Chapter 22 Transition to Parenthood Copyright 2016 by

Learning Objectives Identify parental and infant behaviors that facilitate and those that inhibit parental attachment. Describe sensual responses that strengthen attachment. Examine the process of becoming a mother and becoming a father. Compare maternal adjustment and paternal adjustment to parenthood. Copyright © 2016 by Elsevier Inc. All rights reserved. 2

Learning Objectives (Cont. ) Describe nursing interventions that facilitate parentinfant adjustment. Examine the effects of the following on parenting responses and behavior: parental age (i. e. , adolescence and older than 35 years), social support, culture, samesex parenting, socioeconomic conditions, personal aspirations, and sensory impairment. Copyright © 2016 by Elsevier Inc. All rights reserved. 3

Learning Objectives (Cont. ) Describe sibling adjustment. Discuss grandparent adaptation. Copyright © 2016 by

Parental Attachment, Bonding, and Acquaintance Processes Attachment Bonding Proximity Mutuality Acquaintance Claiming process Assessment of attachment behaviors Assessment of parentinfant attachment relies on skillful observation and interviewing. Copyright © 2016 by Elsevier Inc. All rights reserved. 5

Transitioning to Parenthood Ø Attachment is developed and maintained by: Ø Proximity and interaction with the infant Ø Through which the parent becomes acquainted with the infant Ø Identifies the infant as an individual Ø Claims the infant as a member of the family Copyright © 2016 by Elsevier Inc. All rights reserved. 6

Transitioning to Parenthood Ø Attachment is facilitated by: Ø Positive feedback Ø Social, verbal, and nonverbal responses Ø Whether real or perceived that indicate acceptance of one partner by the other Ø Attachment occurs through a mutually satisfying experience Ø Attachment has been extended to include mutuality (the infant’s behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics) Ø Important part of attachment is acquaintance (parents use eye contact touching, talking, and exploring to become acquainted with their infant during the immediate postpartum period Ø Families engage in the claiming process (identification of the new baby) 7 Copyright © 2016 by Elsevier Inc. All rights reserved. 7

Parent-Infant Contact Early contact Early skin-to-skin contact Promotes early and effective breastfeeding May facilitate attachment process Extended contact Couplet care or rooming in Optimizes family-centered care Copyright © 2016 by Elsevier Inc. All rights reserved. 8

Communication Between Parent and Infant The senses Touch Eye contact Voice Odor Entrainment Biorhythmicity

Transitioning to Parenthood Ø Reciprocity-type of movement or behavior that provides the observer with cues Ø Synchrony-refers to the fit between the infant’s cue and the parent’s response Copyright © 2016 by Elsevier Inc. All rights reserved. 10

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Parental Role After Childbirth Transition to parenthood Parental tasks and responsibilities Becoming a mother Three phases of maternal role attainment (Rubin, 1961) Becoming a mother (Mercer, 2004; Mercer and Walker, 2006) Maternal sensitivity or maternal responsiveness Postpartum “blues” Postpartum depression (PPD) Copyright © 2016 by Elsevier Inc. All rights reserved. 13

Transitioning to Parenthood Ø Dependent phase Ø First 24 to 48 hours after childbirth Ø Taking-in phase-time when nurturing and protective care required by the new mother Ø Last two to three days Dependent-Independent Phase Ø Mother alternates between a need for extensive nurturing and acceptance by others and the desire to “take charge” once again Ø Taking-hold-phase Ø Last approximately 10 days 14 Copyright © 2016 by Elsevier Inc. All rights reserved. 14

Transitioning to Parenthood Ø Interdependent Phase Ø Interdependent behavior reasserts itself, and the mother and her family move forward as a unit with interacting members Ø Letting-go phase Ø Often stressful for the parental pair Ø Women and their partners must resolve the effects on their relationship of their individual roles, related to child rearing, homemaking, and careers 15 Copyright © 2016 by Elsevier Inc. All rights reserved. 15

A nursing instructor asks a nursing student about the Taking-In Phase according to Rubin’s phases of regeneration, and asks the student about the behaviors of the mother that most likely occur in this phase. Which response by the student indicates an understanding of this phase? The mother would be independent. ” 2. “The mother initiates activities on her own. ” 3. “The mother participates in mothering tasks. ” 4. “The mother is self-focused and talks to others about labor. ” 16 Copyright © 2016 by Elsevier Inc. All rights reserved. 16

Parental Role After Childbirth (Cont. ) Becoming a father Predictable phases of paternal transition: 1. Enter parenthood with intentions of being an emotionally involved father 2. Confronting reality, realizing the expectations were inconsistent with realities of life with a newborn during the first few weeks 3. Working to create the role of an involved father 4. Reaping rewards, the most significant being reciprocity from the infant, such as a smile Engrossment Often receive less interpersonal and professional support compared with mothers Copyright © 2016 by Elsevier Inc. All rights reserved. 17

