2. • The postpartum period, or puerperium, refers
to the period beginning immediately after the
birth of a child and extending for about 6-to-
8-week period after delivery during which the
mother’s body returns to its pre-pregnant
state. Many psychological changes occur in
the mother during this time. Nursing care
should focus on helping the mother and her
family adjust to these changes and on easing
the transition to the parenting role.
3. Psychological changes during
puerperium :-
1. Adjustment to all the new changes, new roles
the family will play; this may cause many
different emotions.
2. Postpartum blues: Occurs in some women in
different degrees, as a temporary depression
lasting usually 1 to 2 weeks after birth, and
may be not be afraid to talk out your feelings
with someone, family, friend, or health care
provider. It often helps.
4. 3. Cultural influences: Different cultures have
different rituals they follow after mother has
the baby.
4. Attachment: The process of interaction and
bonding between mother & baby.
5. Psychological adaptation during
postpartum:-
• Mother typically undergo psychological
adjustments during the postpartum period.
• Reva Rubin, a researcher who examined
maternal adaptation to childbirth in the
1960s, identified three phases that can help
the nurse understand maternal behavior after
delivery.
6. • Historically, each phase encompassed a specific
time span and women progressed through
phases sequentially.
• Rubin’s Stages of maternal psychological
adaptation:-
1- Taking in phase(dependent phase):-
• First 3 days post partum.
• Focused on self ,not infant, on her own needs for
sleep & rest.
• Passive , dependent & can’t make decisions.
• Need to discuss labor experiences.
• Sense of wonderment when looking at the
neonate.
7. 2-Taking hold phase (dependent to independent
phase):-
• Last from the 3rd to 10th day postpartum.
• Focus on infant.
• Active, independent & can make decisions.
• Initiates self care activities, focus on
bowels, bladder & breastfeeding.
• Responds to instruction about infant care & self
care.
• May express lack of confidence in caring for the
neonate.
8. 3-Letting go- (interdependent phase):-
• Last from 10 days to 6 weeks postpartum.
• The woman finally redefines her new role.
• See self as separate from infant.
• Gives up fantasized image of her child and
accepts the real one.
• Readjustment.
9. Maternal Concerns & Feelings during
Postpartum period:-
• Abandonment:- Only hours before, she was
the center of attention, with everyone asking
about her health and well-being. Now
suddenly, the baby is the chief interest. The
woman may feel confused by a sensation very
close to jealousy. Shared responsibility for
infant care can help alleviate these feelings.
10. • Disappointment:- It can be difficult for the
mother to feel positive immediately about a child
who does not meet their expectations. Handle
the child warmly . Comment on the child good
points.
• Bonding( attachement):-
• It’s the process by which the mother forms an
emotional relationship with her infant over time.
• Mother explores the infant first with fingers ,
then palms and finally enfolding the newborn
with whole hands and arms.
• Holds infant in face to face position.
11. Postpartum disorders:-
• Some of the most common emotional and
mental health issues that arise during the
postpartum period are:-
1- Postpartum blues (Baby Blues):-
• The baby blues generally show up 3 to 4 days
after birth and may last for the few weeks
after delivery.
• Signs:- 50% of women experience some
feelings of overwhelming sadness.
• Mood swings, sudden crying
episodes, irritability, anxiety, loneliness
12. • Feeling of happiness and love for the newborn
may be accompanied by feelings of helplessness,
sadness and anxiety.
• Causes:-
• Sudden & quick change in the hormones.
• The emotional &physical stress of giving birth.
• It may be a response to dependence and low self-
esteem caused by exhaustion.
• Many new mothers tend to have an increased
sense of anxiety and tension assuming by a new
role.
• The fatigue and lack of sleep that affects all new
mothers only serves to compound the problem.
13. Here are some helpful tips:-
• Advice woman to exercise regularly.
• Advice woman to eat a healthy, well-balanced
diet.
• A woman needs assurance that sudden crying
episodes are normal.
• Allow time to verbalize feelings.
• Make time each day for her self to enjoy.
• Join a support group for new mothers.
14. • Talk with her partner about dividing up the
parenting responsibilities so she don’t feel like
she is doing everything by herself.
