LESSON PLAN ON

Historical perspective & legal and

Ethical aspects

SUBMITTED TO: SUBMITTED BY:

Mrs. Uma maheswari.R MS .Aruna. G

HOD, of OBG Department m.sc (n) 2nd year

Narayana college of nursing Narayana college of nursing

Name of the institution : Narayana college of nursing

Program : M.sc (n)

Subject :Obstetrics & gynecology

Unit : l unit

Topic : historical prospective and legal & ethical issues

Duration : 12-1 pm

Group 3rd E batch

Date : 5/09/13

Methods of teaching : Lecture cum discussion

A.V.aids : white board- introduction

Teacher name : Aruna m.sc (n)

GENERAL OBJECTIVE:
At the end of the class the students will be able to gain knowledge regarding the history, legal and ethical aspects in obstetrical
nursing. These skills and attitude desirable skills applied into their clinical practice.

SPECIFIC OBJECTIVES:
At the end of the class the students will be able to

1. explain about the development of obstetrics.

2. discuss about the development of midwifery in india.

3. define law and ethics.

4. enlist the general aspects.

5. list down the ethical principles.

6. describe the legal issues in obstetrics.

7. discuss about the maternal issues.

8. mention the fetal issues.

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Historical perspective and legal and ethical issues
1 2 min. introduce the topic INTRODUCTION: lecture listening white
board with
Midwifery is as old as the history of human species. There are marker.

references to the midwives in the old testament archaeological evidence

of woman squatting in childbirth supported by another woman from
behind demonstrates the existence of midwifery in 5000BC. lecturing listening
and taking
explain about the Early development: notes
development of The development of obstetrics and gynecology possibly started in
obstetrics
the Indus valley where civilization was flourishing 5 millennia ago. the
Knowledge of medicine spread from the Indus valley, west to the middle
east and east onwards across India.
Aurignacian art in which is represented by paintings of animals
and by status was carried out in Europe and depicted drawing and status
of interest to gynecology. discussing listening
Egypt:(6000-1200BC) and
In the most Muslim countries and in Egypt women were attended answering
only by women. men were excluded from the places where women the
where laboring. this is still in many middle eastern and eastern areas of questions
the world the same. The earliest known records are found in the egtptian
papyruses. In Egypt, the women urine was used to water wheat and
barleys corns. If the plants grew rapidly, pregnancy was confirmed, if the
barley grew faster than the wheat the fetus was a female.
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Greek and Rome:

Greek medicine was dominated 1st by Greek god as Apollo, Diana,
mercury and then by the writing of Hippocrates, a physician named” soranus” explaining listening
Known as the father of obstrectis “ wrote his gynecology book in Greek and
described that fetus could take up various positions in the utrus. he is the best
known for podalic version.
Arestotle:(384-322)
The father of the embryology described the uterus and female pelvic organs.
He also discussed essential qualities of the midwife.
17th century:
The development of the obstetrics forceps was a major break through in
17th century. Instruments to assist delivery had been used for centuries but explaining listening
were mainly for extracting dead fetus.
William Harvey 91578-1657), discoverer of the circulatory system developed
embryology.
19th century:
Gynecology developed separately from midwifery Ephraim Mc dowell
in 1809 performed an ovariotomy . many techniques , procedures and clinical
findings used in modern practices is proposed by Europeans such as breaxton
hicks contractions, hegars sign, nageles rule.
Development of nurse – midwifery services:
By the early 1800’s schools of nursing were being established
throughout Europe. In 1860, Florence nightingale founded ST.
Thomas school of nursing in London. she advocated the training
of a “better class” of women as nurses and midwives to provide
services to women.
In 1872, the obstetrical society of London began issuing
certificates to qualified midwives,
Development in united states:
During the 19th century , obstetrics were greatly influenced by William
dewees. He brought into practice the lithotomy position for delivery, insisted
on relieving pain during labour and advocated judicious use of forceps.
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discuss about the He is considered as the “father of American obstetrics” explain bout
development of Development of midwifery in India: explaining listening the
midwifery in India development
In ancient India, the untrained ‘dias’ belonging to the lower community were of midwifery
mostly responsible for conducting deliveries. This system leads to various in India
complications and increased maternal and infant deaths. Those were the days
when more than 2 lakh women used to die due to childbirth or related facts
and diseases.
By considering these facts , non-official organizations introduced the
training scheme for the dias for safe delivery.

