Pamantasan ng Lungsod ng Maynila

Muralla st. Cor. Intramuros, Manila

College of Nursing

MATERNAL AND CHILD HEALTH NURSING I

A written report

Prepared by:
Padera, Franz Angel
Padora, Allan Marco
Pagasian, Shee Ann Mae
Pineda, Mariah Corinne
Quimson, Ellyse Anne H.
BSN 2-5

September 6, 2019

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

A. NORMAL ADAPTATIONS IN PREGNANCY

Pregnancy brings both physiological and psychological changes to a woman and her partner.
Physiological changes of pregnancy occur gradually but eventually affect all organ systems of a
woman’s body. These changes are necessary to allow a woman to be able to provide oxygen and
nutrients for her growing fetus, as well as extra nutrients for her own increased metabolism.
Physiological changes occur in response not only to the physiologic alterations but also to the
responsibility associated with welcoming a new and completely dependent person to the family.

1. PHYSIOLOGICAL CHANGES IN PREGNANCY

The Diagnosis of Pregnancy

The medical diagnosis of pregnancy serves to date when the birth will occur and also helps predict
the existence of a high-risk status. If a pregnancy was planned, the diagnosis produces a feeling
of intense fulfillment and achievement. If it was not planned or not desired, it can result in an
equally extreme crisis state.

● Presumptive Signs of Pregnancy

- Subjective
- least indicative
- taken as single entities
- they could easily indicate other conditions
- cannot be documented by an examiner
- discussed in connection with the body system
in which they occur.

● Probable Signs of Pregnancy

- objective
- can be documented by an examiner

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

- still are not positive or true diagnostic findings

- discussed in connection with the body system
in which they occur.

Laboratory Tests
- based on detecting the presence of human chorionic gonadotropin (hCG),
- Accurate around all laboratory tests for pregnancy are accurate in only 95% to 98%
- tests are performed by radioimmunoassay (RIA), enzyme- linked immunosorbent assay
(ELISA), or radioreceptor assay (RRA) techniques.
- hCG is measured in international units.
- In the nonpregnant woman, no units are detectable because there are no trophoblast cells
producing hCG.
- Pregnant woman:
● 24-48 hrs= trace amounts of hCG appear in the serum
● 7-9 days= reach a measurable level (about 50 mIU/mL)
● 60th-80th day= peak at about 100 mIU/mL
● After that point, the concentration of hCG declines again so that, at term, it is barely
detectable in serum or urine.
- blood serum tests give earlier results than urine tests.
Home Pregnancy Tests
- based on immunologic reactions are available over the counter.
- About 97% accuracy, very convenient(3-5 mins) & (waiting for a health care appointment
to have a pregnancy confirmed can be an anxious, stressful time for many women.)
- a woman dips a reagent strip into her stream of urine. A color change on the strip denotes
pregnancy. Home tests can detect as little as 35 mIU/mL of hCG.
- Advise any woman who thinks she might be pregnant but gets a negative result from a
home pregnancy test to repeat the test 1 week later if she is still experiencing amenorrhea.
If symptoms persist after two tests, she needs to see a health care provider as she might
have a condition such as an ovarian tumor causing the amenorrhea
● False-Positives (women taking)
- drugs (e.g., antianxiety agents)
- oral contraceptives(such a test to be accurate, oral contraceptives should
have been discontinued 5 days before the test.)
- Proteinuria
- postmenopausal
- hyperthyroid disease

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

∴ In the past, one of the chief reasons women sought early prenatal care was to obtain an official
diagnosis of pregnancy. Now that women can diagnose their pregnancies at home by means of a
test kit, they may not seek prenatal care until something seems to be wrong with the pregnancy or
until they are so far along they feel they should do something about arranging medical coverage
for the birth

● Positive Signs of Pregnancy

Demonstration of a Fetal Heart Separate From the Mother’s Heart

- fetal heart can be shown to be beating on ultrasound as early as the sixth to seventh week
of pregnancy.
- Ultrasonic monitoring systems that convert ultrasonic frequencies to audible frequencies
(Doppler technique) can detect fetal heart sounds as early as the 10th to 12th week of
gestation.
- Echocardiography can demonstrate a heartbeat as early as 5 weeks.
- audible by auscultation of the abdomen with an ordinary stethoscope only at about 18 to
20 weeks of pregnancy. (although started beating at 24th day)
- Hard to hear if:
● a woman’s abdomen has a great deal of subcutaneous fat
● larger than normal amount of amniotic fluid is present
(hydramnios).

- Heard best when

● position of the fetus is determined by palpation and the stethoscope is placed over
the area of the fetus’s back.
- Fetal Heart Rate= 120-160 bpm
Fetal Movements Felt by an Examiner
- may be felt by a woman as early as 16 to 20 weeks of pregnancy.
- Those felt by an objective examiner are considered much more reliable because a woman
could mistake the movement of gas through her intestines for fetal movement.
- Fetal movements can be felt by an examiner at the 20th to 24th week of pregnancy unless
a woman is extremely obese.

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

Visualization of Fetus by Ultrasound

- High-frequency sound waves projected toward a woman’s abdomen
- If a woman is pregnant, a characteristic ring, indicating the gestational sac, will be revealed
on an oscilloscope screen as early as the fourth to sixth week of pregnancy.
- This method also gives information about the site of implantation and whether a multiple
pregnancy exists.
- At the eighth week, a fetal outline can be seen so clearly within the sac that the crown-to-
rump length can be measured to establish the gestational age of the pregnancy.
● Seeing the fetal outline on an ultrasound is clear proof for a couple that a woman is
pregnant if they had any doubt up to that point.

Physiologic changes that occur during pregnancy

-can be categorized as
● local (confined to the reproductive organs) or
● systemic (affecting the entire body).
- Signs & Symptoms of the physiologic changes of pregnancy are used to diagnose and mark
the progress of pregnancy.
REPRODUCTIVE SYSTEM CHANGES
Involves uterus, ovaries, vagina, and breasts.

● Uterine Changes
- increase in the size of the uterus to accommodate the growing fetus LENGTH= from 6.5
to 32 cm
DEPTH=from 2.5 to 22cm
WIDTH= from 4 to 24cm
WEIGHT= from 50 to 1000g ,

THICKNESS=Wall thickens in early pregnancy ( 1 cm to 2cm); thins late in pregnancy

to become flexible (0.5 cm)

VOLUME- from 2 mL to more than 1000 mL.; can hold a 7-lb (3175-g) fetus plus 1000
mL of amniotic fluid for a total of about 4000 g at term.

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

- formation of a few new muscle fibers in the uterine myometrium but principally to the
stretching of existing muscle fibers
● By the end of pregnancy; muscle fibers in the uterus have become two to seven
times longer
● Formation of extra fibroelastic tissue between fibers= reason why uterus can
withstand this stretching of its muscle fibers
● uterus is able to return to its prepregnant state at the end of the pregnancy with little
difficulty and almost no destruction of tissue (because it only stretches)

- Assessing uterine growth its constant, steady, predictable increase in size.

● End of 12th week= uterus is large enough to be palpated as a firm globe under the
abdominal wall, just above the symphysis pubis
● 20th or 22nd week = level of the umbilicus.
● 36th week= reach xiphoid
process and can make breathing
difficult

- Lightening(woman’s breathing is so
much easier it seems to lighten a
woman’s load)= About 2 weeks before
term (the 38th week) for a
primigravida, the fetal head settles into
the pelvis to prepare for birth, and the
uterus returns to the height it was at 36
weeks; multipara= unpredictable, some
in labor

- Changes in fundal height. Uterine height

is measured from the top of the symphysis pubis to over the top of the uterine fundus
(Neilson, 2009).

- As the uterus increases in size, it pushes the intestines to the sides of the abdomen, elevates
the diaphragm and liver, compresses the stomach, and puts pressure on the bladder.
- Uterine blood flow increases during pregnancy as the placenta grows and requires more
and more blood for perfusion.

