Chapter 10: Promoting a Healthy Pregnancy Flashcards
1
Q
Preconception
A
when female reaches menarche and is capable of reproduction
-represents the earliest stage of pregnancy continuum
>time when a woman builds the foundation for a healthy pregnancy long before she may ever think of becoming pregnant
-time to identify conditions that can adversely affect pregnancy (environment)
2
Q
Periconception
A
time immediately before conception through the period of organogenesis (fetus important organs are developing)
3
Q
Interconception
A
time period between the end of one pregnancy and the beginning of the next pregnancy
>optimal time to address problems that occurred with the previous pregnancy to minimize repetition
4
Q
During preconception visit: Menstrual and Medical History
A
- review of menstrual history; frequency and length; keep accurate menstrual calendar
- review of family history
5
Q
Preconception Visit: Physical Exam
A
- performs complete physical exam, pelvic exam, general physical assessment
- Papanicolaou test (Pap test)
- cultures for STIs and other infections obtained
6
Q
Laboratory Evaluation for Prenatal Care
A
- CBC (complete Blood Count); to test for anemia via analysis of hemoglobin and hematocrit
- WBC (infections)
- bloody type
- Rh
7
Q
Exposure to Childhood Illness
A
- Rubella (can be immunized after child is born)
- Varicella (chickenpox) should be immunized before pregnancy
- receive a tetanus booster immunization every 10 years
8
Q
Exposure to STI’s
A
- routine screenings aids in early detection
- VDRL test screening titer for syphillis that measures antibodies; but can result a false positive in pregnant woman; use RPR screening and further tests to confirm
- screen for HIV
- gonorrhea and chlamydia (cervical infections)
- Hepatitis B virus (HBV)
9
Q
Genetics Screening During Pregnancy
A
- Sickle cell disease
- Tay-Sachs disease
- Thalassemia
- Hemophilia
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency
- Cystic Fibrosis
10
Q
Exposures related to lifestyle choices
A
- tobacco
- alcohol
- caffeine
- artificial sweeteners
- marijuana
- cocaine
11
Q
Tobacco and Effects of the fetus
A
-carbon monoxide in the cigarette smoke binds more readily than oxygen to hemoglobin, decreasing oxygen-carrying capacity of the RBCs; decreases amount of oxygen traveling to the placenta; decreasing available oxygen for the growth and development for the tissues and organs of the fetus
-nicotine can be harmful; tachycardia, hypertension, and tachypnea
-vasoconstriction causes decreased blood flow through arteries and decrease oxygen transport to the placenta and developing fetus
>smoking = spontaneous abortion, low birth weight, intrauterine growth restriction, preterm labor and birth, placenta previa, placental abruption, and premature rupture of membranes
-most likely to be small for gestational age
12
Q
Alcohol and Effects on the fetus
A
-alcohol passes quickly through the placenta and reaches fetal bloodstream more rapidly than adults
>the fetal body system functions are immature and unable to metabolize alcohol resulting in elevated alcohol levels and damage to developing organs and tissues; results in the facial features associated with fetal alcohol syndrome (FAS)
-features: low nasal bridge, short nose, flat midface, and short palpebral fissure>can result in spontaneous abortion and low birth weight
13
Q
Caffeine and Effects on the Fetus
A
-caffeine acts as CNS stimulant, causing tachycardia and hypertension
-can readily pass through placenta to the fetus; affects FHR and movement
-increases rate of miscarriage
-harmful to fetus; stresses the fetus’s immature metabolic system and decreases blood flow to placenta
>sources: coffee, tea, and sodas (“caffeine-free” may still contain small amounts)
>nurse should assess daily intake of caffeine
-decreased birth weight
-limit caffeine to 2 cups a day or less or change to decaffeinated sources
14
Q
Artificial Sweeteners and Effects on the Fetus
A
saccharin should be avoided
-aspartame (NutraSweet, Equal), acesulfame potassium (Sunett, and sucralose (Splenda) have not been shown to have negative affects
15
Q
Marijuana and Effects on the Fetus
A
-adverse effects on neonatal neurobehavior producing hyperirritability, tremors, and photosensitivity
