NURSING CARE DURING ANTEPARTUM

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NURSING CARE DURING ANTEPARTUM
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• Maternal Nursing care given by the nurse to the
  expectant family before, during, following
  birth
• Obstetrics branch of medicine that pertains to
  the care of women during pregnancy, childbirth,
  the postpartum period
• Obstetrician physician

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Family-Centered Care

• Recognizes the strength integrity of the family
  as the core of planning implementing health
  care
• Nurse family members need to be partners

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History

• Before the 1900s most babies born _at_ home
• By 1960 more than 90 of births occurred in
  hospitals
• And Now???

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Merging of the Maternity Unit

• Used to be separate labor room, delivery room,
  postpartum room, newborn nursery
• Now combining labor, delivery, recovery (LDR)
  may still be transferred to a postpartum unit,
  but baby usually rooms-in
• Some facilities combine keep woman in same area
  throughout her entire experience (LDRP)

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Lengths of Stay

• Mandated by legislation
• Vaginal delivery 24-48 hrs.
• Cesarean delivery 72 hrs.

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Statistics r/t Maternal Nursing

• Birthrate
• Fertility rate
• Fetal Mortality rate
• Infant Mortality rate
• Maternal Mortality rate
• Neonatal Mortality rate
• Perinatal Mortality rate

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How are these statistics used?

• To become aware of reproductive trends
• To determine populations at risk
• To evaluate the quality of prenatal care
• To compare relevant information from state to
  state country to country

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Male Reproductive System
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Male Reproductive System

• Penis deposits sperm into females vagina to
  fertilize an ovum
• Testes Manufacture sperm secrete male sex
  hormones
• Semen seminal plasma sperm together excreted
  during sexual intercourse
• Testosterone most abundant male sex hormone
• ? muscle mass strength
• Promotes growth of long bones
• ? basal metabolic rate
• Enhanced production of RBCs
• Produces enlargement of vocal cords
• Affects distribution of body hair

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Female Reproductive System
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Female Reproductive System
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Female Reproductive System

• Vagina tubular structure made of muscle
  membranous tissue
• provides passageway for sperm to enter uterus
• allows for drainage of menstrual fluids other
  secretions
• provides passageway for infants birth
• Cervix lower part of uterus
• Lubricates vagina
• Acts as a bacteriostatic agent
• Provides alkaline environment for sperm
• Produces mucus plug during pregnancy
• Thins and dilates during labor

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Female Reproductive System

• Uterus hollow muscular organ site of
  implantation of fertilized ovum houses
  developing fetus
• Consists of 3 parts cervix, corpus, fundus
• Begins a pelvic organ, becomes temporary
  abdominal organ
• Layers
• Perimetrium outermost
• Myometrium middle
• Endometrium - innermost

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Female Reproductive System

• Fallopian Tubes from uterus to ovary on each
  side
• Provide passageway in which sperm meet ovum
• Site of fertilization
• Safe nourishing environment for ovum
• Means of transporting ovum to uterus
• Ovaries almond-shaped glands
• Produce estrogen progesterone
• Maturation of ovum during each reproductive cycle

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Female Reproductive System

• Breasts accessory organs of reproduction
• produce milk after birth to provide nourishment
  maternal antibodies to infant

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Hormones

• Follicle Stimulating Hormone (FSH)
• Stimulates maturation of the follicle in the
  ovary that contains a single ovum
• Luteinizing Hormone (LH)
• Stimulates final maturation release of the ovum
• Corpus Luteum empty follicle after ovum is
  released
• Produces increasing amounts of estrogen
  progesterone which lead to a build-up of the
  endometrium

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• Anterior pituitary secretes FSH LH maturation
  of ovum
• Ovulation occurs when mature ovum is released
  from follicle 14 days before onset of next
  menstrual cycle
• Corpus luteum turns yellow secretes ? amounts
  progesterone
• If no fertilization corpus luteum degenerates -
  ? amts. estrogen progesterone (after 12 days)
• Endometrium breaks down menstruation occurs
• Anterior pituitary secretes more FSH LH
  beginning a new cycle
  (refer to picture in book-pg 27)