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

● Toward the end of pregnancy, one-sixth of a woman’s blood supply is circulating

through the uterus at any given time; therefore, uterine bleeding in pregnancy is
always potentially serious because it could result in a major blood loss.
- Hegar’s sign ( extreme softening of the lower uterine segment) at about 6 weeks during
bimanual examination
- Ballottement (if the lower uterine segment is tapped sharply by the lower hand, the fetus
can be felt to bounce or rise in the amniotic fluid up against the top examining hand.) at
about 16-20th week. (a probable sign, may be simulated by a uterine tumor)
● Between the 20th and 24th week of pregnancy, the uterine wall has become thinned
to such a degree that a fetal outline within the uterus may be palpated by a skilled
examiner.
-Uterine contractions

● begin early in pregnancy(12th week) are

● present throughout the rest of pregnancy
● becomes stronger and harder as the pregnancy advances.
● Braxton Hicks contractions, serve as warm-up exercises for labor and also increase
placental perfusion.
- Different from true labor since they don’t cause cervical dilation
- Probable sign (may be simulated by a uterine tumor)

● Amenorrhea
- occurs with pregnancy because of the suppression of follicle-stimulating hormone (FSH)
by rising estrogen levels.
- heralds the onset of menopause
- could result from delayed menstruation
● uterine infection,
● worry (perhaps over
● becoming pregnant)
● stress.
● severe anemia
● Athletes (body fat drops below a critical point)
- presumptive sign of pregnancy.

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

● Cervical Changes
- Increased estrogen=cervix more vascular and edematous.
- Increased fluid=soften
- increased vascularity= darken from a pale pink to a violet hue.
- Glands of endocervix= undergoes hypertrophy and hyperplasia
- tenacious coating of mucus fills the cervical canal= operculum/mucus plug= seal out
bacteria during pregnancy
- Goodell’s sign (Softening of the cervix)
● consistencies
- non-pregnant(nose)
- pregnant (earlobe)
- Before labor(butter)

● Vaginal Changes
- Increased estrogen---> vaginal epithelium hypertrophied---> enriched w/ glycogen--->
structures loosen from their connective tissue attachments
● Increased activity epithelial cells results in a white vaginal discharge
throughout pregnancy (a presumptive sign).
- increase in the vascularity of the vagina (beginning of pregnancy)---> changes the color of
the vaginal walls from the normal light pink to a deep violet (chadwick’s sign) / probable
sign
- Vaginal secretions from pH 7 to 4 or 5
● increased glycogen environment ---> growth of Lactobacillus acidophilus (lactic
acid increased) ----> makes vagina resistant to bacterial invasion BUT favors the
growth of Candida albicans
- manifested by an itching, burning sensation in addition to a cream cheese–
like discharge
- Medication for non-preggy = for comfort, preggy= prevent transmission to
the baby through the birth canal
- thrush or oral monilia= Candidal infection in the newborn
● Ovarian Changes
- Active feedback mechanism (pituitary gland stop production of FSH and
luteinizing hormone (LH)) of estrogen and progesterone produced by the corpus
luteum and/or placenta= ovulation stops--->
- Corpus luteum increases in size until end of the 16th week because placenta takes
over
- Corpus luteum regresses and becomes white and fibrous (corpus albicans)

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

● Breast Changes
- At 6 weeks, she may experience a feeling of fullness, tingling, or tenderness in her
breasts because of the increased stimulation of breast tissue (through estrogen) \
- Increased breast size due to hyperplasia of the mammary alveoli and fat deposits
- areola of the nipple darkens, and its diameter increases from about 3.5 cm (1.5 in)
to 5 or 7.5 cm (2 or 3 in).
- In some women, there’s additional darkening of the skin surrounding the areola
- Increasedvascularity--->prominence of blue veins on surface
- At 16th week, colostrum, that is the precursor of breast milk, can be expelled from
the nipples
- (Montgomery’s tubercles)/sebaceous gland enlarges
● keeps the nipple flexible and helps to prevent nipples from cracking and
drying during lactation.

SYSTEMATIC CHANGES
Although the physiologic changes first noticed by a woman are apt to be those of the reproductive
system and breasts, changes are occuring in almost all body systems.

● INTEGUMENTARY SYSTEM
- rupture and atrophy of small segments of the connective layer of the skin due to
stretched abdominal wall at abdomen side and thigh =pinkish red (striae
gravidarum)
- Weeks after birth, striae gravidarum--->striae albicans/atrophicae
- abdominal wall has difficulty stretching enough to accommodate the growing fetus,
causing the rectus muscles to actually separate= diastisis
- Linea nigra= from the umbilicus to the symphysis pubis and separating the
abdomen into right and left hemispheres
- Melasma/chloasma=“mask of pregnancy” particularly on the cheeks and across
the nose
- These darkened areas disappear after birth as hormones decreases.
- Vascular spiders or telangiectases, small, fiery-red branching spots on thighs
- Increased in perspiration ((due to high estrogen)
- Palmar erythema (redness and itching) may occur on the hands (due to high
estrogen)
- Fewer hairs on the head enter a resting phase because of overall increased
metabolism, so scalp hair growth is increased.

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

● RESPIRATORY SYSTEM
- congestion, or “stuffiness,” of the nasopharynx (due to high estrogen level)
- Lots of pressure on the diaphragm specially lungs as uterus enlarge
- Diaphragm= 4cm upward---> causes sensation of shortness of breath late in
pregnancy
- Vital Capacity (maximum volume exhaled after a maximum inspiration) remains
the same because, although the lungs are crowded in the vertical dimension, they
can still expand horizontally
- Residual volume (the amount of air remaining in the lungs after expiration) is
decreased up to 20% by the pressure of the diaphragm.
- Tidal volume (the volume of air inspired) is increased up to 40% as a woman draws
in extra volume to increase the effectiveness of air exchange.
- Total oxygen consumption increases by as much as 20%.
- The increased level of progesterone during pregnancy appears to set a new level in
the hypothalamus for acceptable blood carbon dioxide levels (PCO2), because,
during pregnancy, a woman’s body tends to maintain a PCO2 at closer to 32 mm
Hg than the normal 40 mm Hg. This low PCO2 level causes a favorable CO2
gradient at the placenta (the fetal CO2 level is higher than that in the mother,
allowing CO2 to cross readily from the fetus to the mother)
- (mild hyperventilation) to blow off excess CO2 (which comes from the fetus)
- To compensate, kidneys excrete plasma bicarbonate in urine. This results in
increased urination or polyuria, an early sign of pregnancy. With greater urine
output, both additional sodium and additional water are lost.
- The cumulative effect of these respiratory changes is often experienced by a woman
as chronic shortness of breath. Although her breathing rate is more rapid than usual
(18–20 breaths per minute), this is normal for pregnancy.

● Temperature
- Early in pregnancy---> secretion of progesterone from the corpus luteum---> BT
increases ---> At 16 weeks---> placenta takes over---> BT decreases
● CARDIOVASCULAR SYSTEM
Changes in the circulatory system are extremely significant to the health of the fetus,
because they are necessary for adequate placental and fetal circulation.

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

Blood Volume
- total circulatory blood volume of a woman’s body increases by at least 30% (and possibly
as much as 50% ---> provide for an adequate exchange of nutrients in the placenta &
compensate for blood loss at birth
- Blood Loss
● Normal delivery= 300-400mL
● Caesarean= 800-1000mL
- At the end of the 1st trimester, BloodV gradually increases; Peaks at 28th - 32nd week
- Plasma Volume Increase faster the RBC-->concentration of hemoglobin and erythrocytes
may decline--->pseudoanemia ealy in preg
● At 2nd semester, woman’s body compensates for this change by producing more
red blood cells,

Iron, Folic Acid, and Vitamin Needs.

- Almost all women need some iron supplementation during pregnancy because of a variety
of factors. The fetus requires a total of about 350 to 400 mg of iron to grow. The increases
in the mother’s circulatory red blood cell mass require an additional 400 mg of iron. This
is a total increased need of about 800 mg. Because the average woman’s store of iron is
less than this amount (about 500 mg), and because iron absorption may be impaired
during pregnancy as a result of decreased gastric acidity (iron is absorbed best from an
acid medium), additional iron is often prescribed during pregnancy to prevent a true
anemia.
- The need for folic acid increases even more during pregnancy. If the intake of folic acid is
not great enough, megalohemoglobinemia (large, nonfunctioning red blood cells) will
result. Inadequate folic acid levels have also been linked to an increased risk for neural
tube disorders in fetuses
- Encourage women to eat foods that are high in folic acid (e.g., spinach, asparagus,
legumes) both during the prepregnancy period and during pregnancy.