16
Q
Cocaine and Effects on Fetus
A
- congenita anomalies that involve the brain, skull, face, eyes, heart, limbs, intestines, genitals, and urinary tract
- stillbirth, abruptio placentae, preterm labor, preterm birth, and small for gestational age (SGA)
17
Q
Readiness for Motherhood
A
- relationship with mother plays a role
- have patient educate herself about maternal changes, fetal growth and development, and motherhood
- books, brochures, online resources, community programs
18
Q
Physiological Changes During Pregnancy
A
- hormone levels; progesterone exerts depressant effect
- anxiety may develop
- provider be aware of S/S of mental illness in pregnant woman
19
Q
The Healthy Relationship
A
- incidence of intimate partner violence (IVP) during pregnancy is high
- every woman should be screened for IVP during initial visit and when needed (e.g. if bruises or other injuries are present) throughout pregnancy
20
Q
Stress During Pregnancy
A
- anxious and stressed are more likely to deliver preterm or give birth to smaller babies
- nurse should assess for stressors and coping skills
21
Q
Promoting Stress Management during Pregnancy
A
- Massage therapy: increases blood flow to maternal and fetal tissues; increases relaxation
- Chiropractic care: treats lower back pain and headaches related to increased hormone levels
- Acupuncture and acupressure: treat many physical ailments without introduction of medications
- Relaxation exercises, meditation, and breathing techniques; increase blood flow to maternal and fetal tissues; increases relaxation
- Light therapy: enhances mood and treats depression
- Reflexology: stimulates nerve pathways to increase blood flow and energy flow to corresponding areas of the body
- Aromatherapy: increases relaxation
- Mindfulness-based yoga: enhances physical well-being and diminishes psychological stress
22
Q
Readiness for Fatherhood
A
-First Trimester: deal with reality of pregnancy, worry about financial strain and ability to be a good father
>Couvade: experience maternal signs and symptoms
-Second trimester: becomes more real to father, identify fetal movement, willingness to learn
-Third Trimester: both parents are preparing for new roles
23
Q
Important Nutritional Elements
A
- calories
- protein
- water
- minerals and vitamins
24
Q
Important Nutritional Elements: Calories
A
-signifies the energy expenditure of food
-kcal = 1000 calories
-increase of 300 kcal./day from prepregnant needs
>increase in maternal caloric intake is most important in second and third trimester; third trimester= growth in fetal tissues
-calories should be from the major food groups (skim milk, yogurt, or cheese; fruits, vegetables and bread, cereal, rice, or pasta) not from soda, candy, or simple carbohydrates
25
Important Nutritional Elements: Protein
-for tissue growth and repair
-needs just a modest increase; increase intake of milk and dairy by one or two servings per day meets the daily requirement
>protein found in animal sources; meat, poultry, and fish
>eggs, milk, cheese, and yogurt
>lactose-intolerant: soy milk, and soy cheese
>peanut butter, but high in fat
>beans and legumes
26
Important Nutritional Elements: Water
necessary for all body tissues and body system functions
-8-10 (8oz) glasses of fluid per day
>increased need during pregnancy is necessary to meet the changing physiology of the maternal cardiovascular system and maintain adequate blood flow to the fetus
-can be in the form of fruit juice and vegetable juice (but at least 4 to 6 glasses should be water)
>caution diet sodas (high in sodium and artificial sweeteners) and caffeinated drinks (promote diuresis) in moderation
-avoid alcohol
27
Important Nutritional Elements: Minerals and Vitamins: Calcium and Vitamin D
>calcium: essential in maintaining bone and tooth mineralization and calcification
-1000 mg/day
-dairy products (milk and milk products)
-others: legumes, dark green leafy vegetables, dried fruits, and nuts
>Vitamin D: important in absorption and metabolism of calcium
-600 IU (15 mcg)/day
-vitamin D fortified foods or supplements
-fortified milk and ready-to-eat cereals constitute major food sources for vitamin D
