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FAMILY,
traditional or non-traditional,
is the best source of information about their
beliefs,
needs and concerns.
1. Maternal Adaptation
Women of all ages use the months of pregnancy to adapt to the maternal
role, a complex process of social and cognitive learning.
Many women actively prepare for birth by reading books and information
on various websites.
Anxiety can arise from concern about a safe passage for herself and her
child during the birth process (Mercer, 1995; Rubin, 1975, 1984)
Many women fear the pain of labor and birth because they do not
understand anatomy and the birth process.
Most women become impatient for labor to begin, whether the birth is
anticipated with joy, dread, or a mixture of both.
A strong desire to see the end of pregnancy, to be over and done with it,
makes women at this stage ready to move on to birth.
2. PATERNAL ADAPTATION
The father’s beliefs and feeling about the ideal mother and father and his
cultural expectations of appropriate behavior during pregnancy affect his
response to his partner’s need for him.
Some men view pregnancy as proof of their masculinity and their dominant
role.
To others, pregnancy has no meaning in terms of responsibility to either
mother or child.
Preganancy is a time of preparation for the parental role with intense
learning.
2.1 ACCEPTING PREGNANCY
Nurses can help fathers identify concerns and prepare for the reality of a baby
by asking questions such as the following:
Major concerns for the man are getting the woman to a health care facility
in time for the birth and not appearing ignorant.
They also have fears concerning safe passage of his child and partner and
the possible death or complications of his partner and child.
It is important to verbalize these fears.
Mothers often sense the tensions and apprehensions of the unprepared,
unsupported father, and it can increase their fears
3. ADAPTATION TO PARENTHOOD FOR
THE NONPREGNANT PARTNER
The same fears, questions and concerns can affect birth partners who are
not biologic fathers or who are the nonpregnant partner in a same-sex
couple.
Much attentions is paid to the needs of the pregnant woman, but
nonpregnant partner’s needs receive less attention.
Partners need to be kept informed, supported and included in all activities
in which the mother desires their participation.
4. SIBLING ADAPTATION
The older chils oftern experiences a sense of loss or feels jealous at being
“replaced” by the new sibling.
1yo child: largely unaware of the process.
2yo: notices changes in mother’s appearance.
3yo or 4yo: children like to be told the story of their own beginning &
accept a comparison of their own development with that of the present
pregnancy.
School-age: They may want to know in more detail.
Early & Middle Adolescents: preoccupied of their own sexual identity.
Late adolescents: do not appear to be unduly disturbed.
5. GRANDPARENT ADAPTATION
It reawakens the feelings of their own youth, the excitement of giving birth,
and their delight in the behavior of the parents-to-be when they were
infants.
Grandparent is the historian who transmits the family history; a resource
person who shares knowledge based on experience; a role model; and a
support person.
CARE MANAGEMENT
PRENATAL CARE
optimal care is provided by an interprofessional team that includes the
obstetric care provide, nurses and other health care professionals and
support groups.
The goal is to promote the health and well-being of the pregnant woman,
her fetus, the newborn, and the family.
In holistic care, nurses provide information and guidance about the
physical changes and the psychosocial impact of pregnancy on the
woman and members of the family.
The goals of prenatal nursing care are to foster a safe birth for the mother
and infant and to promote satisfaction of the mother and family with the
pregnancy and birth experience.
CARE MANAGEMENT
PRENATAL CARE
Women’s reasons to delaying prenatal care include cost, lack of insurance,
child care, transportation barriers, or inability to take time off from work.
Lack of culturally sensitive care providers, discrimination based on sexual
orientation, and barriers to communication resulting from differences in
language also interfere with access to care.
Problems with preterm birth, low birth weight (LBW: less than 2500g) and
infant mortality are associated with lack of adequate prenatal care.
Initial visit: first trimester monthly until week 28 of pregnancy, every 2weeks
until week 36 & every week until birth.
Prenatal care is ideally a multidisciplinary activity in which nurses work
collaboratively with health care providers.
INITIAL VISIT
Prenatal Interview
During this interview, the nurse has the opportunity to gain the woman’s
trust.
The initial evaluation includes comprehensive health history emphasizing
the current pregnancy, previous pregnancies, the family, the psychosocial
profile, a physical assessment, diagnostic testing, and an overall risk
assessment.
INITIAL VISIT
Prenatal Interview
Reason for Seeking Care
Reassurance about a particular reason
Current Pregnancy
Signs of pregnancy, review of symptoms
Obstetric and Gynecologic History
Woman’s age at menarche, menstrual history & contraceptive history
Any infertility or reproductive system conditions
History of STDs, sexualn history, detailed history of all pregnancies including the
present pregnancy, and their outcomes.
Date of last Papanicolau (Pap) test and result are noted.
Date of LMP is obtained to calculate the EDB.
INITIAL VISIT
Prenatal Interview
Health History
Includes all physical or surgical procedures that can affect the pregnancy or
that can be affected by the pregnancy.
Women who have chronic or handicapping conditions.
Nutritional History
Nutritional status has direct effect on the growth and development of the fetus.
Body Mass Index (BMI) should be calculated
Maternal weight gain and fetal growth should be closely monitored.
