Pregnancy and Child Birth Flashcards
How do we decide whether to have a child?
· must fully consider the impact of having a child
□ financial impact
□ child care responsibilities
□ change in lifestyle
□ child rearing (e.g. discipline, religion)
· maternal and paternal health
□ emotional, mental and physical
□ age of mother (35+ is a genetic pregnancy)
>35y associated with increased infertility, down syndrome
When can pregnancy occur?
· menstrual cycle - 28 days
· ovulation occurs on or around day 14
· sperm viable for up to a week
· ovum (female egg) capable of being fertilized to 48 hours
· pregnancy
day 6 - day 18
What are the signs of pregnancy?
presumptive, probable and positive
Presumptive signs of pregnancy?
□ missed period
□ morning sickness, fatigue
increase in size and tenderness of breasts
Probable signs of pregnancy?
□ increase in frequency of urination (embryo is near bladder)
□ increase in size of abdomen
positive pregnancy test (urinalysis)
Positive signs of pregnancy?
□ pregnancy test confirmed by blood test and pelvic exam
□ e.g. cervix softens by the sixth week
□ observation of fetus by ultrasound, fetal heartbeat (see at 5 weeks)
fetal movement - “quickening” - 16-25 weeks like gas in stomach, arm leg movement
What are home pregnancy tests?
· accuracy can be up to 99%
· urine: presence of human chorionic gonadotropin (HCG) - occurs at implantation (takes 7-8 days)
· errors usually involve false negatives
· test done too soon
check expiration dates and follow instructions carefully
Prenatal care- medical care early and throughout pregnancy?
- monitor health of mother and baby
○ e.g. weight gain, BP, size and position of baby- mother or fetus?
- early detection of fetal abnormalities
- Nutritional status, support system?
Prenatal care- Obstetrician, Family MD, Midwife, Nurse Practitioner present?
- complete medical history, clinical exam
- prenatal visits:
○ monthly to 28 weeks, bi-weekly to 36 weeks,
…weekly
- prenatal visits:
When should an Obstetrician, Family MD, Midwife, and Nurse Practitioner be present during prenatal care?
- Family MD – in normal situation
- Obstetrician – nowadays more common
- Nurse Practitioner – weighing new born baby, looking for body health state
- Partner should be visit commonly.
- Final week for preparation
What are the prenatal classes:
□ lifestyle behaviors - healthy pregnancy
□ Labor and delivery - making a birth plan
□ psychosocial issues
○ bonding, parenting
○ body image
○ Social support
Prenatal care- baby care?
· feeding, bathing, safety, growth & development
· equipment and supplies
- First time would be really helpful!
- Encourage the client to create a birth plan that is flexible
- Failure to progress? Have worst to prepare first, natural or surgical
Car seat should be implemented in car due to law
Prenatal care- Well-balanced diet?
- need for additional kcals, protein, iron, folate, essential fatty acids
* adequate calcium, vitamin D
* multi-vitamin (with Iron, folic acid) recommended
What are some benefits of a well-balanced diet during prenatal care?
- proper nutrition supports the developing fetus
* optimal maternal health - preparation for delivery
* appropriate weight gain (no dieting!)
○ 11-16 kgs (25-35 lbs) - 350-450 kcals
- Deficiency in vitamin D would be negative for permanented women
Weight gain could be flexible
Prenatal care- regular physical activity?
- aerobic, strength training, flexibility
- modifications in type, intensity, duration
○ avoid activities that risk balance, trauma, overheating
avoid exercises on back beyond 3rd month
- modifications in type, intensity, duration
What are the benefits of regular physical activity during prenatal care>
- assists with weight management
- reduces fatigue
- improves GI function
- eases delivery & recovery
- Kegel exercises - ¯ risk of urinary incontinence
Do regular exercise, adjust intensity
Kegel exercises – training on vagina’s strength to hold urinary incontinence
What are some risks factors associated with prenatal care?
Teratogenic effects: causing birth
* alcohol, drugs, toxic exposures, infectious diseases
avoid alcohol
* Fetal alcohol spectrum disorder
no smoking
* risk of miscarriage birth
* risk of premature delivery, low birth weight
* discuss all medications with health care provider
* limit caffeine. Not even 8oz cup
No hot tubs, saunas
Prenatal testing - screening?
- Blood tests: e.g. MMS
- pelvic ultrasound
○ high-frequency sound waves
□ Fetal size and position
can detect some fetal anomalies
- pelvic ultrasound
Prenatal testing - diagnostics?
- amniocentesis
○ needle draws amniotic fluid from amniotic sac
□ test for genetic abnormalities (e.g. Down Syndrome)- Chorionic villus sampling
○ sample of tissue from fetal sac
- Chorionic villus sampling
What occurs during fetal development?
- fertilization - outer 1/3 of fallopian tube
- zygote (fertilized egg): first 7 days
- blastocyst: 7-14 days
- embryo: 2-8 weeks
- fetus: 9th week to birth
- Embryo – facial feature
- Could be observe on prenatal women’s skin surface
20th weeks and beyond start to develop organs. Increase in body size, connect to placenta.
Pregnancy?
- gestation period is 40 weeks
- calculated from last menstrual period
- pregnancy is divided into 3 trimester
What happens during the first trimester of pregnancy?
