Chapter 11 Maternal Adaptation During Nursing Flashcards
Pregnancy
A dynamic & precisely coordinated process involving systemic & local changes in the mother that support the supply of oxygen & nutrients to the growing fetus in utero & in subsequent lactation
Lasts ~280 days (40 weeks)
Key Fertilization Basics
Fertilization usually occurs in the outer third of the fallopian tube (ampulla)
Ovum is receptive to fertilization for 24-48 hours after release from ovary
Sperm are viable for 24-72 hours after ejaculation
Once a sperm has penetrated the ovum, further sperm penetration is prohibited
Zygote: Fertilized ovum will begin cell division
Between 6-10 days the blastocyst will implant to the endometrium
Gestation
The length of time between conception and birth during which a fertilized ovum matures and grows in the female’s uterus
Gestational Age
Age of the pregnancy from the last normal menstrual period (LMP)
- Most references to pregnancy are usually in gestational age rather than fetal age
Fetal Age
Actual age of the growing baby
Factors that Determine the Success of Pregnancy
1) Fertilization & successful implantation of the developing embryo into the endometrium
2) Development & function of the placenta
3) Adaptation of the maternal physiology to accept the fetal allograft & satisfy its nutritional, metabolic, & physical demands
4) Appropriate growth and functional development of organs & homeostatic systems in the fetus
5) Proper timing of the birth so the fetus is mature enough to survive outside of the uterus
What is a pregnancy divided into?
Trimesters
How long does each trimester last?
Each trimester lasts 13 weeks
W/in each trimester, numerous adaptations take place that facilitate the growth of the fetus
What types of groups have the signs/symptoms of pregnancy been arranged into?
Presumptive, probable, & positive
Presumptive (Subjective) Signs
Signs that the mother can perceive
Most obvious presumptive sign: Absence of menstruation
- Skipping a period is not a reliable sign by itself; however, if it is accompanied w/ consistent nausea, fatigue, breast tenderness, & urinary frequency it may be likely
LEAST reliable indicators of pregnancy
- Any one of them can be caused by something other than pregnancy
Ex) Amenorrhea can also be caused by early menopause, endocrine dysfunction, malnutrition,..
Probable (Objective) Signs
Signs of pregnancy that can be detected on physical examination by a health care provider
Common probable signs include:
- Hegar Sign: Softening of the lower uterine segment or isthmus
- Goodell Sign: Softening of the cervix
- Chadwick Sign: Bluish-purple coloration of the vaginal mucosa & cervix
Other probable signs include:
- Changes in size & shape of the uterus
- Abdominal enlargement
- Braxton Hicks contractions
- Ballottement: Provider pushes against the woman’s cervix & feels rebound from the fetus
Elevation of hCG corresponds to the morning sickness period of ~6-12 weeks of pregnancy
Although they are more reliable than presumptive signs, they are still NOT 100% ACCURATE!!!!
Pregnancy Tests
Also considered to be a probable sign of pregnancy
In-home testing became available in 1977
- Appealing to the general public due to convenience, cost, & confidentiality
Vary in sensitivity, specificity, & accuracy
Influenced by length of gestation, specimen concentration, presence of blood, & presence of some drugs
- Human chorionic gonadotropin (hCG) is detectable in a serum of ~5% of clients 8 days after conception & in more than 98% of of clients by day 11
Most claim 99% accuracy (misleading-> has no bearing on the ability of at-home pregnancy tests to detect early pregnancy)
Human Chorionic Gonadotropin (hCG)
Glycoprotein & earliest biochemical marker of pregnancy
hCG level < 5 mIU/mL: Negative
Any hCG level > 25 mIU/mL: Positive
hCG levels in normal pregnancy usually double every 48 -72hrs until they peak ~60-70 days after fertilization
- At this point, they decrease to a plateau at 100-130 days of pregnancy
hCG doubling time is used as a marker by clinicians to differentiate normal from abnormal gestations
- Low levels are associated w/ ectopic pregnancies
- Higher than normal levels may indicate molar pregnancy or multiple-gestational pregnancies
Positive Signs
Confirm that a fetus is growing in the uterus
Include:
- Visualizing a fetus via ultrasound
- Palpating for fetal movements
- Hearing a fetal heartbeat
* All signs that make pregnancy a certainty*
If a pregnancy test is (+), a clinical visit SHOULD include an estimation of gestational age so, appropriate counseling can be given
- Should also receive info on normal signs & symptoms of early pregnancy
- Instructed to report any concerns to the provider for further evaluation
- Prenatal visits will be set-up throughout the duration of the pregnancy
What are the only signs that can determine a pregnancy w/ 100% accuracy?
