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

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.

3. Learning Objectives (Cont.)
Describe nursing interventions that facilitate parent- infant adjustment.
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, and sensory impairment.

4. Learning Objectives (Cont.)
Describe sibling adjustment.
Discuss grandparent adaptation.

5. 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.

6. Transitioning to Parenthood
Attachment is developed and maintained by:
Proximity and interaction with the infant
Through which the parent becomes acquainted with the infant
Identifies the infant as an individual
Claims the infant as a member of the family

7. Transitioning to Parenthood
Attachment is facilitated by:
Positive feedback
Social, verbal, and nonverbal responses
Whether real or perceived that indicate acceptance of one partner by the other
Attachment occurs through a mutually satisfying experience
Attachment has been extended to include mutuality (the infant’s behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics)
Important part of attachment is acquaintance (parents use eye contact touching, talking, and exploring to become acquainted with the their infant during the immediate postpartum period
Families engage in the claiming process (identification of the new baby)

8. 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

9. Communication Between Parent and Infant
The senses
Touch
Eye contact
Voice
Odor
Entrainment
Biorhythmicity
Reciprocity and synchrony

10. Transitioning to Parenthood
Reciprocity-type of movement or behavior that provides the observer with cues
Synchrony-refers to the fit between the infant’s cue and the parent’s response

13. 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)

14. Transitioning to Parenthood
Dependent phase
First 24 to 48 hours after childbirth
Taking-in phase-time when nurturing and protective care are required by the new mother
Last two to three days
Dependent-Independent Phase
Mother alternates between a need for extensive nurturing and acceptance by others and the desire to “take charge” once again
Taking-hold-phase
Last approximately 10 days

15. Transitioning to Parenthood
Interdependent Phase
Interdependent behavior reasserts itself, and the mother and her family move forward as a unit with interacting members
Letting-go phase
Often stressful for the parental pair
Women and their partners must resolve the effects on their relationship of their individual roles, related to child rearing, homemaking, and careers

16. The mother would be independent.”
A nursing instructor asks a nursing student about the Taking-In Phase according to Rubin’s phases of regeneration, and asks the student about the behaviors of the mother that most likely occur in this phase. Which response by the student indicates an understanding of this phase?
The mother would be independent.” 
2.“The mother initiates activities on her own.”
 3.“The mother participates in mothering tasks.” 
4.“The mother is self-focused and talks to others about labor.”

17. Parental Role After Childbirth (Cont.)
Becoming a father
Predictable phases of paternal transition:
Enter parenthood with intentions of being an emotionally involved father
Confronting reality, realizing the expectations were inconsistent with realities of life with a newborn during the first few weeks
Working to create the role of an involved father
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

18. Transitioning to Parenthood
Father-Infant Relationship
Engrossment-father’s absorption, preoccupation, and interest in the infant
Two consistent findings are that:
Fathers spend less time than mothers with infants
Father’s interaction with infants tend to be characterized by stimulating social play rather than care taking
U.S., fathers tend to take the lead in initiating play and to play in a rougher manner
Mothers tend to take the lead in care giving activities
Fathers can benefit from nursing interventions during the postpartum period

20. 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

21. Transitioning to Parenthood
Infant-Parent Adjustment
Can be facilitated in three ways:
Modulation of rhythm-both parent and must be able to interact
Infant must be in the alert state
Occurs most often during a feeding or face- to-face play
Repertories of Behaviors
Fathers and mothers engage in these behaviors depending on the extent of contact and care giving of the infant
Infant’s behavioral repertoire includes gazing, vocalizing, and facial expressions
Baby’s early language-body gestures

22. Transitioning to Parenthood
Responsivity
Those that occur within a specific time and are similar in form to a stimulus behavior
Adult has the feeling of having an influence on the interaction
Infant behaviors such as smiling, cooing, and sustained eye contact are viewed as contingent responses

23. Transitioning to Parenthood
Paternal Adjustment
Fathers go through a predictable three-stage process during the first three weeks of transition to parenthood
Stage 1 expectations
Has preconceptions of what life will be like after baby comes home
Stage 2 Reality
Father realizes that expectations are not always based on fact
Common feeling experienced are as follow:
Sadness
Ambivalence
Frustration
Overwhelming desire to be more involved
Stage 3 Transition to mastery
Makes a conscious decision to take control and become more actively involved with infant