Heart
- Increased blood volume=Increased Cardiac output; increases 10bpm
- rise in circulating load has implications for a woman with cardiac disease.
- diaphragm is pushed upward by the growing uterus late in pregnancy---> the heart is shifted

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

to a more transverse position in the chest cavity, a position that may make it appear
enlarged on x-ray examination.
● audible functional (innocent) heart murmurs due to position change
- Palpitations of the heart are not uncommon during pregnancy, particularly on quick motion.

BLOOD PRESSURE
- Despite the hypervolemia of pregnancy, the blood pressure does not normally rise because
the increased heart action takes care of the greater amount of circulating blood.
- In most women, blood pressure actually decreases slightly during the second trimester
because the peripheral resistance to circulation is lowered as the placenta expands rapidly.
During the third trimester, the blood pressure rises again to first-trimester levels

Peripheral Blood Flow

- At 3rd trimester, blood flow to the lower extremities is impaired by the pressure of the
expanding uterus on veins and arteries---> edema and varicosities of the vulva, rectum, and
legs.

Supine Hypotension Syndrome.

- When a pregnant woman lies supine, the weight of the growing uterus presses the vena
cava against the vertebrae, obstructing blood flow from the lower extremities.---> decrease
in blood return to the heart and---> decreased cardiac output and hypotension
● A woman experiences this hypotension as lightheadedness, faintness, and
palpitations
- potentially dangerous because it can cause fetal hypoxia.
- be corrected by having a woman turn onto her side (preferably the left side),
so that blood flow through the vena cava increases again.
Blood Constitution
- Fibrinogen (for clotting),increase in 50% other clotting factors, such as factors VII, VIII,
IX, and X, and the platelet count increase as well
● safeguard against major bleeding should the placenta be dislodged and the uterine
arteries or veins be opened
- Total white blood cell count rises slightly, both as a protective mechanism and as a
reflection of a woman’s increased total blood volume (up to about 20,000 cells/mm3).
- The total protein level of blood decreases, perhaps indicating the amount of protein being

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

used by the fetus

- Lowered protein & Hypervolemia--->fluid readily leaves the blood for institial tissue
vessels to equalize osmotic and hydrostatic pressure --->ankle and foot edema
- Blood lipids increase by one third, and the cholesterol serum level increases by 90% to
100%. These increases provide a ready supply of available energy for the fetus.

 GASTROINTESTINAL SYSTEM
Gastrointestinal (GI) issues are some of the most common complaints during pregnancy. Some
women may experience GI issues that develop after becoming pregnant. Gastrointestinal problems
affect the gastrointestinal tract, primarily the esophagus, stomach, small intestine, large intestine
and rectum, but can also affect other organs of digestion, including the liver, gallbladder, and
pancreas. Some women may have chronic GI disorders prior to pregnancy that can worsen and
require special consideration during pregnancy.

Some of the most common gastrointestinal issues women experience during pregnancy are nausea
and vomiting, hyperemesis gravidarum, gastroesophageal reflux disease, gallstones, diarrhea,
and constipation. Some women may have been diagnosed prior to pregnancy with GI disorders
such as Crohn’s disease or ulcerative colitis. It is also possible to have had these underlying
conditions but they had been undiagnosed until pregnancy made them more apparent.

 IMMUNE SYSTEM
Immunologic competency during pregnancy apparently decreases, probably to prevent a woman’s
body from rejecting the fetus as if it were a transplanted organ. Immunoglobulin G (IgG)
production is particularly decreased, which can make a woman more prone to infection during
pregnancy. A simultaneous increase in the white blood cell count may help to counteract the
decrease in IgG response.

 ENDOCRINE SYSTEM
Placenta
- The most striking change in the endocrine system during pregnancy is the addition of the
placenta as an endocrine organ that produces large amounts of estrogen, progesterone,
hCG, human placental lactogen (hPL), relaxin, and prostaglandins.

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

Pituitary Gland
- The pituitary gland is affected by pregnancy, because there is a halt in the production of
FSH and LH brought on by the high estrogen and progesterone levels of the placenta. There
is increased production of growth hormone and melanocyte-stimulating hormone (which
causes skin pigment changes).

Thyroid and Parathyroid Glands

- The thyroid gland enlarges in early pregnancy to such an extent that the basal body
metabolic rate increases by about 20%. Levels of protein-bound iodine, butanol-extractable
iodine, and thyroxine are all elevated in blood serum. If a sufficient supply of iodine is not
present during pregnancy, goiter (thyroid hypertrophy) can occur as the gland intensifies
its productive effort.

Adrenal Glands
- Adrenal gland activity increases in pregnancy as increased levels of corticosteroids and
aldosterone are produced. It is assumed that these increased levels aid in suppressing an
inflammatory reaction or help reduce the possibility of a woman’s body rejecting the
foreign protein of the fetus, the same as it would a foreign-tissue transplant.

Pancreas
- The pancreas increases production of insulin in response to the higher levels of
glucocorticoid produced by the adrenal glands. Insulin is less effective than normal,
however, because estrogen, progesterone, and hPL are all antagonists to insulin. Therefore,
a woman who is diabetic and taking insulin before pregnancy will need more insulin during
pregnancy. A woman who is prediabetic may develop overt diabetes for the first-time
during pregnancy. Overall, the effect of diminishing the action of insulin is beneficial
because it ensures a ready supply of glucose for fetal growth.

 SKELETAL SYSTEM
Calcium and phosphorus needs are increased during pregnancy, because the fetal skeleton must be
built. As pregnancy advances, there is a gradual softening of a woman’s pelvic ligaments and joints
to create pliability and to facilitate passage of the baby through the pelvis at birth. This softening
is probably caused by the influence of both the ovarian hormone relaxin and placental
progesterone. Excessive mobility of the joints can cause discomfort. A wide separation of the

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

symphysis pubis, as much as 3 to 4 mm by 32 weeks of pregnancy, may occur. This makes women
walk with difficulty because of pain.

To change her center of gravity and make ambulation easier, a pregnant woman tends to stand
straighter and taller than usual. This stance is sometimes referred to as the “pride of pregnancy.”
Standing this way, with the shoulders back and the abdomen forward, creates a lordosis (forward
curve of the lumbar spine), which may lead to backache.

2. PSYCHOLOGICAL CHANGES IN PREGNANCY

Woman’s attitude toward pregnancy depends a great deal on psychological aspects such as:

- the environment in which she was raised

- the messages about pregnancy her family communicated to her as a child
- the society and culture she lives as an adult
- whether the pregnancy has come at a good time in her life

 SOCIAL INFLUENCES
- The heavy emphasis on medical management for women during pregnancy conveyed the
idea that pregnancy is a 9-month long illness wherein,
- pregnant woman went alone to a physician’s office for care;
- at time of birth, she was separated from her family and admitted to a hospital.
- Hospitalized with seclusion from visitors and even with the new baby for a week
afterward.
- Today, long-standing protocols that separated women from their families are no longer
appropriate.
- Women now bring families or her partner during prenatal care.
- Instead of being given general anesthetics so they can “sleep-through” labor and
birth, they are urged to participate actively in the experience.
- The way the pregnant woman and her partner feel about pregnancy and childbirth may be
affected by:
- Cultural background
- Personal experiences
- Experiences of friends and relatives
- Current public philosophy of childbirth
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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

