Psychological

& Emotional
Changes in
Postpartum
Mothers
Caesar G. Balatero, RN, MN
01 Objective
Compare and contrast the three
postpartum phases of restoration.
02 Objective
Describe bonding.
03 Objective
Discuss the different postpartum
mood changes.
04 Objective
Recognize the basic emotional
needs of a postpartum woman.
 Introduction
 Greatest change in
postpartum period: change
in role
 With postpartum-related
modifications, other
changes starts to set in.
 Woman must be armed with
information to be able to
deal with these life changes.
 Introduction
 Restorative period: from
delivery to the 4-6 weeks
stabilization point
 Emotional changes in the
mother during the
postpartum period
(restorative process) pass
through three phrases
(Reva Rubin).
 POSTPARTUM PHASES OF
RESTORATION
(Reva Rubin)

Taking Hold

Taking-in Letting Go
Taking-In Phase
 Usually sets 1 to 2 days
after delivery, may last
for a day or two.
 Time of reflection, within
the 2 to 3 day period, the
woman is passive.
 Focus is on primary
needs, such as sleep and
food.
Taking-In Phase
 Dependent on her
healthcare provider or
support person due to
physical discomfort from
hemorrhoids or the
afterpains, from the
uncertainty of caring for
the newborn, from the
extreme tiredness
Taking-In Phase
 Initiates little activity on
her own
 Quite talkative, prefers to
talk about experiences
during labor and birth and
also pregnancy
Taking-In Phase
 Time for the woman to
regain physical strength
and organize rambling
thoughts about the new
role.
 Encourage the woman to
talk about her experiences
during labor and birth.
Taking-In Phase
 Does not usually initiate
contact with the infant
 Taking-in information to
identify the infant; may
use fingertip to touch the
infant (one of the first
steps in the identification
process)
 Relives the delivery
Taking-In Phase
 Not an optimum time to
teach about baby care
Nurse’s Role:
 Listen, help the mother
interpret events of
delivery
 Plan activities, allow rest,
prevent “sleep hunger”
(irritability, fatigue,
general interference)
Taking-In Phase
Father’s Role:
 Support
Taking Hold Phase
 Starts 2 to 4 days after
delivery.
 Women who
underwent anesthesia
reach this phase only
hours after delivery.
 Emphasis is on the
present
Taking Hold Phase
 Strives for
independence and
autonomy
 From passive to being
in command
 Initiates action, make
decisions without
relying on others
Taking Hold Phase
 Driven to organize
herself and her life
 Concerned about the
ability to control
bodily functions
 Active part in
controlling these
functions
Taking Hold Phase
 Concerned on taking care
of the newborn
 Assume tasks of
mothering
 Focus on the newborn
instead of self
 Optimum time to teach
about baby care
Taking Hold Phase
 Lasts 10 days (most of this
phase is accomplished at
home)
 Woman still needs
positive reinforcements
(due to insecurity)
 May experience a great
deal of anxiety, mood
swings, fatigue,
exhaustion
Taking Hold Phase
Nurse’s Role:
 Demonstrate newborn
care, return demo
 Allow to settle in
gradually
 Allow the mother to
actually perform infant
care tasks, positive
reinforcements, provide
guidance, reassurance
Letting Go Phase
 Finally accepts new role,
gives up old roles like
being a childless woman
or just a mother of one
child.
 Generally occurs when
the mother returns home.
Letting Go Phase
Two separations:
 1. Realize and accept
physical separation from
the infant
 2. Relinquish former role
as a childless person,
accept new situation
Letting Go Phase
 If quitting work – adapt to
less freedom, less
autonomy, less social
stimulation
 If continuing work – strain
of finding sitters, meeting
additional workload
 Let-down feeling –
postpartal, or baby
“blues”
Letting Go Phase
 Postpartum depression
may set in
 Deep loss over separation
of the baby
 Caught in dependent-
independent role
 Readjustment of
relationship is needed for
easy transition
Bonding
 “Attachment”
 Emotional relationship
 Influenced by many
factors
 Important characteristics:
trust, self-esteem,
reactions to present
pregnancy
 Interest in child rearing
Postpartum Mood
Changes
 Postpartum
Blues
 About 1 in 8 people
 Occur during the first few
days after birth, usually 3rd
or 4th day
 Usually over by two weeks
postpartum
 Postpartum
Blues
 Tearfulness, impatience,
irritability, restlessness,
anxiety
 Fairly short, don’t last all
day
 Come and then go away
 Extreme fatigue due to
lack of sleep
 Postpartum
Depression
 About 1 out of 10 people
 Often appears around 4th
week after birth
 Can also begin before the
period returns, after
weaning, or anytime in
the first year
 Paternal postpartum
depression
 Postpartum
Depression
 Tired, overwhelmed,
stressed, loss of identity,
less control of time 
postpartum depression
 Postpartum
Depression
 nervousness, anxiety,
panic, restlessness
 sluggishness, fatigue,
exhaustion
 sadness, hopelessness,
irritability
 eating and sleeping
problems
 Postpartum
Depression
 poor concentration,
confusion, memory loss
 over-concern for the baby
 lack of interest in the baby
 feelings of guilt,
inadequacy, worthlessness
 exaggerated highs, lows or
both
 fear of harming the baby,
herself or both
 Postpartum
Depression
 Symptoms may be mild or
so severe
 Symptoms don’t go away
by themselves
 Symptoms are treatable
with medicine, talk
therapy or both
 Postpartum
Depression
Ways to mitigate
 Rest, no pressure, ask for
help with chores and night
feedings, talking with
family and friends, getting
out of the house, spend
time with partner, support
group, avoid major life
changes
 Postpartum
Depression
When to seek professional
help
 Symptoms persists >2
weeks
 Can’t function normally,
can’t cope with everyday
situations, thoughts of
harming, extreme anxiety,
scared, panicking
 Postpartum
Depression
Risk Factors
 History of depression
 Age at time of pregnancy
 Ambivalence about the
pregnancy
 Children
 Family history of mood
disorders
 Extremely stressful event
 Child with special needs
 Postpartum
Depression
Risk Factors
 Twins or triplets
 History of depression or
premenstrual dysphoric
disorder (PMDD)
 Limited social support
 Living alone
 Marital conflict
 Postpartum
Depression
Causes
 Hormones
 Lack of sleep
 Anxiety
 Self-image
 Postpartum
Psychosis
 Rare (1 in 1,000), typically
develops with the first
week after delivery
 Severe signs and
symptoms: confusion,
disorientation, obsession
about the baby,
hallucinations, delusions,
sleep disturbances,
agitation, paranoia, harm
Emotional Needs
of the Woman
during
Postpartum
Emotional Needs
 Recognition of the effort
made during labor
 Support and
encouragement
 Attention
 A listening ear
 Comfort, nourishment,
hygiene
Thank You
Have a good day!