Published Aug 13, 2004
I work in postpartum as a nurse extern (student nurse). We had a patient this week that concerned me. She was 18 yrs, single and had a c-section. In the 4 days she was in the hospital, I never saw her hold her baby. Her mother was always the one feeding the baby, changing his diaper, cuddling him, etc. The father of the baby, also very young, was in the room often and he seemed excited about the baby.
But the patient just sat in her bed and seemed very detached from what was happening around her. She didn't ask questions about caring for herself or the baby. The only time she really responded to me was when I commented on how great she looked. Her stomach was so flat; you could barely tell that she just had a baby.
My question is, as a postpartum nurse, what do you do with a patient like that? Do you just let her be and hope things get better when she and baby go home? Do you try to talk to her about how she is feeling? If you talk with her, can you throw all the family members and friends out of the room so you can talk in private? Do you mention it to her doctor? Would her attitude put her baby at risk for neglect?
We have had other young mothers who were scared or very emotional, but no one who responded like this. It really worried me. We learn a lot about handling physical problems in nursing school, but we really don't learn much about handling patients' emotional issues.
I would love to know how experienced nurses would handle the situation. Thank you.
I would talk to her to see where her head is at......and....I would have gotten her a social service consult STAT. Failure to bond IS a major concern,something always to follow up on .....You were very observant and did a good job....make sure people like this get social service/follow-up visits at home. Both THEY and their BABIES are at risk here!
purplemania, BSN, RN
our nurses notes have an area to document assessment of the bonding between mother and child. Social work should be notified as neglected babies can be starved or beaten. However, I have to add that young mothers focus on themselves a lot, just like all teenagers. If someone else if willing to take over the care of the baby, like the grandmother, the mother might just let her do it. But social services needs to determine who will be the primary caretaker and what support systems are in place.
You also have to think of other things going on....such as culture. Some cultures do not allow mothers to have any care of the baby (other than breastfeeding) for one-two months postpartum. Some even keep them in bedd for the whole two months.
I would talk to her about whats going on. Look in on her often and see how she is interacting with others....not only the baby.
Build trust with her and then take some alone time to see if she has anything to talk to you about.
If need be contact a hospital psych or other such resource.
I was a teenage mother and had my son at 17. I was scared out of my mind as I had never even held a baby before my son. What hurt the most during my hospital stay, was my nurse asking my mother if she was ready to take caare of another baby! NEVER asume that because a mother is young, that she will not be a good mother or that her mother will be taking care of the child. My mother has never cared for my son or I after he was born.
My son is now seven and I am an RN. :)
i was 23 when i have my baby, she is now 20 monthes old. it was what i think some calls baby-blue, kind of postpartum depression, but it is wrong when it goes over 6-8 weeks after delivery.
my md was notified about it and i did took care of my baby i just did not feel anything for her. i remember being always tired, upset, anxious, i cried a lot. after about 6 weeks it was gone. now i jusy cannot imagen how i could do what i did and felt. she is the most important for me and i know i give up my life for her if needed.
now, consider your pt age, i would talk to her first and later on to her mother. also, i would notify her md and social worker. there need to be proper care taken not only for your pt but also for her baby. i am sure she is scared but she can take care about herself but her baby not. her mom is her mom not her baby. there cannot be reverse roles unless there is something else to be consider in her situation. there may be taken also adoption to discuss, psychologist consultation, social worker visits, to see what will happen. notice your charge nurse, your pt nd and all of you should prepare proper care plan for that pt.
One thing I have learned is to always consider developmental stages....remember in psych when we learned that teenagers are most concerned about themselves; their own feelings, and their own bodies. This is why your patient responded to you when you told her how good she looked. She's 18; she's an adolescent. There's no telling what has gone on for her at home in the last nine months.
Our policy where I work is to get a social work consult on every teen mom.
You seem very insightful; give all you can to your patients, and you will change their lives more than you will ever know.
Developmental issues may be a factor, but the situation as described does merit some further observation and intervention. A social service consult is an excellent idea but in the past, when confronted with a similar circumstance, I have actually asked the patient how she feels about being a mom, and attempting to establish a rapport by sometimes simply asking if she feels overwhelmed. Humor is a good tool and I will sometimes approach a situation where the mom ( of the infant) doesn't seem interested or involved in the care, by just letting the family know that I need to see the mom doing some of the tasks....Often, beyond the developmental issues, a patient is or has been controlled by their mom or people in the family OR just doesn't feel strong enough to be assertive....Not to mention the sleep deprivation and shock that happens to everyone let alone an 18 year old..The status of the fob is also a factor. The bottom line is that you had a feeling and observed something that concerned you- the mark of an excellent nurse to be...If I have learned anything it is trust your instincts..You may not always be correct but usually there is a good reason for those feelings of discomfort....Good job!
Not long ago I had a teen mom who was quite responsible, loving, involved with the FOB and her family as well as all the resources available to her, who was highly insulted at that "every teen gets a social service consult" She mentioned that the logic used in that case should apply to every woman as well as older moms because they are at least affected differently than young moms. By the time she was done with her speech, I was agreeing with her! I disagree that just because one is a teen one should have a social service consult, ESPECIALLY when I have put in social service consults on well to do patients in the resort area I reside, that myseteriously disappeared or were not considered due to the wealth and connection of the patients...
I think if a teen (18, 19 or so) has researched the resources open to them, has positive family and social support and genuinely interested and involved in her infant and its care as well as her own, a social services consult is not always indicated...
With a young woman like that (or any age) we would get social service involved and most like also make sure that we have a VNA referral foe someone like that. There are many services available for someone like that.
You know, I am sorry to hear you say the thing about SS copnsults disappearing that should ahve been put through on someone wealthy........ it is sad how some (nurses and physicians) will make a judgement like that. That wealthy person that you mentioned probably needed the SS consult more than your teen mom with her head on straight!
As the mother of a pregnant teen, I'm extremely grateful that a referral to a social worker was made on her first antenatal visit. She may never need to call on the support which is available to her, but the fact that contact has already been established will make it much easier for her to ask for help if she ever needs it (plus the social worker is a qualified paediatric nurse who can do all the baby's post-natal checkups at home, making it much easier to ensure those are done on time).
...the way my unit will drug screen a mom with no prenatal care, but only if she has no insurance. The ones who are well to do and were planning on a home birth with the midwife, then happened to wind up with a section, don't "need" to get drug screened, apparently. Ticks me off... :angryfire
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