In 1931,” Indian red cross society “started maternity centers in different lecturing listening &
parts of the country through its maternal and child welfare bureau. taking notes

International organizatio like WHO and UNICEF, also began to help the
nations in improving MCH services.
During the 1st five year plan, more than 200 MCH centers were started
in different states with the help of union govt. and international organization.

During the 2nd five year plan , MCH services were integrated with the
services of primary health centers. More staff such as public health nurses,
lady health visitors and midwives , dias etc were trained and appointed .the
training programmed of dias was taken up as a regular measures.

During the late 60s, the govt. of India realized that the children and
women of childbearing age contributes of the total population and are
vulnerable groups.
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Immunization of infants and preschool age children against diphtheria,
pertusis and tetanus.
Immunization of expectant mother against tetanus .
Prophylaxis against nutritional anemia of mother and child.
Prophylaxis against blindness in children caused by vitamin A
deficiency.
Legal and ethical aspects of maternity nursing : explaining listening& what law and
taking notes ethics
3 define law and Definition:
ethics Law:
the law is the system of rights and obligations which the state enforces.
Ethics:
Ethics has to do with action we wish actions we wish people would take, not
actions they must take.
what are the
4 enlist the general General legal aspects: explaining listening & legal aspects
aspects Accountability taking notes
Standards of care
Statutory law
Common laws of torts
Reasonably prudent nurse
Floating
Negligence
Charting
Informed consent
Maternal rights
Insurance
Nurse midwives
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list down the Ethical principles: explaining taking notes what are the
5 ethical principles Respect for persons and ethical
Autonomy listening principles
Freedom
Beneficence(doing good)
Veracity(truth telling)
Malfeasance(avoiding harm to others)
Justice(fair and equal treatment)
Rights
Fidelity(fulfilling promises)
Confidentiality(protecting privileged information)
6 describe the legal Ethical and legal issues in obstetrics:
issues in obstetrics  General information: explaining taking notes
Great advances have been made in the reproductive technology and and
genetic research. listening
These advances have created ethical and legal issues.
Prenatal testing can provide information about gender, congenital
abnormalities and chromosomal defects and can help the parents and
the health care team prepare foe the infant.
However some fear that this knowledge may be used incorrectly.
Will genetic engineering leads to the creation of only desirable
individuals.
 Standards of care:
Guidelines are based on the scienitific principles and offer
direction when providing the health care.
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Guidelines are set by an accrediting body and based on the scope explaining listening
of practices as defined by the states nurse practice act.
Maternal neonatal organizations provide standards of care and
guidelines for registered and advanced practice nurses for this
specialty area.
1. association of women’s health obstetrics and neonatal nursing.
2. national association of neonatal nurses.
3. national association of nurse practitioners in womans health.
Facilities must meet the accrediting body’s minimum standards.
 Patients rights:
 A pregnant patient has the right to actively participate in the decision
involving her health and health of her fetus, unless a medical
emergency prevents her from doing so.
 The American hospital association patients bill of rights explains the
rights of all patients. The pregnant patients bill of right the specific
rights of the pregnant women.
Ethical and legal issues in midwifery and obstetrics:
Issuses are mainly divided into 3
 Maternal issues
 Fetal issues explaining listening explain about
7 Discuss about the  Other issues the maternal
maternal issues Maternal issues: issues
 Surrogacy:
The issue of surrogacy can cause great moral, ethical and legal debate with in
the community. A surrogate mother is someone who gestates and then gives
birth to a child for another person, with the full intention of handling the child
over to that person after the birth.
 Egg donation:
Egg donation may be used successfully in treatment of multiple causes of
infertility, as well as some genetic diseases. Egg donation is usually used
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In the following clinical situations;
 Patient is either in menopause or early menopause and is unable to explaining listening
produce her own eggs.
 Patient with absent ovaries.
 Patient at risk of passing on a genetic disease which may not be
prevented through pre- implantation genetic diagnosis.
 Patient who has had multiple prior in vitro fertilization failures.
 Same gender couples who wish to become parents.
An egg donor may be anonymous or known to the patient requiring this
procedure.
Anonymous egg donors are typically women younger than age 30, whose
identity will remain undisclosed to the prospective parents.
They would agree to undergo a cycle of a hormonal ovarian situation and egg
retrival for the purpose of helping infertile couples become pregnant.
Known donors are either family members or friends of the prospective
parents, or simply recruited donors that will be introduced to the
prospective parents. explaining listening
Reproductive fertility center currently uses both anonymous and known egg
donors.
The expert team at reproductive fertility center is dedicated to help patients
find and match an egg donor.
The team will help the prospective family in every aspect of the process,
providing medical advice, emotional support, legal guidance and financial
assistance.
 Artificial reproductive techniques:
Artificial insemination: insemination of the wife with her husband’s sperm