- Nurses and healthcare providers can help make pregnancy and childbirth even more
enjoyable for clients and their families.
 CULTURAL INFLUENCES
- A woman’s cultural background may strongly influence how active a role she wants to take
in her pregnancy, because certain beliefs and taboos may place restrictions on her behavior
and activities.
- Ask the woman if there is anything they believe or should not be done to make the
pregnancy successful and keep the baby healthy.
- Supporting these beliefs shows respect for the individuality of the woman and her
knowledge of good health.
 FAMILY INFLUENCES
- If the woman and her siblings were loved and seen as the pleasant outcome of a happy
marriage, she is more likely to have a positive attitude toward her pregnancy than if she
and her siblings were seen as intruders or were blamed for breakup of a marriage or things
that could have been.
- No matter how many times a woman is told that pregnancy is natural and simple, she will
not be overjoyed to find herself pregnant if all she has heard are stories about excruciating
pain and endless suffering in labor.
- “People love as they have been loved” – relevant to whether pregnancy will be viewed in
positive or negative light. If a woman has had difficulty loving others because she has not
received love, she may worry that she will have difficulty loving and accepting the fetus
growing within her.
- To mother her baby well, she should be able to feel pleasurable anticipation at the prospect
of rearing a child; being a mother is a second adjustment above and beyond being pregnant.
- The woman who views mothering as a positive activity is more likely to be pleased
when she becomes pregnant than one who devalues mothering.
 INDIVIDUAL INFLUENCES
- A woman’s ability to cope with or adapt to stress plays a major role in how she will
resolve conflict and adapt to the new life contingencies that are coming.
- Depends in part on her basic temperament, on whether she adapts to new
situations quickly or slowly, whether she faces them with intensity or maintains a
low-key approach, and whether she has had experiences coping with change and
stress.
- The extent to which a woman feels secure in her relationship with the people around her,
especially the father of her child, is usually important to her acceptance of pregnancy.

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

- Acceptance is usually easier if she has confidence in stability of her relationship

with the child’s father and knows that he will be there to give her emotional
support.
- Some concerns that must be taken seriously when counseling pregnant women:
- A woman who thinks of brides as young but mothers as old may believe
pregnancy will rob her of her youth.
- If she thinks children are sticky-fingered and time-consuming, she may view the
pregnancy as taking away her freedom.
- If she has heard that pregnancy will permanently stretch her abdomen and her
breasts, her concern may be that she will lose her looks.
- She may feel that pregnancy will rob her financially and ruin her chance of job
promotion.
- Whether the father of a child is able to accept the pregnancy and the coming child also
depends on cultural background, past experiences, and relationship with family members.
- Men may be able to convey such emotions by a touch or a caress, one reason
men’s presence is always desirable at a prenatal visit and certainly in the birthing
room.
- Their partner will know that a hand on hers is as meaningful an expression of
emotion as a spoken word.

THE PSYCHOLOGICAL TASKS OF PREGNANCY

First Trimester: Accepting the Pregnancy
The psychological task during the first trimester is accepting that she is pregnant.
The Woman

 Every pregnancy is a surprise, either because a woman had not planned on becoming
pregnant or she had been looking forward to being pregnant but came too quickly.
 Pregnancy test kits helped women by confirming pregnancy as early as the first missed
menstrual period. It is later verified by a health care visit.
 Uncertainty of the symptoms makes pregnancy only a theoretical possibility that
leaves room for denial.
 Almost all drugs cross the placenta and many can cause fetal harm, the earlier she
realizes that she is pregnant the sooner she can discontinue all drugs that are not
prescribed by her physician.

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

 Most women experience the feeling of ambivalence or feeling both pleased and not
pleased about pregnancy.
 When talking to a pregnant woman, emphasize that the feeling of wanting and not
wanting to be pregnant is normal.
 Most women are able to change their attitude towards pregnancy by the time their child
move inside them or seeing a beating heart or fetal outline on the monitor screen during
ultrasound, can be a major step in promoting acceptance.
The Partner

 Partners were forgotten persons in the childbearing process.

 Today, it is all recognized that all partners are important and should be encouraged to
play an emotional role in pregnancy. As the woman adapts to pregnancy her partner may
go through some of the same psychological changes.
 Even the unwed fathers and female partners.
 Accepting pregnancy; accepting the certainty and reality of the child to come, also
accepting the woman in her changed state.
 Partners should also try to give the woman an emotional support while she is learning to
accept the reality of pregnancy, and she should also reciprocate.
 Partners’ feelings with regards to pregnancy may vary.
 Some may feel happy & proud
 Some may feel jealous since she would be a lot closer to the child.
 They may also experience ambivalence. They are afraid to raise their concerns
since they don’t want to alleviate the woman’s anxiety by appearing anxious
themselves.
 Some may feel ambivalent since they are not well prepared for parenthood or has
no experiences with children.
 Unwed father may have a great deal of difficulty accepting pregnancy
 If he realized that he doesn’t want to marry his partner.
 He may not have a strong support network.

(It is harder to resolve their feelings of ambivalence since they do not experience the changes of
pregnancy and may not have strong support system.)

Second Trimester: Accepting the Baby

The psychological task during the second trimester is to accept that she is having a baby.

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Muralla st. Cor. Intramuros, Manila
College of Nursing

The Woman

 The change usually happens at “quickening”, this may become a proof of the child’s
existence. She may think of the life inside her as an integral part of herself rather than a
separate entity, but with the quickening she assumes that the fetus is a separate entity.
 It might be this moment when she realize that the fetus is an active being
 Anticipatory role-playing is an important activity for mid-pregnancy. Helps her realize
that she is not only pregnant, but there is also a child inside her.
 Most women can pinpoint a moment during pregnancy when they knew definitely they
wanted their child.
 For those who carefully planned their pregnancy, this moment of awareness may
occur as soon as she recovers from the shock that she has actually able to
conceive.
 Accepting the baby as a family addition may not come until the labor has begun or it
might even be the moment she hears her baby’s cry or first touch or feeding her newborn.
 If the woman is dealing with financial difficulties, complications of pregnancy, or
lacks emotional support, accepting the baby could take several weeks after the
baby has been delivered.
 Emotional and physical changes brought by hormonal changes are so tremendous
that can lead to postpartum depression or psychosis.
 You can see the level of her acceptance by how well she follows the pre-natal
instructions.
The Partner

 He/She may feel as if he is left out or waiting to be asked to take part in the event. The
may become overly absorbed in his/her work, striving to produce something or earning
enough money, that they are also capable of creating something.
 Preoccupation with work may limit the amount of time that a partner spends with the
family.
 Some men may have difficulty enjoying pregnancy since they are misinformed about
pregnancy, women’s health and sexuality
 They might believe that breastfeeding will make their wife’s breast no longer
attractive so they’ll advice against it.
 They may also believe that normal spontaneous delivery will stretch their wife’s
vagina and they will no longer enjoy coitus, so they’ll choose caesarean birth.
 Partners need education to correct the false information that they believe in.

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Muralla st. Cor. Intramuros, Manila
College of Nursing

Third Trimester: Preparing for Parenthood

 The couple usually begin “nest-building” activities. These activities are evidence that
women are completing the 3rd trimester task of pregnancy.
 Planning the infant’s sleeping arrangement
 Choosing a name
 Buying clothes
 Ensuring safe passages by learning about birth
 They are usually interested in prenatal classes. You can also see how prepared they are
for the baby’s arrival.
 Childbirth education can expose them to other parent role models, and provide
information about pregnancy and childcare.

Reworking Developmental Tasks

 Woman’s relationship with her parents, particularly her mother. She finds someone that
she can empathize with. She may also find her own mother important to her and develops
a new, more equal relationship with her mom.
 She may able to reveal the intensity of her conflict with her mother and how she can’t
bear to think of the child inside her feeling that way about her.
 Pregnant teenagers may have a hard time to sink in that she is both a mother and a child.
 Women that has a fear on being separated from her family or dying may also think “Am I
ever going to make it through this?”
 Woman needs to have confidence in those who provide health care for her during
pregnancy so that she can express her disturbing thoughts an can work through them.
That’s why woman who is comfortable seeking information experiences less anxiety than
others who feels unable to do this.
 Partners may also rethink their relationship with his father to understand what kind of
father will they become.
 Men who has an emotionally distant fathers may wish to be more emotionally
available for their children.

Role-playing and Fantasizing

 It is another step in preparing for parenthood, fantasizing about what it will be like to be a
parent.