24. Diversity in Transitions to Parenthood
Age
Adolescent mother
Adolescent father
Maternal age older than 35 years
Paternal age older than 35 years

25. Transitioning to Parenthood
Factors Influencing Parental Responses
Adolescent Mother
Feel different then their peers
Excluded from fun activities
Forced to enter an adult social role
Use less verbal interaction than do older parents
Less responsive and interact less positive with their infants
Respond to their infant infants inappropriately
Continued support from family members, grandparents, as well as home visits and group sessions for discussion of infant-care and parenting problems
Adolescent Father
Developmental tasks of adolescences
Transitioning into parenthood
Adapting to marriage
Counseling the father in topics such as : finances, child care, parenting skills, and the father’s role in the birthing experience

26. Transitioning to Parenthood
Maternal Age Older Than 35 Years
Have a harder time coping
Especially with irregular sleep patterns and the fussy periods babies have in the late afternoon and early evening
Adjust to changes in the relationship with their partners
Work and career issues are sources of conflict
Main drawback of midlife parenting is that the parenthood makes in the relationships with their partners

27. Diversity in Transitions to Parenthood (Cont.)
Parenting in same-sex couples
Lesbian couple
Gay couples
Social support
Culture
Socioeconomic conditions
Personal aspirations

28. Transitioning to Parenthood
Culture
Defines what is socially acceptable in terms of eye contact, touch, and space
Influences the interaction with the baby as well as the parents’ or family’s care giving style
The provision for a period of rest and recuperation for the mother after birth is prominent in several cultures
Nurses may become concerned when they observe cultural practices that appear to reflect poor maternal-infant bonding

29. 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.

30. Transitioning to Parenthood
Parental Sensory Impairment
Visually impaired parent
Do differently include the preparation of the infant’s nursery, clothes, and supplies
Put an entire clothing outfit together and hang it in the closet rather than keeping the items separately in draws
Labeling system for the infant’s clothing
Put diapering, bathing, and other care supplies where these will be easy to locate with minimal searching
Concerns expressed by visually impaired mothers include:
Their infant’s safety
The extra planning, time, and effort needed to accommodate their visual limitations beyond those parenting usually requires
Transportation
Handling other people’s reactions
Missing out visually

31. Transitioning to Parenthood
Hearing-Impaired Parent
Devices that transform sound into light flashes are now marketed and can be fitted into the infant’s room to permit immediate detection of crying
Provide additional vocal training by use of recordings and television so that from birth, this child is aware of the full range of the human voice
Young children acquire sign language readily, and the first sign used is as varied as the first word
Lip reading

32. 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.

33. Sibling Adaptation Sibling Adaptation
Older children have to assume new positions within the family hierarchy
Older child’s goal is to maintain a lead position
Parents need to distribute their attention in an equitable manner
Sibling reactions are manifested in behavioral changes:
Positive behavioral changes include interest in and concerns for the baby and increased independence
Regression in toileting and sleep habits, aggression toward the baby, and increased seeking of attention and whining are examples of negative behaviors
Initial adjustment of older children to a newborn takes time, and children should be allowed to interact at their own pace rather than be forced to do so.
The relationship that develops between siblings has been conceptualized as sibling adjustment
Sibling rivalry- negative behaviors in siblings

34. Grandparent Adaptation
Contributes to family continuity
Intergenerational relationships shift
Involvement depends on cultural and familial factors

35. Grandparent Adaptation
Contribute to a sense of family continuity and provide maintenance of cultural traditions
Educate their grandchildren about their roots and relate anecdotes about their parents
Grandchildren often help relieve the grandparents’ loneliness and boredom
Significant positive influence on the child’s life
Extent of the involvement of grandparents in the care of the newborn depends on many factors:
Willingness of the grandparents to become involved
The proximity of the grandparents
Ethnic and cultural expectations of the grandparents’ role
Support of grandparents can be a stabilizing influence for families undergoing developmental transitions such as childrearing and new parenthood
Grand parents can foster the learning of parental skills and preserve tradition

37. 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.

38. 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.

40. 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?
Assist the woman with initiating breastfeeding and remain with her as long as necessary.
Recognize this as behavior of the taking-hold stage.
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.

41. 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.

42. 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.

43. 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.

44. 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.