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• Menarche beginning of menstruation
• Climacteric period of years during which
  womans ability to reproduce gradually declines
• Menopause end of menstruation
• ___________________________________
• Conception (Fertilization) sperm joins with ovum

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Physiology of Pregnancy

• Fertilization
• During sexual intercourse, the sperm carried in
  the ejaculatory semen of the male enters the
  vagina of the female.
• Through flagellation, the sperm travel through
  the mucus of the cervical canal, enter the
  uterine chamber, and move into the ampulla, the
  outer third of the fallopian tube.
• If the timing is such that an ovum has been
  produced and is also within the ampulla of the
  tube, fertilization may occur.

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Physiology of Pregnancy

• Fertilization (continued)
• Fertilization takes place when the sperm joins or
  fuses with the ovum this is called conception.
• Once fertilization has occurred, the new cell is
  referred to as a zygote or fertilized ovum.
• At the moment of fertilization, the sex of the
  zygote and all other genetic characteristics are
  determined and they do not change.
• 46 chromosomes- xx-girl xy-boy

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Physiology of Pregnancy

• Implantation
• The zygote moves through the uterine tube through
  ciliary action and some irregular peristaltic
  activity.
• It requires about 3 or 4 days to enter the
  uterine cavity.
• During this time, the zygote is in a phase of
  rapid cell division called mitosis further
  changes result in formation of a structure called
  the morula.
• The morula develops into a blastocyst.

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• Implantation (continued)
• The condition of the uterine lining is critical
  if implantation of the zygote is to occur.
• Implantation usually occurs in the fundus of the
  uterus on either the anterior or posterior
  surface.
• If uterine conditions are not suitable, it is
  unlikely that implantation will occur.
• If the intrauterine vascular or hormonal
  conditions cannot sustain the implanted embryo, a
  spontaneous abortion will occur usually during
  the first 8 weeks of pregnancy.

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• Implantation (continued)
• After the blastocyst is free in the uterine
  cavity for 1 or 2 days, the exposed cell walls of
  the blastocyst (called the trophoblast) secrete
  enzymes that are able to break down protein and
  penetrate cell membranes.
• These enzymes allow the blastocyst to enter the
  endometrium and implant.
• The action of the enzymes normally stops short of
  the myometrium but may cause slight bleeding
  this is called implantation bleeding.
• The bleeding may confuse some women who think
  they had a very light and short menstrual cycle.

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Physiology of Pregnancy

• Implantation (continued)
• Ectopic pregnancy, in which implantation occurs
  outside of the uterine cavity, also poses serious
  problems.
• During the first few weeks after implantation,
  primary villi appear these villi are able to use
  maternal blood vessels as a source of nourishment
  and oxygen for the developing embryo.

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Physiology of Pregnancy

• Implantation (continued)
• It is also during these first few weeks that the
  first stages of the chorionic villi occur.
• Chorionic villi secrete human chorionic
  gonadotropin (hCG), a hormone that stimulates the
  continued production of progesterone and estrogen
  by the corpus luteum this is the reason that
  ovulation and menstruation cease during
  pregnancy.
• The chorionic villi become the fetal portion of
  the placenta.

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PLACENTA

• Is a disc-like endocrine organ that secretes HCG,
  estrogen, progesterone. Only present during
  preg.
• Site of nutrient waste exchange
• Circulation thru to fetus is well established
  after 4th week gest.
• Able to block transfer of certain substances
  placental barrier
• Meds such as Insulin Ephedrine do not cross
• Most bacteria do not cross (too large), some
  viruses able to cross
• Shiny Schultz fetal side, Dirty Duncan- maternal
  side

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• Amniotic Sac 2 layers amnion (fetal side)
  chorion (outer layer) appears fragile but strong
  enough to hold fetus amniotic fluid _at_ full term
• Amniotic Fluid acts as cushion against
  mechanical injury helps regulate fetal body
  temp., allows room for growth, indicator of fetal
  well being renal perfusion

