Question: Does Getting Regular Prenatal Care Affect the Risk of Pregnancy Loss?

My doctor just weighs me, measures my uterus, and listens to the baby on a doppler for a few seconds at each prenatal care appointment. The whole thing takes just 5 minutes. I have to take time off from work to come in, and I end up sitting in the waiting room for up to an hour. The whole thing is a big hassle, and this isn't my first pregnancy so I don't need any handholding. Are regular prenatal appointments really all that important? Answer: Prenatal care appointments are that important. Although it is true that not much happens during most prenatal visits, the measurements taken during these appointments can be crucial in allowing early detection of complications in later pregnancy. When your doctor has a record of your baby's measurements, your blood pressure, and other factors as well as a reliable due date for your pregnancy (all of which are established during prenatal care), your doctor should be able to quickly detect if your baby develops intrauterine growth restriction, pre-eclampsia or other such complications. With early detection, your doctor may have the ability to take action to stop the problems from becoming more serious. Regular prenatal care starting in early pregnancy can sharply reduce your risk of a stillbirth because of this, given that many stillbirths are preventable if complications are detected early. According to the National Women's Health Information Center, lack of prenatal care means a five times higher risk of stillbirth and a three times higher risk of having a baby with low birth weight. (That's not to say that all stillbirths are preventable with prenatal care, of course, but many are.) For the majority of women, of course, the pregnancy will proceed smoothly and uneventfully without these complications. But no one can predict who will be affected by late pregnancy complications. The safest bet is to keep going in on the recommended schedule and establishing these records from early on to help your doctor monitor your pregnancy as adequately as possible. If the appointments are causing problems with your work, consider asking for the first appointment of the day and coming early in the morning to reduce the risk of delays in the doctor's office.

Nutrition importance of good nutrition during pregnancy is very crucial in preventing complications of childbirth. Teens often have poor dietary habits that may affect the growth and development of the unborn child. Poor nutrition during pregnancy may cause premature birth or babies with low-birth weight. They can benefit from nutrition counseling that promotes good eating habits and the use of vitamin supplements such as folic acid and iron. How Do I Eat Healthy? Choosing a variety of foods from the four food groups in Canada's Food Guide is the best way to make sure you get the nutrients needed to grow a healthy baby. The key nutrients needed to grow a healthy baby are carbohydrates (energy), folate and other vitamins, calcium and iron. All of these nutrients are found in different foods from each of the four food groups. Carbohydrates are found in the Grain Products food group, folate and other vitamins are found in the Vegetable and Fruits food group, calcium is found in the Milk Products food group and iron is found in the Meats and Alternatives food group. So, as you can see it is very important to include foods from all four food groups to make sure you are getting the nutrients needed to grow a healthy baby. Refer to Eating Well with Canada's Food Guide The tips below can help you get the nutrients needed for you and your baby:

Eat 6 servings of grain products each day - Choose whole grain breads, cereals, crackers, pasta and rice such as barley, brown rice, oats, quinoa and wild rice. Make at least half of your grain products whole grain each day. Grain products are a great source of carbohydrate (energy), iron and fibre. Eat 7 servings of fruits and vegetable each day - Eat at least one dark green and one orange vegetable each day such as broccoli, romaine lettuce, spinach, carrots, sweet potatoes and winter squash. Have vegetables and fruit more often than juice. Eat 3-4 servings of milk products each day - Milk, chocolate milk, yogurt, cheese and foods made with milk are all great sources of calcium and protein. Make sure to have at least 2 cups of milk every day for adequate Vitamin D. Drink fortified soy beverages if you do not drink milk. Eat 2 servings of meats and alternatives each day - For a great source of iron and protein choose lean meat, fish and poultry or meat alternatives such as eggs, lentils, beans, tofu and peanut butter. Eat at least two Food Guide Servings of fish each week such as char, herring, mackerel, salmon, sardines and trout. Refer to www.healthcanada.gc.ca for the latest information on limiting exposure to mercury from certain types of fish.

In addition to the above recommended servings, a pregnant woman needs an additional 2-3 servings per day from any of the food groups. For example these extra servings may be: -glass of milk+ apple + piece of whole wheat toast -crackers+cheese+orange Eat regular meals - Remember that if you don't eat, neither does your baby. Eat breakfast every day - Breakfast is an important meal to start off the day and if you skip breakfast you will probably not be able to make up those nutrients lost. Eat healthy snacks between meals - Follow your appetite. If you are hungry between meals choose healthy foods such as yogurt, fruit, vegetables, homemade bran or oatmeal muffins, whole grain crackers with cheese, nuts, etc. Healthy snacks are a great way to meet your extra nutrient needs. Take a prenatal vitamin every day - Remember a prenatal vitamin does not reduce or replace healthy eating. It will help you get the extra vitamins and minerals you need while you are pregnant.

More information on the role that folate, calcium and iron have in the growth of your baby.

How Much Weight Should I Gain? Some girls may feel afraid to gain weight during pregnancy. It is important to know that you need to gain a healthy amount of weight during your pregnancy to grow a healthy baby. Both you and your baby need nutrients such as iron, calcium and folate/folic acid to be healthy. Your baby needs these nutrients to develop and grow properly. You need nutrients to support your baby's growth but also to make sure your nutrient stores don't run out. There is no exact amount of weight teens should gain during pregnancy. All girls are different shapes and sizes, therefore weight gain will be different for everyone. The weight you gain during your pregnancy depends on your weight before pregnancy. The average weight gain for most adult women who are pregnant is 25-35 pounds. It is important to know that teens who are pregnant need to gain more weight than most adult women who are pregnant. The reason for this is because teens need to eat enough for their own growth plus the growth of their baby. The amount of weight you should gain during your pregnancy depends on whether you were underweight or overweight before you were pregnant. Talk to your health care worker to make sure you are gaining a healthy amount of weight. Remember, pregnancy is not a time for dieting. Dieting and weight loss during pregnancy can harm you and your baby.

During pregnancy you gain weight in many areas. Below is a list of the average weight gain in each area during a typical pregnancy. You may be surprised that only 5-8 pounds of this weight gain is fat. The fat is stored for extra energy that you will need while you are pregnant and breastfeeding. Average weight gain in each area during pregnancy:

Blood - 4 lbs Extra fluids/fluid retention - 2 to 3 lbs Energy stored as fat for pregnancy and breastfeeding - 5 to 8 lbs Placenta and amniotic fluid - 4 to 6 lbs Baby - 6 to 8 lbs Breasts - 2 to 3 lbs Uterus - 2 to 3 lbs

Learn more about the changes to you body and the growth of your baby.

Move That Body Staying active while you are pregnant has many benefits. Physical activity can help make labour and delivery easier and help you recover more quickly after your baby is born. It can also prevent constipation, help you gain a healthy amount of weight and give you more energy. It is recommended to choose safe, low impact activities such as swimming, walking, water aerobics or yoga during your pregnancy. More information on physical activity during pregnancy.

Caffeine, Cigarettes, Drugs and Alcohol Caffeine, cigarettes, drugs and alcohol all are made up of different chemicals that get absorbed in your stomach, carried into your blood and cross over to your baby. They all affect the growth and development of your baby in one way or another. Click here for more information drugs and alcohol. (Adapted from Healthy Eating for a Healthy Baby produced by Best Start and the Nutrition Resource Centre, November 2002.)

Introduction

Despite the fact that the teen birth rate is climbing after slowly falling for years, there are still an estimated one million teen pregnancies in the United States alone. About 85% of these pregnancies are unplanned, which in any population can increase the risk for problems. The biggest risk for teen mothers is delaying prenatal care or worse, 7.2% received no care at all. The reason for lack of prenatal care is usually delayed pregnancy testing, denial or even fear of telling others about the pregnancy. Most states have a health department or University clinic where prenatal care is free or low cost and patient confidentiality is very important, meaning no one can tell the teen mother's family. Because the body of a teen is still growing she will need more nutritional support to meet both her needs and that of her baby. Nutritional counseling can be a large portion of prenatal care, usually done by a doctor or a midwife, sometimes a nutritionist. This counseling will usually include information about prenatal vitamins, folic acid, and the dos and don'ts of eating and drinking. Lack of proper nutrition can lead to problems like anemia (low iron), low weight gain, etc. Another problem facing teen mothers is the use of drugs and alcohol, including cigarette smoking. No amount of any of these substances is safe for use in pregnancy. In fact, their use can complicate pregnancy even further increasing the likelihood of premature birth and other complications. Premature birth and low birth weight create a wealth of their own problems, including brain damage, physical disabilities and more. The potentially lengthy hospital stay and increased risk of health problems for these babies leads to more stress on the teen mother. While facing the grim realities of teen pregnancy is not pleasant, this is not the picture that has to be painted. Teen mothers are perfectly capable of having a healthy pregnancy and a healthy baby. With the proper nutrition, early prenatal care and good screening for potential problems the majority of these potential problems will not come to light. While some tend to think that you can't teach a teen mother anything about her body or baby, it's really a ridiculous notion. Many of the teen mothers who take active roles in their care do go on to have healthy babies, despite the other hardships that they will face in their lives. Support from the families and communities is a must for the young, new family to be successful.

Family Support If your daughter is pregnant and planning to have the baby, many changes await your family. And though it's certainly not what most parents expect, it happens every day: nearly 1 million teenage girls in the United States give birth every year. If your teen is about to become a mother (or your son has fathered a child), it can be overwhelming for all of you. How can you support your child through the challenges that lie ahead?

What You May Be Feeling

If you have just learned that your teen is having a baby, you're probably experiencing a wide range of emotions, from shock and disappointment to grief and worry about the future. Some parents feel a sense of guilt, thinking that if only they'd done more to protect their child this wouldn't have happened. And although some parents are embarrassed by their teen's pregnancy and worried about how family, friends, and neighbors will react, others are happy about the news of a soon-to-be grandchild especially if the teen is older and in a mature relationship. Whatever feelings you're experiencing, this is likely to be a difficult time for your family. The important thing is that your teen needs you now more than ever. Being able to communicate with each other especially when emotions are running high is essential. Teens who carry a baby to term have special health concerns, and your daughter will have a healthier pregnancy emotionally and physically if she knows she doesn't have to go it alone. So what can you do as the parent of a teen having a baby? Recognize your feelings and work through them so that you can accept and support her. Does that mean you don't have the right to feel disappointed and even angry? No. Such reactions are common. You might have a strong flood of emotions to deal with, especially at first. But the reality of the upcoming baby means that you'll have to get beyond your initial feelings for the sake of your daughter and her child. If you need help coping with your feelings about the situation, talk to someone you trust or seek professional counseling. A neutral third party can be a great resource at a time like this. Teen boys who are going to become fathers also need the involvement of their parents. Although some boys may welcome the chance to be involved with their children, others feel frightened and guilty and may need to be encouraged to face their responsibilities (the father is legally responsible for child support in every state).

That doesn't mean, however, that you should pressure your teen son or daughter into an unwanted marriage. Offer advice, but remember that forcing your opinions on your teen or using threats is likely to backfire in the long run. There's no "one size fits all" solution here. Open communication between you and your teen will help as you consider the future.

Special Concerns of Pregnant Teens

Even though most teen girls are biologically able to produce healthy babies, whether they do often depends on whether they receive adequate medical care especially in those critical early months of pregnancy. Teens who receive proper medical care and take care of themselves are more likely to have healthy babies. Those who don't receive medical care are at greater risk for:

fetal death high blood pressure anemia labor and delivery complications (such as premature labor and stillbirth) low birth-weight infant

The earlier your teen gets prenatal care, the better her chances for a healthy pregnancy, so bring her to the doctor as soon as possible after finding out she's pregnant. If you need help finding medical care, check with social service groups in the community or at your child's school. Your teen's health care provider can tell her what to expect during her pregnancy, how to take care of herself and her growing baby, and how to prepare for life as a parent. Some topics that will be addressed include:

Medical Care
At her first prenatal visit, your teen will probably be given a full physical exam, including blood and urine tests. She'll be screened for sexually transmitted diseases (STDs) and for exposure to certain diseases, such as measles, mumps, and rubella. Her health care provider also will discuss:

how often prenatal visits should be scheduled what she may be feeling physically and emotionally what changes she can expect in her body how to deal with some of the uncomfortable side effects of pregnancy, like nausea and vomiting

Knowing what to expect can help alleviate some of the fears your teen may have about being pregnant. Her health care provider will probably prescribe a daily prenatal vitamin to

make sure she gets enough folic acid, iron, and calcium. Folic acid is especially important during the early weeks of pregnancy, when it plays a role in the healthy development of the neural tube (the structure that develops into the brain and spinal cord).

Lifestyle Changes
Your teen's health care provider will talk about the lifestyle changes she'll have to make for the health of her baby, including:

not smoking (smoking while pregnant increases the risk of miscarriage, stillbirth, low birth weight, and sudden infant death syndrome) not drinking (alcohol causes mental and physical birth defects) not using drugs (drugs are associated with pregnancy complications and fetal death) avoiding excess caffeine (too much caffeine has been linked to an increased risk of miscarriage) eating right getting enough rest avoiding risky sexual behaviors (such as having unsafe sex)

If your teen smokes or uses alcohol or other drugs, her health care provider can offer ways to help her quit.

Nutrition
Fast food, soft drinks, sweets teen diets are notoriously unbalanced. Eating well greatly increases your teen's chances of having a healthy baby, so encourage her to maintain a well-balanced diet that includes plenty of fruits, vegetables, and whole-grain breads (use the Food Guide Pyramid as a guide). Important nutrients include:

proteins (lean meat, fish, poultry, egg whites, beans, peanut butter, tofu) calcium (milk and other dairy products) iron (lean red meats, spinach, iron-fortified cereals) folic acid (green leafy vegetables, beans, peas, fortified cereals)

Drinking plenty of water is essential, too. Pregnancy is not the time for your teen to go on a diet. When pregnant, some teens might be tempted to counter normal pregnancy weight gain by cutting calories or exercising excessively both of which can seriously harm their babies. If you suspect that your teen has an unhealthy preoccupation with her weight, talk to her health care provider.

Exercise

If your teen was physically fit before getting pregnant and is not experiencing any pregnancy complications, her health care provider will probably encourage her to continue exercising. Most women benefit from getting some exercise during pregnancy, although they might have to modify their activity. Low-impact exercises, such as walking and swimming, are best. Have your teen discuss her exercise plans with her health care provider early on.

Stress
Most teens enter parenthood unprepared for the stress a new baby brings, and many experience frustration, resentment, and even anger toward their newborns which may explain why teen parents are at higher risk for abusing and neglecting their babies. You may want to talk with your teen's doctor to discuss ways you can help her manage her stress levels so that she can better cope with changes in her life. She also may want to spend some time with other parents of newborns to get a better sense of what caring for a baby involves.

Prenatal Classes
Your teen's health care provider will probably recommend that she take classes on pregnancy, giving birth, and parenting. These classes (some of which are held just for teens) can help prepare her for the practical side of parenthood by teaching skills such as feeding, diapering, child safety, and other basic baby care techniques.

Preparing for New Responsibilities

Many practical issues must be considered. Will your teen keep the baby or consider adoption? If she keeps it, will she raise the baby herself? Will she continue to go to school? Will the father be involved in the baby's life? Who will be financially responsible for the baby? The answers to these questions often depend on the support your teen receives. Some teens raise their child alone, some have the involvement of the baby's father, and some rely on their families for support. As a parent, you need to think about your own level of involvement and commitment and discuss it with your teen. How much support financial and otherwise are you willing and able to offer? Will your teen and her child live with you? Will you help pay for food, clothing, doctor visits, and necessary items like a car seat and stroller? Can you assist with child care while your teen is at school and/or work? A social worker or counselor can help you and your teen sort through some of these issues. If at all possible, it's best for teens who are pregnant to finish school so they can get better jobs and create a better life for themselves and their babies. This is no easy task 60% to

70% of all pregnant teens drop out of school. And going back after quitting is especially hard, so try to offer your teen the support she needs to stay in school both she and the baby will benefit. Check for school and community programs that offer special services for teen mothers, such as child care, rides, or tutoring. Help your teen understand that as rewarding as having a child is, it isn't always fun caring for a baby is a huge responsibility and a lifelong commitment. Prepare your teen for the reality that she won't have as much time for the things she used to do that her life is about change and the baby will take priority. As a parent, you can have a great impact on your teen's life and on her baby's. You may still wish that she had made different choices. But by supporting your teen, making sure she gets good prenatal care, and listening as she shares her fears and anxieties, both of you may find that you're better parents in the long run. Reviewed by: Krishna Wood White, MD, MPH Date reviewed: September 2008

Nursing Care Plan Statistics for 1995 reveal that 56.9 babies were born for every 1000 females between the ages of 15 and 19. Although these rates appear to be dropping, pregnant adolescents are at risk physically, emotionally, and socially. The impact of adolescent pregnancy on the individual has far-reaching consequences, which may restrict or limit future opportunities for the adolescent and the child(ren). Educational goals may be altered or eliminated, thus limiting potential for a productive life. The client frequently may be of lower socioeconomic status, with the pregnancy perpetuating financial dependence and lowered self-esteem. Statistically, the obstetric hazards for adolescents and their infants include increased mortality and morbidity rates. Therefore, individualized prenatal nursing care for the adolescent client/family/partner that incorporates developmental needs and health education with prenatal needs has the potential to contribute positively to prenatal, intrapartal, and postpartal outcomes. In addition, neonatal outcomes associated with better Apgar scores, lower incidence of resuscitation, and fewer LBW infants can also be expected. (Refer to CPs: First Trimester, Second Trimester; Third Trimester, for discussion of usual/expected pregnancy needs.) CLIENT ASSESSMENT DATA BASE (In addition to Prenatal Client Assessment Data Base) Circulation Elevated blood pressure (risk indicator of PIH) Ego Integrity Pregnancy may or may not be wanted by client; may be result of abuse. Varied cultural/religious responses to pregnancy out of wedlock; or as a stressor on teen marriage (note whether clients mother was a teenage mother). Expressions of worthlessness, discounting self. Decision making varies from abdicating all responsibility to extreme independence. May or may not be involved with father of child by own/partners choice, family demands, or question of paternity. May feel helpless, hopeless; fear family/peer response. Emotional status varies; for example, calm, acceptance, denial, hysteria. History of limited/no financial resources. Elimination Proteinuria (risk indicator of PIH) Food/Fluid Weight gain may be less than optimal. Dietary choices may not include all food groups (adolescent eating patterns; presence of eating disorder).

Edema (risk indicator of PIH). Hb and/or Hct may reveal anemia and hemoconcentration, suggesting PIH. Hygiene Dress may be inappropriate for stage of gestation (e.g., wearing restrictive or bulky clothing to conceal pregnancy). Respiratory May be a cigarette smoker Safety History/presence of STDs. Fundal height may be less than normal for gestation (indicating IUGR of fetus). Ultrasonography may reveal inappropriate fetal growth, low-lying placental implantation. Sexuality Lack of/incorrect use of contraception. Pelvic measurements may be borderline/contracted. Social Interactions May report problems with family dynamics, lack of available resources/support Little or no concept of reality of situation; future expectations, potential responsibilities History of encounters with judicial systems Teaching/Learning Level of maturity varies/may regress; barriers of age and developmental stage. Experimentation with substance use or abuse. Lack of achievement in school. Lack of awareness of own health/pregnancy needs. Fantasies/fears about childbirth. NURSING PRIORITIES 1. Promote optimal physical/emotional well-being of client. 2. Monitor fetal well-being. 3. Provide information and review the available options. 4. Facilitate positive adaptation to new and changing roles. 5. Encourage family/partner participation in problem-solving. DISCHARGE GOALS Inpatient care is not required unless complications develop necessitating hospitalization (refer to appropriate plans of care.

Adolescent pregnancy continues to be a major social challenge for the United States. It has the highest rate of teenage pregnancy yearly as compared to other developed nations (2003). Adolescent pregnancy occurs across socioeconomic classes, in public and private schools, among all ethnic and religious backgrounds, and in all parts of the country. Tina, is just one of the thousands of teenage girls who have gotten pregnant and had a child. At 15, it cannot be denied that she is still in her transition from childhood to adulthood. Adolescents are at high risk for preterm labor, probably because their uteruses are not fully grown. Because their own development is still immature, adolescents are prone to cephalopelvic disproportion during labor and birth. Adolescent labor does not differ from labor in the older women if cephalopelvic disproportion is absent ( 2003). Young adolescents are more prone to postpartum hemorrhage than the average woman because if a girls uterus is not yet fully developed, it becomes overdistended by pregnancy. An overdistended uterus does not contract as readily as a normally distended uterus in the postpartum period. Adolescents also may have more frequent or deeper perineal and cervical lacerations than older women because of the size of the infant in relation to their body. On the other hand, young adolescents are generally healthy and have supple body tissue that allows for adequate perineal stretching. If a laceration does occur, it

usually heals readily without complication (2003). At first, the vaginal discharge is grossly bloody and Tina should not get alarmed by this. Over the next 10 to 12 days, the color of the discharge changes to pale brown and finally to yellowish white. External sanitary pads may be used to absorb the discharge. The clinical manifestations of the puerperium, the 6-week period following delivery, are numerous and variable but generally reflect reversal of the physiologic changes that occurred in pregnancy. Within the first 24 hours, it is normal for Tinas pulse rate to drop and her temperature slightly elevated. It is also normal for Tinas urine to be temporarily increased in volume and may contain protein and sugar. These events are mild and temporary and should not be confused with more serious conditions. The immediate postpartum period may be an almost unreal time for an adolescent like Tina. Giving birth is such a stress and a major crisis that all women have difficulty integrating it into their life. it may be particularly difficult for the adolescent. The girl may block out the hours of labor as if they didnt happen. Tina should be urged to talk about labor and birth to make the happening real to her; otherwise, postpartum depression can occur ( 2003). Breast engorgement may become very painful during early lactation when the amount of milk is beginning to increase. Tinas difficulty in breast feeding could be attributed to this. Analgesia, properly fitting support nursing brassiere, ice packs, and sympathetic competent nursing care will ease Tinas temporary difficulty. Furthermore, Tina may have to manually express her milk just before

