NURSING CARE DURING

ANTEPARTUM

Nursing care given by the

nurse to the expectant family before,
during, & following birth

Maternal

branch of medicine that

pertains to the care of women during
pregnancy, childbirth, & the postpartum
period

Obstetrics

Obstetrician = physician

Family-Centered Care
Recognizes

the strength & integrity of the

family as the core of planning &
implementing health care
Nurse & family members need to be
partners

History:
Before

the 1900s most babies born @

home
1960 more than 90% of births
occurred in hospitals

By

And

Now???

Merging of the Maternity Unit

Used

to be separate labor room, delivery

room, postpartum room, & newborn
nursery
Now combining labor, delivery, & recovery
(LDR) may still be transferred to a
postpartum unit, but baby usually rooms-in
Some facilities combine keep woman in
same area throughout her entire
experience (LDRP)

Lengths of Stay
Mandated
Vaginal

by legislation

delivery = 24-48 hrs.

Cesarean

delivery = 72 hrs.

Statistics r/t Maternal Nursing:

Birthrate

Fertility

rate
Fetal Mortality rate
Infant Mortality rate
Maternal Mortality rate
Neonatal Mortality rate
Perinatal Mortality rate

How are these statistics used?

To

become aware of reproductive trends

To determine populations at risk
To evaluate the quality of prenatal care
To compare relevant information from
state to state & country to country

Male Reproductive System:

Male Reproductive System:

Penis deposits sperm into females vagina to
fertilize an ovum
Testes Manufacture sperm & secrete male sex
hormones
Semen seminal plasma & sperm together;
excreted during sexual intercourse
Testosterone most abundant male sex
hormone

muscle mass & strength

Promotes growth of long bones
basal metabolic rate
Enhanced production of RBCs
Produces enlargement of vocal cords
Affects distribution of body hair

Female Reproductive System:

Female Reproductive System:

Female Reproductive System:

Vagina tubular structure made of muscle &

membranous tissue

provides passageway for sperm to enter uterus

allows for drainage of menstrual fluids & other
secretions
provides passageway for infants birth

Cervix lower part of uterus

Lubricates vagina
Acts as a bacteriostatic agent
Provides alkaline environment for sperm
Produces mucus plug during pregnancy
Thins and dilates during labor

Female Reproductive System:

hollow muscular organ; site of
implantation of fertilized ovum & houses
developing fetus

Uterus

Consists of 3 parts: cervix, corpus, & fundus

Begins a pelvic organ, becomes temporary
abdominal organ
Layers:
Perimetrium outermost
Myometrium middle
Endometrium - innermost

Female Reproductive System:

Fallopian Tubes from uterus to ovary on each

side

Provide passageway in which sperm meet ovum

Site of fertilization
Safe nourishing environment for ovum
Means of transporting ovum to uterus

Ovaries almond-shaped glands

Produce estrogen & progesterone

Maturation of ovum during each reproductive cycle

Female Reproductive System

Breasts = accessory organs of reproduction;
produce milk after birth to provide
nourishment & maternal antibodies to
infant

Hormones

Follicle Stimulating Hormone (FSH):

Luteinizing Hormone (LH):

Stimulates maturation of the follicle in the ovary that

contains a single ovum

Stimulates final maturation & release of the ovum

Corpus Luteum empty follicle after ovum is

released

Produces increasing amounts of estrogen &

progesterone which lead to a build-up of the
endometrium

Anterior pituitary secretes FSH & LH maturation of ovum

Ovulation occurs when mature ovum is released from follicle
~ 14 days before onset of next menstrual cycle
Corpus luteum turns yellow & secretes amounts progesterone
If no fertilization corpus luteum degenerates - amts.
estrogen & progesterone (after 12 days)
Endometrium breaks down menstruation occurs

Anterior pituitary secretes more FSH & LH beginning a new

cycle
(refer to picture in book-pg 27)

 beginning of menstruation
Climacteric period of years during which
womans ability to reproduce gradually
declines
Menopause end of menstruation
___________________________________
Menarche

Conception

with ovum

(Fertilization) sperm joins

Physiology of Pregnancy
Fertilization

During sexual intercourse, the sperm carried

in the ejaculatory semen of the male enters
the vagina of the female.
Through flagellation, the sperm travel through
the mucus of the cervical canal, enter the
uterine chamber, and move into the ampulla,
the outer third of the fallopian tube.
If the timing is such that an ovum has been
produced and is also within the ampulla of the
tube, fertilization may occur.

