I do have the references to Reva Rubin's theories, and am trying to track
down all the articles, which can be a challenge. Her original study was
published in 1961, and stated the first 2-3 days the mother is "taking in"
or passive and dependent. Sometime during the third day, the new mother
becomes assertive and enters the "taking-hold" phase in which she is open to
teaching, guidance and support. L. Ament (1990) reevaluated the taking-in
and taking-hold behaviors, and reported that women's attitudes and behaviors
are consistent with Rubin's work, but the time frames have shortened. The
taking-hold stage is now thought to occur 24-48 hours after birth. As we
know most mothers having a NSVD are discharged at 48 hours or less.
Rubin published a paper in AJN in 1975, where she concluded "While much
attention has been paid to antepartal services and miracles are routine at
delivery, the big failure is in the postpartum period." Another article in
1984 by Rubin she discussed the shortened hospital stay, the gap of time
from discharge and seeing a hcp, and noted that the new mother experiences
many needs, particularly in regard to education.
In our program, we have found much of the above to be true. Mothers
frequently tell their home visit nurse that they were not instructed in
things like cord care, bathing, etc. in the hospital, where it was
documented that it was done. If you accept Rubin's hypothesis, the new
mother can't "hear" the teaching, because she if focused on her own needs of
pain and healing. You can tie Maslow's heiracy theory in with this, also.
I agree a study is needed!
References:
Ament, L. (1990). Maternal tasks of the puerperium reidentified. Journal of
Obstetric, Gynecologic, and Neonatal Nursing, 19, 330-333.
Rubin, R. (1961). Puerperal change. Nursing Outlook, 9, 753-755.
Rubin, R. (1975). Amercian Journal of Nursing, 75, (10), 1680-1684.
Rubin, R. Maternal identity and the maternal experience. New York:
Springer.
Linda J. Tandy, MSN, RN, IBCLC
Cedar Rapids, Iowa
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