Module No.

3 Common Discomforts of Pregnancy

Learning Objectives
At the end of the module, the student should be able to:
1. Relate the previous concepts
2. Discuss the different discomforts associated with pregnancy
3. Explain the cause of the discomforts
4. Formulate a plan of care

INTRODUCTION:
During pregnancy, women may experience one or more of a wide variety of discomforts. Every
pregnancy is different; discomforts felt during one pregnancy may not appear in another. Most
discomforts experienced during pregnancy are thought to be the result of abundant hormonal
changes. As pregnancy progresses, other discomforts are attributed to physical changes
associated with the enlarging uterus. Nurses can do something to decrease discomforts associated
with pregnancy.

ENGAGEMENT
The pregnant client tells the nurse that she is experiencing morning sickness.
Question:
1. What is happening to the client?
The client is experiencing a sign which is normal to a pregnant woman brought by the
hormonal changes during pregnancy.
2. Why is the client experiencing morning sickness?
The client is experiencing morning sickness because of the body’s reaction to the
pregnancy hormone. This is common during 1 st trimester and it is attributed because of
the presence or increase level of HCG
3. Until when will this discomfort be felt?
Cn be felt until the end of 1st trimester of pregnancy.Usually peaks between 8-11 weeks.
4. What happen if this discomfort persists until the second trimester?
It is maybe cause of round ligament paint.The womb of the women is expanding which
results for the ligaments to stretch.This probably the cause why discomfort continue to
arise until the second trimester.
5. What should the nurse instruct the client to do to assist in the relief of the discomfort?

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The nurse should instruct the client to Eating dry crackles before arising.Avoiding brushing
teeth immediately after arising,Eating small, frequent low-fat meal during the day,Drinking
fluids between meal rather than during meals.Avoiding fried foods and spicy foods

EXPLORATION
I. Psychological Maternal Changes
A. Ambivalence
1. Occurs early in pregnancy, even when the pregnancy is planned
2. The mother may experience a dependence-independence conflict and
ambivalence related to role changes
3. The father may experience ambivalence related to the new role that he is
assuming, increased financial responsibilities and sharing the wife’s attention
with the child.
B. Acceptance: factors that may be related to acceptance of the pregnancy are the
woman’s readiness for the experience and her identification with the motherhood
role
C. Emotional lability
1. May be manifested by frequent changes of emotional states or extreme of
emotional states
2. These emotional changes are common, but the mother may think that these
changes are abnormal
D. Body image changes
1. The changes in a woman’s perception of her image during pregnancy occur
gradually and may be positive or negative
2. The physical changes and symptoms that the woman experiences during
pregnancy contribute to her body image
E. Relationship with the fetus
1. The woman may daydream to prepare for motherhood and think about the
maternal qualities that she would like to possess
2. The woman first accepts the biological fact that she is pregnant
3. The woman next accepts the growing fetus as distinct from herself and as a
person to nurture
4. Finally, the woman prepares realistically for the birth and parenting of the
child

II. Discomforts of pregnancy

A. Nausea and vomiting
1. Occurs in the first trimester and subsides on the third month
2. Caused by elevated level of HCG and changes in carbohydrates metabolism
3. Interventions
a. Eating dry crackles before arising

Catherine C. Maribbay (leMaN 06)

 b. Avoiding brushing teeth immediately after arising
c. Eating small, frequent low-fat meal during the day
d. Drinking fluids between meal rather than during meals
e. Avoiding fried foods and spicy foods

B. Syncope
1. Usually occurs in the first trimester, supine hypotension occurs particularly in
the second and third trimester
2. May be triggered hormonally or caused by the increased blood volume,
anemia, fatigue, sudden position changes, or lying supine
3. Interventions
a. Sitting with the feet elevated
b. Risk for falls, teach to change position slowly
C. Urinary incontinence
1. Usually occurs in the first and third trimesters
2. Caused by pressure of the uterus on the bladder
3. Interventions
a. Drinking no less than 2000 ml of fluid during the day
b. Limiting fluid intake in the evening
c. Voiding at regular intervals
d. Sleeping side-lying at night
e. Wearing perineal pads, if necessary
f. Performing kegel exercise
D. Breast tenderness
1. Can occur in the first through the third trimesters
2. Caused by increased levels of estrogen and progesterone
3. Interventions
a. Wearing a supportive bra
b. Avoiding the use of soap on the nipples and areolar area to prevent drying
of skin
E. Increased vaginal discharge (Leukorrhea)
1. Can occur in the first through the third trimesters
2. Caused by hyper-trophy and thickening of the vaginal mucosa and increased
mucus production and increased estrogen
3. Interventions
a. Using proper cleansing and hygiene techniques
b. Wearing cotton underwear
c. Avoiding douching
F. Nasal stuffiness
1. Occurs in the first through third trimesters
2. Results from increased estrogen, which causes swelling of the nasal tissues
and dryness