nursing to allow the baby girl to get the swollen areola into her mouth. Excessive expression of milk between feedings encourages continued engorgement, therefore this should be done only to relieve discomfort. If Tina decides she is not going to breastfeed because of other reasons provided that the baby will still be properly fed, lactation can be suppressed by a variety of methods. However, nurses and even the whole health care community strongly encourages mothers to breastfeed their baby during the first few months after birth. Breastfeeding provides optimal nutrition, protection against infection, and a safe, reliable food source for babies--attributes that are critical in emergencies (2006). Given adequate support and encouragement, Tina can nurse her baby girl successfully. The chief contraindication to this would be a lack of desire and interest on the part of Tina. If in the first place the mother does not have the desire to breastfeed the baby, then no amount of encouragement and support can make the mother overcome the difficulties of breastfeeding. Unfortunately, most adolescent mothers are like Tina, they have difficulty breastfeeding or do not breastfeed at all. This is related to their perception of breast-feeding as something that will tie-me-down and the reality (in many instances) that they will be returning to school full-time soon after birth. Education about the importance of breastfeeding and tips for how to incorporate it into a busy lifestyle can increase the number of adolescents breastfeed (2003). Adolescents show the same positive bonding behavior with their infants as their more mature counterparts. They may, however, lack knowledge of infant

care. Although they may consider themselves to be knowledgeable in child care because they baby-sat for a neighbors child or a younger sibling, they can be overwhelmed in the postpartum period to realize that when the baby is their own, child care is not as simple as it once seemed. When the child cries, they cannot hand it to someone else; at the end of 4 hours, when they are tired of caring for the baby, they cannot leave and walk away. Teenage pregnancy with early prenatal supervision is considered less harmful to both mother and child. Pregnant teens need special attention to nutrition, as well as health supervision and psychological support. It is important to assess how prepared each family is to care for their infant at home, to be sure the newborn remains safe. Tina, as well as her parents may need to make changes in their routine, such as shifting their usual dinner time or work schedule in order to take care of the newborn. Sleep schedules are certain to be disrupted, because infants wake during the night for about the first 4 months of life. The nurse and other healthcare professionals should assess if local support organization within Tinas community is available for referral. It should be suggested that Tina and her parents keep telephone numbers of support groups and lactation consultant available in case Tina needs additional help while she is at school. The rationale for this is that support can go a long way toward preventing a client from becoming discouraged. A teaching plan is designed to help Tina through her postpartum concerns. Assessment factors to be considered in formulating a teaching plan for

a client involves individual, significant others, socioeconomic, cultural, disease, nurse- related, nursing priorities, and discharge goals. On the individual level of Tinas assessment, her age and emotional response to current situation are to be considered. Family development cycle as well as the marital status of Tina also has to be considered on the Significant others level. On the socioeconomic level, her familys finances, the employment of family members, and social acceptability of the condition are to be considered. Ethnic background and beliefs regarding caring are cultural factors. Nursing priorities include reducing anxiety or fear, facilitate integration of self-concept and body-image changes, encourage effective coping skills, and promote safe environment/patient well-being. A teaching plan is developed specifically for Tinas difficulty on breastfeeding. Out of the many concerns in the postpartum period, this is chosen since proper nutrition is essential for the infant for optimal growth and development, especially in the first few months of life, because brain growth proceeds at such a rapid rate during this time. During feeding, a parent is close to the infant, and a baby is apt to be particularly sensitive to the parents demonstration of affection or lack of warmth. An infant who does not experience a warm relationship with a mother may fail to thrive as surely as one who is denied sufficient protein or calories. Tina and her parents have to be taught how to recognize signs of hunger in a newborn, including restlessness, tense body posture, smacking lips, and tongue thrusting. Otherwise, younger and new mothers usually wait for the infant

to cry, and this is actually a late sign of newborn hunger. The teaching plan is designed for Tina yet it also requires cooperation from her parents. At 15 years old, Tina still isnt mature enough to do things on her own and thus needs the guidance and support of her parents.

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