Nursing Care During Pregnancy

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Chapter 11

• Nursing Care During Pregnancy
• Debbie Hogan RN

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Nursing Care During Pregnancy

• Prenatal period
• Period of physical and psychologic preparation
  for birth and parenthood
• Opportunity for nurses and members of health care
  team to influence family health
• Healthy women seek care and guidance
• Health promotion interventions can affect
  well-being of woman, child, and rest of family

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Nursing Care During Pregnancycontd

• Pregnancy
• Spans 9 months
• 10 lunar months of 28 days (280 days total)
• Trimesters
• First weeks 1 through 13
• Second weeks 14 through 26
• Third weeks 27 through 40

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Diagnosis of Pregnancy

• Signs and symptoms
• Presumptive indicators
• Missed menstrual period
• Home pregnancy test positive
• Amenorrhea, nausea, vomiting, breast tenderness,
  urinary frequency, fatigue (morning sickness)
• Quickening (perception of fetal movement)

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Diagnosis of Pregnancycontd

• Signs and symptoms
• Probable indicators
• Uterine enlargement
• Braxton Hicks contractions
• Uterine souffle
• Ballottement
• Positive pregnancy test

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Diagnosis of Pregnancycontd

• Signs and symptoms
• Positive indicators
• Presence of fetal heartbeat distinct from
  mothers
• Fetal movement felt by someone other than mother
• Visualization (e.g., ultrasound examination)

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Diagnosis of Pregnancycontd

• Estimated date of birth (EDB)
• Formulas for calculating EDB but none infallible
• Nägeles rule
• Determine first day of last menstrual period
  (LMP), subtract 3 months, add 7 days plus 1 year
• Alternatively add 7 days to LMP and count forward
  9 months
• Most women give birth from 7 days before to 7
  days after EDB

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Adaptation to Pregnancy

• Maternal adaptation
• Accepting pregnancy
• Identifying with mother role
• Reordering personal relationships
• Establishing relationship with fetus
• Emotional attachment
• Preparing for childbirth

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Adaptation to Pregnancycontd

• Paternal adaptation
• Accepting pregnancy
• Identifying with father role
• Reordering personal relationships
• Establishing relationship with fetus
• Emotional attachment
• Preparing for childbirth
• Sibling adaptation
• Grandparent adaptation

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Nursing Care Management

• Purpose of prenatal care is to identify existing
  risk factors and other deviations from normal
• Emphasis on preventive care and optimal self-care
• Prenatal care is sought routinely by women of
  middle or high socioeconomic status

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Nursing Care Managementcontd

• Women in poverty or lacking health insurance may
  not have access to public or private care
• Lack of culturally sensitive care and
  communication interferes with access to care
• Immigrant women may not seek prenatal care
• Birth outcomes are less positive, with higher
  rates of maternal and newborn complications
• Problems with low birth rate and infant mortality
  associated with inadequate prenatal care

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Nursing Care Managementcontd

• Barriers to obtaining prenatal care include
• Inadequate number of providers
• Unpleasant facilities or procedures
• Inconvenient clinic hours
• Distance to facilities
• Lack of transportation
• Fragmentation of services
• Inadequate finances
• Personal and cultural attitudes

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Nursing Care Managementcontd

• Effectiveness of home visiting by nurses during
  pregnancy has been validated
• Current model of prenatal care used for more than
  a century
• Model is being questioned, and tendency to fewer
  visits with women at low risk for complications

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Nursing Care Managementcontd

• Initial visit interview
• Reason for seeking care
• Current pregnancy
• Obstetric and gynecologic history
• Medical history
• Nutrition history
• History of drug use and herbal preparations

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Nursing Care Managementcontd

• Initial visit interview
• Family history
• Social, experiential, and occupational history
• History of physical abuse
• Review of systems
• Initial visit physical examination
• Initial visit laboratory tests

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Nursing Care Managementcontd

• Follow-up visits
• Interview
• Physical examination
• Fetal assessment
• Fundal height
• Gestational age
• Health status

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Nursing Care Managementcontd

• Follow-up visits
• Fetal assessment
• Laboratory tests
• Multiple-marker or triple-screen blood test
• Other blood tests (RPR/VDRL, CBC, anti-Rh)
• Other tests
• Ultrasonography
• Amniocentesis

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Nursing Care Managementcontd

• Nursing care
• Care paths
• Education for self-management
• Nutrition
• Personal hygiene
• Prevention of urinary tract infections
• Kegel exercises
• Preparation for breastfeeding newborn
• Dental health

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Nursing Care Managementcontd

• Nursing care
• Care paths
• Education for self-management
• Physical activity
• Posture and body mechanics
• Rest and relaxation
• Employment
• Clothing
• Travel

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Nursing Care Managementcontd

• Nursing care
• Care paths
• Education for self-management
• Medications and herbal preparations
• Immunizations
• Alcohol, cigarettes, and other substances
• Normal discomforts
• Recognizing potential complications
• Recognizing preterm labor

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Variations in Prenatal Care

• Cultural influences
• Emotional response
• Clothing
• Physical activity and rest
• Sexual activity
• Nutrition

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Variations in Prenatal Carecontd

• Age differences
• Adolescents
• Much less likely than older women to receive
  adequate prenatal care
• Women older than 35 years
• Multiparous women
• Nulliparous women

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Variations in Prenatal Carecontd

• Multifetal pregnancy
• Twin pregnancies often end in prematurity
• Rupture of membranes before term common
• Congenital malformations twice as common in
  monozygotic twins as in singletons
• No increase in incidence of congenital anomalies
  in dizygotic twins

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Childbirth and Perinatal Education

• Perinatal education goals
• Establish lifestyle behaviors for optimal health
• Prepare psychologically for pregnancy and the
  responsibilities that come with parenthood
• Identify, minimize, and treat risk factors
• Screen health hazards in workplace and home
• Get genetic counseling for inherited diseases
• Compare perinatal care options available

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Childbirth and Perinatal Educationcontd

• Options for care
• Physicians
• Nurse-midwives
• Direct-entry midwives
• Independent midwives
• Doula
• Birth Plans

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Childbirth and Perinatal Educationcontd

• Birth setting choices
• Labor, delivery, recovery, postpartum (birthing)
  rooms
• Birth centers
• Home birth
• Factors increasing the safety of birth at home

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Childbirth and Perinatal Educationcontd

• Components of perinatal education programs
• Pain management
• Relaxation
• Imagery and visualization
• Conscious breathing
• Biofeedback
• Massage and acupressure

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Childbirth and Perinatal Educationcontd

• Preparation for cesarean birth
• Almost 30 of births in the United States are
  surgical
• Vary by provider and care setting
• More common in women who choose epidurals
• Vaginal birth after cesarean
• Childbirth education outcomes

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Key Points

• Prenatal period is physically and psychologically
  preparatory
• Psychosocial aspects may affect pregnancy,
  childbirth, and adjustment of the new family
• Pregnant womans readiness to learn is high level
  and excellent time to help expand her self-care
  skills

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Key Pointscontd

• Maternal physical and familial adaptations to
  pregnancy generate needs that nurse can
  anticipate and meet
• Nurse must be alert to hazards such as supine
  hypotension, warning signs and symptoms, and
  signs of family maladaptation
• Each pregnant woman needs to know how to
  recognize and report preterm labor

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Key Pointscontd

• Parent-child, sibling-child, and
  grandparent-child relationships are affected by
  pregnancy
• Cultural prescriptions and proscriptions
  influence responses to pregnancy and health care
• Childbirth education helps parents make
  transition from role of expectant parents to role
  and responsibilities of parents