Positive signs
What does the elevation of hCG correspond to?
Morning sickness period of ~6–12 weeks of pregnancy
Reproductive Adaptations During Pregnancy: Uterus
Decrease in uterine vascular and muscle tone
Grows at a steady & predictable rate during pregnancy
- Uterus is normally pear-shaped, the uterus will expand more in length than width-> globe shape
-> Exits the pelvis by 12 weeks gestation
-> Walls thin to 1.5 cm or less
Estrogen stimulates uterine growth-> increases in size, weight, length, width, depth, volume, & overall capacity
- Weight: Increases from 70g to ~1,100-1,200g at term
- Capacity: Increases from 10-5,000 mL or more at term
Uterine growth occurs as a result of both hyperplasia & hypertrophy of myometrium cells (increase in size)
- Major component of myometrial growth occurs after mid-gestation due to smooth muscle hypertrophy via mechanical switch from the fetus
Reproductive Adaptations During Pregnancy: Uterine Blood Flow
Increase in blood flow -> blood vessels elongate, enlarge, dilate & sprout new branches to support and nourish growing tissue
As pregnancy progresses, 80-90% of blood flow is directed to the placenta & remainder is distributed between the endometrium & myometrium
Diameter of the main uterine artery ~2X in size
- Enlargement from a narrow to large-caliber vessel enhances the capacity of the uteroplacental vessels to accommodate the increased blood volume needed to supply the placents
Reproductive Adaptations During Pregnancy: Uterine Contractility
Uterine contractility is enhanced as well
Braxton-Hicks begin during the 1st trimester of pregnancy
- Continue throughout the pregnancy and become more noticeable during the last month
- Function: To thin out or efface the cervix before birth
Braxton-Hicks
Spontaneous, irregular, & painless contractions
Begin during the 1st trimester
- Continue throughout pregnancy, become more noticeable during last month-> Thin out or efface the cervix
Reproductive Adaptations During Pregnancy: The Impact of Uterine Changes on the Bladder
Lower portion of the uterus (isthmus) does NOT undergo hypertrophy & becomes increasingly thinner as pregnancy progresses-> forms the lower uterine segment
- Occur during the first 6-8 weeks gestation-> produces most of of the signs (includes Hegar’s sign)
Softening & compressibility of the lower uterine segments results in exaggerated uterine anteflexion during early months of pregnancy
- Adds to urinary frequency by placing pressure on the bladder
Uterus remains in the pelvis in the 1st 3 months of pregnancy, then ascends into the abdomen
- As uterus grows, puts pressure on the bladder
Reproductive Adaptations During Pregnancy: Uterine Ascension
Uterus remains in pelvic cavity for the 1st 3 months of pregnancy-> progressively ascends into the abdomen
The heavy gravid uterus in the last trimester can fall back on the inferior vena cava in supine position
- Causes vena cava compression-> reduces venous pressure, CO, & BP, increases orthostatic stress
-> May experience lightheadedness when changing position from sitting to standing
Hypotensive Syndrome
- These changes may be reversed in the side-lying position: displaces the uterus to the left and off the vena cava
- Do not lay on the back!!! (Side-lying or w/pillow)
Hypotensive Syndrome
Causes a woman to experience symptoms of weakness, lightheadedness, nausea, dizziness, or syncope
(T/F) True or False: It is fine for a pregnant mother to lie in supine position.
FALSE!!