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• Umbilical Cord joins embryo to placenta
• 20-22 long, lt1 diameter
• Whartons jelly major part of the cord
• Vessels (remember AVA)
• 1 vein carries oxygenated blood to fetus
• 2 arteries carries deoxygenated blood back to
  placenta
• No pain receptors
• Can have knots, wrapped around fetus

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Placental Hormones

• Progesterone
• Maintains uterine lining
• ? uterine contractions
• Prepares glands of breasts for lactation
• Stimulates testosterone production in male fetus
• Estrogen
• Stimulates uterine growth
• ? blood flow to uterine vessels
• Stimulates development of breast ducts to prepare
  for lactation

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Placental Hormones

• Human Chorionic Gonadotropin (HCG)
• Causes corpus luteum to persist continue
  production of estrogen progesterone to sustain
  pregnancy
• Basis of most pregnancy tests
• Human Placental Lactogen (HPL)
• ?s insulin sensitivity utilization of glucose
  by mother making more glucose available to fetus.
  Is Insulin Antagonist.
• Relaxin
• Increases. Helps decrease contractions and
  remodel
• collagen in cervix

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Tissue Layers of the Zygote
Tissue Layer Gives rise to
Ectoderm (Outermost layer) Skin, nails, hair
Mesoderm (Middle layer) Muscles, CT, bone, blood, lymphoid tissue, epithelial tissue, conn tissue
Endoderm (Innermost layer) Lining of cavities passages, covering of most internal organs
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Stages of Prenatal Development

• Germinal fertilization to implantation
• Called Zygote, up to 2 weeks
• Embryonic implantation (2nd wk) thru 8 weeks,
  basic form of all major organs systems develop,
  simple heart beat, human appearance
• Called Embryo
• Fetal 9 weeks to birth (38-40 wks. considered
  full term)
• Called Fetus

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Stages of Pregnancy

• Trimesters
• First conception-12 weeks
• Second 13-27 weeks
• Third 28- delivery

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4 weeks
8 weeks
3 weeks
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16 weeks
12 weeks
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Maternal-Fetal circulation
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Fetal Neonatal Circulation
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Fetal Circulatory Shunts

• Ductus Venosus diverts some blood away from the
  liver as it returns from the placenta and goes to
  Rt atrium
• Foramen Ovale diverts most of the blood from
  the Rt. Atrium directly to Lt. Atrium, rather
  than circulating to the lungs
• Ductus Arteriosus diverts most of the blood
  from the pulmonary artery into the aorta

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Fetal Circulation
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Fetal Circulation
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Fetal Circulation
Rest of blood from Rt. Ventricle
Blood from Left Ventricle
Join thru Ductus Arteriosus
Circulates thru fetal body
Returns to placenta thru Umbilical Arteries
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Closure of Fetal Shunts

• Foramen Ovale pressure in Rt. side of heart ?s
  as lungs become fully inflated now is little
  resistance to blood flow
• Functional 2 hrs. post birth
• Permanent by 3 months
• Ductus Arteriosus blood O2 level ?s
• Functional 15 hrs. post birth
• Permanent 3 weeks
• Ductus Venosus flow from umbilical cord stops
• Functional when umbilical cord is cut
• Permanent 1 week

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• Conditions that impede full lung expansion
  decrease blood O2 levels may cause the Foramen
  Ovale /or Ductus Arteriosus to reopen
• Example Respiratory Distress Syndrome
• Can give Prostaglandins to keep open
• Can give Indomethacin to help close

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Determination of Pregnancy

• Presumptive Signs
• Amenorrhea
• Nausea and vomiting
• Frequent urination
• Breast changes
• Changes in shape of the abdomen
• Quickening
• Skin changes
• Chadwicks sign discoloration of cervix
• Fatigue

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Determination of Pregnancy

• Probable Signs
• Changes in the Reproductive Organs
• Hegars sign softening of uterus
• Goodells sign softening of cervix
• Chadwicks sign discoloration of cervix
• Ballottement
• Enlargement of uterus
• Positive Pregnancy Test

