The role of the General Practice (GP) in the community has developed and can be the first point of contact for medical assistance. This has enabled the nurse in General practice to expand their role, becoming more involved in the primary care of the patient and their families. Families today are becoming smaller and are usually separated from each other as the world is becoming a more transient population. This transition has led to new parents having less contact with babies. As a consequence they have become unfamiliar as to what is expected of them.
With less family assistance, parents can turn to their General Practice (GP) for this support from the doctor and nurse. The nurse in fulfilling this role of a supporting link to the new parent will offer reassurance and promote education. This in turn allows the nurse to form a relationship with the parent and in doing so can assist and support the new mother in their babies care. This is important as the nurse is not present at the birth, so the relationship will differ to that of a midwife. The GP nurse often sees the mother pre conception and postnatally enhancing follow up care.
A factor in the necessity of the importance of developing this rapport with the new mother is the trend for shorter hospital stays where education at times is not fully comprehended by the new parents. This paper will discuss strategies to assist the new mother in preparation for caring for her baby. It will concentrate on feeding and sleeping issues that may develop with the infant in its first few months of life. Through referencing of current literature, the paper will examine these plans and the possible outcomes for both mother and infant.
In our role as a GP nurse we are in a position to facilitate a mother’s knowledge about how she is going to feed her baby. The Centre for Community Child Health suggests that “education programs with support and peer support” rather then the supply of leaflets all contribute to an increase in the instigation and length of breastfeeding (www. raisingchildren. com. au). If mothers are bombarded with large amounts of reading material they can find it overwhelming and not benefit from the literature.
Robertson states that “parents often complain of receiving conflicting advice postnatally and one good reference manual can help overcome this by providing consistency within itself”(Robertson 2003). By having someone which the mother can speak to lessens the feeling of isolation. The GP nurse can use her position to encourage mothers to speak to her about any problems that they may be having with caring for her infant. Promoting attendance to an antenatal clinic will give the new mother access to advice, education and peer support which is a valuable tool for new mothers to have.
With the population being computer savvy many new parents may wish to access advice on the internet. This is especially true for new mothers who live away from their family and friends or who live in the rural community. “In general, living in a rural or remote area translates to limited access to medical and health professional facilities”(www. aph. gov. au). Breastfeeding is considered to be the most important method to feed a baby. ‘Breastfeeding is the natural, physiologic way of feeding infants and young children, and human milk is the milk made specifically for human infants” (Newman 2008).
Newman states that breastfeeding should be simple and uncomplicated for the majority of inexperienced mothers. To prepare herself for breast feeding a number of matters need to be discussed. Firstly a good fitting bra is essential in supporting her new breast tissue and a proper bra fitting may aid this. Discussions on what clothes to take to hospital to aid in effective breastfeeding needs to be addressed as the correct clothing will make it a more comfortable experience for the mother and child. This knowledge can be mparted by encouraging the woman to speak with family and friends, referral to nursing mothers and accessing this information on the internet from accredited sources. “Providing support to women is about giving practical help, advice, positive feedback and praise” (Pairman,Pincombe,Thorogood,Tracey p466) Shorter hospital stays means the mother and her infant are often discharged from hospital by day three. This can have an impact on the mother’s ability to cope with any feeding issues they may have. Usually the method mothers have chosen to feed their baby has been established whilst in hospital.
However, early discharge can mean that the mother has not established a good routine with the feeding of their baby. “While breastfeeding is initiated in hospital many women are discharged prior to their milk ‘coming in’” (Mazza p153). Correct positioning and attachment is a vital formula to ensuring success in breastfeeding. This is often difficult to achieve when the mother is discharged early as when her milk ‘comes in’ her breasts becomes large and sore and it is difficult for the baby to latch on.
It is important to discus with the mother the available services that she can access. For example, encouraging her to seek out services that are provided by the hospital and child health community in her area, will facilitate her knowledge on where and how to seek help easily. Breastfeeding problems can be caused from poor attachment and lead to cracked and sore nipples, mastitis and engorgement. It is necessary to stress to the mother of the importance in obtaining help early in regards to breastfeeding difficulties.
Mothers feel inadequate when they are having difficulty in feeding their baby. Educating the new mother in issues of breastfeeding difficulties will assist her in obtaining the necessary help for her to overcome these problems. Early discharge from hospital usually means the mother will bring their baby to the GP for the 6-10 day postnatal check. Any feeding problems can be addressed and the nurse will be able to use her time to watch the mother feed her baby ensuring correct attachment is achieved and to answer any questions the mother may have.
When spending time with the breastfeeding mother, the nurse is able to give her praise and encouragement. Despite the abundance of information they receive, they can never be given too much encouragement towards breastfeeding their baby (Lutav 2006). Referral to a lactation consultant or to nursing mothers association will also assist new mothers with any feeding issues they may be having. Without this support and information a mother may chose to stop breastfeeding and commence artificial feeding. Many women stop nursing because the problems encountered seem to have no solutions” (Olds,London,Ladewig p932). This goes against the recommendation of The National Health and Medical Research Council which is for all infants to be fully breastfed until they reach six months of age (www. nhmrc. gov. au). Olds et al states that it is the nurses role to provide education to the mother in regards to potential problems that they may encounter whilst breastfeeding (2006).
