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
•
 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

Psychologic Changes During Pregnancy lecture notes

Physiologic and Psychologic Changes
During Pregnancy

• Profile of previous pregnancy history –
§ GTPALM
§ PG – we will use this one mostly
§ P: para (number of births after 20 weeks gestation)
§ G: gravida (total number of pregnancies, including current pregnancy)
§ T: Term births
§ P: Preterm births
§ A: Abortions
§ L: living children

Prenatal Care

Determination of date of birth

Nägele’s rule –

Wheel – see example

Duration of pregnancy

280 days using 28-day months is called lunar months; 10 lunar months; 40
weeks

9 calendar months; Divided into 3 trimesters

Abortion/miscarriage – a pregnancy that terminates before the fetus
reaches 20 weeks gestation

Preterm/premature – a pregnancy that terminates after the 20^th
week of gestation, but before full term

Prenatal Care

Signs of pregnancy

Presumptive – (may suggest pregnancy)

Probable – (strongly indicates pregnancy)

Positive – (confirms pregnancy)

fetal heart tones are heard

fetal movement is palpated by the examiner

fetal outline is visualized by ultrasound

Physiologic Changes in Body Systems

• Endocrine System
• increase in hormones
• addition of the placenta during pregnancy; producing large amounts of estrogen & progesterone

Reproductive system

Uterus- prepregnancy wt – 60g or 2 oz

postpregnancy wt – 1000g or 2.2 lbs

Cervix – becomes shorter & softer

Ovaries – follicles cease to develop to maturity Ovulation does not
occur; produces the hormone relaxin

Vagina- walls become thicker, pliable & expandable in preparation for the
tremendous stretching necessary for the birth; increased vaginal discharge

Breasts – preparation for lactation; size increases; breasts become full,
sensitive, & tender; darkening of the areola & nipple; Montgomery’s glands
become more prominent & lubricate & protect nipple in preparation for
breastfeeding

Physiologic Changes in Body Systems

Musculoskeletal system – relaxation of joints and adjustments in posture

joints relax & symphysis pubis widens as result of relaxin & progesterone

as the uterus enlarges, the center of gravity shifts forward causing
lordosis

abdominal muscles may separate causing diastasis recti abdominis

may develop carpal tunnel syndrome due to compression of the medial nerve
around the wrist

Cardiovascular system –

• Respiratory system – thoracic circumference increases; 02 consumption increases by 15%
§ Dyspnea – caused by a greater sensitivity of the respiratory system & pressure of the uterus on the diaphragm
§ Epistaxis – caused by increased vascularity due to increased estrogen; deepening of the voice
• Gastrointestinal system
gum hypertrophy
increased saliva production
nausea with or without vomiting during 1st trimester
increased heartburn
delayed emptying of intestines leading to constipation
altered CHO metabolism; gestational diabetes

Physiologic Changes in Body Systems

Renal system

frequent urination

urine stasis

more prone to developing pyelonephritis (infection of the upper urinary
tract)

Integumentary system

hyperpigmentation of skin

on the face; chloasma; mask of pregnancy

linea nigra dark line on the abdomen – fig 4-5

striae gravidarum or stretch marks

Psychologic Changes During Pregnancy

• Body image may change
appearance; may begin to feel ugly or fat; negative about pregnancy
function; losing control of body; urine incontinence
sensation may become more acute; change in sexuality & libido mobility may be a problem

Developmental tasks

Pregnancy validation – 1^st trimester; focus on nurturing &
protecting the fetus; questioning identity as a woman & mother

Fetal embodiment – 2^nd trimester; attempts to incorporate the
fetus into her body image as part of self

Fetal distinction – feels quickening or fetal movement; the fetus becomes
separate from her – fig 4-7

Role transition – 3^rd trimester; psychologically separates
self from fetus & makes concrete plans for the baby

Psychologic Changes During Pregnancy

Responses to pregnancy

partners’ response; announcement, adjustment, focus

older couple

adolescent

single

grandparents

siblings