Catherine C. Maribbay (leMaN 06)

 3. Interventions
a. Encourage the use of humidifier
b. Avoiding the use of nasal sprays or antihistamines
G. Fatigue
1. Occurs usually in the first and third trimesters
2. Usually results from hormonal changes
3. Interventions
a. Arranging frequent rest periods throughout the day
b. Using correct posture and body mechanics
c. Obtaining regular exercise
d. Performing muscle relaxation and strengthening muscle exercises of the
legs and hip joints
e. Avoiding eating and drinking foods containing stimulants throughout the
pregnancy
H. Heartburn
1. Occurs in the second and third trimesters
2. Results from increased progesterone levels, decreased GIT motility,
esophageal reflux, and displacement of the stomach by the enlarging uterus
3. Interventions
a. Eating small, frequent meals
b. Sitting upright for 30 minutes after a meal
c. Drinking milk between meals
d. Avoiding fatty and spicy foods
e. Performing tailor sitting exercises
I. Ankle edema
1. Usually occurs in the second and third trimester
2. Results from vasodilation, venous stasis, and increased venous pressure below
the uterus
3. Interventions
a. Elevating the legs at least twice a day and when resting
b. Sleeping in a side-lying position
c. Wearing supportive stockings or support hose
d. Avoiding sitting or standing in one position for long periods
J. Varicose veins
1. Usually occurs in the second and third trimesters
2. Results from weakening walls of the veins or valves and venous congestion
3. Interventions
a. Wearing supportive stockings or support hose
b. Elevating the legs when sitting
c. Lying the legs and hips elevated
d. Avoiding long periods of standing or sitting
e. Moving about while standing to improve circulation
f. Avoiding leg crossing

Catherine C. Maribbay (leMaN 06)

 g. Avoiding constricting articles of clothing such as knee-high stockings, and
girdle
K. Headaches
1. Usually occurs in the second and third trimesters
2. Results from changes of blood volume and vascular tone
3. Interventions
a. Changing position slowly
b. Applying a cool cloth to the forehead
c. Eating a small snack
d. Using acetaminophen only if prescribed
L. Hemorrhoids
1. Usually occurs in the second and third trimesters
2. Results from increased venous pressure and constipation
3. Interventions
a. Soaking in a warm sitz-bath
b. Sitting on a soft pillow
c. Eating high fiber foods and drinking sufficient fluids
d. Increasing exercise such as walking
e. Applying ointments, suppositories, or compresses as prescribed
M. Constipation
1. Usually occurs in the second and third trimesters
2. Results from an increase in progesterone production, decreased GIT motility,
displacement of the intestines, pressure of the uterus and taking iron
supplement
3. Interventions
a. Eating high fiber foods such as whole grains, fruits and vegetables
b. Drink no less than 2000 ml/day
c. Exercising regularly at least 20- minute walk
N. Backache
1. Usually occurs in the second and third trimester
2. Caused by exaggerated lumbosacral curve resulting from an enlarged uterus
3. Interventions
a. Obtaining rest
b. Using correct posture and body mechanics
c. Wearing low-heeled shoes
d. Perform pelvic tilt/rock exercises and conscious relaxation exercises
e. Sleeping on a firm mattress
O. Leg cramps
1. Usually occurs in the second and third trimesters
2. Results from altered calcium-phosphorus balance and pressure of the uterus
on nerves or from fatigue
3. Interventions
a. Getting regular exercise, especially walking

Catherine C. Maribbay (leMaN 06)

 b. Dorsiflexing the feet of the affected leg
c. Increasing calcium intake

EXECUTION:

You work as a nurse consultant with a group of midwives. Today you are meeting with Mardhes,
a 34 years old woman who is 30 weeks pregnant. Mardheshas had one previous pregnancy that
resulted in the birth of a 4400 grams healthy baby, Sarah, who is now 16 months old. Mardhes is
married, and her husband, John Paul, is with her at this visit. John Paul works full time as a
Physician Assistant, but the practice that he works for has recently been purchased by a health
plan and he is unsure about his job's future right now. Mardhesworks half time as a legal
secretary.

