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Successful adaptation to this function provides confidence and satisfaction to the mother in her capacity to care for her baby Nichols and Roux described maternal perception and returning to work during postpartum as a negative experience, with more challenges than expected.
Preparing to again assume the former role was important, but unpleasant. Some positive aspects are highlighted, like satisfaction for their professional role and the maternal role Regarding the role with their spouse and with their sexual life, this is generally diminished.
Aspects like vaginal bleeding, perineal discomfort, hemorrhoids, breast pain, and decreased vaginal lubrication associated to breastfeeding, aggravated by the fatigue of restless nights, contribute to diminished motivation for sexual activity.
Other factors like fear of waking the baby, the sense of reduced attraction, change of bodily image, or changes in frame of mind also influence. Most do not speak of the issue with their partners or with healthcare professionals, who seem uncomfortable dealing with the matter Addressing sexuality issues in nursing can contribute to the woman's health, as long as the nurse is adequately prepared for such and manages to establish empathy.
These problems can be solved by providing clear information, within a comfortable and reliable setting. Some disorders, however, will require bio-psychosocial support from other disciplines. As an adaptation mode, it involves the affective and social relationships women establish with significant individuals and with support systems.
In it, socio-cultural aspects surrounding the gestating woman become important. In an investigation conducted by Argote et al. Her social relationships are reduced, in great part, to family gatherings.
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Puerperium is also considered a stage of transition. In this regard, the Medium-range Theory of transitions, described by Schumaker and Meleis, has been used to identify the elements that characterize the transitions of gestation and postpartum. During this stage, women undergo changes in their external and internal world and in how they perceive them.
If women know what can happen during the postpartum, the anxiety associated diminishes and their coping and adaptation capacity improves Alves inquired on the perceptions of the transition to the maternal role of primiparous puerperium women, finding that it is possible to understand the experience of women on their way to the maternal role: The adaptation modes described permit recognizing that these are present in women during puerperium, but healthcare personnel emphasizes specifically on the physiological, leaving aside the other adaptation modes, such as, the self-concept, domain of the role, and interdependence, which could limit comprehensively approaching women during this stage, insofar as opportune diagnosis and management.
Among the recourses indicated during puerperium, there are self-esteem, prior experiences, permanent learning, knowledge, beliefs, and the organization to return to work This is evidenced by the cognitive subsystem that contemplates perception, emotion, learning, and judgment. In perception, prior experiences become important in the coping process. Mercer references that, in relation to their children, women reconstructed the maternal model and those who remembered having been accepted by their mothers, who currently had a balanced relationship with them, showed to be more sensitive in child rearing; on the contrary, rejection during their childhood was a predictor of depressive symptoms Emotion is manifested through defense mechanisms to relieve anxiety, via responses like crying, despair, or angst; these responses produce effects like tachycardia, tachypnea, and even, depression.
It can also be manifested with joy, satisfaction, desire of unconditional dedication in caring for the child, strengthening the maternal bond 5. Learning involves imitation, reinforcement, and insight and implies the domain of necessary skills to perform the maternal role 23 ; here, beliefs intervene, which influence hoe postpartum is confronted.
Judgment comprises decision making and problem solving, becoming evident during postpartum, where women adjust to new challenges and pose solutions, which involve their beliefs, experiences, values, principles, feelings, and education. In research conducted by Knaak 24women manifested that among the main recourses used in the process of adjustment to maternity, there are prioritizing their self-care, controlling stressful situations, having sufficient help, and having real expectations.
As can be noted, considering the cognitive subsystem is fundamental, given that it is present in the woman's decision making, it is part of her everyday life, and influences directly on her self-care and the care she offers her child.
For example, not washing her hair during puerperium or placing a bracelet on the wrist of the newborn to avoid the evil eye. Problems of adaptation and support recourses When women fail to maintain the equilibrium between the demands of the situation and the recourses puerperium women have to confront such situation, they may enter cognitive, emotional, and motivational deficit, which will lead them to non-adaptive conducts like depression.