Artificial inseminations of the women with a donors sperm.

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Invitro fertilization:
One of the most recent ethical dilemmas brought to focus by modern
obstetrics is the issue of invitro fertilization with subsequent embryo
transplantation, known in the vernacular test tube babies.

Abortion:
From an ethical perspective abortion is essential the removal of womans
support from the uterus, leading to fetal death. discussing listening &
answering
Ethical and medico legal aspects of obstetrics anesthesia and informed the
consent. questions
Prenatal screening: a). Amniocentesis s
b) other prenatal diagnosis

sexual counseling
sterilization
genetic counseling
home births
ethical issues related to preimplantation genetic diagnosis
ethical and legal issues in prenatal and labour care
a). fetal monitors
b). during labour and delivery
c). maternal complications
d). still born infants
e). neonatal complications
f). ethical issues in neonatal care and resuscitation
s.no time Specific Content Teacher Student a.v. aids evaluation
objectives Activity activity

mention the fetal Fetal issues: discussing listening What are the
issues Fetal research: it is a criminal offense and states that fetal research have fetal issues
placed many constraints on this activity. Right to get consent. It should
be the health needs of the fetus.
Fetal tissue research
Eugenics and gene manipulation
Preterm and high risk neonate treatment
Cord blood banking embryonic stem cell research
Femal foeticide
The human genome product
Other issues:
Colostrums feeding
Hymen reconstructing
SUMMARY:
Till now we discussed about the historical prospectives, legal and ethical aspects in obstetrics, general legal aspects, maternal, fetal,
other issues .

CONCLUSION :
I concluded that at the end of the class the students will be able to gain in depth, knowledge regarding the legal and ethical aspects in midwifery
nursing .

BIBLIOGRAPHY:

Teacher reference:

1. Nima bhasker, the text book of midwifery and obstetrical nursing,2013, emmess medical publishers, p.no. 774-783.

2.Lowder milk perry, the text book of obstetrics , 7th edition, Elsevier publication, p.no.4-7.

3. Myles, the text book of midwives, 15th edition, 2009, Elsevier, p.no.7-9.

Student reference:

1. . Nima bhasker, the text book of midwifery and obstetrical nursing,2013, emmess medical publishers, p.no. 774-783.

2.Lowder milk perry, the text book of obstetrics , 7th edition, Elsevier publication, p.no.4-7.

3. Myles, the text book of midwives, 15th edition, 2009, Elsevier, p.no. 654.
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O
• Vaginal discharge:
* Ask the woman about any increase or change of vaginal discharge.
• Report to the obstetrician any mucoid loss before the 37th week of
pregnancy.
Vaginal bleeding:
* Vaginal bleeding at any time during pregnancy should be reported to the
obstetrician to investigate its origin.
Test Purpose

Blood group To determine blood type.