Transitioning to Parenthood Ø Father-Infant Relationship Ø Engrossment-father’s absorption, preoccupation, and interest in the infant Ø Two consistent findings are that: Ø Fathers spend less time than mothers with infants Ø Father’s interaction with infants tend to be characterized by stimulating social play rather than care taking Ø U. S. , fathers tend to take the lead in initiating play and to play in a rougher manner Ø Mothers tend to take the lead in care giving activities Ø Fathers can benefit from nursing interventions during the postpartum period 18 Copyright © 2016 by Elsevier Inc. All rights reserved. 18

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Parental Role After Childbirth (Cont. ) Adjustment for the couple Resuming sexual intimacy Infant-parent adjustment: behavioral characteristics of the infant influence parenting behaviors Rhythm Behavioral repertoires Responsivity Copyright © 2016 by Elsevier Inc. All rights reserved. 20

Transitioning to Parenthood Infant-Parent Adjustment Ø Can be facilitated in three ways: Ø Modulation of rhythm-both parent and must be able to interact Ø Infant must be in the alert state Ø Occurs most often during a feeding or faceto-face play Repertories of Behaviors Ø Ø Fathers and mothers engage in these behaviors depending on the extent of contact and care giving of the infant Ø Infant’s behavioral repertoire includes gazing, vocalizing, and facial expressions Ø Baby’s early language-body gestures Copyright © 2016 by Elsevier Inc. All rights reserved. 21

Transitioning to Parenthood Ø Responsivity Ø Those that occur within a specific time and are similar in form to a stimulus behavior Ø Adult has the feeling of having an influence on the interaction Ø Infant behaviors such as smiling, cooing, and sustained eye contact are viewed as contingent responses 22 Copyright © 2016 by Elsevier Inc. All rights reserved. 22

Transitioning to Parenthood Ø Paternal Adjustment Ø Fathers go through a predictable three-stage process during the first three weeks of transition to parenthood Ø Stage 1 expectations Ø Has preconceptions of what life will be like after baby comes home Stage 2 Reality Ø Father realizes that expectations are not always based on fact Ø Common feeling experienced are as follow: Ø Sadness Ø Ambivalence Ø Frustration Ø Overwhelming desire to be more involved Stage 3 Transition to mastery Ø Makes a conscious decision to take control and become more actively involved with infant 23 Copyright © 2016 by Elsevier Inc. All rights reserved. 23

Diversity in Transitions to Parenthood Age Adolescent mother Adolescent father Maternal age older than 35 years Paternal age older than 35 years Copyright © 2016 by Elsevier Inc. All rights reserved. 24

Transitioning to Parenthood Ø Ø Factors Influencing Parental Responses Adolescent Mother Ø Feel different then their peers Ø Excluded from fun activities Ø Forced to enter an adult social role Ø Use less verbal interaction than do older parents Ø Less responsive and interact less positive with their infants Ø Respond to their infants inappropriately Ø Continued support from family members, grandparents, as well as home visits and group sessions for discussion of infant-care and parenting problems Adolescent Father Ø Developmental tasks of adolescences Ø Transitioning into parenthood Ø Adapting to marriage Ø Counseling the father in topics such as : finances, child care, parenting skills, and the father’s role in the birthing experience 25 Copyright © 2016 by Elsevier Inc. All rights reserved. 25

Transitioning to Parenthood Ø Maternal Age Older Than 35 Years Ø Have a harder time coping Ø Especially with irregular sleep patterns and the fussy periods babies have in the late afternoon and early evening Ø Adjust to changes in the relationship with their partners Ø Work and career issues are sources of conflict Ø Main drawback of midlife parenting is that the parenthood makes in the relationships with their partners 26 Copyright © 2016 by Elsevier Inc. All rights reserved. 26

Diversity in Transitions to Parenthood (Cont. ) Parenting in same-sex couples Lesbian couple Gay couples Social support Culture Socioeconomic conditions Personal aspirations Copyright © 2016 by Elsevier Inc. All rights reserved. 27

Transitioning to Parenthood Ø Culture Ø Defines what is socially acceptable in terms of eye contact, touch, and space Ø Influences the interaction with the baby as well as the parents’ or family’s care giving style Ø The provision for a period of rest and recuperation for the mother after birth is prominent in several cultures Ø Nurses may become concerned when they observe cultural practices that appear to reflect poor maternal-infant bonding 28 Copyright © 2016 by Elsevier Inc. All rights reserved. 28

Parental Sensory Impairment Visually impaired parent Hearing-impaired parent Section 504 of the Rehabilitation Act of 1973 requires hospitals to use various communication devices and resources with the deaf, including having staff members or certified interpreters who are proficient in sign language. Copyright © 2016 by Elsevier Inc. All rights reserved. 29

Transitioning to Parenthood Ø Parental Sensory Impairment Ø Visually impaired parent Ø Do differently include the preparation of the infant’s nursery, clothes, and supplies Ø Put an entire clothing outfit together and hang it in the closet rather than keeping the items separately in draws Ø Labeling system for the infant’s clothing Ø Put diapering, bathing, and other care supplies where these will be easy to locate with minimal searching Ø Concerns expressed by visually impaired mothers include: Ø Their infant’s safety Ø The extra planning, time, and effort needed to accommodate their visual limitations beyond those parenting usually requires Ø Transportation Ø Handling other people’s reactions Ø Missing out visually 30 Copyright © 2016 by Elsevier Inc. All rights reserved. 30

