RUBIN’S STAGES OF MATERNALPSYCHOLOGICAL ADAPTATION:-
TAKING IN PHASE(DEPENDENT PHASE):- First 3 days post partum. Focused on self ,not infant, on her own needs forsleep & rest. Passive , dependent & can’t make decisions. Need to discuss labor experiences. Sense of wonderment when looking at the neonate.
2-TAKING HOLD PHASE (DEPENDENT TOINDEPENDENT PHASE):- Last from the 3rd to 10th day postpartum. Focus on infant. Active, independent & can make decisions. Initiates self care activities, focus onbowels, bladder & breastfeeding. Responds to instruction about infant care & selfcare. May express lack of confidence in caring for theneonate.
3-LETTING GO- (INTERDEPENDENTPHASE):- 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 acceptsthe real one. Readjustment.
SIGNS:- 50% of women experience some feelings ofoverwhelming sadness. Mood swings, sudden cryingepisodes, irritability, anxiety, loneliness&restlessness. Feeling of happiness and love for thenewborn may be accompanied by feelingsof helplessness, sadness and anxiety.
CAUSES:-Sudden & quick change in the hormones.The emotional &physical stress of givingbirth.It may be a response to dependence andlow self-esteem caused by exhaustion.increased sense of anxiety and tensionassuming by a new role.The fatigue and lack of sleep
HERE ARE SOME HELPFUL TIPS:- Advice woman to exercise regularly. Advice woman to eat a healthy, well-balanceddiet. A woman needs assurance that sudden cryingepisodes are normal. Allow time to verbalize feelings.
Make time each day for her self to enjoy. Join a support group for new mothers. Talk with her partner about dividing up theparenting responsibilities so she don’t feel likeshe is doing everything by herself.
CAUSES:- mood changes changes in hormone levels. non-hormonal factors Changes in your body Changes in work and social relationships. Having less time and freedom Lack of sleep. Worries about ability as a mother.
SYMPTOMS:- Irritability. Changes in appetite. Feeling depressed the majority of the day Feeling of worthlessness or guilt. Feeling withdrawn or unconnected. Lack of pleasure or interest in most activities
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.
HELPFUL TIPS:- Ask the partner, family, and friends of thewoman 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 orright after giving birth.
Advice her to take time to go out, visit friends, orspend time alone with her partner. Advice her to rest as much as she can. Sleepwhen the baby is sleeping. Talk with other mothers or join a support group.
NURSING INTERVENTION TOWARDPSYCHOLOGICAL CHANGES &DISORDERS DURING POSTPARTUMPERIOD:-
Postpartum Depression Predictors Inventory – Cheryl BeckPostpartum Depression Screening Scale – also Cheryl Beck –Self-administered followed by a clinician interview, copyrightissues, reliability studied have been done but are not yet publishedAnte Partum Questionnaire – self-report, not widely usedZung Self-Rating Depression Scale – 20 item, self report(Aaron) Beck Depression Inventory – not specifically forPPD, used in psychiatry, cost associatedEdinburgh Postnatal Depression Scale (EPDS)SCREENING TOOLS
The thought of harming myself hasoccurred to me.Yes, quite oftenSometimesHardly everNeverEXAMPLE-QUESTION 10
Physicians, nurse midwives and other licensed healthcare professionals providing prenatal and postnatalcare to women shall:•include fathers and other family members, asappropriate, in both the education and treatmentprocesses to help them better understand the natureand causes of PPDPATIENT & FAMILY EDUCATION
REFERNCES Adele Pilletteri,textbook Of Maternity Nursing D.C. Dutta ,Textbook Of Obstetrics,centralPublications,6th Edition Diane M .Fraser ,Margaret ,Cooper,myles TextbookFor Midwives,churchill Livingstone Publications,15thEdition Annamma Jacob.Textbook Of Midwifery AndGynecologic Nursing.Jaypee Publications,3rdEdition M.C.Kenzie Vestal K.W.High Risk PerinatalNursing,st .Louis.Saunders Publication Www.Drdonnica.Com.PostpartumDepression.Article154