This can cause further compression on the inferior vena cava-> cutting off blood flow
Reproductive Adaptations During Pregnancy: Fundus
Uterus becomes ovoid as length increases over width
By 20 weeks, fundus is at the level of the umbilicus & measures 20 cm
Can usually be correlated w/ gestational weeks, most accurately between 8-12 weeks
- Obesity, hydramnios, & uterine fibroids interfere w/accuracy
Reaches the highest level at xiphoid process around the 36-week mark
- Breathing becomes difficult since its pushing against the diaphragm
Between 38-40 weeks, the fundal height drops as baby begins to descend & engage into the pelvis
- Breathing becomes easier from descent
- Pressure on the bladder increases-> urinary frequency
Fundus
The top of the uterus
Lightening
The fetal head begins to descend & engage into the pelvis
Occurs by the 40 week mark
- In women w/1st pregnancy, occurs ~2 weeks before onset of labor
- In women w/ subsequent pregnancy, occurs at the onset of labor
Reproductive Adaptations During Pregnancy: Cervix
Between weeks 6-8, cervix begins to soften due to vasocongestion & influence of estrogen (Goodell’s sign)
Endocervical glands increase in size & number & produces more cervical mucus
Under progesterone influence: Thick mucus plug is formed & blocks the cervical os & protects opening from bacterial invasion
Increased vascularization occurs at the same time-> bluish-purple coloration of the cervix (Chadwick’s sign)
Cervical ripening occurs ~4 weeks before birth
Connective tissue change elasticity & strength to prep for birth
Cervical Ripening
Softening, effacement, & increased distensibility
Cervical Effacement
The thinning & shortening of the cervix
Reproductive Adaptations During Pregnancy: Vagina
Vascularity increases due to estrogen-> pelvic congestion & vaginal hypertrophy
- Prep for distentsion needed for birth
Vaginal mucosa thickens, connective tissue begins to loosen, smooth muscle begins to hypertrophy & vaginal vault begins to lengthen
Secretions tend to become more acidic, white, & thick
Leukorrhea: Increase in vaginal whitish discharge
- Normal, except when accompanied w/itching-> Candida albicans (monilial vaginitis)
- Can be passed from mother-> baby (oral thrush)
-> White patches on mucous membranes of mouth
Treatment: Local antifungal agents
Reproductive Adaptations During Pregnancy: Ovaries
Increased blood supply to ovaries-> Enlarge until, ~12-14th week of gestation
- Cannot be palpated after due to the uterus filling up the pelvic cavity
Ovulation ceases: Elevated estrogen & progesterone block follicle-stimulating hormone (FSH) & luteinizing hormone (LH)
Ovaries in charge of hormone production until, week 6-7
- Corpus luteum regresses & placenta takes over hormone production
Reproductive Adaptations During Pregnancy: Breasts
Increase fullness, become tender & enlarged throughout pregnancy via estrogen & progesterone
Become highly vascular (veins are seen under the skin)
Nipples become larger & more erect
- Both nipples & areola are deeply pigmented
Tubercles of Montgomery (sebaceous glands) become more prominent-> keeps nipples lubricated for breast feeding
Stretch marks appear due to changes in connective tissue
- Initially pink-purple lines on the skin but, gradually change to silver (never fade away)
Produce colostrum: Creamy yellowish fluid that produces nutrients for the baby
General Body System Adaptations During Pregnancy: GI System
Mouth & Pharynx: Gums become hyperemic, swollen, & friable. Tend to bleed easily & saliva production increases
Esophagus: Decreased lower esophageal sphincter pressure and tone, which increases the risk of developing heartburn.
Stomach: Decreased tone and mobility with delayed gastric emptying time, which increases the risk of gastroesophageal reflux and vomiting.
-Decreased gastric acidity and histamine output, which improves symptoms of peptic ulcer disease.
Intestines: Decreased intestinal tone motility with increased transit time, which increases risk of constipation and flatulence.
Gallbladder: Decreased tone and motility, which may increase risk of gallstone formation.
Ptyalism
Excessive salivation
May be caused a decrease in unconscious swallowing by the woman when nauseated
Typically resolves spontaneously but, can remain in some women throughout pregnancy
Temporary relief via chewing on gum or sucking on hard candies
Risk of Gingivitis
Dental plaque, calculus, and debris deposits increase during pregnancy
Vascular permeability and possible tissue edema are both increased
It is reported that as many as 50% to 70% of pregnant women will have some level of gingivitis during pregnancy as a result of hormonal changes that promote inflammation
Previous studies linked periodontal disease with:
- Preterm birth
- Preeclampsia
- Low-birth-weight risk
- Stillbirth
- Early-onset neonatal sepsis
General Body System Adaptations During Pregnancy: Cardiovascular System
Blood volume: Marked increase in plasma (50%) and RBCs (25–33%) compared to nonpregnant values.
-Causes: hemodilution AEB a lower hematocrit and hemoglobin.
CO and HR: CO increases from 30% ->50% over the nonpregnant rate by the 32nd week of pregnancy.
-Associated w/ an increase in venous return and greater right ventricular output, especially in the left lateral position.
- HR increases by 10–15 bpm between 14 and 20 weeks’ gestation, and this increase will persist to term.
