Nursing Care of the Family During Pregnancy

Determine first day of LMP, subtract 3 months, and add 7 days plus one year.

Determine first day of LMP, subtract 3 months, and add 7 days plus one year.

Naegele’s Rule

First trimester ultrasound

What is the most acurate method to deterine EDB?

It means that the life they knew is changing, they’re working through it and realizing that they are not as free as they used to be

What does it mean for mother/father to go through a period of ambivalence after the high period when they find out they’re pregnant?

Their partner. Positive partner support leads to positive consequences, to carry to term.

To the pregnant mother, who becomes the most important person to them in pregnancy?

1. They first feel baby move

2. See outline of fetus in ultrasound

When do pregnant mothers emotionally attach to baby?

Part of her. She starts to see herself as a caregiver to baby

When mothers announce pregnancy, mothers typically see the baby as what?

Prenatal classes

What is a way (besides doctors visits) for mothers to get current, accurate, and correct knowledge about pregnancy and childbirth?

They are less geared towards medical interventions, unlike those classes at the hospital. These tend to be more about what is available in the hospital.

Prenatal classes in the community are less geared towards what?

Couvade syndrome

When the father takes on some characteristics of pregnancy (nausea, actual weight gain, etc.)

Accepting changes in lifestyle, goals they had, etc.

In the fathers period of ambivalence after pregnancy is announced, he may think about what?

During pregnancy

In domestic partner violence, the first outburst my be seen when?

Moratorium period. They become reflective, philosophical, and may look at their own paternal relationship (relationship with their father). Thinking about what kind of father he’ll be

Fathers tend to go through a period of what as they accept the pregnancy?

1. Listening to baby’s heart rate

2. feeling belly

3. figuring out their role in labour and birth

In the last trimester, how might fathers become more involved? [3]

Age of their child

Some grandparents may be more excited than others during pregnancy, depending on what?

It can be traumatic to think about their parents having sex. They tend to rebel.

How might teenage siblings react to pregnancy?

We are able to identify issues and intervene. We believe with prenatal care we get healthy mom, healthy baby, healthy population.

In western countries, why is prenatal time followed very closely?

Sees it as a healthy, lifechaning event. Some may not believe in the value of hospital prenatal care. Some are trying to get indigenous midwives, and go back to pre-colonization.

How might indigenous cultures see pregnancy?

1. Lack of providers in general

2. Deficit of physicians who want maternity patients

3. Malpractice insurance is so high

Why is it difficult to get into the prenatal health care system? (3 systemic issues)

1. Not knowing language

2. not knowing system

3. not knowing where to go

Barriers new immigrants might have to prenatal care: [3]

They might not want to be seen in fear of doctor finding out

Why might pregnant women in intimate partner violence relationships not seek prenatal care?

They could be afraid their baby would be taken away.

Why might women using drugs, sex workers, etc., not want to seek prenatal care?

ØInadequate number of providers or lack of access to providers

ØLower income

ØLower education

ØSocial isolation

ØUnpleasant facilities or procedures

ØInconvenient clinic hours

ØDistance to facilities

ØLack of transportation

ØFragmentation of services (going different places for different services)

ØInadequate finances

ØPersonal attitudes

barriers to obtaining prenatal care [11]

First visit confirms the pregnancy

When is the first doctor’s visit for rpregnant women?

Once a month

How often do pregnant women go to the doctor between the first visit and 28 weeks?

Once every 2 weeks

How often do pregnant women go to the doctor between 29 and 36 weeks?

Once a week

How often do pregnant women go to the doctor between 37 weeks until birth?

If they have a condition (gestational diabetes, preeclampsia, chronic conditions)

When would some women go to prenantal doctors visits more frequently?

Pregnant women and their families (whoever they want to bring)

Group prenatal care includes who?

1. iproved birth outcomes

2. less preterm births

3. less small for gestational age babies

4. more knowledge

5. happier with pregnancy and birthing process

6. higher rate of breastfeeding initiation

Public health has found what about group prenatal care?

first half hour is focused on assessments, the rest is on discussing education and peer support

How is group prenatal care structured? [3]

25-35lb

Recommended weight gain in pregnancy

1. Pregnant before?

2. If so, how many deliveries?

3. How many babies?

4. What kind of birth?

5. Any premature babies?

6. Any small for gestational age babies?

7. History of fertility treatments?

Reproductive history questions to ask mom on first appointment: [7]

1. Hx of high blood pressure

2. Diabetes?

3. Any bleeding issues/disorders?

Health history questions to ask mom on first appointment: [3]

1. On a diet? (vegan, gluten free, etc.)

2. Any allergies?

3. Hx of eating disorders?

4. Hx of Pica?

Nutritional history questions to ask mom on first appointment:

1. Hx of anxiety/depression?

2. Did your mother have post partum depression?

Mental health screening questions to ask mom on first appointment: [2]

1. What type of job?

2. How many jobs (could she be exhausted?)

3. Any sitting, lifting, standing?

Occupational history questions to ask mom on first appointment: [3]

Do you feel safe/threatened at home?