Transitioning to Parenthood Ø Hearing-Impaired Parent Ø Devices that transform sound into light flashes are now marketed and can be fitted into the infant’s room to permit immediate detection of crying Ø Provide additional vocal training by use of recordings and television so that from birth, this child is aware of the full range of the human voice Ø Young children acquire sign language readily, and the first sign used is as varied as the first word Ø Lip reading 31 Copyright © 2016 by Elsevier Inc. All rights reserved. 31

Sibling Adaptation Reactions manifested in behavioral changes Involvement in planning and care Acquaintance process The initial adjustment of older children to a newborn takes time, and parents should allow children to interact at their own pace rather than forcing them to interact. Copyright © 2016 by Elsevier Inc. All rights reserved. 32

Sibling Adaptation Ø Older children have to assume new positions within the family hierarchy Ø Older child’s goal is to maintain a lead position Ø Parents need to distribute their attention in an equitable manner Ø Sibling reactions are manifested in behavioral changes: Ø Positive behavioral changes include interest in and concerns for the baby and increased independence Ø Regression in toileting and sleep habits, aggression toward the baby, and increased seeking of attention and whining are examples of negative behaviors Ø Initial adjustment of older children to a newborn takes time, and children should be allowed to interact at their own pace rather than be forced to do so. Ø The relationship that develops between siblings has been conceptualized as sibling adjustment Ø Sibling rivalry- negative behaviors in siblings Copyright © 2016 by Elsevier Inc. All rights reserved. 33

Grandparent Adaptation Contributes to family continuity Intergenerational relationships shift Involvement depends on cultural and familial factors Copyright © 2016 by Elsevier Inc. All rights reserved. 34

Grandparent Adaptation Ø Contribute to a sense of family continuity and provide maintenance of cultural traditions Ø Educate their grandchildren about their roots and relate anecdotes about their parents Ø Grandchildren often help relieve the grandparents’ loneliness and boredom Ø Significant positive influence on the child’s life Ø Extent of the involvement of grandparents in the care of the newborn depends on many factors: Ø Willingness of the grandparents to become involved Ø The proximity of the grandparents Ø Ethnic and cultural expectations of the grandparents’ role Support of grandparents can be a stabilizing influence for families undergoing developmental transitions such as childrearing and new parenthood Grand parents can foster the learning of parental skills and preserve tradition Copyright © 2016 by Elsevier Inc. All rights reserved. 35

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Nursing Care Management Nursing actions can include the following: Provide opportunities for parent-infant interaction. Implement strategies to facilitate sibling acceptance of the infant. Provide practical suggestions for infant care. Provide anticipatory guidance on what to expect as the infant grows and develops, including sleep-wake cycles, interpretation of infant behaviors, quieting techniques, infant developmental milestones, sensory enrichment/infant stimulation, recognizing signs of illness, well-baby follow-up and immunizations. Copyright © 2016 by Elsevier Inc. All rights reserved. 37

Nursing Care Management (Cont. ) Provide positive reinforcement for loving and nurturing behaviors with the infant. Closely monitor parents who interact in inappropriate or abusive ways with their infants, and notify an appropriate mental health practitioner or professional social worker. Copyright © 2016 by Elsevier Inc. All rights reserved. 38

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Question Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. What should the nurse do? a. Assist the woman with initiating breastfeeding and remain with her as long as necessary. b. Recognize this as behavior of the taking-hold stage. c. Record the behavior as ineffective maternal-newborn attachment. the baby back to the nursery, reassuring the woman that her rest is a priority at this time. Copyright © 2016 by Elsevier Inc. All rights reserved. 40

Key Points The birth of a child necessitates changes in the existing interactional structure of a family. Attachment is the process by which the parent and infant come to love and accept each other. Attachment is strengthened through the use of sensual responses or interactions by both partners in the parent-infant interaction. Copyright © 2016 by Elsevier Inc. All rights reserved. 41

Key Points (Cont. ) Women go through predictable stages in becoming a mother. Many mothers exhibit signs of postpartum blues (baby blues). Fathers experience emotions and adjustments during the transition to parenthood that are similar to, and also distinctly different from, those of mothers. Copyright © 2016 by Elsevier Inc. All rights reserved. 42

Key Points (Cont. ) Modulation of rhythm, modification of behavioral repertoires, and mutual responsivity facilitate infantparent adjustment. Many factors influence adaptation to parenthood (e. g. , age, culture, socioeconomic level, expectations of what the child will be like). A parent who has a sensory impairment needs to maximize use of the remaining senses. Copyright © 2016 by Elsevier Inc. All rights reserved. 43

Key Points (Cont. ) Sibling adjustment to a new baby requires creative parental interventions. Grandparents can have a positive influence on the postpartum family. Nurses play a major role in educating and supporting new parents in the transition to parenthood. Copyright © 2016 by Elsevier Inc. All rights reserved. 44