Mardhesand john Paul carefully planned for their first pregnancy. They were married several
years ago, but waited to have their first child until they were financially secure enough that
Mardhes could work part time after the baby came. They both made a point of making healthy
food choices and avoiding alcohol when they were trying to conceive their first child. They
attended both a preconception health education class and a prepared childbirth class.

Sarah proved to be a challenging baby. She is only now beginning to sleep through the night. She
had "colic" symptoms until she was almost 6 months old. Mardhes and John Paul felt strongly
about breastfeeding, and had been to classes and read books about breastfeeding. However, they
encountered some difficulties with breastfeeding for the first few weeks. These included sore
nipples, a breast infection, and a perceived lack of an adequate milk supply. When Mardhes went
back to work 3 months post- partum Sarah eagerly took bottles of formula while her mother was
at work. Despite Mardhes’ plan to maintain exclusive breastfeeding and pumping of breastmilk
for several months, Sarah was soon just nursing a couple of times a day, and stopped nursing
altogether 2 to 3 weeks after Mardhes discovered that she was pregnant again.

Mardhes and John Paul had wanted another child at some point, but this current pregnancy was
not intended. Although they have accepted the pregnancy, they state that they have concerns
about the effect that a new baby will have on Sarah, their marriage, and their finances.

Mardhes and John Paul have good health insurance coverage, but Mardhes has only been seen 4
times for prenatal care for this pregnancy.

Anthropometric Data

Mardhes’ pre-pregnancy weight with this pregnancy was 175 lbs. She is 61 " tall. She gained 55
pounds in her first pregnancy, and lost 20 of those pounds before she became pregnant again.
Today her weight is 200 lbs.

Health History

Catherine C. Maribbay (leMaN 06)

Mardhes’ health history is unremarkable. Her blood pressure today is within normal limits. She
denies use of drugs, tobacco.

Mardhes states that she does not like to exercise. She joined a health club a few years ago, but
stopped going after about 6 weeks because she felt out of place and she thought that it was
boring. She started a walking program after her first pregnancy with another new mother from
her mom’s group, but her friend moved away and Mardhes doesn’t like to walk alone.

At the beginning of both of her pregnancies Mardhes experienced considerable nausea and
occasional vomiting as well as overwhelming fatigue. Today Mardhescomplains of the onset of
several pregnancy discomforts that also bothered her toward the end of her first pregnancy.
These include heartburn, intermittent diarrhea and constipation, fatigue, and edema in her ankles.

Laboratory Values

Last week Mardheshad a 50 grams oral glucose screen. Results at one hour were 120 mg/100 ml.
Mardhes’ hematocrit today is 31%.

Dietary Intake

Day One Day Two Day Three

Breakfast Breakfast Breakfast

2 c. Coffee with cream 2 c. Coffee with cream 2 c. Coffee with cream

Break at Work Break at Work Break at Work

Donut Donut Donut

Decaf Coffee with cream Decaf Coffee with cream Decaf Coffee with cream

Lunch Lunch Lunch

Tuna sandwich (water packed tuna,
mayo, pickle relish, white bread)
12 oz unpasturized Whole milk
Potato chips
½ sandwich leftover from Sarah's
lunch
Tuna sandwich (water packed Tuna sandwich (water
tuna, mayo, pickle relish, packed tuna, mayo, pickle
white bread) relish, white bread)
unpasturized Whole Milk  
½ c pretzels 1 c Apple slices
¼ sandwich leftover from 12 oz unpasturized Whole
Sarah Milk

½ leftover sandwich from

Catherine C. Maribbay (leMaN 06)

 Sarah

Snack with Sarah Snack with Sarah Snack Sarah

10 Triscuit  Crackers 10 Triscuit Crackers 10 Triscuit Crackers

2 oz Cheddar Cheese slices 2 oz Cheddar Cheese slices 2 oz Cheddar Cheese

slices
Unpasturized Apple Juice - 12 oz Unpasturized Apple Juice -
12 oz Unpasturized Apple Juice
- 12 oz

Dinner Dinner Dinner

1/3 a large  chicken and spinach 1 ½ c. Spaghetti 1 Ham and Cheese "Hot
Pagliachi Pizza Pocket"
¾ c tomato sauce with
12 oz beer ground beef ½ c Green Peas

1 ½ c Salad with iceberg 20 French Fries

lettuce, carrots, and tomatoes
2 Tbsp. Ranch Dressing
2 thick slices buttered garlic
bread
12 oz whole milk
1c. Hagen Das Ice Cream
with Dove Chocolate
Sauce

12 oz whole unpasturized
milk

Peppermint tea 12 oz Peppermint tea 12 oz Peppermint tea 12 oz

Questions:

1. Discuss the possible role that pregnancy intendedness may play in both of Mardhes’
pregnancies.
2. Preconception desire for pregnancy,steps taken to prepare for pregnancy,fertility
behaviour and expectations,postconception desire for pregnancy and adaptation to
pregnancy and the baby.
3. Assess anthropometric data, health history, lab values, and dietary intake information.