-cereals, egg yolks, liver, and fatty fish such as salmon, sardines, and trout if you do not like milk
-sunscreens with recommended SPF rating 8 appear to block vitamin D producing UV rays
28
Important Nutritional Elements: Iron and Vitamin C
>Iron: as blood volume increases, the number of circulating red blood cells also increases
-maternal iron intake must be increased to maintain the oxygen-carrying capacity of the blood and to provide an adequate number of red blood cells
-27 mg/day
-fortified ready-to-eat cereals, white beans, lentils, spinach, kidney beans, lima beans, soy beans, shrimp, and prune juice
-red meats including beef, duck, and lamb
-best= oysters, organ meats (giblets and liver) and fortified instant cooked cereals
>Vitamin C: tissue formation; enhances absorption of iron
-red and green sweet peppers, oranges, kiwi fruit, grape fruit, strawberries, brussels sprouts, cantaloupe, broccoli, sweet potatoes, tomato juice, cauliflower, pineapple, and kale
-80 to 85 mg
29
Important Nutritional Elements: Folic Acid
Vitamin B9 or folic acid (folate): helps regulate RBC development and facilitates oxygen carrying capacity of the blood
- essential in production of DNA and RNA and helps maintain normal brain function and stabilize mental and emotional health
- minimum of 800 mcg/day
- supplementation
- dark leafy greens, asparagus, broccoli, citrus fruits, beans, peas, and lentils, avocado, okra, brussels sprouts, seeds and nuts, fortified breakfast cereals and calf liver
30
Factors Affecting Weight Gain
>nurses should assess weight at initial visit and monitor throughout pregnancy
- from increased blood volume, dilation of renal pelvis and ureters from increased blood flow adds volume to the bladder and results in increased production of urine, enlargement of placenta and fetal body
- social factors for insufficient weight gain; inability to purchase food, intimate partner violence (IVP), anorexia nervosa, shortened time period between pregnancies, and lack of prenatal care
- increased weight gain; inadequate physical activity, high carb or fat intake, excessive consumption of sweets, and lack of prenatal care
31
Factors Affecting Nutrition During Pregnancy
- eating disorders
- cultural factors
- vegetarian diets
32
Eating Disorders: Pica
consumption of non-nutritive substances or food
-clay, dirt, cornstarch, and ice
-causes: nutritional deficiencies, cultural and familial factors, stress, low socioeconomic status, and biochemical disorders
Treatment: diagnoses and treatment of underlying nutritional deficiencies
33
Eating Disorders: Anorexia Nervosa and Bulimia Nervos
characterized by distorted body image; involve an intense fear of becoming obese
>Anorexia nervosa lose weight by excessive dieting or by purging themselves of calories ingested
>Bulimia nervosa engage in recurrent episodes of binge eating, self-induced vomiting and diarrhea, excessive exercise, strict dieting, or fasting and display an exaggerated concern about body shape and weight
>nutritional counseling, psychological counseling, stress management, and support groups
34
Nutrition and Cultural factors
- -nurse must understand different dietary habits and knowledge of cooking methods and basic ingredients
- good may have symbolic meaning
35
Factors Affecting Nutrition During Pregnancy: Vegetarian Diets
-compromised of nutrients
-vegans are deficient in vitamin B12 found only in animal origin
-counseled to consume vitamin B12 fortified foods such as soy milk or supplementation
-can be deficient in iron, calcium, zinc, vitamin B6, calories, and protein
>counseling, assessment of weight gain and laboratory testing for evidence of anemia help ensure fetal-well being
36
Teratogen
anything that adversely affects the normal cellular development in the embryo or fetus
37
Over-the Counter Mediations
(ex: acetaminophen or guaifenesin)
- do not take any medication without first consulting with primary care provider
- nonprescription drugs should be avoided during pregnancy
38
Herbal and Homeopathic Preparations
-major draw backs
-no regulation that controls product development
-dosages aren't consistent
-additives used may be different in type and amount
-no guarantee claims made about them are true
