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 had my daughter in a military hospital and it was mandatory that ALL mothers get a visit from a social worker. I was VERY insulted at the time but, afterwards, I was thankful. It was during Desert Storm and there were lots of VERY YOUNG new mom's with no husbands around and little help (not me, I was 28 with my whole family excluding hubby there). I think that one visit made the difference for a lot of those VERY YOUNG mothers.
During nursing school I remember a very similiar situation with a young mother. She was not expecting the c-section and was very sick from the general anestheisa and was experiencing a lot of pain.
She was bewildered by the fact that she was in so much pain. Her family (mom, dad, boyfriend) expected her to be up and about. We did some teaching about the surgery and the pain and healing of abdominal surgery. Her family was surprised that she was having pain because the originally thought that having a c-section was not painful. The poor girl broke down in tears because she felt so lousy and thought nobody understood.
After all the crying was done and the family was more supportive the mom took more interest in the baby. I think the main problem in this case was the unexpected surgery and the knowledge deficit of what to expect after the surgery.
Her family was surprised that she was having pain because the originally thought that having a c-section was not painful.
I hear stuff like this all the time!!! I understand that a lady partsl delivery (especially without any pain meds) is horrifically painful - but why in the world do people sometimes assume that having your entire abdomen sliced open is a walk in the park??? That epidural doesn't last forever!!!
Since the mom brightened up when you complimented her on her flat tummy, she may respond if she feels like she is being complimented on her baby.
One thing I do when I see someone with a baby is to tell them how pretty the baby is, or how bright, or whatever. Even disinterested-appearing parents feel good when they are basically being told they did a good job.
I figure it is child abuse prevention. (Fussy children, incidentally, must really be bright, because the "average" ones hardly ever do that.... It puts parents' perspectives in a place where they can be proactive, rather than reactive.)
Maybe, with the GM doing all the baby care etc., the new mom is feeling a bit inept (didn't we all, the first time around?). Complimenting GM on how well she raised the daughter--"because look at that beautiful baby, the daughter did a good job!"--can get the roles adjusted a bit and the new mom more interested in the baby.
Social services should be invited to visit, but whether the family will accept that kind of support is another thing all together. Most people don't want the intrusion.
Everyone, thank you so much for your insights! I will have to learn more about social worker referrals. I didn't know something like that was routinely available. It is great to know that there are resources available to help patients going through difficult situations.
Sometimes I learn more from this discussion board than I do from lecture class!
Maggie in NC
1 Article; 392 Posts
I had my daughter in a military hospital and it was mandatory that ALL mothers get a visit from a social worker. I was VERY insulted at the time but, afterwards, I was thankful. It was during Desert Storm and there were lots of VERY YOUNG new mom's with no husbands around and little help (not me, I was 28 with my whole family excluding hubby there). I think that one visit made the difference for a lot of those VERY YOUNG mothers.