Maternal-Child Nursing: Adaptations to Pregnancy

Maternal-Child Nursing Overview

  • Authors: Emily Slone McKinney, MSN, RN, C; Sharon Smith Murray, MSN, RN; Kari Mau, DNP, APRN-BC, RNFA, C-EFM; Susan Rowen James, PhD, RN; Kristine Ann Nelson, RN; Jean Weiler Ashwill, MSN, RN; Jacqueline Carroll, MSN, CPNP

Chapter 13: Adaptations to Pregnancy

Reproductive System Changes

  • Uterus: Predictable pattern of growth throughout pregnancy.

  • Cervix:

    • Chadwick’s sign (cyanosis of the cervix).

    • Goodell’s sign (softening of the cervix).

  • Vagina and Vulva: Increased vascularity noted.

  • Ovaries: Function primarily to secrete progesterone.

Uterine Growth During Pregnancy

  • Growth measured using anatomical landmarks:

    • Xiphoid process, ribs, umbilicus, symphysis pubis.

    • Visual chart shows growth at different weeks (e.g., 8, 12, 20, 36 weeks).

Breast Changes During Pregnancy

  • Increased size and appearance changes.

  • Hormonal Influence:

    • Estrogen promotes growth of mammary tissue.

    • Progesterone stimulates growth of lobes, lobules, and alveoli, leading to vascularity changes.

  • Colostrum can be present as early as 12-16 weeks.

Cardiovascular System Changes

  • Increased blood volume raises cardiac output but not blood pressure.

  • Supine Hypotensive Syndrome:

    • Occurs when the gravid uterus compresses the vena cava and aorta in supine position.

    • Relieved by changing position.

  • Plasma volume increase leads to physiological anemia.

Respiratory System Changes

  • Increased oxygen consumption by approximately 20%, primarily for the uterus, fetus, and placenta.

  • Hormonal effects decrease airway resistance.

Gastrointestinal System Changes

  • Mouth: Increased salivation (ptyalism).

  • Esophagus and Stomach: Increased heartburn (pyrosis).

  • Intestines: Slowed emptying time due to hormonal changes.

Urinary System Changes

  • Increased urinary frequency.

  • Changes in kidney and ureter size and shape.

  • 50% increase in renal blood flow increases urinary tract infection risks.

Integumentary System Changes

  • Increased skin circulation leads to active sweat glands.

  • Hyperpigmentation conditions: linea nigra, melasma, chloasma.

  • Hair growth accelerates.

Musculoskeletal System Changes

  • Increased demand for maternal calcium due to fetal development.

  • Progressive postural changes affected by estrogen and progesterone.

  • Separation of rectus abdominus muscles (diastasis recti).

Endocrine System Changes

  • Pituitary: Prolactin for milk production.

  • Thyroid: Increased size and vascularity.

  • Pancreas: Changes in blood glucose and insulin levels.

  • Adrenal Glands: Significant hormonal changes.

Hormonal Changes in Pregnancy

  • Increased levels of human chorionic gonadotropin (hCG) and estrogen can cause early pregnancy nausea.

  • Progesterone relaxes smooth muscle, impacting urinary stasis and constipation.

  • Human chorionic somatomammotropin (hCS) enhances glucose availability for the fetus.

Sensory and Immune Systems Changes

  • Eyes: Corneal edema causing discomfort for contact lens users.

  • Ears: Estrogen effects leading to a blocked sensation.

  • Altered immune function allows for unhindered fetal growth.

Confirmation of Pregnancy Signs

  • Presumptive Signs:

    • Amenorrhea, nausea, fatigue, urinary frequency, breast changes, fetal movements.

  • Probable Signs:

    • Abdominal enlargement, cervical softening, positive pregnancy tests.

  • Positive Signs:

    • Detection of fetal heart sounds, fetal movements by examiner.

Signs of Possible Complications

  • Vaginal bleeding, membrane rupture, facial swelling, severe headaches, visual disturbances, abdominal pain.

  • Symptoms of preterm labor: uterine contractions, cramps, low backache, pelvic pressure.

Psychological Responses to Pregnancy

  • First Trimester: Uncertainty, ambivalence, self-focus.

  • Second Trimester: Focus shifts to physical evidence of pregnancy and body image.

  • Third Trimester: Feelings of vulnerability and preparation for birth.

Parental Tasks of Pregnancy

  • Maternal tasks: Seeking safe passage, acceptance, self-giving.

  • Paternal tasks: Acknowledgement of pregnancy, parental recognition, role creation.

Psychosocial Adaptation Factors

  • Influences include age, multiparity, social support, partner absence, socioeconomic status, abnormal situations.

Barriers to Prenatal Care

  • Financial barriers: Major limiting factor.

  • Systemic barriers: Appointment availability.

  • Attitudinal barriers: Overworked staff and potential judgment.

Cultural Influences on Childbearing

  • Health beliefs regarding pregnancy maintenance and illness prevention, modesty, and practices such as female genital cutting.

  • Communication styles: language, decision-making, eye contact.

Perinatal Education

  • Class options: Preconception, early pregnancy, exercise, childbirth preparation, postpartum.

  • Settings may include home, birth centers, or hospitals.

  • Support person involvement (friend, family, doula) and birth plans detailing preferences for pain management and feeding methods.