>nurses should warn use; provide written information that can be taken home, and reinforce teaching at each visit
39
Prescription Medications
- dosages can be adjusted or mediations can be replaced with safer medications
- prenatal vitamins are usually given during preconception or at the beginning of pregnancy; provide the RDA for most vitamins and minerals as well as the additional calcium, iron, and folic acid needed during pregnancy
- Avoid: Isotretinoin (Accutane) which is prescribed for acne, some antimicrobials caused altered fetal growth and development, Sulfonamides are associated with delayed fetal skeletal development
40
Common Herbs to Avoid During Preconception and Pregnancy
>Uterine stimulants that may cause preterm labor
-barberry, black cohost, feverfew, goldenseal, mugwort, pennyroyal leaf, yarrow root
>Blood thinners and anticoagulants that may cause miscarriage
-dong quai
>Laxatives that may overstimulate digestion and metabolism and cause fluid and electrolyte imbalances
-blessed thistle, cascara Sagrada, drug aloe, Senna
>Cardiovascular stimulants that may elevate blood pressure or use abnormal heart rhythms
-Ephedra, Licorice root
>Others:
-Gotu kola, Juniper berries
41
FDA Classification System for Medications Used During Pregnancy
- Category A
- Category B
- Category C
- Category D
- Category X
42
FDA Pregnancy Categories for Drugs: Category A
controlled studies in pregnant woman have demonstrated no associated fetal risk
43
FDA Pregnancy Categories for Drugs: Category B
no associated fetal risk in animals, but no controlled studies in pregnant woman; or animal studies indicated a risk, but controlled human studies fail to demonstrate a risk
44
FDA Pregnancy Categories for Drugs: Category C
evidence of adverse effects in animal fetuses, but no controlled studies in pregnant women; or no adequate animal or human reproductive studies are available
45
FDA Pregnancy Categories for Drugs: Category D
evidence of adverse effects and fetal risk in humans; benefits and risks must be considered before prescribing
46
FDA Pregnancy Categories for Drugs: Category X
evidence of fetal risk and congenital anomalies in humans; risks outweigh benefits; not prescribed during pregnancy
47
Common Discomforts During Pregnancy
- nausea
- vomiting
- ptyalism (excessive salivation)
- fatigue
- nasal congestion
- upper and lower backache
- leukorrhea
- urinary frequency
- dyspepsia (heartburn)
- flatulence
- constipation
- dental problems
- leg cramps
- dependent edema
- varicosities
- dyspareunia (painful intercourse)
- nocturia
- insomnia
- round ligament pain
- hyperventilation and SOB
- numbness and tingling in the fingers
48
Common Discomforts: Nausea
- vomiting accompanies the nausea; make sure not excessive
- nurses should question frequency and amount and their ability to consume and retain foods and liquids
- assess for weight loss, dehydration, urine ketones, blood alkalosis, and hypokalemia which can be indicative of hyperemesis gravidarum
49
Hyperemesis Gravidarum
pregnancy related condition characterized by persistent, continuous, severe nausea and vomiting, often accompanied by dry retching
50
Common Discomforts: Ptyalism
excessive salivation
- likely related to increased hormone levels
- may be associated with maternal dehydration
- rule out dental abnormalities, upper gastrointestinal problems, and pica
- Nurses can counsel patients to consume small, frequent meals; avoid starchy foods; drink plenty of water in small sips; suck on hard candies; and brush teeth frequently
51
Common Discomfort: Fatigue
- take naps during day when possible
- establish a bed time ritual
- increase daytime exercise
- practice relaxation techniques
52
Common Discomfort: Nasal Congestion
-"rhinitis of pregnancy"
-increased levels of estrogen and progesterone cause swelling of the nasal mucus membranes and produce symptoms of excessive mucus and congestion
>rule out colds and allergies
>increase fluids; take hot, steamy shower; vaporizer or humidifier; occasional administration of nasal saline drops
-Decongestants should be avoided during first trimester
53
Discomforts: Upper and Lower backache
-due to change in center of gravity as the uterus enlarges