BP: Diastolic pressure decreases typically 10–15 mm Hg to reach its lowest point by mid-pregnancy
- Then gradually returns to nonpregnant baseline values by term.
Blood components: The number of RBCs increases throughout pregnancy to a level 25–33% higher than nonpregnant values.
Both fibrin and plasma fibrinogen levels increase, along with various blood clotting factors-> make pregnancy a hypercoagulable state.
Interventions to Reduce the Risk of Developing Varicosities
Elevating both legs when sitting or lying down
Avoiding prolonged standing or sitting; changing position frequently
Resting in the left lateral position
Walking daily for exercise
Avoiding tight clothing or knee-high hosiery
Wearing support hose if varicosities are a preexisting condition to pregnancy
General Body System Adaptations During Pregnancy: Respiratory System
Enlargement of the uterus shifts the diaphragm up to 4 cm above its usual position.
As muscles and cartilage in the thoracic region relax, the chest broadens w/ conversion from abdominal breathing to thoracic breathing.
-This leads to a 50% increase in air volume per minute.
Tidal volume (or the volume of air inhaled) increases gradually by 30–40% (from 500 to 700 mL) as the pregnancy progresses
General Body System Adaptations During Pregnancy: Renal/Urinary System
The renal pelvis becomes dilated. The ureters (especially RT ureter) elongate, widen, and become more curved above the pelvic rim.
Bladder tone decreases and bladder capacity doubles by term.
Glomerular filtration rate increases 40–60% during pregnancy.
Blood flow to the kidneys increases by 50–80% as a result of the increase in CO
General Body System Adaptations During Pregnancy: Musculoskeletal System
Distention of the abdomen with growth of the fetus tilts the pelvis forward, shifting the center of gravity.
-Compensates by developing an increased curvature (lordosis) of the spine.
Relaxation and increased mobility of joints occur due to the hormones progesterone and relaxin
- Lead to the characteristic “waddle gait” that pregnant women demonstrate toward term
General Body System Adaptations During Pregnancy: Integumentary System
Hyperpigmentation of the skin is the most common alteration during pregnancy
-Most common areas include: the areola, genital skin, axilla, inner aspects of the thighs, and linea nigra.
Striae gravidarum(or stretch marks) are irregular reddish streaks that may appear on the abdomen, breasts, and buttocks in about half of pregnant women.
The skin in the middle of the abdomen may develop a pigmented line called the linea nigra, which extends from the umbilicus to the pubic area.
Melasma (“mask of pregnancy”) occurs in up to 70% of pregnant women. It is characterized by irregular, blotchy areas of pigmentation on the face, most commonly on the cheeks, chin, and nose.
Linea Nigra
A dark line that develops on the abdomen during pregnancy
-Usually extends from the umbilicus to the pubic area
Caused by an increase in hormones and fades once the baby is born
Melasma
AKA “Mask of Pregnancy”
A skin condition that causes patches and spots, usually on the face, which are darker than natural skin tone
- Commonly on cheeks, chin, & nose
General Body System Adaptations During Pregnancy: Endocrine System
Controls the integrity and duration of gestation by maintaining the corpus luteum via hCG secretion; production of estrogen, progesterone, hPL, and other hormones and growth factors via the placenta
Release of oxytocin (by the posterior pituitary gland), prolactin (by the anterior pituitary), and relaxin (by the ovary, uterus, and placenta).
