1. Chapter 22 Transition to Parenthood Copyright © 2016 by Elsevier Inc. All rights reserved.

2. 2 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.  Describe nursing interventions that facilitate parent- infant adjustment.

3. 3 Copyright © 2016 by Elsevier Inc. All rights reserved. Learning Objectives (Cont.)  Examine the effects of the following on parenting responses and behavior:  parental age (i.e., adolescence and older than 35 years)  social support  culture  same-sex parenting  socioeconomic conditions  personal aspirations  sensory impairment  Describe sibling adjustment.  Discuss grandparent adaptation.

4. 4 Copyright © 2016 by Elsevier Inc. All rights reserved. Parental Attachment, Bonding, and Acquaintance  Processes  Attachment  Bonding  Proximity  Mutuality  Acquaintance  Claiming process  Assessment of attachment behaviors  Assessment of parent- infant attachment relies on skillful observation and interviewing.

5. 5 Copyright © 2016 by Elsevier Inc. All rights reserved. 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

6. 6 Copyright © 2016 by Elsevier Inc. All rights reserved. Communication Between Parent and Infant  The senses  Touch  Eye contact  Voice  Odor  Entrainment  Biorhythmicity  Reciprocity and synchrony

7. 7 Copyright © 2016 by Elsevier Inc. All rights reserved. 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)

8. 8 Copyright © 2016 by Elsevier Inc. All rights reserved. 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

9. 9 Copyright © 2016 by Elsevier Inc. All rights reserved.

10. 10 Copyright © 2016 by Elsevier Inc. All rights reserved. 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

11. 11 Copyright © 2016 by Elsevier Inc. All rights reserved. Diversity in Transitions to Parenthood  Age  Adolescent mother  Adolescent father  Maternal age older than 35 years  Paternal age older than 35 years

12. 12 Copyright © 2016 by Elsevier Inc. All rights reserved. Diversity in Transitions to Parenthood (Cont.)  Parenting in same-sex couples  Lesbian couple  Gay couples  Social support  Culture  Socioeconomic conditions  Personal aspirations

13. 13 Copyright © 2016 by Elsevier Inc. All rights reserved. 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.

14. 14 Copyright © 2016 by Elsevier Inc. All rights reserved. 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.

15. 15 Copyright © 2016 by Elsevier Inc. All rights reserved. Grandparent Adaptation  Contributes to family continuity  Intergenerational relationships shift  Involvement depends on cultural and familial factors

16. 16 Copyright © 2016 by Elsevier Inc. All rights reserved.

17. 17 Copyright © 2016 by Elsevier Inc. All rights reserved. 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.

18. 18 Copyright © 2016 by Elsevier Inc. All rights reserved. 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.

19. 19 Copyright © 2016 by Elsevier Inc. All rights reserved.

20. 20 Copyright © 2016 by Elsevier Inc. All rights reserved. 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.

21. 21 Copyright © 2016 by Elsevier Inc. All rights reserved. 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.

22. 22 Copyright © 2016 by Elsevier Inc. All rights reserved. Key Points (Cont.)  Modulation of rhythm, modification of behavioral repertoires, and mutual responsivity facilitate infant-parent 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.

23. 23 Copyright © 2016 by Elsevier Inc. All rights reserved. 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.

24. 24 Copyright © 2016 by Elsevier Inc. All rights reserved. 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.