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Muralla st. Cor. Intramuros, Manila
College of Nursing

 The woman begins to spend time with other pregnant women or mothers of young
children to learn more about how to be a mother and how to take care of a young. She
may also offer to babysit for a relative so that she can “practice” caring for a new baby.
 Women’s dreams tend to focus on pregnancy and concern about keeping herself and her
fetus safe.
 Role-playing might be difficult for a pregnant teenager who has not yet adult.
 Try to locate good role models for adolescents so they can find a good maternal
role that they can copy.
 The father-to-be also has role-playing, he has to imagine himself as the father of the
child.
 First-time father – may have to change his view from a carefree human being to a
significant member of the family.
 Already a father – has to cast aside a father-of-one identity to accept his father-
of-two image, and so forth.
 Fathers may also want or need to take on the role of nurturer, but they had little to
no experience taking care of infants and newborns. Newborn care classes can
help fathers grow comfortable with their role.
 Other support persons such as grandparents & close friends will also have an active role
raising the child, but it may be difficult because the roles for support persons are not
clearly defined.

EMOTIONAL RESPONSES TO PREGNANCY

- These emotional responses vary greatly. It is helpful to caution a pregnant woman and
her partner about common changes they may expect. Otherwise, they might misinterpret
these changes not as a change but a loss of interest in their relationship.

o AMBIVALENCE
- A separate individual is growing inside the woman’s body, changing how she looks or
feels. She may want to be pregnant, and yet she may not be enjoying it.
- Refers to the interwoven feelings of wanting and not wanting that exists in high levels.
- It is important to emphasize that this is normal.
- Partners also experience this, sometimes more so than pregnant women. Can be
compounded if partners are afraid to voice their concerns, thinking they ought to already
know about certain things and not wanting to compound the pregnant woman’s anxieties
by appearing anxious themselves.
- Partners may also feel this if they are not prepared for parenthood have had little
experience with children.

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Muralla st. Cor. Intramuros, Manila
College of Nursing

o GRIEF
- Before a woman can take on a mothering role, she has to give up or alter her present
roles. She will never be a daughter on exactly the same way again. She must incorporate
her new role as a mother into her other roles as a daughter, wife, or a friend.
- Her partner must incorporate a new role as a father into his other roles of son, husband or
friend.

o NARCISSISM
- Self-centeredness is generally an early reaction to pregnancy.
- Suddenly begins to concentrate and be conscious of her body, the way she dress, her
posture and her weight.
- She dresses so her pregnancy will or will not show —dressing becomes a time-
consuming mirror-studying procedure.
- She makes ceremony out of fixing her meals
- She may lose interest in her job or community events because the work seems
alien to the more important events taking place in her body, events that constantly
remind her a new round of life is beginning.
- A woman may manifest narcissism by a change in her activity level. She does these
things to unconsciously protect her body and thus her baby.
- She may stop playing tennis even though her physician tells her it will do no harm
in moderation.
- She may also criticize her husband’s driving, although it never bothered her
before.
- Men may demonstrate the same behavior by reducing risky activities such as mountain
biking, trying to ensure that they will be present to raise their child.
- At this stage, a woman may be much more interested in doing things for herself because
it is her body, her tiredness, and her well-being that will be directly affected.

o INTROVERSION VS. EXTROVERSION

- Introversion—turning inward to concentrate on oneself and one’s body. It is a common
finding in pregnancy.
- Some women react in an entirely opposite fashion and become extroverted—more active,
appear healthier than ever before, and are more outgoing. This occurs in women who are
finding unexpected fulfillment in pregnancy, perhaps those who seriously doubted they
would be lucky enough or fertile enough to conceive.

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Muralla st. Cor. Intramuros, Manila
College of Nursing

o BODY IMAGE AND BOUNDARY

- Body image—the way your body appears to yourself.
- Body boundary—a zone of separation you perceive between yourself and objects or other
people)
- Both of these change during pregnancy as the woman begins to envision herself as a
mother aside from her other roles and begins to see herself becoming “bigger” in many
different ways.
- This change in body image is part of the basis of narcissism and introversion.
- Changes in the body boundary concept lead to a firmer distinction between objects, yet at
the same time perceived as extremely vulnerable, as if they were delicate and easily
harmed.

o STRESS
- Pregnancy brings a major role change that most likely can cause extreme stress in a
woman.
- Stress can make it difficult for a woman to make decisions, be aware of her surroundings
as usual or maintain time management with her usual degree of skill.
- It may cause people who were dependent on a woman before pregnancy to feel neglected,
because now that she is pregnant she seems to have strength for herself.
- Remind the family members that any decrease in the ability to function that happens to a
pregnant woman is a reaction to the stress of pregnancy, not the pregnancy itself.
- Woman with fewer support people around her almost automatically has more difficulty
adjusting to and accepting a pregnancy and a new child than do women who have more
support.
- Woman who begins a pregnancy with a strong support person and then loses that person
through trauma, illness, separation, or divorce needs special attention in regard to
loneliness and depression. A loss of this kind has the potential to interfere not only with
her own health but also with parent-child bonding.

o COUVADE SYNDROME
- Many men experience physical symptoms of pregnancy such as
 Nausea
 Vomiting
 Backache
- Even more intensely than their partners during pregnancy. These symptoms result from
stress, anxiety, and empathy for the pregnant woman

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Muralla st. Cor. Intramuros, Manila
College of Nursing

- As woman’s abdomen begins to grow, the partner may perceive that his are growing
larger.
- The more the partner is involves in the changes of pregnancy, the more they experience
the symptoms of the woman.
- These are healthy happenings, but if the man becomes emotionally stressed or delusional
it may require psychological attention

o EMOTIONAL LIABILITY
- Mood changes occur frequently in a pregnant woman, partly as a manifestation of
narcissism and partly because of hormonal changes. (sustained increase in estrogen
and progesterone)
- Mood swings are common that they make a woman’s reaction to her family and to
health care routines unpredictable. (What she finds acceptable one week she may find
intolerable the next.)
- Women, their partners and family should be informed that mood swings may occur,
beginning with early pregnancy so that they can accept them as a part of pregnancy.

o CHANGES IN SEXUAL DESIRE

- Most women report that their sexual desire changes during pregnancy
- Women who formerly were worried about becoming pregnant may truly enjoy sexual
relations for the first time during pregnancy. While others may feel a loss of desire
because of their estrogen increase or they may unconsciously view sexual relations as
a threat to the fetus they must protect.
- First trimester: Decrease in libido because of the physical symptoms of pregnancy.
- Second trimester: Sexual enjoyment rises since there is an increase of blood flow to
the pelvic are increases to supply the placenta.
- Third trimester: Either the sexual desire may remain high or may decrease because of
difficulty finding a comfortable position and increasing abdominal size.
- The couple should be informed that there might be changes that’ll occur about the
woman’s sexual desire. So that the partner can fully understand the changes in her
libido.
o CHANGES IN THE EXPECTANT FAMILY
- Most parents are aware that their older children needs to be prepared when a new
baby comes.
- Pre-school and school-age children may need to be reassured periodically during
pregnancy.
 The newborn will not replace their parent’s unconditional love for them.

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Muralla st. Cor. Intramuros, Manila
College of Nursing

B. PRENATAL CARE

 ASSESSMENT
The first prenatal visit is a time to establish baseline data relevant to health assessment and
health-promotion strategies that will be important at every prenatal visit.

a. This begins with obtaining a health history, including screening for the presence of
teratogens (any factor that may adversely affect the fetus) and any concerns a woman may be
experiencing. Explaining why specific assessment data are relevant to the pregnancy is
important. For instance, when weighing a woman, discussing what routine weight gain she can
expect in the coming months and why monitoring weight gain is important supplies information
to a woman as well as allowing you to obtain baseline data. Relating assessment information and
health-promotion activities this way throughout the pregnancy helps keep a woman and her
family well informed and eager to comply with further health care recommendations.

 NURSING DIAGNOSIS
Although most women probably have used a home pregnancy kit to find out if they are pregnant,
the first prenatal visit officially confirms this, so nursing diagnoses usually focus on the response
of a woman and her family to that information. For example:
• Decisional conflict related to desire to be pregnant
• Risk for ineffective coping related to confirmation of unplanned pregnancy

Nursing diagnoses appropriate to prenatal care include:

• Health-seeking behaviors related to guidelines for nutrition and activity during pregnancy
• Deficient knowledge regarding exposure to teratogens during pregnancy
• Risk for injury to fetus related to current lifestyle behaviors

 OUTCOME IDENTIFICATION AND PLANNING

Be certain to reserve sufficient time at prenatal visits so care can be thorough and there is enough
time to set realistic goals and expected outcomes with both a woman and her partner, if desired.

