Infant Mother Bonding Prepared by Mrs. Raheegeh Awni 24/02/2011

1. Infant Mother Bonding Prepared by Mrs. Raheegeh Awni 24/02/2011

2. Introduction The postpartum period is very special phase in the life of a women and her newborn . for women experiencing childbirth for the first time it marks probably the most significant and life changing event they have yet lived . it is marked by strong emotions ,dramatic physical changes ,new and altered relationships and the assumption of and adjustment to new roles . It is a time of profound transition, making a great demands on the woman resilience and capacity to adapt . Becoming a parent creates a period of change and instability this period referred to as the transition to parenthood

3. Transition :is defined as a passage or process occurring over time involving development ,flow or movement from one state, condition or place to another -six condition influence the transition experience : 1-meaning : understanding the meaning of transition from the perspective of those experiencing it is essential 2-expectation : expectation may or may not be realistic .knowing what to expect realistically may help alleviate some of the stress associated with transitions 3-level of knowledge : transitions often require new knowledge or skills 4-enviroment : facilitative recourses are important for successful transition e.g. : social support from spouse ,family ,friend , effective communication 5-level of planning : effective planning involves identification of needs ,problems, and issues that may arise during the transition 6-emotional and physical well-being: family may have feeling overwhelmed ,anxious ,role conflict and low self- esteem

4. indicators of healthy transition outcomes : 1-subjective well-being : individual experience effective coping, managing one’s Emotions, increased self –esteem 2-role mastery : people comfort with behaviors required in the new situation 3-well-being of interpersonal relationships : as members move toward successful conclusion to the transition, family relation Ship, well-being is restored or promoted

5. Parenting process : is a process of role attainment and role transition that being during pregnancy. the transition ends when the parent develops a sense of comfort and confidence in performing the parental role . the parenting process requires cognitive and affective skill and knowledge -parental attachment, bonding and acquaintance : Attachment :is the process whereby parents come to love and accept a child and a child comes to love and accept a parent, it is linear process beginning during pregnancy ,intensifying during the early postpartum period Bonding : it is a sensitive period in the first minutes and hours after birth when mother and fathers must have close contact with their infants

6. Critical attributes of attachment : 1- proximity: is the physical and emotional experience of the parent’s being close to their infant .parents seek proximity through touching ,holding 2-reciprocity : is the process by which the infant’s capabilities and behaviors elicit parents’ response, parents who are sensitive and responsive to infant’s cues promote the infant’s growth and development 3- commitment: is the enduring nature of the attachment relationship Antecedent and consequences of parent –infant attachment :

7. Antecedent of parent infant attachment: 1-awareness of attachment 2- physical and psychological availability 3-acceptance of the pregnancy and the baby 4-making mutual acceptance with the baby Consequences : 1-consolidation of parenting skills 2-growth and development of the baby 3-establishment of a durable bond

8. Mutuality : is the infant’s behaviors and characteristic call forth a corresponding set of maternal behavior and characteristic -attachment occurs more readily with the infant whose temperament ,social capabilities appearance and sex fit the parent’s expectation -acquaintance : parents use eye contact, touching , talking, to become acquainted with their infant during the immediate postpartum period -claiming process : it is the identification of the new baby

9. Midwives roles -midwife reassure mother who have had C/S births that they can bond successful with their infant through teaching and positive reinforcement ,medwives can strengthen parents’ sense of competence -medwives play an important role in facilitating parental attachment and they can enhance positive parent –infant contact by heightening parental awareness of an infant’s responses and ability to communicate -midwife can identify the actual and potential problems and collaborate with other health care professionals to intervene this problem

10. Assessment of attachment behavior : Assessment of parent- infant attachment requires much more skill in observation How you can assess ? 1-talking with the parent and encourage them to talk about their relationship with their own parents and their views regarding child raring 2-labor process because may affect the immediate attachment 3-assessing the parental expectation

11. PARENT INFANT CONTACT : Early contact :early contact may facilitate the attachment process between parent and child but the delay does not mean inhibit this process -nurses must counsel parent to assure them that the emotional bond to the infant is not necessarily weaker because they missed early contact or the contact was not skin to skin contact Extended contact : extended contact should be available for all parent but especially for those at risk for parenting inadequacies e.g. . Adolescent and low income women

