Maternal Adaptation

Presumptive signs of pregnancy

• fatigue

• breast tenderness

• darker areolas

• nausea and vomiting

• amenorrhea

• urinary frequency

• hyperpigmentation → linea negra

• fetal movements “quickening”

• uterine enlargement

• breast enlargement

Probable signs of pregnancy

• Braxton Hick’s

• Positive pregnancy test

• abdominal enlargement

• ballottement: Forceful push against body part to confirm pregnancy and assess position of fetus in uterus

• goodell sign

• chadwick sign

• hegar sign

Braxton Hick’s

• irregular uterine contractions

• painless; feels like tightening in belly

• need fluid bolus; normally d/t dehydration

Positive signs of pregnancy

• ultrasound verification of embryo or fetus

• fetal movement by experienced clinician

• auscultation of fetal heart tones via doppler

Uterus adaptations

• increase in size, weight, length, width, depth, volume, and overall capacity

• fundal height by 20 weeks gestation at level of umbilicus

• enhanced uterine contractility

• ascent into abdomen after first 3 months

Cervix adaptations

• softens

• mucus plug formation

• increased vascularization

• ripening about 4 weeks before birth (thinning)

Vagina adaptations

• increased vascularity with thickening

• lengthening of vaginal vault

• secretions more acidic, white, and thick; leukorrhea (white or milky vaginal discharge)

Ovaries adaptation

• cessation of ovulation (inability to get pregnant)

Breasts

• increase in size and nodularity to prepare for lactation

• increase in nipple size

• become more erect and pigmented

• colostrum production: antibody rich, yellow fluid that can be expressed after the 12th week; conversion to mature milk after delivery

Lungs

Progesterone

• maintains uterine lining for implantation and fetal development

• prevents uterine contractions (smooth muscle relaxation)

• modulates immune function to prevent rejection of fetus

• prepares breasts for lactation

Estrogen

• stimulates uterine and breast growth

• increases blood flow to uterus and placenta

• promotes fetal organ development

• prepares cervix for labor

GI system adaptation

• Gums: hyperemic, swollen, and friable

• ptyalism: increased salivation

• dental problems; gingivitis

• decreased peristalsis and smooth muscle relaxation: constipation

• hemorrhoids: increased venous pressure + constipation + pressure from uterus + iron supplementation

• slowed gastric emptying; heartburn

• prolonged gallbladder emptying

• nausea and vomiting

Hemorrhoid prevention

• senokot after delivery

• lots of fluids encouraged

• increase fiber

CV system adaptations

• increase in blood volume and RBCs

  • in prep for blood loss during delivery + sustaining life

• increased cardiac output and venous return; increased HR

• slight decline in BP mid-pregnancy, then returns to pre-pregnancy levels

• physiologic anemia from plasma volume increase > RBCs (hemodilution)

• increase in iron demands, fibrin, and plasma fibrinogen levels, and some clotting factors → hypercoagulable state

Respiratory system adaptation

• breathing more diaphragmatic than abdominal d/t increase in diaphragmatic excursion, chest circumference, and tidal volume

• increased oxygen consumption

• congestion secondary to increased vascularity

Resp. system nursing care

• encourage mamas to ambulate d/t increased risk of pneumonia

• prone to short breaths; encourage them to take a deep breath (lungs are compressed)

Renal/urinary system adaptation

• dilation of renal pelvis; elongation, widening, and increase in curve of uterus → prone to UTIs

• increase in length + weight of kidneys

• increased GFR + urine flow and volume

• increased kidney activity when lying down; greater increase later in pregnancy with women laying on side

Musculoskeletal

• lordosis

• waddle gait

• Softening and stretching of ligaments holding sacroiliac joints and pubis symphysis

Musculoskeletal nursing tip

encourage dad to put pillow under mom’s back when she lays down to reduce back pain

Integumentary

• hyperpigmentation → linea negra and facial melasma (mask of pregnancy)

• striae gravidarum

• varicosities

• vascular spider angiomas

• palmar erythema

striae gravidarum tx

• before marks begin to show during pregnancy start applying petroleum jelly and 100% cocoa butter to prevent permanent stretch marks

Varicosities

• increased blood volume → varicose veins

• supportive shoes

• compression socks

Spider angiomas

• increased blood volume + ruptures

Endocrine

• thyroid gland enlargement

• increased BMR → increased number of calories needed to maintain basic physiologic function at rest aka breathing, circulation

• pituitary gland enlargement

  • gradual increase in oxytocin

  • increase in prolactin

• pancreas: insulin resistance → gestational diabetes

• adrenal glands: increased cortisol and progesterone

• placental secretion: hCG, hPL, relaxin, progesterone, estrogen

Gestational diabetes

• diagnosed at 20 weeks gestation

• goes away post-birth

• due to hPL and other hormones during second trimester

Nutritional needs

• need for vitamin and mineral supplements daily (prenatal vitamins) + iron!!

• increase in protein, iron, folate, and calories

• need zinc too!

• more vegetables than anything else

• avoidance of all fish due to mercury content → harmful effects on fetal development → cognitive impairment and negative fetal brain development

Maternal emotional responses

• ambivalence

• introversion

• acceptance

• mood swings

• changes in body image

Ambivalence

fear/anxiety

Introversion

• self-focused

• everything about mother

• i.e. baby is taking away from my beauty/facial features

Acceptance

this is me, this is my new norm, adapts to waddle gait

Weight gain

• some weight goes away (in very active mamas)

• normal to gain weight

• goal: stay active + helps with labor

• mothers can do squats until 40 weeks gestation

Inducing labor

can stimulate nipples

Maternal role tasks

• ensure safe passage throughout pregnancy and birth

• seek acceptance of infant by others

• seeking acceptance of self in maternal role to infant: “binding in”

• learning to give oneself: I come second now

Pregnancy and sexuality

• hormonal changes may make her not want to engage in sexual activity with father

• educate father on this; give her grace

• weight gain may also make them feel less desirable

• encourage dad to tell mom she is beautiful and compliment her

Pregnancy and siblings

• sibling rivalry

• sibling preparation imperative

  • bring older child/children with you to listen to fetal heart

  • allow them the chance to adapt

  • teach them how to feed, hold, or care for sibling

• exposure but inclusion with older sibling