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College of Nursing

a. Make sure that a woman leaving an initial prenatal visit schedules an appointment for a
following visit, as this may not occur to a woman who may be extremely excited or
overwhelmed by all the new things that are happening to her and her family;

b. Establishing a pattern of regular appointments is crucial to providing effective prenatal

care. Although many settings are looking at whether the number of prenatal visits traditionally
scheduled is needed during a normal pregnancy, return appointments are usually scheduled every
4 weeks through the 28th week of pregnancy, every 2 weeks through the 36th week, and then
every week until birth. Women categorized as high risk are followed more closely.

c. Reliable Internet sites to use for referral on preconceptual or prenatal care are the
National Institute of Health and Human Development (http://www.nichd.nih.gov/
health/topics/preconception_care.cfm) and the March of Dimes (http://www.marchofdimes.com).

 IMPLEMENTATION
a. An important nursing intervention at prenatal visits is teaching women and their families
about a safe pregnancy lifestyle.

- It may be helpful to give a woman and her partner pamphlets or books that cover the
same topics. Be certain that you have read all the printed material you give families. This helps
to ensure that a pamphlet’s advice is consistent with what you have said and with the views of a
woman’s primary care physician or nurse-midwife. A pretty picture on the cover of a pamphlet
does not ensure the quality of the advice inside.

b. Reinforce with a woman that she should call, e-mail, or text message the health care
setting if she has any problems or questions between visits. Some women may feel reluctant to
“bother” a health care provider outside of scheduled visits unless you give them permission to do
so.

 OUTCOME EVALUATION
Evaluation during prenatal visits should concentrate on a woman’s initial progress toward
understanding goals of care for pregnancy and assessing outcomes established for specific
concerns. Examples of expected outcomes are:
• Couple states they have reached a mutual decision to both stop smoking.

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Muralla st. Cor. Intramuros, Manila
College of Nursing

• Client states she feels well informed about the common discomforts of pregnancy and actions
to take to relieve them.
• Client lists ways to avoid exposure to teratogens during pregnancy.

PRENATAL CARE
Prenatal care, also known as antenatal care, is a type of preventive healthcare. Its goal is to
provide regular check-ups that allow doctors or midwives to treat and prevent potential health
problems throughout the course of the pregnancy and to promote healthy lifestyles that benefit
both mother and child.

NUTRITION
Nutrition for pregnant women has a very important contribution to bearing a child.
Although it may not guarantee a good pregnancy outcome, it is still essential for mothers to be
knowledgeable on how to take in to consideration their child’s health and also theirs.

In early pregnancy, fetal growth occurs largely by the increase of number of cells called
hyperplasia and in late pregnancy, these existing cells grow (hypertrophy) and develop to a baby.
A fetus deprived of adequate nutrition early in pregnancy can be small for gestational age because
of an inadequate number of cells in the body. Later on, although the number of cells may be
normal, restricted growth can occur because cells cannot grow to their full potential. Nutrition is
needed in order for these natural metabolic processes to happen therefore growth and not only are
we expecting for growth of the baby but also a normal and healthy delivery of the mother.

Relationship of Maternal Nutrition to Fetal Nutrition

During pregnancy, a woman must eat adequately to supply enough nutrients to the fetus,
so it can grow, as well as to support her own nutrition (Crombleholme, 2009). Adequate protein
intake is vital because so much is needed by a fetus to build a body framework. Adequate protein
may also help prevent complications of pregnancy such as pregnancy-induced hypertension or
preterm birth.

Also provide women with positive and specific health teaching with regards to their
nutrition. Take note to emphasize more on what they are eating right rather than good to promote
positive response from the mother.

A. Recommend Weight Gain

A weight gain of 11.2 to 15.9 kg (25 to 35 lb) is recommended as an average weight
gain in pregnancy. If a woman is at high risk for nutritional deficits, a more precise estimation of

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Muralla st. Cor. Intramuros, Manila
College of Nursing

adequate weight gain can be calculated (Rode et al., 2007). This is done by computing body mass
index (BMI), the ratio of weight to height.
Normal Prepregnancy BMI

 Underweight Under 18.5

 Normal weight 18.5–24.9
 Overweight 25.0–29.9
 Obese Above 30.0
 Morbidly obese Above 40.0
Weight gain in pregnancy occurs from both fetal growth and accumulation of maternal
stores and occurs at approximately 0.4 kg (1 lb) per month during the first trimester and then 0.4
kg (1 lb) per week during the last two trimesters (a trimester pattern of 3-12-12). As a general rule,
in the average woman, weight gain is considered excessive if it is more than 3 kg (6.6 lb) a
month during the second and third trimesters; it is less than usual if it is less than 1 kg (2.2 lb)
per month during the second and third trimesters. Women can be assured that most of the weight
gained with pregnancy will be lost afterward (Bernstein & Weinstein, 2007). Weight gain will be
higher for a multiple pregnancy than for a single pregnancy. You can encourage women pregnant
with multiple fetuses to gain at least 1 lb per week for a total of 40to 45 lb (Rolfes, Pinna, &
Whitney, 2009). Sudden increases in weight that suggest fluid retention or polyhydramnios
(excessive amniotic fluid) or a loss of weight that suggests illness should be carefully evaluated
at prenatal visits.

B. Components for Healthy Nutrition for the Pregnant Woman

Pregnant women should take into consideration the food they eat but they should keep in
mind that they should also eat for their baby. But they should know that they should increase the
nutritional quality of the food they eat rather than its quantity.

The DRI of calories for women of childbearing age is 2200. An additional 300 calories, or
a total caloric intake of 2500 calories, is recommended to meet the increased needs of pregnancy.
In addition to supplying energy for a fetus, this increase provides calories to sustain an elevated
metabolic rate in the woman from increased thyroid function and an increased workload from the
extra weight she must carry. An inadequate intake of carbohydrates can lead to protein breakdown
for energy, depriving a fetus of essential protein, and possibly resulting in ketoacidosis, a possible
cause of fetal and neurologic disorders. Do not recommend sugar substitutes for women during
pregnancy, because a pregnant woman needs sugar to maintain glucose levels. Even obese women
should never consume fewer than 1500 calories per day.

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College of Nursing

The easiest method for determining if a woman’s caloric intake is adequate is assessing
the weight she is gaining. Keep in mind that the weight gain pattern is as important as the total
weight gain. Even if a woman has surpassed her target weight before the end of the third trimester,
encourage her not to restrict her caloric intake. She should continue to gain weight because a fetus
grows rapidly during these final weeks.

1. Protein Needs
The DRI for protein in women is 46 g/d. During pregnancy, the need for protein
increases to 71 g daily. Extra protein is best supplied by meat, poultry, fish, yogurt, eggs, and
milk, because the protein in these forms contains all nine essential amino acids, or is complete
protein. The protein in nonanimal sources does not contain all essential amino acids (and so is
incomplete protein). It is possible to provide all amino acids by combining nonanimal proteins.
Proteins that when cooked together provide all essential amino acids are termed complementary
proteins. Examples are beans and rice, legumes and rice, or beans and wheat.

2. Fat Needs
Only linoleic acid, an essential fatty acid necessary for new cell growth, cannot be
manufactured in the body from other sources. Because linoleic acid must be obtained from food,
women must be sure to consume a source of this nutrient during pregnancy. Vegetable oils are a
good source. In addition, using vegetable oils (e.g., safflower, corn, olive, peanut, and cottonseed)
that have a low cholesterol content rather than animal oils (butter) is recommended for all adults
as a means of preventing hypercholesterolemia and coronary heart disease. Women should also

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Muralla st. Cor. Intramuros, Manila
College of Nursing

try and ingest omega-3 oils, found primarily in fish, omega-3–fortified eggs, and the newer omega-
3–fortified spreads (Bourre, 2007).