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Hegars Sign
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Figure 25-5
(From Wong, D.L., Perry, S.E., Hockenberry-Eaton,
M.J. 2002. Maternal-child nursing care. 2nd
ed.. St. Louis Mosby.)
Internal ballottement (18 weeks).
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Determination of Pregnancy

• Positive Signs
• Visualization ultrasound. lt8 wks, vaginal. gt8
  weeks, abdominal.
• Fetal movement detected by Healthcare
  Professional
• Auscultation of fetal heartbeat

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Determination of Pregnancy

• Determination of the Estimated Date of Birth
  (EDB) (EDC)
• Normal human pregnancy, counting from the first
  day of the last menstrual period, is about 280
  days, 40 weeks, or 10 lunar months (slightly more
  than 9 calendar months).
• Nägeles rule
• Start with the first day of the womans last
  menstrual period and count back 3 months then
  add 7 days.
• Birth Date Calculator Wheel

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Determination of Pregnancy

• Determination of the Estimated Date of Birth
  (continued)
• If the woman does not keep a menstrual record,
  the primary care provider must then rely on
  observations such as quickening, estimation of
  fetal size by palpation, or ultrasonic tests, all
  of which can be unreliable.

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Determination of Pregnancy

• Obstetric Terminology
• Terms used to describe the number of times a
  woman has been pregnant and given birth
• Gravida indicates a pregnant woman of times
  woman has been pregnant including present one
• Primigravida one pregnancy 1st pregnancy
• Nulligravida no pregnancies
• Multigravida multiple pregnancies

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• Para woman who has given birth to a
  child/children who have reached 20 wks. gestation
• Primipara given birth to 1st child
• Nullipara no births that have reached 20 wks.
• Multipara multiple births
• Abortion termination of pregnancy before 20 wks.
  gestation spontaneous or induced
• Gestational Age prenatal age of developing fetus
  calculated from 1st day of LMP
• Age of Viability stage where fetus is capable of
  living outside of the uterus usually 20 wks.
  gestation

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• TPALM TERM, PRETERM, ABORTION, LIVING, MULTIPLES
• FPAL FULLTERM, PRETERM, ABORTION, LIVING

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Maternal Physiology

• Hormonal Changes
• Estrogen and progesterone levels remain elevated
  for the first 8 weeks of pregnancy as a result of
  hCG.
• After this time, the placenta takes over
  production and maintains necessary levels.
• As long as these levels are high,
  follicle-stimulating hormone (FSH), luteinizing
  hormone (LH), and ovulation are suppressed, as is
  menstruation.

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Maternal Physiology

• Uterus
• The uterus enlarges during pregnancy as a result
  of hormonal stimulus, increased vascularity,
  hyperplasia, and hypertrophy.
• The nonpregnant uterus is pear-shaped and weighs
  about 2 oz. has a capacity of 10ml.
• _at_ term weighs 2.2 has a capacity of 5000ml.
• In a nonpregnant state, it is a pelvic organ
  when the pregnancy reaches completion, the
  superior aspect of the uterus will be located at
  the level of the xiphoid process.

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• Cervix color consistency change produces
  mucus plug thins dilates near onset of labor
  mucus plug is expelled
• Ovaries do not ovulate corpus luteum persists
  until placenta takes over hormone production (6-7
  weeks)
• Vagina - ?d blood supply bluish color rugae
  become prominent mucosa thickens ?d
  secretions pH becomes more acidic

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• Breasts
• Hypertrophy of the mammary glandular tissue and
  increased vascularization, pigmentation, size,
  and prominence of nipples and areola.
• Sebaceous glands secrete lubrication for nipples
• Respiratory System
• ?d O2 consumption (15)
• Depth increases, slight increase in rate
• Dyspnea until fetus descends into pelvis
• Swollen mucous membranes nasal stuffiness nose
  bleeds voice changes

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• Cardiovascular System
• Heart displaced up to left by uterus
• Blood volume ?s by 45
• HR (10-15 bpm) cardiac output ?s
• Vascular resistance ?s
• Vena Cava Syndrome
• Orthostatic hypotension
• Palpitations
• Dilutional anemia
• Vericose veins
• ? in clotting factors WBC

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• Gastrointestinal System
• Stomach intestines displaced
• ? appetite thirst
• ?d acidity of gastric secretions
• ?d gastric emptying intestinal motility
• Cardiac sphincter of stomach relaxes
• Alteration in glucose metabolism (GDM)
• Urinary System
• GFR ?s d/t maternal fetal waste excretion
• Renal tubules ? reabsorption
• Bladder capacity ?s, lead to urinary stasis
• Skeletal System
• Posture changes rounded shoulders back ache
• Waddling gait
• Joint instability d/t softening of ligaments

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Evaluating Fetal Well-being

• A variety of technologic and assessment tools can
  be used to evaluate fetal well-being.
• These tools are used to evaluate maternal and
  fetal health problems, fetal congenital
  anomalies, and fetal growth and maturity.
• Ultrasonographylt8 wk, vaginal. gt8wk, abd.
• Maternal serum alpha-fetoprotein screening
• Chorionic villus sampling
• Amniocentesis
• Lecithin-Sphingomyelin Ratio
• Nonstress test
• Contraction stress test
• Magnetic resonance imaging
• Biophysical profile
• Fetal kick count

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Figure 25-3
(Courtesy of Marjorie Pyle, RNC, LifeCircle,
Costa Mesa, California.)
Transabdominal amniocentesis.
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21 week fetus diagnosed with spina bifida
undergoing surgery while still in the womb.
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Antepartal Assessment

• General Physical Assessment
• Ideally, the woman has been receiving regular
  medical attention and is already known by the
  health care provider.
• On the first visit, demographic data, such as
  age, occupation, marital status, and insurance
  information, are obtained this helps the primary
  care practitioner identify potential areas of
  concern.
• A basic family and personal medical history is
  obtained it should include genetic diseases.

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Antepartal Assessment

• Lifestyle patterns
• Basic physical examination
• Psychosocial history
• Cultural practices health beliefs that affect
  pregnancy
• Prenatal labs Blood type, Rh, Rubella, Hepatitis
  B, Syphilis, HH, HIV, Urinalysis, Urine culture.
  
• New Test RHD Test- only for Rh- moms, test mom
  serum for Rh of infant and infant sex. Mom must
  be 12wks or gt preg.

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Antepartal Assessment

• Obstetric Assessment
• Information about the womans gynecological,
  menstrual, and obstetric history is obtained.
• The number of pregnancies and their outcomes are
  discussed.
• Gynecological Examination
• The gynecological examination is also performed
  at this time. Pap, GC, Chlamydia
• The nurse is often called on to prepare the
  necessary equipment and assist with this
  examination.

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Antepartal Care

• Health Promotion
• Pregnancy is a time in life when most women see
  the importance of regular medical supervision and
  are more willing to make changes in their habits
  than any other time.
• Once pregnancy is diagnosed, prenatal care is
  instituted.
• Early in pregnancy, the woman often begins to
  seek information and make choices regarding how
  and where she wishes to give birth.

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• Health Promotion (continued)
• Routine care during pregnancy begins with the
  initial examination and history.
• Appointments are recommended once a month through
  the seventh month (28 wks), once every 2 weeks
  for the next month (29-36 wks), and then once
  every week until delivery(36-40 wks).
• Smoking, doing drugs, and drinking alcoholic
  beverages during pregnancy are contraindicated.
• Taking any medications during pregnancy,
  including over-the-counter drugs, should be taken
  only under the direction of a doctor.

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• Danger Signs During Pregnancy
• Visual disturbances
• Headaches
• Edema
• Rapid weight gain
• Pain
• Signs of infection
• Vaginal bleeding or drainage
• Persistent vomiting
• Muscular irritability or convulsions
• Absence or decrease in fetal movement once felt

Nursing Action Stress to the pregnant woman to
contact her care provider promptly if she
develops any of these signs!
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Maternal Nutrition

• Benefits of optimal nutrition during pregnancy
• ? risks of complication
• ? premature deliveries
• ? rate of low-birth weight babies
• Nurse must teach pregnant women that nutrient
  needs increase more than calorie needs (select
  nutrient-dense foods)
• Pregnant woman additional 300 calories
• Lactating woman additional 500 calories (from
  prepregnant intake)

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• All women of childbearing age should be
  encouraged to consume a healthy diet use care
  in the consumption of alcohol caffeine because
• Many women are unaware of the pregnancy during
  the 1st few weeks after conception
• Most women dont attend prenatal information
  classes until the later months of their pregnancy

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Protein

• Intake 60 g.
• Importance metabolism, growth repair of
  maternal fetal tissues
• Sources meat, fish, poultry, dairy products

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Calcium

• Intake 1200 mg.
• Importance bones, proper nerve muscle
  function
• Sources dairy products, enriched cereal,
  legumes, green leafy veggies, broccoli, dried
  fruits, canned salmon sardines

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Iron

• Intake 30 mg.
• Importance ?d production of RBCs, fetus must
  store iron supply to meet needs for 1st 3-6
  months
• Sources red organ meats, whole grains, dark
  green leafy veggies, dried fruit, fortified
  cereals breads

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Folic Acid

• Intake 400 mcg.
• Importance ? incidence of neural tube defects
  formation maturation of RBCs WBCs
• Sources liver, lean beef, kidney lima beans,
  potatoes, fresh dark green leafy veggies, whole
  wheat bread, peanuts, fortified cereals, dried
  beans

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Fluids during Pregnancy

• Drink 8-10 glasses (8oz.) per day
• Most of fluid intake should be water
• Limit caffeinated high-sugar drinks

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Recommended weight gains

• Women of normal weight 25-35
• Underweight women 28-40
• Overweight women 15-25
• Distribution of weight gain
• Uterus 2.5 Breasts 1.5-3
• Fetus 7-7.5 Blood volume 3.5-4
• Placenta 1-1.5 Extravascular fluid 3.5-5
• Amniotic Fluid 2 Maternal reserves 4-9.5

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• Pica
• This is the craving and eating of substances that
  are not normally considered edible.
• Substances such as clay or laundry starch are
  commonly ingested.
• They are not toxic but may interfere with iron
  absorption, resulting in anemia.
• Large amounts of clay may cause constipation.

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Common Discomforts of Pregnancy

• Ptyalism(Excessive salivation)
• Nausea
• Hyperemesis gravidarum
• Constipation
• Pyrosis (heartburn)
• Hemorrhoids
• Urinary Frequency
• Fatigue
• Backache

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Common Discomforts (cont.)

• Varicose veins
• Dyspnea
• Leg cramps
• Edema
• Nasal stuffiness

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Skin Changes during Pregnancy

• Linea nigra dark line midline of abdomen
• Chloasma the mask of pregnancy
• Striae gravidarum stretch marks
• Spider nevi dilated capillaries on the skin
• Palmar erythema reddened palms
• Hirsutism excessive body hair

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• Hygiene Practices
• Bathing and showering during pregnancy should
  continue as part of routine hygiene.
• Increased perspiration is common, and good
  personal hygiene is important to prevent body
  odor.
• Some primary care practitioners restrict tub
  baths in the last month, because the cervix may
  have dilated. No bath once ROM.
• Most primary care practitioners recommend that
  women avoid using hot tubs, sauna baths, and spas
  during pregnancy.

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• Activity/Exercise
• Normal activity should continue throughout an
  uncomplicated pregnancy discuss exercise
  routine with healthcare provider.
• Fatigue is common pace activities, dont overdo
  it.
• Avoid high-risk activities or those requiring a
  great deal of coordination or balance.
• ? exercise 4 wks. before due date.
• Avoid becoming overheated.
• Stop exercising if develop SOB, dizziness,
  numbness, tingling, abd. pain, or vaginal
  bleeding contact provider immediately.

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• Rest/Sleep
• Early in pregnancy, few changes in sleep patterns
  are experienced.
• As the size of the abdomen increases, it may
  become increasingly difficult for the woman to
  find a position of comfort.
• The supine position is not recommended as a woman
  approaches her due date this may cause excessive
  pressure on the aorta and vena cava and may
  result in decreased circulation for the fetus.
• Rest periods during the day with the feet
  elevated should be encouraged.

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Figure 25-7
(From McKinney, E.S., James, S.R., Murray, S.S.,
Ashwill, J.W. 2005. Maternal-child nursing.
2nd ed.. Philadelphia Saunders.)
During third trimester, pillows supporting
abdomen and back provide a comfortable position
for rest.
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• Sexual Activity
• Unless there are complications in the pregnancy
  or the bag of water has ruptured, there is no
  physiological reason to limit sexual activity
  during pregnancy.
• Many women experience a decrease in desire as a
  result of hormonal changes and the multiple
  discomforts that may be occurring.
• Discussion of various coital positions and sexual
  activity that does not include intercourse is
  appropriate.
• Fears concerns normal partners need to
  communicate these concerns.

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• Vaginal Bleeding
• Vaginal bleeding at any time during pregnancy
  should be reported to the physician at once.
• Sexual activity should cease until the cause of
  the bleeding is determined and should be resumed
  only when the physician determines that no danger
  exists.

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• Coping/Stress Tolerance
• All of the physical and hormonal changes of
  pregnancy place additional stress on the woman.
• Mood swings and ambivalence are common as the
  woman works through her fears and comes to grip
  with the reality of pregnancy and how the
  pregnancy will affect her life.
• Listening and allowing the woman adequate time to
  verbalize her fears can also help reduce
  anxieties.

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• Role/Relationship
• Pregnancy introduces a totally new role, that of
  a mother father.
• Culture will have much to do with how the woman
  will define her role.
• Dynamics also change between the woman and the
  babys father, particularly with the first
  pregnancy. The woman is no longer just a wife or
  girlfriend she is also a mother.
• Women will look to family friends as role
  models.

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• Self-Perception/Self-Concept
• Rapid changes in body shape and size can lead to
  changes in self-image.
• Many women feel that they are not attractive when
  they are pregnant.
• They may also feel a loss of control related to
  the changes taking place.

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Impact of Pregnancy

• Adolescents
• Older couple
• Single parents
• Grandparents

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Preparation for Childbirth

• Cultural Variations in Prenatal Care
• It is imperative that the practitioner determine
  and explore cultural practices and beliefs with
  the patient.
• Hispanic
• African American
• Filipino
• Japanese
• Chinese
• Russian
• Southeast Asian

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Preparation for Childbirth

• Prenatal Education special classes offered to
  help the childbearing family understand prepare
  for the demands of pregnancy, labor, the newborn,
  parenthood
• Review reproductive AP
• Discuss changes during pregnancy
• Fetal growth development
• Nutrition
• Danger signs
• Discussion of analgesia anesthesia during labor
• Care of the newborn
• breastfeeding
• Sibling preparation changing family dynamics

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Preparation for Childbirth

• Childbirth Preparation Classes
• Some classes are general in nature, whereas
  others are targeted toward specific groups such
  as adolescents, those having cesarean or vaginal
  birth after cesarean delivery, siblings, or
  grandparents.
• Common methods of prepared childbirth include
• Dick-Read
• Bradley
• Leboyer
• Lamaze

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Figure 25-8
(From Lowdermilk, D.L., Perry, S.E. 2004.
Maternity womens health care. 8th ed.. St.
Louis Mosby.)
Entire family participating in a childbirth
preparation course.
100
Nursing Process

• Nursing Diagnoses
• Body image, disturbed
• Nutrition less than body requirements
• Injury, risk for
• Activity intolerance
• Incontinence, stress urinary
• Constipation
• Sleep pattern, disturbed
• Fatigue

101
Nursing Process

• Nursing Diagnoses (continued)
• Knowledge, deficient
• Family processes, interrupted
• Fear
• Parenting, risk for impaired