A.PRE PREGNANCY WEIGHT:175 LBS

B.ACTUAL WEIGHT:200LB

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 C.HEIGHT:6’1

HEALTH HISTORY:

Experienced considerable nausea and occasional vomiting as well as overwhelming

fatigue.

LAB VALUES:

Oral glucose screen:50 gram

HCT:31%

4. What are the nutritional concerns you have about Mardhes?

Driniking coffee,Beer,Eating left over sandwich and eating to much in the evening.

5. What impacts might her weight status have on this pregnancy?

She will be suffering from obesity or she will gain weight and this may lead to
complication and miscarriage.

6. What recommendations might you make regarding weight gain, diet, exercise dietary
supplements, and discomforts of pregnancy?

RECOMMENDATION REGARDING WEIGHT GAIN

1.know your calorie needs
2.Eat balanced diet
3.Limit added sugar and solid fats
RECOMMENDATION REGARDING DISCOMFORT OF PREGNANCY
1.Lying the legs and hips elevated
2.Changing position slowly
3.Avoid spicy foods
4.Perform pelvic tilt,rock exercises and conscious relaxation exercises.
RECOMMENDATION REGARDING EXERCISE AND DIETARY SUPPLEMENTS
1.YOGA
2.WALKING
3.SWIMMING
4.TAKE PRE NATAL VITAMINS

7. If you have the opportunity to see Mardhes at her next prenatal visits at 32 and 34 weeks,
how would you prioritize and plan your counseling?

EVALUATION:

Catherine C. Maribbay (leMaN 06)

 1. First trimester discomforts include all of the following EXCEPT
a. Nausea and vomiting
b. Urinary incontinence
c. Shortness of breath
d. Breast tenderness
2. Increased oxygen consumption, increased progesterone and relaxin, metabolic demands
and psychosocial changes, sleep disturbances d/t physical discomforts, are the possible
causes of:
a. Fatigue
b. Backache
c. Headache
d. Shortness of breath
3. A pregnant client complains of bleeding gums, the nursing student is correct when she
says that the cause of bleeding gums during pregnancy is:
a. Increased blood volume
b. Increased plasma
c. Increased estrogen and progesterone
d. Increased production of melanocytes
4. A pregnant client at 20 weeks gestation complains of heart burn. What instruction should
be given to relief heartburn?
a. Take deep breathing regularly
b. Have a regular exercise such as walking
c. Avoiding of spicy foods
d. Encourage weight reduction
5. All of the following measures can be done to relief headache EXCEPT:
a. Change posture slowly
b. Darkened room
c. Eating small snack
d. Taking ASA/NSAIDs

SUMMARY
Every woman is a unique individual, and every pregnancy she experiences will have its unique
set of discomforts. Discomforts often are not isolated symptoms but generally are integrated into
a whole gamut of problems, with one sometimes perpetuating another. Pregnancy is not an
illness; it is a physiologic and emotional state of being that is associated with hormonal changes
and physical changes brought about by an enlarging uterus. Many discomforts of pregnancy are
preventable, and others are manageable with common sense measures.The obstetric nurse must
carefully assess all symptoms reported by the pregnant patient. The assessment should include
the level or intensity of the discomfort and what relief measures have been tried. The nurse must
listen to the patient and observe her body language. Snap judgments should not be made. The
nurse must evaluate the whole circumstance before making decisions and must rule out any
disease process that may be the cause of the patient’s discomfort.Interventions should be

Catherine C. Maribbay (leMaN 06)

individualized with a holistic approach. Incorporate lifestyle and cultural differences when
developing a plan of care. Include the pregnant woman and significant other(s) in the
development of the plan of care. Be practical and brief in descriptions and explanations, and give
examples. Ask the pregnant woman if she can implement the plan. If not, what can be done to
allow implementation?
Discomforts are significant to the pregnant woman experiencing them, and therapeutic remedies
should be actively pursued. The extent to which the discomforts of pregnancy are felt and how
well treatment will work depend upon strength from within and the caring, concern, and support
from family, friends, and medical and nursing personnel.

Catherine C. Maribbay (leMaN 06)