"Emotional Health During Pregnancy and Early Parenthood" is a perfect example of a paper on reproduction. The family of John and Ruth has a history of Pelvic inflammatory disease and infertility and probably fetal wasting factors which are risk factors for postnatal depression (RCN, 2012). Infertility was addressed through a fertility program and she conceived twins. History of postnatal depression in the mother of Ruth (Marion) predisposes her to develop postnatal depression herself (RCN, 2012). Both John and Ruth experienced parental divorce at some point when they were being brought up.
This could affect how they raise their family too. John especially experienced harsh treatment of his father during childhood which could be replicated in his parenting ways (Stewart et al. , 2003). The family has received twins, caring for them places a big burden on the family financially, materially, and emotionally compared to one child. The family is also undergoing postnatal adjustments which including postnatal care of the children and mother and postnatal expectations including the resumption of sex is beginning to appear through the mother is not ready an issue if not addressed can adversely affect the family (Stewart et al. , 2003).
Family support of the husband an essential component in newborn care and especially in multiple births is relegated to Ruth as John is busy going to works and there is an expectation that the baby will not bother him since he has to go daily to work hard so that he can manage to cater for his family (Stewart et al. , 2003). The family moved into a new house larger house in a new neighborhood. This has effects on their financial demands since the cost of a mortgage has risen and also postnatal adjustments in a less familiar area.
Since Ruth is no longer working the financial status of the family is low during the first 6 months and this will have effects on the postnatal care of the family in one way or the other (Brooks, 2009). Goal1. Postnatal care of the newborns Postnatal care presents challenges to new mothers, simply because they are not experienced; this can be overwhelming in case of multiple pregnancies (Nova Scotia, 2003).
In order to early identify and postnatal complication and ensure that the mother provides optimal care including proper breastfeeding technique, the child and family nurse need to make scheduled home visits to the new mother to assess care at home and provide services including education to the new mother always (Shepherd, 2011). 2. Psychosocial assessment and care of the mother and family Postnatal depression is experienced by 16% of women after childbirth which represents a considerable public health problem affecting women and families (Stewart et al. , 2003). Ruth has several risk factors for postnatal depression including a family history of postnatal depression in the mother • History of fetal loses before she conceived the current children, • Financial pressures now that she is not working and they moved to a bigger house• Lack of support by the husband who is away for a job most of the time, • past obstetric complications including infertility and fetal loss• Postpartum depression remain under-diagnosed and untreated problem in most families Unattended, postnatal depression will affect the health and well-being of the entire family including the health of the babies now and in long term (Stewart et al. , 2003).
and there is effective treatment available for postnatal depression Nursing interventions Assessment This will involve the use of standardized tools, for example, in the diagnosis of postnatal depression (Stewart et al. , 2003). Unlike other disease patients with postnatal depression may not be aware that they are sick and that is why it remains under-diagnosed and untreated (Brooks, 2009) However through systematic screening that this is diagnosed. Assessment of the baby in the neonatal period is also essential to ensure its well-being including early identification of neonatal infections, infant feeding practices, sleeping patterns, weight loss/gain, and elimination (urine and stools) (Palmer, 2009). A maternal complication that occurs in the postnatal period can increase maternal morbidity and mortality (WHO, 2003).
Continued clinical assessment of the mother by child health nurse will provide early diagnosis and timely referral to a health facility for intervention. Postnatal adjustments in the family also need to be assessed also that a care plan can be created together with the whole family. Assessments need to be coupled with service delivery and timely referral to ensure prompt response to identified needs (Shepherd, 2011). Provision of care In addition to assessing the child and family nurse will provide an interface between the community and health facility after discharge of the mother (Municipal Association of Victoria Maternal and Child Health, 2011).
She represents a continuation of service delivery but at-home care setting instead of the health facility (Shepherd, 2011). As such she will continue the provision of care for the family at home to safeguard the healthy baby, the mother, and the family in general.
