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
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Prenatal care usually consists of a planned series of visits to health specialists, with the visits happening monthly early in the pregnancy and weekly in the last month of pregnancy. Prenatal Care South Florida
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