Hgb & Hct To detect anemia.

(RPR) rapid plasma To screen for syphilis

reagin
Rubella To determine immunity

Urine analysis To detect infection or renal disease.

protein, glucose, and ketones

Papanicolaou (pap) To screen for cervical cancer

test

Chlamydia Urine analysis

Glucose To screen for gestational diabetes.

Stool analysis for ova and parasites

* Venereal disease
tests should be To screen for syphilis
performed (VDRL)

To detect carrier status or active

Hepatitis B surface disease
antigen
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• * Hemoglobin will be repeated:
• - At 36 weeks of gestation.
• - Every 4 weeks if Hb is<9g/dl.
• - If there is any other clinical reason.
Ultra sound:
Is performed to:
• estimate the gestational age.
• Check amniotic fluid volume.
• Check the position of the placenta.
• Detect the multifetal pregnancy.
• The position of the baby.
Fetal kick count:
• The pregnant woman reports at least 10 movements in 12 hours.
* Absence of fetal movements precedes intrauterine fetal death by 48 hours.
Schedule of antenatal care:
• a medical check up every four weeks up to 28 weeks gestation,
 • every 2 weeks until 36 weeks of gestation
• visit each week until delivery
• More frequent visits may be required if there are abnormalities or
complications or if danger signs arise during pregnancy

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 Services at subsequent visits:
• the nurse inquires about physical changes that are related directly to
the pregnancy, such as the woman’s perception of fetal movement,
any exposure to contagious illness, medical treatment and therapy
prescribed for non-pregnancy problems since the last visit,
• prescribed medications that were not prescribed as a part of the
women’s prenatal care.
health education::

• Follow up:
• Advice the mother to follow up according to the schedule of antenatal
care that mentioned before, advise the mother to follow up
immediately if any danger sings appears, describe the important of
follow up to the mother.
8 5min enlist the antenatal Health teaching during pregnancy
advices lecturing listening hand out Explain the
Health promotion during pregnancy begins with reviewing health hare. and answers antenatal
Hygiene: advices
• Daily all over wash is necessary because it is stimulating, refreshing,
and relaxing.
• Warm shower or sponge baths is better than tub bath.
• Hot bath should be avoided because they may cause fatigue. &fainting
• Regular washing for genital area, axilla, and breast due to increased
discharge and sweating.
• Vaginal douches should avoided except in case of excessive secretion
or infection.

SPECIFIC TEACHERS LEARNERS A.V AIDS EVALUATION

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Breast care:
• Wear firm, supportive bra with wide straps to spread weight across
the shoulder.
• Wash breasts with clean tap water (no soap, because that could be
drying). Daily to remove the colostrum & reduce the risk of infection.
• It is not recommended to massage the breast, this may stimulate
oxytocin hormone secretion and possibly lead to contraction.
• advise the mother to be mentally prepared for breast feeding
• advise the pregnant woman to expresses colostrums during the last
trimester of pregnancy to prevent congestion.
Dental care:
• The teeth should be brushed carefully in the morning and after every
meal.
• Encourage the woman the to see her dentist regularly for routine
examination & cleaning.
• Encourage the woman to snack on nutritious foods, such as fresh fruit
 & vegetables to avoid sugar coming in contact with the teeth.
• A tooth can be extracted during pregnancy, but local anesthesia is
recommended.
Dressing:
• Woman should avoid wearing tight cloths such as belt or constricting
bans on the legs, because these could impede lower extremity
circulation.

s.n time objectives content Teacher Student’s a.v. aids evaluation

o activity activity
• Suggest wearing shoes with a moderate to low
heel to minimize pelvic tilt & possible backache.
• Loose, and light clothes are the most comfortable.
Travel:
Many women have questions about travel during
pregnancy.
• Early in normal pregnancy, there are no
restrictions.
• Late in pregnancy, travel plans should take into
consideration the possibility of early labor.
Sexual activity:
• Sexual intercourse is allowed with moderation, is
absolutely safe and normal unless specific
 problem exist such as: vaginal bleeding or
ruptured membrane.
• If a woman has a history of abortion, she should
avoid sexual intercourse in the early months of
pregnancy.