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On the contrary, women who manage to use these recourses adapt more easily to stressful situations Fig. Hung determined the effects of postpartum stress, depression, and social support on the health of puerperium women, finding that stress is related more with life events than with the tension of the adjustment period. Women who were breastfeeding had a high level of social support against those using infant formula; those with high educational levels, full-time work, higher income, and social support had lower levels of depression Poof investigated on the risk factors associated to postpartum depression and found that most are of family type, with the interactions among the family, including the spouse, having the greatest repercussion on the woman's affectivity It was also observed that in cultures where psycho-social support is established during pregnancy, childbirth, and postpartum, the incidence of postpartum depression is low Postpartum depression has a direct relation on maternal adaptation and the care for the child.
Barr concluded on women with this diagnosis that their adaptation to the social role and their competency in caring for the children are delayed, doing this work in mechanical manner. It was also concluded that the education received in prior phases can facilitate an adequate adaptation for them Barlow and Coren analyzed follow-up studies that suggest that the psycho-social health of the mothers can have a considerable effect on the mother-child relationship, and mental-health problems, like postpartum depression, give way to cognitive and emotional deficits in the child Although postpartum depression is an important adaptation problem, it is in everyday life where difficult situations exist, generating conflict in women and their families.
They reported that the most frequent were pain and problems with the breasts; the psycho-emotional aspects that concerned most the primiparous women were the perception on their capacity to care and their loss of autonomy Martin analyzed, through a descriptive study with Roy's model, the most common problems during postpartum in the first two to eight weeks.
The woman's perception of her bodily image can also be altered. Generally, there is discomfort with the physical appearance, due to the weight gain during gestation and the sequelae on the facial skin and the abdomen, which may even contribute to diminished self-esteem.
Add to this the habitual beliefs during postpartum, when women are overfed and remain at rest, leading them to rapid weight gain. Research conducted to explore the experiences of women with their bodies and frame of mind during gestation and postpartum reported that, during pregnancy, there are aspectshat help them to positively face the bodily changes; however, during postpartum, lack of satisfaction is manifested with this image.
They state they no longer have an excuse to seem pregnant and tyearn to return to normality. Physical exercise acts as a stimulus to manage the bodily image and promote effective responses. Generally, this practice starts as of gestation and is related with fetal wellbeing; during postpartum, instead, with weight loss. They concluded that sports and exercise habits in women become predictors of maternal wellbeing. Support from the family and spouse was an influencing factor in maintaining exercise habits Likewise, women who engage in vigorous exercise during postpartum show better results in adaptation, with more possibilities of participating in socialization activities, hobbies, and entertainment, compared to those who do not perform said type of exercise The use of alternative therapies can also support the physical and mental state of puerperium women.
According to Roy's Nursing Model, the family is a factor that intervenes in the health of the individuals, and it can be evaluated in the four adaptive modes - physiological, group identity, role domain, and interdependence The physiological mode evaluates the physical necessities of the family; it is directly related to the other adaptive modes and permits seeing the family group in holistic terms.
Group identity equivalent to the self-concept for the individual reflects how individuals see themselves in the group, based on the feedback from the environment on their interpersonal relationships, goals, and values; the role may be evaluated through the communication among its members; the integration of the different roles determines their level of adaptation; interdependence evaluates their interaction with society and the support systems Frequently, the family constitutes a stimulus that impacts upon the behavior of its members.
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An example of this process is noted when the mother has an illness or problem of adaptation during postpartum and, hence, feels incapable of performing her role.
The main stimuli for the development of this behavior are the family's poor health practices. Also, her inability to perform her role diminishes the group's coping level On the contrary, Wanna found that, in Thailand, to return to work, family help with caring for the child had a positive effect in primiparous women It is thus that the family learns to identify the recourses that are useful to face stressful situations and from there accomplish equilibrium within the family dynamics.
