Oxford Handbook of Midwifery (106 page)

CHAPTER 20
Postnatal care

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Psychological and emotional aspects of postnatal care

• Psychological and emotional well-being and positive mental health are as important as the physical aspects of care.
  
• Postnatal emotional and psychological changes following childbirth are commonly experienced by women.
  
• Midwives have an important role in the early detection of psychological problems and have a responsibility as part of the multi-professional team, to ensure that women are referred appropriately and receive support and care.
  
• Psychological conditions in the postnatal period cover a spectrum of conditions that vary from mild to severe.
  
• At each postnatal contact the mother should be asked about her
  emotional well-being, what family and social support she has, and her
  

  usual coping strategies with day-to-day matters.
  ¹
  

• Good communication, listening to what the mother is telling you and responding appropriately, will do much to alleviate situations causing the mother anxiety, most commonly concerning baby care and feeding.
  
• The mother and her partner should be offered the opportunity to talk about their birth experiences and ask questions about the care they received and the events of labour. For further information (b see Postnatal afterthoughts for parents, p. 510).
  
• The mother and her partner/family should be encouraged to tell the midwife about any changes in mood, emotional state, and behaviour that are outside the woman’s normal pattern.
  ¹
  
• The midwife must always be able to recognize the risks, signs, and symptoms of domestic abuse and whom to contact for advice and management.
  ^2,3
  

  Temporary mood alteration (postpartum ‘blues’)
  

  This is a transient, self-limiting condition, often referred to as ‘baby blues’. It occurs between the third and tenth days, although it occurs most often around the fourth day. It is considered a normal reaction to childbirth and between 50% and 80% will experience the condition.
  ¹
  

  Symptoms
  

  These include:
  

• Tearfulness
  
• Mood swings
  
• Irritability.
  

  PSYCHOLOGICAL AND EMOTIONAL ASPECTS OF POSTNATAL CARE
  

  481
  

  

  The condition usually resolves spontaneously within a day or two, although women with postnatal depression have been shown to have higher occur- rences of the baby blues. Provide emotional support and reassurance that it is a temporary condition that will resolve.
  

  1. National Institute for Health and Clinical Excellence (2006).
     Routine Postnatal Care of Women and Their Babies
     . Clinical guideline 37. London: NICE.
     
  2. Department of Health (2004).
     National Service Framework for Children, Young People and Maternity Services. Standard 11: Maternity Services
     . London: DH. Available at: M
     www.dh.gov.uk (accessed 2.5.10).
     
  3. Department of Health (2005).
     Responding to Domestic Abuse: A Handbook for Health Professionals.
     London: DH. Available at: M
     www.dh.gov.uk (accessed 2.5.10).
     

     CHAPTER 20
     Postnatal care
     

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     Transfer home from hospital
     

     • The exact timing of transfer home is normally negotiated between the mother and the midwife, and is dependent on her circumstances and needs.
       
     • Care is transferred back to the community midwife, if the model of care operating locally has not involved the named community midwife in her care in hospital.
       
     • Examine the mother, to ensure that she is physically fit to go home, and ensure that the baby has been fully examined by a paediatrician or a midwife appropriately trained and competent to undertake this first complete examination of the newborn. Community midwives now also undertake this examination in the UK, for mothers who have had a home birth, or they may carry out the examination on the first visit after transfer home.
       

       •
       Explain to the mother about the continued visiting by her community
       

       midwife, give her her personal notes, duly completed to date, and letters for her family doctor and community midwife, containing the relevant details about the birth and progress of the mother and baby to date.
       

     • This is accompanied by a range of leaflets and details of how to get advice and support night and day, e.g. the telephone number of the community midwife, postnatal ward, community midwifery office, and infant feeding adviser.
       
     • The mother makes her own arrangements for transport home.
       
     • The importance of car safety for mother and baby should be stressed, although it is the mother’s/parents’ responsibility to ensure that the baby is transported in a car seat, appropriately secured in the car.
       
     • On no account must the midwife have any involvement in the process of putting the baby in the car seat or securing the seat in the car.
       
     • It is important that the transfer home between hospital and community midwife is seamless, in that there is continuity of care, no conflicting advice, and records clearly show progress and problems to date and advice given.
       

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       CHAPTER 20
       Postnatal care
       

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       Parent education
       

       Aims
       

     • To promote health improvement
       
     • To give appropriate information and support
       
     • To develop confidence in parenting skills
       
     • To facilitate parental involvement in decision making
       
     • To provide emotional and psychological support for the new parents
       
     • To encourage peer support.
       

       Practice points
       

     • The social, emotional, and psychological needs of parents are as important as the physical skills of caring for the baby.
       
     • Every mother/parent has differing needs.
       

       •
       Certain groups have special needs, e.g. the young, single, women with disability, ethnic minorities, women whose first language is not English,
       

       women with learning difficulties, asylum seekers, refugees.
       

     • Don’t forget the men!
       
     • Preparation for parenthood begins in childhood; in the home, in school, and the social environment, e.g. television, books, magazines.
       
     • Continuity of care and carer, as far as possible, will enable the mother to express her concerns, fears, and anxieties more freely, and will enable the midwife to be more effective in education activities.
       
     • Every meeting with new parents is an opportunity for health education, health promotion, parent education, or referral to other health or social care professionals or agencies that can more effectively address or meet their needs.
       
     • Use each care setting as an educational opportunity.
       
     • Small groups aid discussion and can encourage women/parents to air their problems, learn from each other, and aid peer support for new parents. With the development of local Children’s Centres in the UK, the opportunity for networking and developing social networks of support for the mother, also offers the midwife and other health and social care professionals the ideal opportunity for health education and promotion.
       
     • When offering group sessions, consider the target group and its needs carefully. You may need to offer a choice of groups and times.
       
     • Be realistic about what can be achieved in a series of meetings.
       

       Main educational activities
       

       The mother:
       

     • Adequate rest and sleep
       
     • Well-balanced diet
       
     • Personal hygiene, particularly of the vulval and perineal area
       
     • Prevention of infection
       
     • Healthy lifestyle, e.g. smoking cessation
       
     • Postnatal exercises and encouragement to continue with them for at least 6 weeks
       
     • Resuming normal exercise regimens, e.g. returning to the gym
       
     • Continuing contact with healthcare professionals for personal support and infant care, e.g. immunizations and child development.
       

  PARENT EDUCATION
  

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  The baby: