NURSING CARE TO PROMOTE FETAL AND MATERNAL HEALTH

• • Bathing: daily tub baths or showers are recommended
  • Breast care: As her breast increase she should be certain to wear a firm, supportive bra with wide straps to spread breast weight across the shoulders. At 16th week, colostrum secretions begin
• • Dental care: Must brush after meals and at bedtime. Encourage to see dentist regularly for routine examination. Encourage to snack on nutritious food
  • Perineal care: always wipe from front to the back after voiding to prevent contamination from the rectum
• • Clothing: Maternity clothing should be comfortable. Should be cautioned to avoid garters, extremely firm girdles with panty legs, and knee high stockings. Suggest wearing shoes with a moderate to low heel
• • Sexual activity: as long as the woman may not experience any discomfort during sexual act then this may be allowed. As long as there are no complications during pregnancy
• • Exercise: average well-nourished women should exercise during pregnancy about 3x weekly for 30 consecutive minutes. Exercises that would improve and strengthen muscles of the perineum. That will promote relaxation and breathing and panting.
• • Sleep: a good resting position is left-sided Sims position with the top leg forward. THis position puts the weight of the fetus on the bed not on the woman and allows good circulation in the lower extremities. Encourage 8 to 10 hours a day.
• • Employment: unless a woman's job involves exposure to toxic substances, lifting heavy objects, other kind of physical strain, long periods of standing or sitting or having to maintain a balance there are few reasons a woman cannot continue to work throughout pregnancy.
• • Travel: advise a woman who is taking a long trip automobile to plan for frequent rest or stretch periods. Preferably every hour bu at least every 2 hours, when should get out of the car and walk a short distance. This helps relieve stiffness and muscle aches and improves lower extremities circulation helping prevent varicosities, hemorrhoids and thrombophlebitis
• Preliminary signs of labor and delivery

  • Lightening
  • Increase of energy
  • Slight weight loss
  • Backache
  • Braxton Hicks contraction
• Lightening


  • In primipara, lightening or descent of the fetal presenting part into the pelvis, occurs approximately 10 to 14 days before labor begins
  • Lightening gives a woman relief from the diaphragmatic pressure and shortness of breath she has been experiencing and in this way "lightens" her load
  • As the fetus sinks lower into the pelvis, a woman may experience increased amount of vaginal discharge and urinary frequency from pressure on her bladder
• Increased energy - preparation for nesting phase


  • A woman may awaken in the morning of labor full of energy, in contrast to the feeling of chronic fatigue that she has been feeling for the previous month.
• Backache


  Because labor contractions begin in the back, an intermittent backache stronger than usual may be the first symptom a woman notices
• Slight loss of weight

  • As progesterone level falls, body fluid is more easily excreted form the body
  • This increase in urine production can lead to a weight loss between 1 and 3 lbs.
• Braxton Hicks Contractions


  • painless uterine contraction
  • In the last week or days before labor begins, a woman usually notices extremely strong ___.
• Relationships of Maternal Nutrition and Fetal Health


  • During pregnancy, a woman must eat adequately to not only support her own nutrition but also to supply enough nutrients so the fetus can grow
  • Adequate protein and calcium intake is vital because so much of these are needed by the fetus to build a strong body framework
  • Adequate protein may also help prevent complications of pregnancy such as gestational hypertension, diabetes, or preterm birth
  • Either deficiencies or overuse of vitamins may contribute ti poor intrauterine growth
• Recommended weight gain during pregnancy

  • As a rule, the average woman should gain (25 to 35 lbs) during pregnancy
  • Weight gain in pregnancy occurs form both fetal growth and accumulation of maternal stores and increases by approximately 0.8 kg (1.5 lbs) per month during 1st trimester.
  • 2nd trimester 0.4 kg (1 lbs) per week during the last 2 trimesters
  • A trimester minimum weight gain of 4.5 lbs and 12 lbs respectively
• Labor


  • is the series of events by which uterine contractions and abdominal pressure expel a fetus and placenta from the uterus.
  • Regular contractions cause progressive dilatation of the cervix and create sufficient muscular uterine force to allow a fetus to be pushed out not the extrauterine life
• Theories why labor occurs


  • Labor normally begins between 37 to 42 weeks of pregnancy when a fetus is sufficiently mature to adapt to extrauterine life
  • The uterine muscle stretches from the increasing size of the fetus, which results in release of prostaglandin - initiates uterine contraction
  • The fetus presses on the cervix, which stimulates the release of oxytocin for the pituitary gland
  • Oxytocin stimulation works together with prostaglandin = initiates contraction
• Theories why labor occurs (1)


  • Changes in the ratio of estrogen to progesterone occur. The increase of estrogen stimulates the production of oxytocin, while progesterone decreases
  • The placenta reaches a set age, which trigger contraction
  • Rising fetal cortisol levels reduce progesterone formation and increases prostaglandin formation
  • The fetal membrane begins to produce prostaglandin, which stimulate contraction
• Signs of true labor

  • True labor contractions usually begin in the back and sweep across the abdomen similar to the tightening of a rubber band (lumbosacral pain)
  • They gradually increase in frequency and intensity over a period of hours
  • The typical time that the woman should come to the health care facility is when contraction are 5 mins apart
• Signe of true labor


  • Ripening of cervix
  • Bloody show
  • Rupture of membrane
• Ripening of the cervix - effacement


  • An integral sign that is seen only on pelvic examination
  • Throughout pregnancy, the cervix feels softer than usual to palpation, similar to the consistency of an earlobe (Goodell's sign)
  • At term, the cervix becomes still softer and it tips forward. Dilates from 0 to 10 cm
  • Effacement and cervical dilatation are two requisites of true labor and delivery
• Show - the bloody show


  • As the cervix softens and ripens, the mucus plug that filled the cervical canal during pregnancy is expelled
  • The exposed cervical capillaries seep blood as a result of pressure exerted by the fetus. This blood is mixed with mucus, takes on a pink tinge as is referred to as "show"
• Rupture of the membranes


  • Labor may begin with a rupture of the membranes, experienced either as a sudden gush or a scanty, slow seeping of clear fluid from the vagina
  • Abnormal: Two risks are associated with early ruptured membranes: intrauterine infection and prolapse of the umbilical cord (which could cut off the oxygen supply to the fetus)
  • If labor does not spontaneously begin by 24 hours after membranes rupture and the pregnancy is at term, labor will likely be induce risk for infection
• Immunizations: Schedule of Tetanus Toxoid Immunization for women as per DOH


  • TT1 - as early as possible during pregnancy
  • TT2 - at least 4 weeks later
  • TT3 - at least 6 months later
  • TT4 - at 1 year later
  • TT5 - at least 1 year later

  Benefits: Infants (protection from neonatal tetanus) Mothers (protection from tetanus for 3.5, 10 years and lifetime
• Purposes of exercises


  • Increase flexibility of the lower back
  • relieves pressure or backache
  • promotes posture and appearance
  • help mothers in their breathing of panting
  • strengthen perineal muscles
• Preparation for Childbirth classes


  • Preparing the expectant woman and her support person for the childbirth experience
  • Helping women become more informed about the option available for birth
  • Explaining the role of both pharmacologic and nonpharmacologic methods of pain control that are useful for labor
  • Helping the couple's overall enjoyment of and satisfaction with the childhood experience
• Prenatal yoga


  • are aimed at helping a woman relax and manage stress better at all timed in her life
  • Yoga exercises help a woman stay overall fit by their focus on gentle stretching and deep breathing
  • It is also useful in labor to help both relaxation and pain management