It provides for each person and his or her life project the stimuli and means necessary to reach desirable attitudes and habits for social and personal improvement According to Roy's model, for education to adequately promote the capacity for coping and adaptation, we must bear in mind the individual as a holistic being, placed within a social context and a changing environment Gestation and puerperium are privileged periods for education.
It would be ideal for education to surge from real necessities of gestating and puerperium women, but the current scenario is different. Not all women receive education, nor do healthcare providers have clear guidelines; although, healthcare norms require for education to be offered individually and colectively Consequently, each healthcare institution develops the educational sessions in different manner.
In research with women and educators who took the prenatal courses, Renkert and Nutbeam analyzed the opportunities to improve maternal health through antenatal education. Both groups indicated time as a limiting factor. Furthermore, there is influence from anxiety and curiosity for knowing about pregnancy and childbirth.
Primiparous mothers revealed that they would have wanted more information about postpartum in the antenatal classes and that these had not been of much help Hence, is current prenatal education sufficient to maintain and increase levels of coping and adaptation during puerperium?
Or does it merely center on improving knowledge? Individual education has revealed to promote higher levels of knowledge. The result was that the intervention significantly influenced on the level of knowledge of puerperium women The content of the sessions was based on the needs and interests of the participants and on the preparation of the medical and nursing professionals in charge of interacting with the mother-child couples Research found on education for maternity reflects the need for conclusive studies that investigate its effects on women and their families.
Gagnon and Sandallin a systematic review conducted to evaluate the effects of education conclude that, although in many countries women and their partners are habitually referred to education programs, its benefits continue being uncertain.
The widespread popularity of prenatal classes ratifies the desires of many parents particularly first-time parents to receive this education All this is a reference that must be kept in mind. However, guides are required, based on evidence, that orient education for puerperium women since the prenatal stage.
Additionally, it is necessary to establish a maternal and neo-natal care system extended to the family, defined by Ruiz as comprehensive health-care of mothers and their newborn children based on knowledge of biological, emotional, socioeconomic, cultural, and spiritual needs Maternal health is one of the most important determiners in community development.
The Colombian Ministry of Social Protection considers that women's health, especially safe maternity and the conditions for the exercise of human rights associated to such, like the right to life, directly reflects the level of the nation's development and the degree of reduction of economic and social inequities The maternity event encompasses a high percentage of the population.
However, as revealed by the WHO, for there werematernal deaths worldwide, a figure that has decreased in relation to prior years, but still remains high In Colombia, duringmaternal deaths were registered, generated - in part - by access barriers to healthcare services and the quality of public healthcare attention The main direct cause of maternal death in Colombia is gestational hypertension 51which is an avoidable cause if comprehensive care is offered not only to the woman, but also to the members of her family to act as care agents.
Among the Colombian policies and guidelines that promote healthcare of women during gestation and puerperium, there are the Political Constitution; Legislation ofwhich privileges infant and maternal care; Resolution ofwhich are the guides and technical norms of Sexual and Reproductive Healthcare; Agreement by the Ministry of Social Protection, which prioritizes the entry of gestating women into the Subsidized Regime, with coverage for prenatal care, partum, and puerperium, among others Although there are current national and international regulations, organizations like the Chilean Ministry of Health poses that, currently, there is insufficient concern regarding the needs of women during postpartum, or real awareness of their vulnerability.
Added to this is that the concept of postpartum as a prolonged period is new in the healthcare culture. Furthermore, its duration is quite variable, which hinders programming its care.
Also, postpartum is not recognized as an opportunity to positively influence childrearing, as parental skills are increased. There is no doubt that this is a period in which women are in different conditions to those found during other stages of their lives Because of this, the Pan American Health Organization emphasizes that nursing care for women during gestation, partum, or puerperium requires nursing practices based on evidence to propose, from the very knowledge of the discipline, the revision of healthcare practices But, how much are nurses concerned with caring for the real needs of women, their families, and their newborn infants?
The experiences of the parents regarding hospital and home nursing care during puerperium permit recognizing their advantages and limitations as educational settings.