Maternity Nursing: Intrapartum Q 49
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. The nurse should:
A. Tell the woman she can rest after she feeds her baby.
B. Recognize this as a behavior of the taking-hold stage.
C. Record the behavior as ineffective maternal-newborn attachment.
D. Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.
Correct Answer: D. Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.
The behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. Mothers need to reestablish their own well-being in order to effectively care for their baby.
Option A: Response 1 does not take into consideration the need for the new mother to be nurtured and have her needs met during the taking-in stage.
Option B: During the taking hold phase, the woman starts to initiate actions on her own and makes decisions without relying on others. Demonstrate newborn care to the mother and watch her do a return demonstration of every procedure.
Option C: This dependence is mainly due to her physical discomfort from hemorrhoids or the after pains, from the uncertainty of how she could care for the newborn, and also from the extreme tiredness she feels that follows childbirth and not a reflection of ineffective attachment.