Chapter 11Nursing Care During PregnancyDebbie Hogan RN

Nursing Care During Pregnancy Prenatal periodPeriod of physical and psychologic preparation for birth and parenthoodOpportunity for nurses and members of health care team to influence family healthHealthy women seek care and guidance Health promotion interventions can affect well-being of woman, child, and rest of family

Nursing Care During Pregnancycontd PregnancySpans 9 months10 lunar months of 28 days (280 days total)TrimestersFirst: weeks 1 through 13Second: weeks 14 through 26Third: weeks 27 through 40

Diagnosis of Pregnancy Signs and symptomsPresumptive indicatorsMissed menstrual periodHome pregnancy test positiveAmenorrhea, nausea, vomiting, breast tenderness, urinary frequency, fatigue (morning sickness)Quickening (perception of fetal movement)

Diagnosis of Pregnancycontd Signs and symptomsProbable indicatorsUterine enlargementBraxton Hicks contractionsUterine souffleBallottementPositive pregnancy test

Diagnosis of Pregnancycontd Signs and symptomsPositive indicatorsPresence of fetal heartbeat distinct from mothersFetal movement felt by someone other than motherVisualization (e.g., ultrasound examination)

Diagnosis of Pregnancycontd Estimated date of birth (EDB)Formulas for calculating EDB but none infallibleNgeles ruleDetermine first day of last menstrual period (LMP), subtract 3 months, add 7 days plus 1 yearAlternatively add 7 days to LMP and count forward 9 monthsMost women give birth from 7 days before to 7 days after EDB

Adaptation to Pregnancy Maternal adaptationAccepting pregnancyIdentifying with mother roleReordering personal relationshipsEstablishing relationship with fetusEmotional attachmentPreparing for childbirth

Adaptation to Pregnancycontd Paternal adaptationAccepting pregnancyIdentifying with father roleReordering personal relationshipsEstablishing relationship with fetusEmotional attachmentPreparing for childbirthSibling adaptationGrandparent adaptation

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-carePrenatal care is sought routinely by women of middle or high socioeconomic status

Nursing Care Managementcontd Women in poverty or lacking health insurance may not have access to public or private careLack of culturally sensitive care and communication interferes with access to careImmigrant 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

Nursing Care Managementcontd Barriers to obtaining prenatal care include: Inadequate number of providers Unpleasant facilities or proceduresInconvenient clinic hoursDistance to facilities Lack of transportationFragmentation of servicesInadequate financesPersonal and cultural attitudes

Nursing Care Managementcontd Effectiveness of home visiting by nurses during pregnancy has been validatedCurrent 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

Nursing Care Managementcontd Initial visit: interviewReason for seeking careCurrent pregnancyObstetric and gynecologic historyMedical historyNutrition historyHistory of drug use and herbal preparations

Nursing Care Managementcontd Initial visit: interviewFamily historySocial, experiential, and occupational historyHistory of physical abuseReview of systemsInitial visit: physical examinationInitial visit: laboratory tests

Nursing Care Managementcontd Follow-up visitsInterviewPhysical examinationFetal assessmentFundal heightGestational ageHealth status

Nursing Care Managementcontd Follow-up visitsFetal assessmentLaboratory testsMultiple-marker or triple-screen blood testOther blood tests (RPR/VDRL, CBC, anti-Rh)Other testsUltrasonographyAmniocentesis

Nursing Care Managementcontd Nursing careCare pathsEducation for self-managementNutritionPersonal hygienePrevention of urinary tract infectionsKegel exercisesPreparation for breastfeeding newbornDental health

Nursing Care Managementcontd Nursing careCare pathsEducation for self-managementPhysical activityPosture and body mechanicsRest and relaxationEmploymentClothingTravel

Nursing Care Managementcontd Nursing careCare pathsEducation for self-managementMedications and herbal preparationsImmunizationsAlcohol, cigarettes, and other substancesNormal discomfortsRecognizing potential complicationsRecognizing preterm labor

Variations in Prenatal Care Cultural influencesEmotional responseClothingPhysical activity and restSexual activityNutrition

Variations in Prenatal Carecontd Age differencesAdolescentsMuch less likely than older women to receive adequate prenatal careWomen older than 35 years Multiparous womenNulliparous women

Variations in Prenatal Carecontd Multifetal pregnancyTwin pregnancies often end in prematurityRupture of membranes before term commonCongenital malformations twice as common in monozygotic twins as in singletonsNo increase in incidence of congenital anomalies in dizygotic twins

Childbirth and Perinatal Education Perinatal education goalsEstablish lifestyle behaviors for optimal healthPrepare psychologically for pregnancy and the responsibilities that come with parenthood Identify, minimize, and treat risk factors Screen health hazards in workplace and homeGet genetic counseling for inherited diseasesCompare perinatal care options available

Childbirth and Perinatal Educationcontd Options for carePhysiciansNurse-midwivesDirect-entry midwivesIndependent midwivesDoulaBirth Plans

Childbirth and Perinatal Educationcontd Birth setting choicesLabor, delivery, recovery, postpartum (birthing) roomsBirth centersHome birthFactors increasing the safety of birth at home

Childbirth and Perinatal EducationcontdComponents of perinatal education programsPain managementRelaxationImagery and visualizationConscious breathingBiofeedbackMassage and acupressure

Childbirth and Perinatal EducationcontdPreparation for cesarean birthAlmost 30% of births in the United States are surgicalVary by provider and care settingMore common in women who choose epiduralsVaginal birth after cesareanChildbirth education outcomes

Key Points Prenatal period is physically and psychologically preparatoryPsychosocial aspects may affect pregnancy, childbirth, and adjustment of the new familyPregnant womans readiness to learn is high level and excellent time to help expand her self-care skills

Key Pointscontd Maternal physical and familial adaptations to pregnancy generate needs that nurse can anticipate and meetNurse must be alert to hazards such as supine hypotension, warning signs and symptoms, and signs of family maladaptationEach pregnant woman needs to know how to recognize and report preterm labor

Key Pointscontd Parent-child, sibling-child, and grandparent-child relationships are affected by pregnancyCultural prescriptions and proscriptions influence responses to pregnancy and health careChildbirth education helps parents make transition from role of expectant parents to role and responsibilities of parents