-related to high levels of progesterone, which cause relaxation and softening of the connecting cartilage and joints
-can be exacerbated by standing, walking, bending, or lifting
>rule out other causes of backache; kidney stones, pyelonephritis, pancreatitis, ulcers, muscle sprain or strain, and preterm labor
>wear supportive low-heeled shoes; proper body mechanics; back strengthening and pelvic rock exercises; firm supportive mattress; supportive bra
54
Discomforts: Leukorrhea
increase in vaginal discharge
-usually yellow to white in color, thin, and more acidic than normal
>rule out vaginal and sexually transmitted infection and rupture of membranes
>wear cotton underwear, avoid tight-fitting clothes, follow strict hygiene to prevent infection
>change pad frequently to prevent dampness and odor
55
Discomforts Urinary Frequency
caused by pressure exerted by the enlarging uterus on the bladder
-bladder pressure lessens once the uterus becomes an abdominal organ
>rule out UTI, rupture of membranes, kidney stones, gestational diabetes and stress urinary incontinence
>intake of adequate hydration, Kegel exercises, use of panty liners, frequent voiding, decreasing fluid intake 2 to 3 hours before bedtime
56
Discomforts: Dyspepsia
heartburn
-results from reflux of acidic gastric contents into the lower esophagus
-caused by progesterone-induced relaxation of the cardiac sphincter and delayed gastric emptying
>consume small frequent meals, remain upright after meals, avoid greasy and fatty foods and very cold foods and consuming beverages with meals
-drink cultured or sweet milk and use OTC antacids
57
Discomforts: Flatulence
results from elevated progesterone and pressure of enlarging uterus on the abdominal contents
-avoid gas-forming foods, constipation, gum chewing, consuming large meals, and swallowing air
58
Discomforts: Constipation
elevated levels of progesterone relax the smooth muscles, causing decreased contractility of the lower GI tract and slowed movement of the stool
>regular physical exercise, high fiber diet, increased liquids, and avoid straining
>avoid use of mineral oil and bulk-forming laxatives
59
Discomforts: Dental problems
gums become edematous and friable; bleed during brushing
-can open direct pathway for pathogens to enter blood stream
>meticulous dental care
60
Discomforts: Leg cramps
>regular exercise
>good body mechanics
>elevate legs above the heart several times throughout the day
>dorsiflex the foot
>consume diet in adequate amounts of calcium and phosphorus
61
Discomforts: Dependent Edema
caused by relaxation of blood vessels (from increased progesterone) and increased pressure placed on the pelvic veins
-tight restrictive clothing increases edema
>rule out gestational hypertension, renal disease, liver disease, cardiac disease, vascular disorders, trauma, and infection
>avoid constrictive clothing, elevating legs periodically throughout the day, assuming a side-lying position when resting
62
Discomforts: Variscosities
from positive family history and normal physiological changes of pregnancy
>regular assessment of lower peripheral pulses and education
>avoid crossing legs
>avoid constrictive clothing and knee-high stocking
>elevate legs above level of heart
63
Danger Signs of the First Trimester
- Severe nausea + Vomiting
- abdominal pain and vaginal bleeding
- infection
64
Danger signs of first trimester: Severe nausea + vomiting
-when it is severe, weight loss and dehydration can occur
-severe persistent vomiting indicative of hyperemesis gravidarum
>managed by oral fluids; small, frequent meals, and emotional support
>dehydration may require intravenous fluids and hospitalization
65
Danger Signs of First Trimester: Abdominal Pain and Vaginal Bleeding
abdominal cramping and vaginal spotting or bleeding may indicate spontaneous abortion, or miscarriage
-a woman may assume she is having a heavy period when she is actually experiencing a miscarriage
>Treatment: bedrest and emotional support
>if bleeding and/or abdominal pain are excessive; contact primary health provider and report to ED
66
Spontaneous abortion
termination of pregnancy by natural causes before 20 weeks gestation
67
Danger Signs of First Trimester: Infection
-chills, fever, malaise, and anorexia