Exercises:
• Exercise should be simple. Walking is ideal, but
long period of walking should be avoided.

s.no time objectives content Teacher Learner a.v. aids evaluation

activity activitty
• The pregnant woman should avoid lifting heavy
weights such as: mattresses furniture, as it may
lead to abortion.
• She should avoid long period of standing because
it predisposes her to varicose vein.
• She should avoid setting with legs crossed because
it will impede circulation.
Purpose:
1. To develop a good posture.
2. To reduce constipation & insomnia.
3. To alleviate discomvortable, postural back ache&
fatigue.
4. To ensure good muscles tone& strength pelvic
supports.
5 To develop good breathing habits, ensure good oxygen
 supply to the fetus.
6- to prevent circulatory stasis in lower extremities,
promote circulation, lessen the possibility of venous
thrombosis
Sleep:
• The pregnant woman should lie down to relax or
sleep for 1 or 2 hours during the afternoon.
• At least 8 hours sleep should be obtained every
night & increased towards term, because the
highest level of growth hormone secretion occurs
at sleep.
• Advise woman to use natural sedatives such as:
warm bath & glass of worm milk.

s.no time objectives content Teacher Learner a.v.aids evaluation

activity activity
• Smoking & alcohol: increase risk for pregnancy,
prematurity, fetal death, mental retardation &
congenital anomalies.
• Drugs: as sedative & analysis, anticoagulant,
antithyrodism, hormones& antibiotics.

Immunization:
the nurse instructs the woman to receive immunization
against -tetanus to prevent the risk for her and her fetus.
Also, it is important that every pregnant mother should
receive a tetanus vaccination card with her first tetanus
dose and keep it to record subsequent doses
 Diet:
• -Daily requirement in pregnancy about 2500
calories.
• - Women should be advised to eat more
vegetables, fruits, proteins, and vitamins and to
minimize their intake of fats.
• Purpose:
– *Growing fetus.
– *Maintain mother health.
– *Physical strength & vitality in labor.
– *Successful lactation.

s.no time objectives content Teacher Learner a.v aids evaluation

activity activity
9 7min illusterate Managing the minor disorders of pregnancy: discussion listening pamphlet What are the
the minor minor
disorders Nausea and vomiting: disorders
• -occur between 4-6 weeks gestation
• Causes:
- hormonal influences: hcg, progesterone, estrogen.
- emotional factors like tension.
• Management:
- adequate rest and relaxation.
- eating small six meals a day rather than three large
meals.
- solid food tolerated better than liquid food like:
crackers or piece of dry toast.
- carbohydrate snacks at bedtime can prevent
 hypoglycemia which cause nausea & vomiting.
- Food should not have a strong odor, should not be either
very hot or very cold, and fried or greasy foods should be
avoided.
Heart burn:
Causes:
- progesterone hormone relaxes the cardiac sphincter of
the stomach and allows reflex or bubbling back of gastric
contents into the esophagus.
- the pressure of the growing uterus on the stomach
from about 30-40 weeks.

s.no time objectives content Teacher Learner a.v.aids evaluation

activity activity
Management:
- avoid lying flat.
- sleeping with more pillows and lying on the right side.
- small frequent meals.
- take antacids.
- taking baking soda in a glass of water is
contraindicated because of the possibility of retention of
sodium and subsequent edema
Avoid fried ,spicy, and fatty food
Avoid citrus juices
• Backache : Cause:
Backache may be due to muscular fatigue and strain that
accompany poor body balance.
 • It may be due to increased lordosis during
pregnancy in an effort to balance the body.
• •The pregnancy hormones sometimes soften the
ligaments to such a degree that some support is
needed.
• Management:
- exercise.
- sit with knee slightly higher than the hips.
-The pregnant woman is reassured that once birth has
occurred, the ligaments will return to their pre-pregnant
strength.

