Page 761 - ACCCN's Critical Care Nursing

738 S P E C I A LT Y P R A C T I C E I N C R I T I C A L C A R E

postpartum and comfort measures may assist if the is able to ‘room in’ with the mother for periods of time
breasts become very uncomfortable. Cold compresses in ICU. Skin to skin contact is usually recommended
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may be of use and it is important for the critical care to promote bonding. Alternatively, the baby may be
nurse to observe for signs like reddened hot areas on the able to visit the mother in ICU or the mother may be
breast that may be an indication of mastitis. able to visit the baby in NICU. Physically seeing and
touching the baby may be an important step for the
Medication Administration and Lactation mother. Newer technologies, like Skype, have been used
Many drugs are safe to use in breastfeeding, although by some ICUs to enable the mother to see her baby in
most common critical care drugs have not been well eval- a different hospital and to watch significant events, such
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uated. Even if the woman is receiving a medication that as the first bath.
is contraindicated during breastfeeding, you can still The use of diaries, one about the mother’s condition and
express (and discard) the milk to establish the process of one about the baby’s progress, complete with photos,
lactation, unless the woman is likely to stay on the medi- visitor and clinician entries is another strategy that may
cation long term. be useful to promote maternal-infant attachment. The
The safety of the expressed milk for the baby depends on first few days following birth are often a blur for the
three factors: the amount of the medication in the milk, mother with little recollection of events. It is also common
the oral bioavailability of the medication, and the ability to have photographs of the baby for the mother to look
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of the infant to metabolise the medication. The gesta- at and clinicians keep in touch with the nursery where
tion and condition of the infant are relevant as the func- the baby is being cared for and gives the mother regular
tion of the gut, liver and kidney varies with maturity and updates on the baby’s condition.
illness. Consequently, advice from the baby’s neonatolo-
gist or paediatrician can help determine whether the
neonate can receive the expressed breast milk, or whether Caring for the Partner and Other
it should be discarded. Family Members
The partner is similarly ‘bowled over’ by the sudden and
PSYCHOLOGY OF THE PUERPERIUM severe illness of the mother. The partner is often torn
Major emotional changes take place in the majority of between two ICUs, with the newborn admitted to NICU
women during the puerperium, but there is a wide varia- in one hospital and the mother in ICU in another hospi-
tion in the amount of distress caused by these changes. tal. This situation is further compounded if there are
The first three days post delivery are known as the latent other children who also need the care and attention of
period because functional mental illness is very unlikely their father and need an explanation about what has hap-
to occur at this time interval. The woman is usually in pened to their mother. Most women recover and do so
state of euphoria, excitement and restlessness, extreme fairly quickly, so there is usually hope that the woman
tiredness is also present. Days 3–10 are often referred to will survive and fully recover. Usual strategies such as
as the ‘baby blues’ and are characterised by emotional explanation, open visiting and social work support are
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lability (mood swing). The ‘baby blues’ are usually important.
characterised by thoughts of inadequacy and generalised
panic that there is something wrong with either their SUMMARY
baby or themselves. A very severe ‘baby blues’ response
may herald the onset of postnatal depression. Intensive care management of pregnant and postpartum
women is challenging for a variety of reasons including,
THE FAMILY UNIT but not limited to, the presence of the fetus, physiological
Maternal admission to ICU often separates the mother adaptations of pregnancy and due to clinical conditions
that are unique to the obstetric population. ICU staff are
from her newborn and may also be associated with a often not educationally-prepared to provide midwifery
period of heavy sedation/loss of consciousness. Thus the care and there may be difficulty in obtaining midwifery
woman may not be able to recollect the birth process and and obstetric consultation. Importantly, childbirth is
will often not have seen her baby before being transferred viewed as a normal, healthy event in our society and is
to ICU. usually a cause of celebration. A life-threatening event
associated with childbirth may seem more overwhelming
Promoting Maternal–infant Attachment due to this context. The best outcomes for both the
Promoting maternal–infant attachment depends on the mother and her baby will result from collaborative and
condition of both the mother and her baby, and their coordinated care between maternity and critical care
physical locations. The best case scenario is that the baby service providers.