Question to ask ALL patients about intimate partner violence on first appointment:

ØChild-bearing and female reproductive system history

ØHealth history

ØNutritional history

ØHistory of use of drugs and herbal preparations

ØFamily history

ØSocial, experiential, and occupational history

ØMental health screening

ØPhysical, sexual abuse and intimate partner violence

ØReview of systems

Types of questions to ask mom on initial visit: [9]

1. CBC

2. Blood type

3. VDRL

4. HIV status

5. HPV

6. Hepatitis B

7. Hepatitis C (high risk only)

8. Bacterial STIs

9. Group B streptococcus

10. Pap test

11. Rubella titres

Laboratory tests pregnant women are sent for on initial visit: [8]

Pap test

Baseline test checks for cervical dysplasia

1. Bacterial vaginosis

2. Trichomoniasis

Two sexually transmitted infections that require amniotic treatment. If left untreated, pregnant mother can have premature birth or premature rupture. These are tested for at beginning of pregnancy

High risk pregnancies

1. known IV drug users

2. multiple partners

Who is tested for hepatitis C early in pregnancy:

VDRL: Venereal disease research laboratories

Tests for syphilis that all women receive at beginning of pregnancy

Risk of congenital syphilis, has many complications

Maternal syphilis can cause what in baby?

C-section. Don’t want baby to pass through birth canal and come into contact with lesions.

What happens if mother has herpes simplex type II outbreak before birth?

Risk of ophthalmia neonatorum (neonatal conjunctivitis), a bacterial eye infection causing redness, puss, and swelling

How can gonorrhea and chlamydia affect baby’s eyes?

Only if mother is gonorrhea/chlamydia positive

When is erythromycin gel put on baby’s eyes:?

early, and again at 36 weeks

When are moms tested for chlamydia and gonorrhea? [2]

Group B streptococcus

Bacteria that can grow in the vagina but does not overtake normal flora at normal pH. When it is out of control, causes grief to baby (neonatal sepsis, septosemia, chorioamnionitis)

Vaginal/rectal swab at 35 weeks

When is mom tested for group B streptococcus?

She is treated as soon as membranes rupture (or when labour starts) with IV antibiotics (penicillin G) every 4 hours until birth. Loading dose is given (5 million units).

What happens if mom test positive for group B streptococcus?

24-28 weeks for glucose challenge test

when is gestational diabetes checked?

No fasting. Goes to ab, drinks 50g of glucose in a drink. After an hour, blood is drawn to see what readings are.

How does glucose challenge test work?

It is a live vaccine.

Why cant pregnant women get rubella vaccine while pregnant?

1. is fetus developing normally?

2. amount of amniotic fluid

3. Where is the placenta

Things to look for on ultrasound [3]

1. 10 weeks

2. 18/20 weeks

When are ultrasounds done? [2]

Deafness

Rubella puts fetus at risk for what?

17-19 weeks

When are we able to hear fetal HR with doctone/fetoscope?

1. Weight

2. Check urine for glucose and proteins

3. Vitals

4. Fetal HR (after 17-19 weeks)

5. Palpate the fetus (leopolds)

What other checks and assessments are done at prenatal appointments? [5]

Regular fetal movemets

This is a good indicator of wellbeing of the fetus:

16-20 weeks

When will she start to feel fetal movement?

110-160

Normal fetal heartrate:

Folic acid

What suppliment to encourage in pregnancy?

Leukorrhea (discharge)

Due to an increase in estrogen, there may be excess secretions from the cervis. Can be white/yellow and more acidic than normal

Wearing cotton underwear only

Recommendations for leukorrhea

early and late (1st and 3rd trimester, product of conception are pressing on bladder)

When might women see an increase in urinary frequency:

Progesterone is a smooth muscle relaxant, and products of conception are pressing on bladder (pressure and changes in hormones)

Why might pregnant women have a bit of urinary incontinence?

Dyspepsia

“heartburn”.

Progesterone delays gastric emptying. Food sits in the stomach longer, and uterus is pushing up on stomach.

Why might pregnant women experience heartburn?

Progesterone slow the bowel. The longer stool sits, more water is drawn out.

Why might pregnant women experience constipation?

Dyspareunia

Painful intercourse due to enlarging uterus

Developing pre-eclampsia

Pathological edema could be a sign of what?

SOGC guidelines: 30 minutes of movement. Continue as you did pre-pregnancy if you were an athlete. Wear supportive shoes

Recommendation for pregnancy exercise:

TIghter perineum, want to keep organs in original place

Benefits of Kegels:

Due to hormones in early pregnancy

Why might pregnant patients see bleeding gums?