Psychological changes during puerperium

• 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.

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.

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.

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.

• 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.

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.

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.

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.

• 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.

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 &restlessness.

• 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.

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.

• Talk with her partner about dividing up the parenting responsibilities so she don’t feel like she is doing everything by herself.

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.

• 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.

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.

• 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.

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.

• 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.

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.

• 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)

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.

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).

• 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).

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.

• 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).

• Drastic mood swings.• Disorganization of speech(incoherence).• Disorganization of behavior( extremely

inappropriate dress).• Extreme restlessness.• Anger & agitation.

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.

• 6- Refer the client to:-• Psychiatrist.• Nurse psychotherapist• Pediatrician.• Support group.• Public health nurse.