15. 2- Postpartum depression:-
• It is moderate to sever depression in a woman
after she has given birth. It may occur soon
after delivery or up to a year later.
• Causes:-
• Women commonly have mood changes during
pregnancy, especially after delivery.
• These mood changes may be caused by
changes in hormone levels.
16. • Many non-hormonal factors may also affect
mood during this period.
• Changes in your body from pregnancy and
delivery.
• Changes in work and social relationships.
• Having less time and freedom for yourself.
• Lack of sleep.
• Worries about your ability as a mother.
17. Symptoms:-
Includes the following :-
• Irritability.
• Changes in appetite.
• Feeling depressed the majority of the
day, almost every day of the week.
• Feeling of worthlessness or guilt.
• Feeling withdrawn or unconnected.
• Lack of pleasure or interest in most or all
activities.
18. • Significant weight gain or weight loss.
• Extreme insomnia or sleeping all the time.
• Loss of energy.
• Problems doing tasks at home or work.
• Negative feelings toward the baby.
19. Here some helpful tips:-
• Ask the partner, family, and friends of the
woman for help with her baby.
• Advice the woman doesn’t hide her feelings.
Talk about her feeling with her
partner, family, and friends.
• Don’t make any major life changes during or
right after giving birth.
20. • Advice her to take time to go out, visit
friends, or spend time alone with her partner.
• Advice her to rest as much as she can. Sleep
when the baby is sleeping.
• Talk with other mothers or join a support
group.
21. 3- Delivery-related Anxiety, Stress
Reactions, and Trauma:-
Postpartum depression is one of several emotional
and psychological issues that a woman may
experience during the postpartum period. In
addition to postpartum depression, delivery-related
anxiety and stress reactions may be experienced by
some women, due to unexpected or traumatic
situations during the delivery. Any given birth
experience, itself, might also trigger the recollection
and re-experiencing of post traumas ( e.g, domestic
abuse, rape) for a woman.
22. • Given this, symptoms of obsessive-
compulsive(OCD) AND Post-traumatic stress
disorder (PTSD) may be experienced during
the post partum period for some women.
These post-partum experiences become
impairments when the degree of anxiety is
beyond what might be considered a typical
response to the delivery of a new baby (
e.g, excessive worry about baby’s
welfare, feeding. Sleeping patterns; excessive
concerns about the ability to care for a baby
properly)
23. may experiencing symptoms of anxiety disorder.
Specifically, anew mother who is experiencing
unwelcome, persistent, and uncontrollable
thoughts about her self or baby may be
experiencing symptoms of OCD.
24. Some women in the postpartum period
experience the following symptoms of PTSD:-
• Intense fear, horror, or feelings of helplessness
in response to experienced trauma.
• Re-experiencing of the traumatic event
through recurrent and distressing
recollections( thoughts, images, perceptions,
and dreams).
• Acting and feeling like the trauma is occurring
again (flashbacks, hallucinations, reliving the
event).
25. • Extreme psychological distress or physical
reaction when exposed to any thing
resembling the traumatic experience.
• Continued avoidance of
thoughts, feelings, activities, people, places
related to the trauma.
• Increases in arousal level (can’t fall
asleep, irritability, anger outbursts).
26. Postpartum Psychosis
• In comparison to the incidence of depression
and anxiety that is experienced by new
mothers in the postpartum period,
postpartum psychosis is rare. Nevertheless,
when it is experienced by anew mother, she
might be scared or confused, once out of the
psychotic state.
27. • A woman experiencing postpartum psychosis
requires immediate attention, especially if her
symptoms include thoughts of suicide or other
harm to her self or baby. A new mother with
postpartum psychosis may be experiencing
the following symptoms:-
• Hallucinations (of hearing, sight, touch, etc.)
• Delusions( false, bizarre beliefs, which are not
reality- based).
29. Nursing intervention toward
psychological changes & disorders
during postpartum period:-
1- Early detection of any behavioral and
psychological responses changes.
2-Early detection of depression-anger or blues.
3- Early detection of male adaptation in
attachment.
4- Refer the client to obstetrician to evaluate
physiological status.
5- Support positive parenting behaviors.
30. • 6- Refer the client to:-
• Psychiatrist.
• Nurse psychotherapist
• Pediatrician.
• Support group.
• Public health nurse.
