Health Care During Pregnancy

Health Care During Pregnancy

Preconception Care

• Health care and screening before pregnancy to identify medical risk factors and/or lifestyle behaviors that can be managed before conception
Goals of Prenatal Care
• Promote good health habits and reduce risk factors to ensure a safe birth for mother and child
• Teach health habits that may be continued after pregnancy
• Educate for self-care during pregnancy
• Provide physical assessment and care
• Prepare parents for parenthood

Cultural Competence

• Awareness and acceptance of and respect for beliefs, values, traditions, and practices different from one’s own
• The ability to adapt health care so that it does not violate the culture or religion of the patient and her family
• Avoid “cultural stereotyping

Prenatal Visits

• Initial health and social history
 personal information; social hx
 medical hx of client & family
 past obstetrical hx

• Physical examination
 head to toe of all body systems
 wt, ht, v/s; urine
 pelvic examination; have the woman empty her bladder prior

Prenatal Visits

Subsequent visits

Every month for 7 months, every 2 weeks during 8th month, then every week until delivery
Weight, blood pressure, urine (protein, acetone, and glucose)
Uterine height measurement for fetal growth
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 Every month for 7 months, every 2 weeks during 8th month, then every week until delivery
 Weight, blood pressure, urine (protein, acetone, and glucose)
 Uterine height measurement for fetal growth
 Leopold’s maneuvers to assess presentation and position of fetus
 Listen to fetal heart rate
 Assess for CVA and calf tenderness
 Identify discomforts and suggest nursing or medical relief measures
 Discuss birth plans and infant feeding

Patient Teaching for Self-Care and Common Discomforts of Pregnancy

Douching – do not douch during pregnancy
Clothing – wear adjustable, loose, washable, and lightweight clothing. Do not wear knee highs, tight garters or high heeled shoes once the center of gravity starts to shift
Breast and nipple care – wear supportive bra; do not apply soap to nipples during bathing because it causes a drying effect; breasts may secrete colostrum, a yellow fluid, before or during the last trimester; may need to wear pads inside bra

Bathing

 avoid hot tubs or saunas because they increase body temperature which may cause fetal abnormalities
• Physical activity and exercise
 Special considerations: mild to moderate exercise is good; she should not lie supine, twist, bounce, or make jerky movements during exercise, box 5-1
 helpful exercises: pelvic tilt-fig 5-6 & Kegel exercise-box 5-2
 avoid supine hypotensive syndrome

• Sexual activity

 should not have to be restricted except if the bag of waters has ruptured or after labor begins
• Douching – do not douch during pregnancy
• Clothing – wear adjustable, loose, washable, and lightweight clothing. Do not wear knee highs, tight garters or high heeled shoes once the center of gravity starts to shift
• Breast and nipple care – wear supportive bra; do not apply soap to nipples during bathing because it causes a drying effect; breasts may secrete colostrum, a yellow fluid, before or during the last trimester; may need to wear pads inside bra

• Dental care – continue routine care except avoid xrays

• Immunizations

 Avoid MMR and varicella (potential fetal damage)
• Employment – no heavy lifting or exposure to harmful substances
• Travel – maximum of 6 hours per day driving; stop every 2 hrs for 10 minutes to walk around
• Medications
 No medications unless prescribed by health care provider (includes OTCs and herbal remedies)
Danger signs
 Provide information on reportable danger signs, written at an appropriate level and in a language she can read – fast focus 5-2
• Weight gain and fetal growth
 25 to 35 lb total--with 3 lb in 1st trimester, then 1 lb per week
 Dieting is not recommended—may limit fetal growth

Nutrition
• Obtain nutritional history of food habits and preferences, monitor nutritional status, and provide nutritional education
• Food guide pyramid
• Nutritional requirements during pregnancy – table 5-3
• Pica: eating substances usually considered inedible, with no nutritional value
• Pregnant adolescent

Education for Childbirth

• Principles
 Partner participation and support
 Relaxation and breathing strategies
 Muscle conditioning
 Knowledge of choices and alternatives
• Breathing patterns used during labor
 First-stage
• Slow-paced
• Modified-paced
• Patterned-paced

• Breathing patterns used during labor
 Second-stage (expulsion breathing)
• Open-glottis technique-pushing as if blowing out a candle
• Closed-glottis technique-not recommended because it decreases blood flow to fetus; if done do not hold breath for more than 6 sec