INITIAL VISIT
Prenatal Interview
History of Drug and Herbal Preparation
Includes past and present use of drugs.
Many substances cross the placenta and can therefore pose a risk to the
developing fetus.
Allergies to medication & type of reaction should also be obtained & recorded
Immunization record should be reviewed for vaccinations against rubella
(German measles, varicella (chickenpox), seasonal influenza, hepatitis B &
pertussis (whooping cough).
Family History
Can help identify familial or genetic disorders or conditions that can affect the
health status of the woman or the fetus.
INITIAL VISIT
Prenatal Interview
Social, Experiential and Occupational History
During interviews throughout the pregnancy, nurses should remain alert to the
appearance of potential parenting problems, such as depression, lack of family
support, and inadequate living conditions.
Nurses assess the woman’s attitude toward health care, particularly during
childbearing, her expectations of health care providers, and her view of the
relationship between herself and the nurse.
Nurse should determine the woman’s knowledge in various areas: pregnancy,
maternal changes, fetal growth, self-care, and care of the newborn, including
feeding.
Occupation:
Standing long hours: Orthostatic Hypotension
Long hours of sitting: Carpal tunnel syndrome or Ciuclatory stasis in the legs.
INITIAL VISIT
Prenatal Interview
Mental health screening
Review of Systems
The woman is asked to identify and describe preexisting or concurrent problems
in any of the body systems; and her mental status is assessed.
PHYSICAL EXAMINATION
Women should receive information information about the various tests and
the purpose for each test and be provided an opportunity to opt-out of
testing.
All pregnant women should receive HIV risk reduction counselling.
LABORATORY TESTS
LABORATORY TEST PURPOSE
Hemoglobin, Hematocrit, WBC, Detects anemia, infection
differential
Hemoglobin Electrophoresis Identifies women with
hemoglobinopathies
Blood type, Rh, & irregular antibody Fetuses are at risk for developing
erythroblastosis fetalis of
hyperbilirubirubinemia
Rubella Titer Immunity to rubella
Tuberculin Test; chest x-ray after 20 Screens for exposure to tuberculosis
weeks if gestation in women with
reactive tuberlin tests
Urinalysis, including microscopic Identifies women with glycosuria, renal
examination ofn urinary sediment; pH, disease, hypertensive disease of
specific gravity, color, glucose, pregnancy; infection, occult
albumin, protein, RBCs, WBCs, casts, hematuria; hCG for confirmation of
acetone; hCG pregnancy
LABORATORY TESTS
Interview
Physical Examination
BP, Weight, BMI, examination of the abdomen
Fetal Assessment
Quickening usually occurs between 16 and 20 weeks of gestation
Ultrasonography (sonogram) is used to determine the estimated date of birth &
to establish the duration of pregnancy.
Fetal Heart Tones
Assessed routinely.
Heartbeat can be heard with a Doppler device.
Pinard horn – fetoscope commonly used by midwives & in much Europe.
SIGNS OF POTENTIAL COMPLICATIONS:
1st, 2nd & 3rd trimesters
Signs and Symptoms Possible causes
Severe vomiting Hyperemesis gravidarum
Chills, fever, burning on urination, Infection
diarrhea
Abdominal cramping, vaginal Miscarriage, ectopic pregnancy
bleeding
** persistent severe vomiting Hyperemesis gravidarum,
hypertension, preeclampsia
Sudden discharge of fluid from vagina Preterm premature rupture of
before 37 weeks membranes (PPROM)
Vaginal bleeding, severe abdominal Miscarriage, placenta previa,
pain abruptio placentae
Chills, fever, burning on urination, Infection
SIGNS OF POTENTIAL COMPLICATIONS:
1st, 2nd & 3rd trimesters
Signs and Symptoms Possible causes
Severe backache or flank pain Kidney infection or stones; preterm
labor
Change in fetal movements: absence Fetal jeopardy or intrauterine fetal
of fetal movements after quickening, death
any unusual change I pattern or
amount
Uterine contractions, pelvic pressure, Preterm labor
cramping before 37 weeks
Visual disturbances: blurring, double Hypertensive conditions,
vision, or spots preeclampsia
Swelling of face or fingers and over Hypertensive conditions,
sacrum preeclampsia
Headaches: severe, frequent, or Hypertensive conditions,
continuous preeclampsia
SIGNS OF POTENTIAL COMPLICATIONS:
1st, 2nd & 3rd trimesters
Signs and Symptoms Possible Causes
Muscular irritability or seizures Hypertensive conditions,
preeclampsia
Epigastric or abdominal pain Hypertensive conditions,
(perceived as heartburn or severe preeclampsia; abruptio placentae
stomachache)
Glycosuria, positive glucose tolerance Gestational diabetes mellitus
test reaction
FOLLOW-UP VISITS
Health Status
Includes consideration of fetal movement
Absence of fetal movement is correlated with fetal death
Fundal Height
The measurement of the height of the uterus above the symphysis pubis
One indicator of fetal growth.
Measurement also provides a gross estimate of the duration of pregnancy.
FH measurement can iad in identifying risk factors.
Stable/ Decreased FH – intrauterine growth restriction (IUGR)
Excessive increase – presence of multifetal gestation or polyhydramnios.
LABORATORY TESTS