-burning on urination may = UTI; treated with antibiotics
-Education;: use white, unscented toilet paper; avoid bubble baths or addition of additives" in the bath; wear underwear with cotton crotches; drink 8 to 12 glasses of liquid each day; urinate before going to bed and after sexual intercourse
>diarrhea may indicate GI infection; antibiotics if bacterial in origin
68
Danger Signs In the Second Trimester
- Maternal Complications (preeclampsia, premature rupture of membranes, and preterm labor)
- Fetal complications
69
Danger Signs In Second Trimester: Preeclampsia
increase in blood pressure (greater than or equal to 140 mm Hg systolic or greater than or equal to 90 mm Hg diastolic) on 2 occasions at least 4 hours apart after 20 weeks gestation accompanied by proteinuria
- Early S/S: headache, vision changes, elevated BP, and edema
- First intervention: Bedrest in effort to reduce BP
70
Danger Signs In Second Trimester: Premature Rupture of Membranes
rupture of the membranes before the onset of labor
-seek advice from healthcare provider if vaginal discharge is present
-although increased vaginal discharge is normal, the provider will determine if normal, associated with infection, or results from leakage of amniotic fluid
>if this happens, must be monitored for signs of infection
71
Danger Signs In Second Trimester: Preterm labor
presence of uterine contractions during second trimester may indicate preterm labor
-defined as regular uterine contractions and cervical dilation before the end of the 36th week of gestation
72
Danger Signs in Second Trimester: Fetal Complications
- decrease in fundal height may indicate intrauterine growth restriction
- increased fundal height suggestive of multiple gestation, fetal macrosomia, or hydramnios
- hypoxia from maternal hypertension, irregular or absent heart rate, preterm birth, infection from premature rupture of membranes, and absence of fetal movement after quickening
73
Intervention if the woman experiences absence of fetal movement?
drink 2 full glasses of water, rest on left side for 2 hours, and assess for fetal movements once again
>if fewer than 10 fetal movements are noted after liquid intake, notify provider
74
Danger Signs In the Third Trimester
- same problems that can occur in the second trimester in addition to gestational diabetes, hemorrhage; placenta previa, abruptio placentae
- fetal complications
75
Danger Signs In Third Trimester: Gestational Diabetes
a Glucose Challenge Test (Glucola Screening) is performed between 24 and 28 weeks of gestation and a positive test warrants further screening with a 3 hour oral glucose tolerance test (OGTT)
76
Danger Signs In Third Trimester: Placenta Previa
implantation of the placenta in the lower uterine segment, near or over the internal cervical os
-abnormal location can cause painless, bright red vaginal bleeding as the lower uterine segment stretches' and thins during the third trimester
>depending on placental location, may need to adhere to strict bedrest and a C-section birth my be necessary
77
Danger Signs In Third Trimester: Abruptio Placentae
or placental abruption, is the premature separation of a normally implanted placenta from the uterine wall
-results in hemorrhage between the uterine wall and the placenta, causing abdominal pain and vaginal bleeding
>hospitalization, bedrest, Trendelenburg position, IV fluids, and delivery
78
Danger Signs In Third Trimester: Fetal Complications
nonstress tests may be used to evaluate fetal-well being
-same as for second trimester:-decrease in fundal height may indicate intrauterine growth restriction
-increased fundal height suggestive of multiple gestation, fetal macrosomia, or hydramnios
-hypoxia from maternal hypertension, irregular or absent heart rate, preterm birth, infection from premature rupture of membranes, and absence of fetal movement after quickening
>hypoxia r/t poor placental perfusion may be more of a threat during this time
79
What is the goal or "heart" of the Lamaze Method
empowerment, recognizing the woman's innate ability to give birth, while finding strength and support from her family and the members of the healthcare team during the labor and birth process
