Post partum day 2 found me with 4 completely different patients. The first was 19 and a first time mom. The second was 30 something and a first time mom. The third was almost 30 and gave birth to a set of twins (this her third time giving birth). The last was a post hysterectomy patient who came to PP as an overflow. She was in her 70s. After doing initial assessments on all four patients and giving my notes to the care nurse (probably one of the nicest encounters I've had with another colleague)...she asked me which one I wanted to assume care on...I thought about it in a split second. "I want the 19 year old." Before I explain why, my reason was simply this. She needed a mom who could also be her nurse.
When I first came into the room, it was dark. The shades were closed, the room was hot and the patient was down in the bed...curled in a ball. Her newborn in the bassinet looked small and jaundiced. The mother's affect was flat and emotionless. She refused to make eye contact with me. I had taken report and heard this first timer was "difficult." My care nurse was awesome. I loved her style. Pulling my patient up in bed, I explained to my 'baby' that we were going on a journey today. She was going with me, and we were going to learn all we could about her baby. This required me to take care of her, so that she in turn could take care of her baby. She looked at me totally surprised and asked "why?" Laughing, I told her to smile, she had a baby, it wasn't the end of the world. I went out and reviewed my plan with my nurse who belly laughed and said "good luck". Ok..it was a little too cheerleader. After I packed her hemorrhoids, gave her breakfast and a motrin, I pulled out supplies, and told her to put her baby in the window near the light because he was looking yellow. While she did that, I asked her to take a shower. A shower to wash all the labor and delivery away. A shower to wake her up. She had no idea how much her life had changed in 12 hours.
I reviewed her chart. She had a history of a neurological disorder and learning disability. The flat affect could be slightly explained with the neuro disorder, the psych problems were situational. So, after getting a handle on her situation, I went back into her room to talk to her some more about her support system. She had no parents. Mom was dead. Dad was absent. Boyfriend was dysfunctional and abusive. They were living with his mother in what could only be equated to a double wide in a bad neighborhood. This case screamed for long term support. I could think of a handful of couples I know who would take her baby and raise it for her. She chose to do this, but I wonder for how long and at what price.
After talking to the nurses, they called social services, who in turn, came in for a second eval. The first didn't go so well. It was decided this time, the patient would get a public health nurse home health referral. Score 1.
Throughout the day, as I gained the patient's trust, we talked about how the days ahead would be for her as a new mother. What resources were available to her and her baby and where respite care and services could be attained. We talked about depression and abuse. She looked at me like my teenagers look at me when I am giving them a lecture, but while talking to her I did so more as a nurse who was also a mother. Her boyfriend and I talked about shaken baby syndrome. It all sounds so simple, when I say I told him "don't do that under any circumstances" but if ever there was a candidate for something like that, it was him.
Perhaps the connection for me was in the questions she asked, the suggestions I made that she obeyed. She got outside while her baby when to the nursery for phototherapy. She came back and watched all the instructional videos and she asked me questions. At the end of the day, she smiled and said 'thank you'. Score 2. I did nothing but get her out of bed and into her new life as a mother with a future paved with uncertainty. The rest is up to her.
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