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However, moms' priorities change at the first home visit following childbirth, a recent study at the School of Nursing shows. And shorter stays in the hospital after childbirth mean less time for nurses to address both self and infant care. The study appears in the May/June issue of the Journal of Obstetrics, Gynecology and Neonatal Nursing.
Shorter hospital stays for mothers and newborns have affected their care in a number of ways. "Specifically, I wanted to see how the shorter stays have impacted the nurses' care of mothers and babies," said study author Dr. Patsy Ruchala, associate professor and coordinator of perinatal nursing at the School of Nursing. "I see nurses having to do more and more in less time."
Because hospital stays are often 24 hours or less, nurses rarely observe mothers functioning independently with their newborns, and the mothers are too exhausted from the birthing process to learn all that nurses try to teach them.
"It can be difficult for nurses to teach everything they are supposed to and try to communicate with the mother during the time available. Right after childbirth, mothers are dealing with pain, emotion and fatigue," Ruchala said.
Since the time nurses and new mothers have together is essential yet brief, Ruchala compared perceptions of postpartum teaching needs for 103 low-risk postpartum women, 71 in-hospital R.N.s and 53 home health R.N.s.
For hospital postpartum teaching, the nurses said that infant feeding, signs of postpartum complications and signs of infant illness were the top three teaching priorities, the study shows. Mothers listed episotomy care, perineal care and infant feeding as their three greatest concerns. Both groups rated circumcision care as fourth.
The next six teaching priorities for hospital nurses were episiotomy care, infant safety, cord care, perineal care, breast care and taking the infant's temperature. The mothers rated their other six priorities as cord care, signs of infant illness, indications of postpartum complications, lochia flow, infant bathing and bowel function.
Yet, at the first home visit, the mother's priorities shifted toward the care of the child, with signs of infant illness listed first, followed by signs of postpartum complications and infant feeding.
Home health nurses prioritized infant feeding first, with signs of postpartum complications and signs of infant illness placing second and third. Whether a new mom receives a home visit depends upon factors such as need and insurance coverage. Nurses typically make home visits within 24 to 48 hours of discharge from the hospital.
"The results of this study show that new mothers need to feel good about themselves before they can focus on their baby," said Ruchala, who noted further research is needed to bring each group's priorities together.
Some experts say that prepartum teaching may be a partial answer, but Ruchala cautions that it won't solve the problem completely. "We need to communicate this information during 'the teachable moment,' " Ruchala said. "During the pregnancy, women are overwhelmed with being pregnant -- they are not truly receptive to the information. It's not until the baby arrives that reality hits, and the teachings need to be reinforced."
While awaiting further research, Ruchala suggests that nurses might pay closer attention to what the mothers are interested in learning. "Perhaps they can ask what the mothers think they need help with, rather than taking a straight cookbook approach," Ruchala said. "Nurses should remember the importance of incorporating the mother's needs into their teachings. We should always ask new moms: 'Is there anything I haven't covered?' "
Ruchala also emphasizes that nurses still play a major role after childbirth. "By incorporating our expertise with the mothers' needs and adapting to the changes within health care, we can help them with self and infant care and maximize our time with the new moms."
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