12. Communication between parent and infant : 1- touch 2-eye to eye contact 3-voice 4-odor 5-entrainment 6-biorhythmicity 7-reciprocity and synchrony Reciprocity :is a type of body movement or behavior that provide the observer with cues Synchrony : refer to the fit between he infant’s cues and the parent’s response

13. Maternal adjustment : 1-dependent (taking –in): .during the first 24-48 hr’s .focus: self and meeting of basic need .reliance to others to meet needs comfort ,rest,closenes ,nourishment .exited and talkative .desire to review birth experience 2-dependent-independent (taking –hold) : . Start second or third day ;lasts 10 days to several weeks .focus: care of baby and competent mothering .desire to take charge . Still need for nurturing and acceptance by others .eagerness to learn and practice –optimal period for teaching by nurses .handling of physical discomfort and emotional changes .possible experience with “blues’’

14. Interdependent (letting go ): .focus: forward movement of family as unit with interacting members ..reassertion of relationship with partner .resumption of sexual intimacy .resolution of individual roles

15. Development of a father –infant relationship :process component 1-making a commitment 2-becoming connected 3-making room for baby

16. Paternal adjustment : (three stage ) Stage1: expectation : father has preconception about what life will be like after baby comes home Stage2:reality: father realize that expectation are not always based on fact common feelings experienced are : (sadness ,ambivalence ,frustration ) Stage3:transition to mastery father makes conscious decision to take control and become more actively involved with infant

17. Infant –parent adjustment : newborn participate actively in shaping their parent’s reaction to them the infant and the parent each have unique rhythm ,behavior ,and response styles that are brought to every interaction ,infant –parent interaction can be facilitated in any of three way : 1-modification of behavioral repertoires 2-modulation of rhythm 3- mutual responsiveness Nursing role :is to teach parents about these three aspect of infant-parent interaction through discussion ,written materials

18. Breast feeding

19. The importance of the breast feeding : The establishment and maintenance of breast feeding should be one of the major goal of good postpartum care ,because human breast milk is the optimal Food for the newborn infant Early sucking : It is recommended that baby is given to the mother to hold immediately after delivery ,to provide skin to skin contact and for the baby start suckling as soon as possible ,early skin to skin contact and early suckling is associated With more affectionate behavior of mothers towards infant Positioning and attaching the baby to the breast : Inaccurate and inconsistent guidance from the health staff has been recognized as a major obstacle to breast feeding ,so one of the important tasks of the Caregiver in the postpartum period is to help and teach the women correctly Attach their babies ,because if the attachment is not corrected ,sore nipples and engorgement are more common

20. 10 steps of breast feeding : 1-writen BF promotion policies 2-BFtrainingfor all health personnel 3- prenatal BF promotion 4-BFwithen 30 min postpartum 5-BFcounseling to mothers in maternity wards 6-breast milk only for the newborn 7-rooming in 8-BFon demand 9-no baby bottle or pacifiers 10-community based postnatal support

21. Evidence base : The introduction of breast milk donation in Muslim country Breast milk donation for full term babies is well known practice in Kuwait but it has never been organized formally in NICU for preterm babies Milk donor and the recipient are required to know each other .human milk is known to decrease the incidence of necrotizing enterocolitis ,improve host defense ,digestion absorption of nutrients al-naqeeb n,etal(2000)

22. Evidenced: Follow up study was conducted to examine the effect of infant sex changes in and differences between parents reports of infant self –efficacy and parenting and marital satisfaction from 4-12 months . Result : Mothers reported higher infant care self efficacy and parenting satisfaction than father at both times Fathers of boys reported greater parenting satisfaction and infant care self efficacy than fathers of girl Elek ,s etal (2002) marital and parenting satisfaction

23. Evidence : The result of this study : Clinical nurse has a great responsibility in supporting parent .if the father has trustful relation ship with the nurse his involvement in the CH care is presumed to increase Support of father of infant s by the child health nurse (fagerskiold ,A 2006)