Assess Causative or Contributing Factors
Prolonged or difficult labor and delivery
Postpartum pain or fatigue
Lack of positive support system (mother, spouse, friends)
Lack of positive role model (mother, relative, neighbor)
Inability to prepare emotionally for an unexpected delivery
Inadequate Coping Patterns (One or Both Parents)
Marital difficulties (separation, divorce, violence)
Change in lifestyle related to new role
Career change (eg, working woman to mother)
Illness in family
Premature, defective, ill
Eliminate or Reduce Contributing Factors, if Possible
Illness, Pain, Fatigue
Establish with mother what infant care activities are feasible.
Provide mother with uninterrupted sleep periods of at least 2 h during the day and 4 h at night.
Provide relief for discomforts.
Lack of Experience or Positive Mothering Role Model
Explore with mother her feelings and attitudes concerning her own mother.
Assist her to identify someone who is a positive mother; encourage her to seek that person’s aid.
Outline the teaching program available during hospitalization.
Determine who will assist her at home initially.
Identify community programs and reference material that can increase her learning about child care after discharge (see References/Bibliography).
Lack of Positive Support System
Identify parent’s support system; assess its strengths and weaknesses.
Assess the need for counseling.
Encourage parents to express feelings about the experience and about the future.
Be an active listener to the parents.
Observe the parents interacting with the infant.
Assess for resources (financial, emotional) already available to the family.
Be aware of resources available both within the hospital and in the community.
Counsel the parents on assessed needs.
Refer to hospital or community services.
Barriers to Practicing Cultural Beliefs That May Affect the Family Unit During Hospitalization
Support mother-infant-family beliefs.
Integrate culture and traditions into routine care.
Identify community resources.
Elimination of Institutional Barriers That Inhibit Individualizing of Care
Sensitize staff to practicing family-centered care.
Use families to review practice and policies.
Encourage cultural sensitization of staff.
Provide Opportunities for the Process of Mutual Interaction
Promote Bonding in the Immediate Postdelivery Phase
Encourage mother to hold infant after birth (may need a short recovery period).
Provide skin-to-skin contact if desired; keep room warm (72°F to 76°F) or use a heat panel over the infant.
Provide mother with an opportunity to breast-feed immediately after delivery, if desired.
Delay administration of silver nitrate to allow for eye contact.
Give family as much time as they need together with minimum interruption from staff (the “sensitive period” lasts from 30 to 90 min).
Encourage father to hold infant.
Facilitate the Attachment Process During the Postpartum Phase
Check mother regularly for signs of fatigue, especially if she had anesthesia.
Offer flexible rooming-in to the mother; establish with her the care she will assume initially and support her requests for assistance.
Discuss future involvement of the father in the infant’s care (if desired, plan opportunities for father to participate in his child’s care during visits).
Provide Support to the Parents
Listen to the mother’s replay of her labor and delivery experience.
Allow for verbalization of feelings.
Indicate acceptance of feelings.
Point out the infant’s strengths and individual characteristics to the parents.
Demonstrate the infant’s responses to the parents.
Have a system of follow-up after discharge, especially for families considered at risk (eg, phone call or a home visit by the community health nurse).
Be aware of resources and support groups available within the hospital and community; refer the family as needed.
Assess the Need to Support the Parents’ Emerging Confidence in Child Care
Observe the parents interacting with the infant.
Support each parent’s strengths.
Assist each parent in those areas in which he or she is uncomfortable (role modeling).
Have handouts and audiovisual aids available for parents to view at odd hours.
Assess for level of knowledge in growth and development; provide information as needed.
Help parents understand infant’s cues and temperament.
See References/Bibliography for recommended printed material on parenting and child care.
When Immediate Separation of the Child from the Parents is Necessary Because of Prematurity or Illness, Provide for Bonding/Attachment Experiences, as Possible
Invite parents to see and touch infant as soon as possible.
Encourage parents to spend prolonged time with infant.
Support activities such as skin-to-skin holding, containment of infant with parental hands in the isolette, and basic caregiving activities.
If infant is transported to another facility and separated from mother:
Have staff make frequent calls to mother.
Encourage family to spend time in NICU; bring back verbal reports and pictures of infant.
Explore family and community resources to provide means of rejoining mother and infant as soon as possible.
For Adoptive Parents:
Counsel adoptive parents that many emotions are normal on first interaction with their children.
Counsel adoptive parents about the possibility of postadoption depression.
Encourage adoptive parents to seek parenting classes before receiving their infant.
Initiate Referrals, as Needed
Consult with community agencies for follow-up visits if indicated.
Refer parents to pertinent organizations (see References/Bibliography).