- focuses on breathing techniques during labor and birth
- uses techniques that focus the woman on recognizing the signals of labor using controlled breathing and muscle relaxation to facilitate birth
80
Lamaze Approach to Birth
- birth is normal, natural, and healthy
- the experience of birth profoundly affects woman and their families
- woman's inner wisdom guides them through birth
- women's confidence and ability to give birth either enhanced or diminished by the care provider and place of birth
- woman have the right to give birth free from routine medical interventions
- birth can safely take place in homes, centers, and hospitals
- childbirth education empowers women to make informed choices in health care, to assume responsibility for their health, and to trust their inner wisdom
81
Bradley Method of Natural Childbirth
focus the woman on inward relaxation, by means of breathing control, abdominal breathing, and general relaxation
- teaches woman to breathe normally throughout the labor and birth process to maintain her state of relaxation and oxygenate the baby adequately
- uses "husband-coached childbirth"
82
Other Methods besides Lamaze and Bradley Method
- Dick-read
- HypnoBirthing
- LeBoyer Method
- Odent Method
- Birthing From Within
83
Finding Information on Childbirth Education
- begin with healthcare provider
| - Internet sources
84
When selectin childbirth education class, a woman should identify 4 of the following factors that are most important when choosing
- familiarize me with hospital routines
- prepare me for natural, nonmedical birth
- teach me breathing patterns and distracting techniques
- give my partner the skills necessary to be an active and informed labor coach
- teach us as parents to be childbirth consumers and to take responsibility for our childs birth
- follow current medical policies
- represent the most common type of childbirth education class in our area
- teach relaxation and natural breathing
- stress good nutrition and exercise
- discuss medication options without making value judgments
85
Doula
woman who is experienced in childbirth and provides physical and emotional support to the mother during the prenatal period, during labor, during birth, and during the postpartum period
86
Birth Plan Choices
- who she wants to be in the room (partner, friends, relatives, a doula, birthing coach, and children)
- personalize experience by wearing own clothes, listening to music, and taking picture or videotaping the birth
- fluid and food preferences noted
- desire for saline or heparin lock or a IV line
- intermittent monitoring or no monitoring at all unless emergency develops
- laboring and birthing position preferences
- strategies for pharmacological or nonpharmacological pain management; right to change and later her plan at any time
- partners involvement
- if vaginal birth, preference regarding episiotomy or medication to augment labor contractions
- like to hold baby immediately after birth?
- plan to breastfeed?
- infant feeding, rooming-in, and circumcision should be noted in birth plan
87
Summary Points
- preconception counseling empowers families to plan for pregnancy and develop healthy bodies and minds to optimize birth outcomes
- nurses and other health-care providers must collaboratively provide families with prenatal education and incorporate interventions for a holistic approach to pregnancy
- a balance diet and nutrition, exercise, work, and rest enhances the development of a healthy pregnancy
- to determine safety of use during pregnancy, all medications, including prescription, OTC, and herbal preparations must be carefully evaluated. Essential nurse obtain a comprehensive medical history during each prenatal visit
- ongoing prenatal education regarding pregnancy danger signs and symptoms and appropriate home interventions is key in reducing complications
- nurses can help to empower families by providing information about childbirth education programs and other community resources
- a holistic approach to a healthy pregnancy and birth includes all members of the family and the health-care team. Encouraging the family to develop a birth plan is an important step in helping create a positive, satisfying birthing experience