Human Chorionic Gonadotropin (hCG)
Responsible for maintaining the maternal corpus luteum, which secretes progesterone and estrogens with synthesis occurring before implantation
Production by fetal trophoblast cells until the placenta is developed sufficiently to take over that function
Basis for early pregnancy tests because it appears in the maternal bloodstream soon after implantation
Production peaks at 8 weeks and then gradually declines
Human Chorionic Somatomammotropin (hCS)
Preparation of mammary glands for lactation and involved in the process of making glucose available for fetal growth by altering maternal carbohydrate, fat, and protein metabolism
Antagonist of insulin: Decreases tissue sensitivity or alters the ability to use insulin
Increase in the amount of circulating free fatty acids for maternal metabolic needs and decrease in maternal metabolism of glucose to facilitate fetal growth
Relaxin
Secretion by the placenta as well as the corpus luteum during pregnancy
Thought to act synergistically with progesterone to maintain pregnancy
Increase in flexibility of the pubic symphysis, permitting the pelvis to expand during delivery
Dilation of the cervix, making it easier for the fetus to enter the vaginal canal; thought to suppress the release of oxytocin by the hypothalamus, thus delaying the onset of labor contractions
Progesterone
AKA “Hormone of Pregnancy” because of the critical role it plays in supporting the endometrium of the uterus
Supports the endometrium to provide an environment conducive to fetal survival
Produced by the corpus luteum during the first few weeks of pregnancy and then by the placenta until term
Initially, causes thickening of the uterine lining in anticipation of implantation of the fertilized ovum;
- Then, it maintains the endometrium, inhibits uterine contractility, and assists in the development of the breasts for lactation
Estrogen
Promotes enlargement of the genitals, uterus, and breasts, and increases vascularity, causing vasodilatation
Relaxation of pelvic ligaments and joints
Associated with hyperpigmentation, vascular changes in the skin, increased activity of the salivary glands, and hyperemia of the gums and nasal mucous membranes
Aids in developing the ductal system of the breasts in preparation for lactation
Thyroid Gland Adaptations
Enlarges slightly & becomes more active during pregnancy as a result of increased vascularity & hyperplasia
Increased gland activity-> increase in thyroid hormone secretion during the 1st trimester
- Levels taper off w/in a few weeks & return back w/in normal limits after birth
Critical for fetal brain development, neurogenesis, & organizational processes prior to 20 weeks (low levels)
Pancreas Maternal Adaptations
Ideally hormonal changes of pregnancy help meet fetal needs w/out putting the mother’s metabolism out of balance
Women’s insulin needs work on supply vs demand
- As demand to meet the pregnancy’s demands-> more insulin is produced
Maternal insulin does NOT cross the placenta
- Fetus must produce their own supply to maintain glucose control
During 1st trimester of pregnancy most of the glucose in the mother’s body is diverted to the growing fetus-> glucose levels are low
Human placental lactogen & other antagonists increase during 2nd half of pregnancy
Adrenal Gland Maternal Adaptations
Rate of cortisol secretion is NOT increased in pregnancy-> cortisol clearance is decreased
Cortisol increases in response to increase in estrogen levels
- Returns to normal levels w/in 6 weeks postpartum
Functions of Cortisol During Pregnancy:
- Helps keep up the level of glucose in the plasma by breaking down noncarbohydrate sources, such as amino and fatty acids, to make glycogen.
- Glycogen, stored in the liver, is easily broken down to glucose when needed so that glucose is available in times of stress.
Breaks down proteins to repair tissues and manufacture enzymes. has antiinsulin, antiinflammatory, and antiallergic actions
Needed to make the precursors of adrenaline, which the adrenal medulla produces and secretes
General Body System Adaptations During Pregnancy: Immune System
A general enhancement of innate immunity (inflammatory response and phagocytosis) and suppression of adaptive immunity (protective response to a specific foreign antigen) take place during pregnancy.
-Help prevent the mother’s immune system from rejecting the fetus (foreign body)
- Increase her risk of developing certain infections
and influence the course of chronic disorders such as autoimmune diseases.
What pregnancy outcomes are associated w/ inadequate nutritional intake?
Preterm birth, low birth weight, & congenital anomalies
What pregnancy outcomes are associated w/ excessive nutritional intake?
Macrosomia -> lead to a difficult birth, neonatal hypoglycemia, continued obesity in the mother, child has risk for childhood obesity accompanied w/ metabolic syndrome
What prescription acts as safeguard against less-than-optimal diets?
Prenatal vitamins
Iron and folic acid are needed to…
…form new RBCs for expanded maternal blood volume & prevent anemia
Dietary Reference Intakes (DRIs)
27 mg of ferrous iron & 400-800 mcg of folic acid per day
Nutritional Guidelines for Pregnant Women
Increase consumption of fruits and vegetables, taking up half the plate with these.
Replace saturated fats with unsaturated ones.
Eat breakfast every day.
Choose whole grains in place of refined grains.
Choose foods with a lot of fiber to prevent constipation.
Avoid hydrogenated or partially hydrogenated fats.
Do not consume any alcoholic beverages.
Limit calories from added sugars and saturated fats.
Use reduced-fat spreads and dairy products instead of full-fat ones.
Eat at least two servings of fish weekly, with one of them being an oily fish.
