have teaching lists and printed handouts or booklets that cover all the key areas (see Box 27-7). To prevent the woman from becoming overwhelmed, pace teaching throughout the hospital stay, rather than leaving it until discharge. Also, document newborn teaching (see Box 27-8).