3. Vitamin Needs
Requirements for both fat-soluble and water-soluble vitamins increase during pregnancy
to support the growth of new fetal cells. Vitamin deficiency can result in several common
problems. For example, vitamin D, essential for calcium absorption, when lacking, can begin to
diminish both fetal and maternal mineral bone density. Lack of vitamin A results in tender gums
and poor night vision. For as-yet-unknown reasons, there is an association between multivitamin
supplementation during pregnancy and reduced cancers such as neuroblastoma, leukemia, and
brain tumors in children (Goh et al., 2007).

Commonly, a prenatal vitamin is prescribed during pregnancy to be certain that pregnant

women ingest sufficient vitamins. Caution women to avoid taking mega doses of vitamins. The
mechanism of placental transfer of water-soluble vitamins makes fetal blood levels regularly
higher than maternal blood levels, so a maternal over dosage can cause fetal toxicity.

Folic acid (folacin) is essential for the nutrition of pregnant women. Found predominantly
in fresh fruits and vegetables, folic acid is necessary for red blood cell formation. As a woman’s
blood increase her blood volume during her pregnancy, her folic acid needs would also increase
and this have a great effect to her child. If folic acid is inadequate, there would be a possibility
of a megaloblastic anemia – large but ineffective red blood cells.

4. Mineral Needs
Minerals are essential for new cell formation for the fetus. Mineral absorption improves
during pregnancy, mineral deficiency, with the exceptions of calcium, iodine, and iron, is rare.
a. Calcium and Phosphorus - To supply adequate calcium and phosphorus for bone
formation, pregnant women need to eat foods high in calcium and vitamin D (necessary
for calcium to be absorbed from the gastrointestinal tract and to enter bones). The
recommended amount of calcium during pregnancy is 1300 mg.
b. Iodine - is essential for the formation of thyroxine and, therefore, for the proper functioning
of the thyroid gland. As thyroid function increases during pregnancy, a woman needs to
ingest enough iodine during pregnancy to supply this increased need. The DRI for iodine
is 220 µg daily during pregnancy.
c. Iron - The DRI for iron for pregnant women is 27 mg. An average diet supplies about 6
mg of iron per 1000 calories. If a woman eats a 2500-calorie diet daily, her daily intake,
therefore, is about 15 mg iron. Because only 10% to 20% of dietary iron is absorbed, she
is actually taking in less than this amount (closer to 1.5 to 3 mg). Therefore, dietary
supplementation with 15 mg iron per day helps ensure that adequate iron is ingested and

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College of Nursing

absorbed. Stress to women that iron supplementation is intended as a supplement to, not a
replacement for, iron-rich foods.
d. Fluoride - Because fluoride aids in the formation of sound teeth, a pregnant woman should
drink fluoridated water. Fluoride in large amounts causes brown-stained teeth, so a woman
should not take the supplement more often than prescribed or if tap water in her area is
already fluoridated.
e. Sodium - is the major electrolyte that acts to maintain fluid in the body: when sodium is
retained rather than excreted by the kidneys, an equal or balancing amount of fluid is also
retained. Retaining enough fluid during pregnancy in the maternal circulation is important
to ensure a pressure gradient to allow optimal exchange of nutrients across the placenta.
f. Zinc - is necessary for the synthesis of DNA and RNA. The DRI for zinc during pregnancy
is 12 mg, or an increase of 3 mg over pre-pregnancy needs.

5. Fluid Needs
Extra amounts of water are needed during pregnancy to promote kidney function because
a woman must excrete waste products for two. Two or three glasses of fluid daily over and above
the three servings of milk recommended by the food pyramid is a common recommendation during
pregnancy (a total of six to eight glasses daily).

6. Fiber Needs
Constipation can occur during pregnancy from slowed peristalsis because of the pressure
of the uterus on the intestine. Eating fiber-rich foods, foods consisting of parts of the plant cell
wall resistant to normal digestive enzymes such as broccoli and asparagus, are a natural way of
preventing constipation, because the bulk of the fiber left in the intestine aids evacuation. Fiber
also has the advantage of lowering cholesterol levels and may remove carcinogenic contaminants
from the intestine.

Foods to Avoid or Limit in Pregnancy

A. Excess Seafood - Women should eat up to 12 ounces (2 to 3 meals) of seafood or shellfish
a week for their omega-3 and iodine content. Fish such as shark, swordfish, king mackerel
or tilefish are high in mercury contamination, however, so should be avoided (Genuis,
2008).
B. Foods with Caffeine - Caffeine is thought of by many women as just an incidental
ingredient in beverages. Actually, it is a central nervous system stimulant capable of
increasing heart rate, urine production in the kidney, and secretion of acid in the stomach
(Rolfes, Pinna, & Whitney, 2009). A daily intake of caffeine of two or three cups of coffee

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Muralla st. Cor. Intramuros, Manila
College of Nursing

has not been associated with low birth weight, but drinking over three cups is associated
with an increased rate of early miscarriage (Applebee, 2008).
C. Artificial Sweeteners - are used to improve the taste and to limit the caloric content of
foods. It is probably safest for pregnant women to reduce their intake of these. The use of
saccharine is not recommended during pregnancy because it is eliminated slowly from the
fetal bloodstream. In any event, pregnant women need carbohydrates furnished by sugar
rather than artificial substances (Rolfes, Pinna, & Whitney, 2009).
D. Weight Loss Diets - As a rule, weight reduction is not healthy during pregnancy. Liquid
reducing diets and/or diets that are combined with weight-reducing drugs are particularly
contraindicated during pregnancy because they may lead to fetal ketoacidosis and poor
growth.

CLOTHING
Maternity Clothing is worn by women in some cultures as an adaptation to changes in
body size during pregnancy. During pregnancy, it is recommended for a woman to wear loose-
fitting and comfortable clothes. Inform them not to wear tight-fitting clothes such as girdles and
knee-high stockings. These clothing will impede the blood circulation on the lower extremities.
For the shoes, recommend to wear low-heeled shoes, flats, and rubber shoes to avoid pelvic tilting
and possible back ache.

When to start wearing maternity clothes

 Most women can wear their normal clothes for most of the first trimester (3 months).
 But you might need to consider a larger bra or looser fitting clothes for comfort during this
time.

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Muralla st. Cor. Intramuros, Manila
College of Nursing

 When you are around 4 or 5 months pregnant, you may have to start wearing larger clothes.
Most women switch to maternity wear when they are about 6 months pregnant.
Clothes they need

 maternity bra
 comfortable cotton underwear
 two pairs of well-cut maternity trousers, such as maternity leggings or jeans
 a plain skirt or dress, such as a stretch jersey wrap dress
 a maxi dress
 a jacket
 two maternity tops (empire line tops are more flattering)
 one smart outfit
 comfortable, flat shoes.

EXERCISE
Regular exercise during pregnancy can improve health, reduce the risk of excess weight
gain and back pain, and it may make delivery easier. Moderate exercise during pregnancy may
give a newborn a healthier start. Also, exercise at any time can improve heart health and stamina,
decrease fatigue and constipation, boost mood and energy levels, enhance sleep, and improve
muscle strength. It is important to discuss any changes in exercise habits with a health care
provider, to make sure you do the right kind of exercise at the right stage of pregnancy.

During pregnancy, exercise should aim to:

 increase heart rate steadily and improve circulation

 keep the body flexible and strong
 support and control healthy weight gain
 prepare the muscles for labor and birth

Exercise during pregnancy can help:

 shorten the labor process

 increase the chances of a natural birth
 decrease the need for pain relief
 speed up recovery after delivery
 reduce the risk of gestational diabetes and hypertension

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Muralla st. Cor. Intramuros, Manila
College of Nursing

 decrease the likelihood of preterm labor and birth

It may also give an infant a healthier start.

Research shows that when pregnant women exercise, fetal heart rate is lower. Newborns
may also have a healthier birth weight, a lower fat mass, improved stress tolerance, and advanced
neurobehavioral maturation.

1. Brisk walking

If pre-pregnancy exercise levels were low, a quick stroll around the neighborhood is a good
way to start. This will provide a cardiovascular workout without too much impact on the knees
and ankles. It can be done for free, almost anywhere, and at any time during pregnancy.