s.no time objectives content Teacher Learner a.v.aids evaluation

activity activity
Urinary frequention:Cause:
Occur due to the pressure of the growing uterus on the
bladder.
• Management:
The problem will resolved when the uterus rises into the
abdomen after the 12th week.
Kegel exercises are some times recommended to help
maintain the bladder.
Varicosities:Causes:
- progesterone relaxes the smooth muscles of the veins
 and result in sluggish circulation. The valves of the
dilated veins become inefficient & varicose veins result.
- weight of the uterus partially compressed the veins
returning blood from the legs.
• Management:
- lying flat on the bed with the feet elevated.
- moving the legs about is better than standing still.
Constipation:
• Causes:
- intestinal motility decreased during pregnancy as a
result of progesterone.
- iron supplementation.
• Management:
- the food should have amount of fruit & green
vegetables which contain fibers.
- drinking a lot of water.
- exercise & walking.

SUMMARY:
Let me summaries the topic of antenatal care that is aims & objectives, signs and symptoms, visits, examination, health education, minor
disorders during pregnancy & nursing responsibilities.

CONCLUSION :

EVALUATION:
FILL IN THE BLANKS: 5 MARKES
 TIME : 5 mts

1. Systematic supervision of a women during pregnancy is called ________________

2. What is primi gravid __________
3. Dose of the folic acid ___________/day
4. The first dose of T.T is to be given between ___________weeks
5. The check up is done at interval of ____up to ______________weeks.

ASSIGNMENT:
Write an assignment on physical examination.

BIBLIOGRAPHY:
STUDENT REFERENCE:

1. Perry & Lowder milk, “ maternal child health care”, c. 2006, 3rd edition, elsevier , publication p 255-304
2. S.s ricci , essentials of meternity, new born & womens health nursing, c. 1999, 11th edition, lippencot,p.p 256 -257
3. Gorrie, murrey, foundation of maternal new born nursing, c. 1989, 9th edition. W.b. sonders p.p 172-176

TEACHER’S REFERENCE:
4. Lowdermilk ,” maternity & women’s health care”, c. 2006, 3rd edition, , elsevier , publication p 255-304
 5. Ammula radan ramana “hand book of obstetrical nursing”, c.2007 9th edition, frontline publications, londonp.p 92-96

JOURNAL REFERENCE:
1. The American journal of maternal & child nursing, 2009, vol.32, p.p 32-33

NET REFERENCE:
1.http://antenatal care. Wikepedia.com

2. http://www.pregnancy care . com/org/content….

Name of the institution : Narayana college of nursing

Program : m.sc (n)

Subject :obstetrics & gynecology

Unit : III unit

Topic : antenatal care

 Duration : 2-3 pm

Group 3rd A batch

Date : 12/02/13

Methods of teaching : white board, roller board, leaflet, chart, OHP

Teacher name : Aruna m.sc (n)

Evaluator Ms . winey m.sc (n)

Lecturer,OBG Department

GENERAL OBJECTIVE:
At the end of the class the students will be able to gain knowledge regarding attitude desirable skills

to achieve in the health care settings.

SPECIFIC OBJECTIVES:
 At the end of the class the students will be able to

1. introduce the antenatal care.

2. define antenatal care.

3. enumerate the signs of pregnancy.

4. describe the aims & objectives of antenatal care.

5. discuss the antenatal counseling.

6. list out the antenatal services.

7. assess the physical examination.

8. enlist the antenatal advices.

9. illustrate the minor disorders during pregnancy.