This is necessary to reduce maternal, neonatal and infant morbidity and mortality that occur after discharge to the community (WHO, 2003). Such care will include but not limited to: • Continued observation of mother and child to ensure physiologic stability, infant feeding practices, growth monitoring • Administering and monitoring medications that might have been provided at discharge including management of pain in the mother • Education and training on proper breastfeeding techniques to ensure maximum benefits of breast milk to both children and also to prevent cracked nipples and discomfort to the mother • Promotion of good hygiene reduce infection in both mother and children • Establishment of care plans with the family to have the whole family involved in the care of the baby to include social interaction and stimulation • Addressing postnatal adjustment for the family including resumption of sex • Safety information for newborns including sleeping position infant death syndrome, shaken baby syndrome, car safety • Skills of engaging and developing supportive and effective relationships with families Service delivery by child and family nurse provide an essential component of the continuum of care between the health facility and community providing culturally sensitive health care at the convenience of family setting (Shepherd, 2011).
It focuses on the entire family compared to facility-based care that is individualized Referral The benefits of assessment cannot be complete without the option of referral after diagnosis of a condition that cannot be managed at the community level or that needs further investigation (Stewart et al. , 2003). Depression screening for instance needs to be combined with the systemic referral of cases and well-defined and implemented care plans to achieve outcome benefits (Shepherd, 2011).
Infection in neonatal presents a medical emergence and early recognition and with proper referral is critical to saving the life of the baby (Nova, 2003). Puerperal sepsis is one of the main causes of maternal mortality and early diagnosis by the child and family nurse will reduce maternal mortality and complication related to puerperal sepsis (WHO, 2009). The child and family Nurse should work with the family to develop and utilize a directory of services available for both emergence and ongoing care including postnatal exercise that helps in the return of pelvic muscle tone after delivery (Stewart et al. , 2003). At six weeks after the birth, a final postnatal check is carried out to ensure that the woman and her baby are physically well, Contraception is usually discussed, as well as adjustment to family life.
Pap smear should be done at this visit if it is due to reduce missed opportunities (Palmer, 2009)Conclusion The family of John and Ruth represent one that can really benefit from child and family nursing care. The family experiences a bad obstetric history in Ruth, a family history of postnatal depression, and childhood exposure to divorce among the parents.
The family now has delivered twins which usually presents significant financial, physiologic, and psychological burdens to the family (RCN, 2012). A child and family nurse will be necessary to assess the both medical and psychological needs of the family and also participate in service delivery to ensure both immediate and long-term needs are addressed. The family is going through a very hard time in their life; they are experiencing financial difficulties which are caused by the mother not working in her business and the husband having to move daily to work in addition to the need for a bigger house for the twins which exerts greater financial need.
Maintaining a bigger house is more expensive unlike a smaller house they hard. Postnatal adjustments training needs are clearly visible with the resumption of sex already being raised so soon after discharge (Brooks, 2009).
Brooks J. (2009). Emotional health during pregnancy and early parenthood. [online] available at < http:www.beyondblue.org.au > accessed on 26/9/2013
Helpguide (2012). Postpartum depression and baby blues. Symptoms, Treatment, and Support for New Moms [online] available at http://www.Helpguide.com > accessed on 26/9/2013
Municipal association of Victoria Maternal and Child Health (2011). The Voice of Local Government, 32(3), 14-15.
Nova Scotia (2003). Healthy babies health families. Postpartum and Postnatal Guidelines Nova Scotia department of health, 68(1),53-66.
NSW Department of Health (2011). Child and Family Health Nursing Professional Practice Framework 2011–2016. [online] available at< http://www.health.nsw.gov.au > accessed on 24/9/2013
Palmer J. (2009). The postnatal woman. What to expect. Pregnancy, Birth and Beyond.princeton university press.
Royal college of Nursing. (2012). Core competencies for nursing children and young people. Royal College of Nursing, 20 Cavendish Square, London,W1G 0RN.
Shepherd, M. (2011). Behind the scales: Child and family health nurses taking care of women's emotional wellbeing. Contemporary Nurse, 37, (2) pp. 137-148. ISSN 1037-6178
Stewart, D., Robertson, E., Dennis, C., Grace, S., & Wallington, T. (2003). Postpartum depression: Literature review of risk factors and interventions. Melbourne: NPHP.
World Health Organization. (2003). Essential Antenatal, Perinatal and Postnatal care. Training modules. WHO Regional Office for Europe, Copenhagen