- 1st trimester: few observable changes in mother
- may experience:
○ fatigue
○ frequent urination
○ Nausea and vomiting
○ breast tenderness - minimal weight gain
38 weeks since ovulation take out.
Morning sickness – crackers in the morning because of sodium
Nausea and vomiting are good signs here
- may experience:
What happens during the second trimester of pregnancy?
- noticeable changes in mother
○ Breast enlargement
morning sickness typically subsides
What happens during the third trimester of pregnancy?
- fatigue, frequent urination
Weight gain (significantly)
What are some complication in pregnancy?
- Ectopic pregnancy
- embryo implants outside uterus - usually fallopian tube
- Hyperemesis gravidarum
- excessive vomiting during pregnancy
- miscarriage - spontaneous abortion
- loss of fetus before viability
- Rh blood incompatibility
- Rh-negative mother, Rh-positive fetus
○ maternal antibodies destroy fetal RBC’s
- Rh-negative mother, Rh-positive fetus
- Women should be more accepted when they have miscarriage experience
· gestational diabetes- mother does not produce enough insulin to handle increased blood sugar of pregnancy
· premature labor: before 37 weeks, low weight of baby
- mother does not produce enough insulin to handle increased blood sugar of pregnancy
- premature rupture of membranes
- risk of infection
- stillbirth - baby born with no signs of life at or after 28 weeks’ gestation (WHO, 2015).
What is labor?
· may be preceded by mild irregular contractions
□ Braxton hicks - “false labor”
· baby often rotates and drops into the pelvic girdle before the onset of labor - known as “lightening” (one path of least resistance)
· labor for a primigravida (first pregnancy)
□ usually 12-16 hours (average)
- Precipitate labor
Repaid labor and delivery
What are the stages of labor and delivery?
- Effacement and Dilation of the cervix
- Delivery of the body - usually < 1 hour
- Delivery of the placenta (afterbirth )
- Effacement and Dilation of the cervix ?
□ thinning (effacement)
□ opening of the cervix to 10 cm. (dilation)
· Amniotic sac ruptures
□ spontaneously or artificially (pelvic exam using instrument) - hind water leak: little amniotic fluid
· gradual increasing in intensity, duration of contractions( regular 5 minutes part then go to the hospital)
· usually the longest phase
· final phase is transition
- baby prepares to enter birth canal
- Delivery of the body - usually < 1 hour?
· contractions are intense
□ baby moves through the birth canal
· baby is “crowning” when the top of the head is visible
□ usually presents head first
□ may be “breech” presentation
· Vernix - thick white substance that protects the skin
▪ Vernix is gone after a 38 week pregnancy
▪ Baby’s skin will be very dry
Sunnyside up position= harder delivery
- Delivery of the placenta (afterbirth )?
usually within 30 minutes
Fetal presentations?
cephalic: Path of least resistance 95% time or more
breech: Legs up, bottom down 1st time breech pregnancy is more complicated than C section
What are caesarean sections?
· C-section (could be from improper positioning)
□ surgical removal of the baby through an incision in the abdominal wall delivery through birth canal not optimal or possible:
□ Cephalopelvic disproportion (different in size of head and pelvis head too big for inner pelvis)
□ Placenta previa
- placenta partially or fully covers cervix
□ fetal distress
- e.g. prolapsed cord or cord compression
□ placenta abruption
- premature separation of the placenta
□ the mother or baby’s health is at risk for any other reason
Classical incision - for fast delivery (up and down)
What are some drugs in labor and delivery?
· Drug free labor and delivery - “natural childbirth”
□ Physical activity, positioning
□ massage, breathing techniques
· Pain management options:
□ regional anesthesia - epidural (freezes from the waist down, freezing around muscle in abdominal floor)
□ local anesthesia
□ general anesthesia
□ pain medications
act systemically (could be transferred to baby)
What occurs during postpartum?
· “postpartum”- period of time following delivery
□ begins in recovery room (as soon as baby is born)
□ Breast feeding initiated early (day 3)
□ bonding of mother and baby (baby nursing releases oxytocin to help contraction of uterus)
□ first 2-3 days colostrum - rich in antibodies (immunological boost)
· first 4-6 weeks:
□ family bonding, routine
mixed emotions, fatigue
What is infertility and what are causes?
· usual causes:
□ irregular ovulation (not monthly 128 day cycle), blocked fallopian tubes, hormone imbalance (woman)
□ low sperm count, low sperm motility (not fast enough) (man)
10% of infertility cases have no known cause (idiopathic)
What are infertility treatments for female and male?
· female:
□ hormone therapy to regular ovulation
□ cycle monitoring
□ surgical procedures to clear blocked fallopian tubes
· male: testicles are too warm boxer shorts and periodic cold packs
What are some alternative insemination?
· sperm is deposited near the cervical opening or intrauterine
· Invitro fertilization (IVF) and embryo transfer
· own sperm and eggs, donated sperm or eggs
· e.g. medical reasons, single, same sex couple
· use of surrogate
· inability to conceive or carry to term
· male same sex couple
Other Options?
adoption, foster, parenting
What makes a responsible parent?
· what kids need from parents
□ unconditional love
□ to feel safe and secure
□ active interest, involvement & encouragement
□ firm rules, boundaries and expectations
□ to make age appropriate decisions
□ experience the consequences
respect
authoritative parenting: active interest, involvement & encouragement, and firm rules, boundaries and expectations