Consume at least 3 qt of water daily
Good Food Sources of Folic Acid
Includes dark green vegetables, such as broccoli, romaine lettuce, and spinach; baked beans; black-eyed peas; citrus fruits; peanuts; and liver
Consumption of Fish
Avoid consumption of fish with moderate to high mercury levels (e.g., for 6 to 12 months prior to conception and throughout pregnancy).
Avoid eating shark, swordfish, king mackerel, orange roughy, ahi tuna, and tilefish because they are high in mercury levels.
Eat up to 12 oz (two average meals) weekly of fish known to have low mercury levels, such as shrimp, canned light tuna, salmon, lobster, sole, tilapia, cod, haddock, pollock, and catfish.
Check local advisories about the safety of fish caught by family and friends in local lakes, rivers, and coastal areas
Underweight Pregnancy BMI
BMI: Less than 18.5
Total Weight Gain Range: 28-40 lbs
Normal Weight Pregnancy BMI
BMI: 18.5–24.9
Total Weight Gain Range: 25–35 lbs
Overweight Pregnancy BMI
BMI: 25-29.9
Total Weight Gain Range: 15–25 lbs
Obese Pregnancy BMI
BMI: 30 or higher
Total Weight Gain Range: 11–20 lbs
Pica
A term used to describe the intense craving for and eating of nonfood items over a period of time of at least 1 month
Geophagia
Consume soil or clay
Nutritional Implications: Replaces nutritive sources & causes iron-deficiency
- Clay: Produces constipation, can contain toxic substances & cause parasitic infection
Pagophagia
Consume ice
Nutritional Implications: Can cause iron-deficiency anemia, tooth fractures, & freezer burn injuries
Amylophagia
Consume laundry starch
Nutritional Implications: Replaces iron-rich foods, leads to iron deficiencies, and replaces protein metabolism, thus depriving the fetus of amino acids needed for proper development
What usually precedes pica?
Anemia
What are the most common maternal responses that are evoked during pregnancy?
Ambivalence
Introversion
Acceptance
Mood Swings
Changes in Body Image
Ambivalence
Having conflicting emotions at the same time
Ex) Woman who planned to get pregnant gets pregnant-> happy and nervous at the same time
Mostly common in the 1st trimester
- Usually evolves into acceptance in the 2nd trimester where fetal movements are perceived
Introversion
Focusing on one’s self
Common during early part of pregnancy
- Woman may withdraw & become intensely occupied w/ herself & her fetus
- Also may come up again during the 3rd trimester
To ensure a safe environment for both mother & child
Acceptance
During the second trimester, the physical changes of the growing fetus, including an enlarging abdomen and fetal movement, bring a sense of reality and validity to the pregnancy
Able to differentiate herself from the growing fetus
- Different sleep & wake cycles
Reva Rubin’s “Becoming a Mother Tasks”
Ensuring safe passage throughout pregnancy & birth
- Primary focus of the woman’s attention
- First trimester: woman focuses on herself, not on the fetus
- Second trimester: woman develops attachment of great value to her fetus
- Third trimester: woman has concern for herself and her fetus as a unit
- Participation in positive self-care activities related to diet, exercise, and overall well-being
Seeking acceptance of infant by others
- First trimester: acceptance of pregnancy by herself and others
- Second trimester: family needs to relate to the fetus as member
- Third trimester: unconditional acceptance without rejection
Seeking acceptance of self in maternal role to infant (“binding in”)
- First trimester: mother accepts idea of pregnancy, but not of infant
- Second trimester: with sensation of fetal movement (quickening), mother acknowledges fetus as a separate entity within her
- Third trimester: mother longs to hold infant and becomes tired of being pregnant
Learning to give of oneself
- First trimester: identifies what must be given up to assume new role
- Second trimester: identifies with infant, learns how to delay own desires
- Third trimester: questions her ability to become a good mother to infant
Sexual Desire & Pregnancy
1st Trimester: The woman may be less interested in sex because of fatigue, nausea, and fear of disturbing the early embryonic development
2nd Trimester: her interest may increase because of the stability of the pregnancy.
3rd Trimester: her enlarging size may produce discomfort during sexual activity
Potential Complications of Sex During Pregnancy
Includes: preterm labor, pelvic inflammatory disease, antepartum hemorrhage in placenta previa, and venous air embolism
Generally, sexual relations are considered safe in pregnancy
- Abstinence ONLY for women who are at risk for preterm labor or for antepartum hemorrhage because of placenta previa
Alternative Non-Coital Sexual Expression
Cuddling, caressing, & holding