Encouraging the new mother to attend support groups in her area, for example antenatal classes and playgroups will give her the opportunity to develop relationships with others who are experiencing similar feelings and emotions. Peer groups are important because it can give a new mother support from someone else who is going through a similar experience. Peers can provide practical and emotional support for each other through the trying times of breastfeeding problems.
Social interaction is necessary to a new mother in establishing friendships with other families as a tool for encouragement and assistance in maintaining breastfeeding. The Australian Breastfeeding Association is one such organization that has a wealth of information and they hold classes to assist women in their efforts to breastfeed her infant. The classes give the mother the opportunity to discuss any queries that they may have, as well as meeting and enjoying the company of other mothers. This can increase the mother’s confidence in her ability to care for her baby.
Encouraging the new mother to attend these classes whilst pregnant can prepare her for the coming event (Snell 2008). Snell also suggests finding friends and family that have successfully breastfed will be a good source of positive information (2008). Apart from breastfeeding, effective strategies are also necessary for sleep as it is essential to mother, baby and other family members. Acquiring enough sleep is essential for overall health and wellbeing. As many new mothers are often sleep deprived with their new baby, it is essential to impart this knowledge while the mother can think more clearly.
Sleep deprivation causes you to have short term memory and so it is important for mothers to prepare themselves with resources and to get an understanding on what help and advice there is and where to obtain it. New parents are aware that a lack of sleep is common when raising a newborn. “Most women are aware that high levels of tiredness can be expected following the birth because of the physical activity of giving birth followed by interrupted sleep patterns due to the needs of the baby”(Pairman et al p464).
Discussing sleep issues with the pregnant women allows the nurse to explain various strategies that can be used in obtaining adequate rest and sleep during the day and maintaining a good diet to help decrease the amount of tiredness they may feel (Olds et al 2000) It is essential to stress the importance of sleeping when the baby sleeps, accepting help when it is offered and recognising that they do not need to be a ‘supermum’. Mothers need to be encouraged to identify and recognise adults who may be able to assist them in their responsibilities of caring for the baby (Nichols 1997).
Facilitating a mother’s knowledge about sleeping issues will allow her to gather resources she can use once the infant is born. It is necessary to stress the importance of ensuring the baby sleeps in the correct position. SIDS Australia recommended guidelines are to put the baby on their back, with their feet at the end of the cot, ensure the baby is not too hot, provide a smoke free environment, not to sleep with your baby in your bed and to have the cot free from bumpers and toys(www. sidsand kids. org).
By ensuring these measures are used, the risk factors of sudden infant death syndrome are reduced. Mothers need to be deterred in taking the baby back to bed with her. Although it is tempting to have the baby in bed with the parent so they can sleep, it increases the risk of “sleeping accidents” (www. sidsandkids. org. au). Babies are much safer sleeping in their own cot or bassinet. Most infants can start their own sleep schedule early, but some can stay unsettled (www. cyh. com). All babies will sleep to a routine. It may be helpful to develop a routine or regular order of doing things” (www. cyh. com). Identifying tiredness signs in a baby will allow the mother to assist her baby to settle more easily. Signs of tiredness include grizzling and crying, clenching of fists, jerky movement and yawning (www. cyh. com). In recognising these signs a mother can prevent a baby from becoming overtired. An overtired baby becomes upset and will be difficult to settle. Instructing a mother in how to swaddle her child and position the baby for sleep will give the skills to settle her baby.
The baby should be put to bed whilst awake as this will help the baby to put itself to sleep. Referral to organizations such as Child Youth and Family Health Services can assist the new mother with sleeping issues as they can attend information sessions that are held on a regular basis. They are able to receive information from health professional from sleep to child development and nutrition. “A newborns biological sleep clock is programmed to wake him at night to ensure he gets the food he needs in this time of incredible growth and development” (www. aisingchildren. com. au). The new mother needs to know that this is normal and the baby will start to sleep through the night in time. To assist the new mother the nurse can encourage her to seek assistance from her husband in doing a night time feed. The mother can express breast milk so the father can feed his baby and the mother can get some much needed sleep. This also allows the father to bond with their baby as they are often at work and time spent with their baby is limited compared to the mother.
Developing a connection with the baby allows the father to assist the mother in finding a routine that will enable both parents and baby to sleep. With effective strategies in place for breastfeeding and sleeping issues, bonding and attachment will follow on and lead to a more settled family life for all involved. Nurses can provide the most direct patient care of health professionals in a general practice setting. They are in a position to develop a relationship with the mother and are able to discuss the many areas that are of importance both pre and post natally.
Much of our time with new and expectant mothers is often opportunistic, so it is important to be able to use our time wisely. The use of health promotion materials such as posters and handouts can facilitate the nurse in delivering the necessary information to the new mother. Promoting breastfeeding and assisting the mother to establish this method of feeding her baby will allow the mother gain confidence in caring for her baby. The gathering of necessary information on where to seek help will encourage the mother to access help earlier rather then later.
Developing sleep strategies will allow the mother to acquire the tools required in helping a baby to develop a sleeping routine that suits the family. Mothers are encouraged to access their General Practice for a 6-10 day check up, allowing the foundations for help and assistance to be offered once they have left the hospital situation. Facilitating and enhancing a mother’s knowledge in caring for her baby is a fundamental component of General Practice nursing.