Safety tip: As pregnancy progresses, your center of gravity changes, and you can lose your sense
of balance and coordination. Choose smooth surfaces, avoid potholes, rocks, and other obstacles,
and wear supportive footwear.

2. Swimming

Swimming and exercising in water give a better range of motion without putting pressure
on the joints. The buoyancy offered by the water may offer some relief from the extra weight.
Swimming, walking in water, and aqua aerobics offer health benefits throughout pregnancy.

Safety tip: Choose a stroke that feels comfortable, and that does not strain or hurt your neck,
shoulders, or back muscles, for example, breaststroke. A kickboard can help strengthen the leg and
buttock muscles.

3. Stationary cycling

Cycling on a stationary bike, also called spinning, is normally safe even for first-time
exercisers. It helps raise the heart rate without putting too much stress on the joints. The bike helps
support body weight, and, because it is stationary, the risk of falling is low. Later in pregnancy, a
higher handlebar may be more comfortable.

4. Yoga

Prenatal yoga classes keep the joints limber and help maintain flexibility. Yoga strengthens
muscles, stimulates blood circulation, and enhances relaxation. These may contribute to a healthy

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Muralla st. Cor. Intramuros, Manila
College of Nursing

blood pressure during pregnancy. The techniques learnt in yoga class can also help you to stay
calm and in control during labor.

Safety tip: As pregnancy progresses, skip positions that could cause you to overbalance. From the
second semester, it is better to avoid poses that involve lying on the abdomen or flat on the back.
Lying on the back can cause the weight of the fetus and the uterus to put pressure on major veins
and arteries and decrease blood flow to the heart. It can be tempting to overstretch, as the hormone
relaxin increases flexibility and joint mobility during pregnancy. Overstretching could lead to
injury.

5. Low-impact aerobics

Aerobic exercise strengthens the heart and lungs and helps maintain muscle tone. Low-
impact aerobics excludes jumping, high kicks, leaps, or fast running. In low-impact exercise, one
foot should stay on the ground at all times. Compared with high-impact aerobics, the low-impact
option:

 limits stress on the joints

 helps maintain balance
 reduces the risk of weakening the pelvic floor muscles

A weak pelvic floor increases the chances of urine leakage.

Some aerobics classes are designed especially for pregnant women. This can be a good
way to meet other pregnant women, as well as exercising with an instructor who is trained to meet
your specific needs. Women who already attend a regular aerobics class should let the instructor
know that they are pregnant so they can modify exercises and advise about suitable movements.

6. Preparing for labor: Squatting and pelvic tilts

Squatting: During labor, squatting may help to open the pelvis, so it may be a good idea
to practice during pregnancy.

1. Stand with the feet flat on the floor, shoulder-width apart, and the back straight.
2. Lower yourself slowly, keeping your feet flat and your knees no further forward than your
feet.
3. Hold for 10 to 30 seconds, then slowly push up.
Pelvic tilts: These can strengthen the abdominal muscles and help reduce back pain.

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Muralla st. Cor. Intramuros, Manila
College of Nursing

1. Go down on the hands and knees.

2. Tilt the hips forward and pull the abdomen in, arching the back.
3. Hold for a few seconds.
4. Release, and let the back drop.
5. Repeat this up to 10 times.

CHECK-UPS

What is prenatal care and why is it important?

- Getting early & regular prenatal care can help you have a healthy pregnancy & a full-term
baby
- Full term means your baby is born between:
o 39 weeks (1 week before your due date)
o 40 weeks, 6 days (1 week after your due date)
- Being born full term gives your baby right amount of time he needs in womb to grow and
develop
Who can you go to for prenatal care?

- obstetrician/gynecologist (also called OB/GYN)

- family practice doctor (also called a family physician)
- maternal-fetal medicine (also called MFM) specialist
- certified nurse-midwife (also called CNM)
- family nurse practitioner (also called FNP) or a women’s health nurse practitioner
How often do you go for prenatal care checkups?

- Most pregnant women can follow a schedule like this:

o Weeks 4 to 28 of pregnancy. Go for one checkup every 4 weeks (once a month).
o Weeks 28 to 36 of pregnancy. Go for one checkup every 2 weeks (twice a month).
o Weeks 36 to 41 of pregnancy. Go for one checkup every week (once a week).

Clinical Appointments Comparing DOH and ICSI

Schedule of VIsit Age of Gestation in Weeks

DOH ICSI

1 4-16 6-8

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

2 17-28 10-12

3 29-36 16-18

4 37-40 22

5 28

6 32

7 36

8-11 38-41

High-Risk Pregnant Women

- Less than 18 years old

- Who only received elementary education
- 20% of the poorest household
- In areas of armed conflict
- Victims of domestic violence
- With concurrent illness
What could be Expected in each visit?

First Trimester Second Trimester Third Trimester

4-16 weeks 17-28 weeks 29-36 weeks 37-40 weeks

Compute AOG & Validate AOG & Validate AOG & Validate AOG &
EDC; prepares EDC; update HBMR confirm EDC; update EDC; update HBMR
Home-Based HBMR
Maternal Record
(HBMR)

Physical Examination Physical Physical Physical

and Vital SIgns Examination, fundic Examination, fundic Examination, fundic
height, quickening & height, fetal heart height, fetal heart
vital signs tone & vital signs tone & vital signs

Screening for medical Screen for danger Screen for danger Screen for danger
records and danger signs: signs: signs:
signs (initiate first aid

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

measures as needed - Pallor - Pallor - Pallor

& refer to physician) - Bleeding - Bleeding - Bleeding
- Abdominal - Abdominal - Abdominal
pain pain pain

Screen for: Screen for: Screen for:

- Pre-eclampsia - Painless - Painless

(20th week) vaginal vaginal
- Gestational bleeding bleeding
diabetes (24th - Preterm labor - Preterm labor
week) - Headache - Headache
- Puffiness - Puffiness
edema edema
Urinalysis and
random blood sugar,
if available

Provide 1st aid

measures, as needed
and refer to
physician.

Provide routine Provide routine Provide routine Provide routine

pregnancy care: pregnancy care: pregnancy care: pregnancy care:

- Iron - Iron - Iron - Iron

supplement supplement supplement supplement
- Low dose vit - Low dose vit - Low dose vit - Low dose vit
A A A A
- Tetanus - Tetanus - Tetanus - Tetanus
toxoid toxoid toxoid toxoid
immunization immunization immunization, immunization,
- Malaria if needed if needed
prophylaxis - Repeat - Repeat
for endemic haemoglobin, CBC/Hgb,
area protein in

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 Pamantasan ng Lungsod ng Maynila
Muralla st. Cor. Intramuros, Manila
College of Nursing

- CBC, urine and blood typing

Urinalysis random blood if available
sugar, if
available
Provide counselling Provide counselling Provide counselling Provide information
messages and messages and messages and and validate birth
initialize birth plan: initialize birth plan: initialize birth plan: plan:

- Nutrition and - Nutrition and - Nutrition and - Do’s and

hygiene hygiene hygiene don’t’s in
- Discomforts - Discomforts - Discomforts pregnancy
in pregnancy in pregnancy in pregnancy - Warning signs
- Do’s and - Do’s and - Do’s and in pregnancy
don’t’s in don’t’s in don’t’s in - Fertility
pregnancy pregnancy pregnancy awareness and
- Warning signs - Warning signs - Warning signs FP
in pregnancy in pregnancy in pregnancy - Breastfeeding,
- Fertility - Fertility - Fertility Child care and
awareness and awareness and awareness and family health
FP FP FP - Delivery and
- Breastfeeding, - Breastfeeding, - Breastfeeding, emergency
Child care and Child care Child care and preparations
family health and family family health - Personal
- Delivery and health - Delivery and hygiene after
emergency - Delivery and emergency delivery
preparations emergency preparations
preparations - Personal
rd
Schedule 3 prenatal hygiene after
Schedule 2nd prenatal
visit & update delivery
visit & update
HBMR Schedule 4th prenatal
HBMR
visit, preferably 1-2
weeks before delivery
st
If this is the 1 vivst,
ensure that 1st
trimester activities
have been done.

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