LESSON PLAN ON
 Antenatal care

SUBMITTED TO: SUBMITTED BY:

Ms. Winny M.sc (n) MS .Aruna. G

Lecturer ,OBG Department m.sc (n) 2nd year

Narayana college of nursing Narayana college of nursing

Health teaching during pregnancy

Health promotion during pregnancy begins with reviewing health hare.

Hygiene:

• Daily all over wash is necessary because it is stimulating, refreshing, and relaxing.

• Warm shower or sponge baths is better than tub bath.

• Hot bath should be avoided because they may cause fatigue. &fainting

• Regular washing for genital area, axilla, and breast due to increased discharge and sweating.

• Vaginal douches should avoided except in case of excessive secretion or infection.

Breast care:

• Wear firm, supportive bra with wide straps to spread weight across the shoulder.

• Wash breasts with clean tap water (no soap, because that could be drying). Daily to remove the colostrum & reduce the risk of infection.

• It is not recommended to massage the breast, this may stimulate oxytocin hormone secretion and possibly lead to contraction.

• advise the mother to be mentally prepared for breast feeding

• advise the pregnant woman to expresses colostrums during the last trimester of pregnancy to prevent congestion.

Dental care:

• The teeth should be brushed carefully in the morning and after every meal.

• Encourage the woman the to see her dentist regularly for routine examination & cleaning.

• Encourage the woman to snack on nutritious foods, such as fresh fruit & vegetables to avoid sugar coming in contact with the teeth.
 • A tooth can be extracted during pregnancy, but local anesthesia is recommended.

Dressing:

• Woman should avoid wearing tight cloths such as belt or constricting bans on the legs, because these could impede lower extremity circulation.

• Suggest wearing shoes with a moderate to low heel to minimize pelvic tilt & possible backache.

• Loose, and light clothes are the most comfortable.

Travel:

Many women have questions about travel during pregnancy.

• Early in normal pregnancy, there are no restrictions.

• Late in pregnancy, travel plans should take into consideration the possibility of early labor.

Sexual activity:

• Sexual intercourse is allowed with moderation, is absolutely safe and normal unless specific problem exist such as: vaginal bleeding or
ruptured membrane.

• If a woman has a history of abortion, she should avoid sexual intercourse in the early months of pregnancy.

Exercises:

• Exercise should be simple. Walking is ideal, but long period of walking should be avoided.

• The pregnant woman should avoid lifting heavy weights such as: mattresses furniture, as it may lead to abortion.

• She should avoid long period of standing because it predisposes her to varicose vein.
 • She should avoid setting with legs crossed because it will impede circulation.

Purpose:

1. To develop a good posture.

2. To reduce constipation & insomnia.

3. To alleviate discomvortable, postural back ache& fatigue.

4. To ensure good muscles tone& strength pelvic supports.

5 To develop good breathing habits, ensure good oxygen supply to the fetus.

6- to prevent circulatory stasis in lower extremities, promote circulation, lessen the possibility of venous thrombosis

Sleep:

• The pregnant woman should lie down to relax or sleep for 1 or 2 hours during the afternoon.

• At least 8 hours sleep should be obtained every night & increased towards term, because the highest level of growth hormone secretion
occurs at sleep.

• Advise woman to use natural sedatives such as: warm bath & glass of worm milk.

• Smoking & alcohol: increase risk for pregnancy, prematurity, fetal death, mental retardation & congenital anomalies.

• Drugs: as sedative & analysis, anticoagulant, antithyrodism, hormones& antibiotics.

Immunization:
the nurse instructs the woman to receive immunization against -tetanus to prevent the risk for her and her fetus.

Also, it is important that every pregnant mother should receive a tetanus vaccination card with her first tetanus dose and keep it to record
subsequent doses

Diet:

• -Daily requirement in pregnancy about 2500 calories.

• - Women should be advised to eat more vegetables, fruits, proteins, and vitamins and to minimize their intake of fats.

• Purpose:

– *Growing fetus.

– *Maintain mother health.

– *Physical strength & vitality in labor.

– *Successful lactation.