Physiology of Pregnancy
Fertilization

(continued)

Fertilization takes place when the sperm joins

or fuses with the ovum; this is called
conception.
Once fertilization has occurred, the new cell is
referred to as a zygote or fertilized ovum.
At the moment of fertilization, the sex of the
zygote and all other genetic characteristics
are determined and they do not change.
46 chromosomes- xx-girl xy-boy

Physiology of Pregnancy
Implantation

The zygote moves through the uterine tube

through ciliary action and some irregular
peristaltic activity.
It requires about 3 or 4 days to enter the
uterine cavity.
During this time, the zygote is in a phase of
rapid cell division called mitosis; further
changes result in formation of a structure
called the morula.
The morula develops into a blastocyst.

 Implantation

(continued)

The condition of the uterine lining is critical if

implantation of the zygote is to occur.
Implantation usually occurs in the fundus of
the uterus on either the anterior or posterior
surface.
If uterine conditions are not suitable, it is
unlikely that implantation will occur.
If the intrauterine vascular or hormonal
conditions cannot sustain the implanted
embryo, a spontaneous abortion will occur;
usually during the first 8 weeks of pregnancy.

 Implantation

(continued)

After the blastocyst is free in the uterine cavity

for 1 or 2 days, the exposed cell walls of the
blastocyst (called the trophoblast) secrete
enzymes that are able to break down protein
and penetrate cell membranes.
These enzymes allow the blastocyst to enter
the endometrium and implant.
The action of the enzymes normally stops
short of the myometrium but may cause slight
bleeding; this is called implantation bleeding.
The bleeding may confuse some women who
think they had a very light and short menstrual
cycle.

Physiology of Pregnancy
Implantation

(continued)

Ectopic pregnancy, in which implantation

occurs outside of the uterine cavity, also
poses serious problems.
During the first few weeks after implantation,
primary villi appear; these villi are able to use
maternal blood vessels as a source of
nourishment and oxygen for the developing
embryo.

Physiology of Pregnancy

Implantation (continued)
It is also during these first few weeks that the
first stages of the chorionic villi occur.
Chorionic villi secrete human chorionic
gonadotropin (hCG), a hormone that
stimulates the continued production of
progesterone and estrogen by the corpus
luteum; this is the reason that ovulation and
menstruation cease during pregnancy.
The chorionic villi become the fetal portion of
the placenta.

PLACENTA

Is a disc-like endocrine organ that secretes HCG,

estrogen, & progesterone. Only present during preg.
Site of nutrient & waste exchange
Circulation thru to fetus is well established after 4th week
gest.
Able to block transfer of certain substances: placental
barrier
Meds such as Insulin & Ephedrine do not cross
Most bacteria do not cross (too large), some viruses able
to cross
Shiny Schultz fetal side, Dirty Duncan- maternal side

Sac 2 layers: amnion (fetal

side) & chorion (outer layer); appears
fragile but strong enough to hold fetus &
amniotic fluid @ full term
Amniotic Fluid acts as cushion against
mechanical injury; helps regulate fetal
body temp., allows room for growth,
indicator of fetal well being & renal
perfusion
Amniotic

 Umbilical

Cord joins embryo to placenta

20-22 long, <1 diameter

Whartons jelly major part of the cord
Vessels: (remember AVA)
1 vein carries oxygenated blood to fetus
2 arteries carries deoxygenated blood back to
placenta

No pain receptors
Can have knots, wrapped around fetus

Placental Hormones
Progesterone

Maintains uterine lining

uterine contractions
Prepares glands of breasts for lactation
Stimulates testosterone production in male
fetus

Estrogen

Stimulates uterine growth

blood flow to uterine vessels
Stimulates development of breast ducts to
prepare for lactation

Placental Hormones
Human

Causes corpus luteum to persist & continue

production of estrogen & progesterone to sustain
pregnancy
Basis of most pregnancy tests

Human

Chorionic Gonadotropin (HCG)

Placental Lactogen (HPL)

s insulin sensitivity & utilization of glucose by mother

making more glucose available to fetus. Is Insulin
Antagonist.

Relaxin:

Increases. Helps decrease contractions and remodel

collagen in cervix

Tissue Layers of the Zygote:

Tissue Layer
Ectoderm
(Outermost layer)
Mesoderm
(Middle layer)

Endoderm
(Innermost layer)

Gives rise to:

Skin, nails, hair
Muscles, CT, bone,
blood, lymphoid tissue,
epithelial tissue, conn
tissue
Lining of cavities &
passages, covering of
most internal organs

Stages of Prenatal Development

Germinal fertilization to implantation

Embryonic implantation (2nd wk) thru 8

weeks, basic form of all major organs & systems
develop, simple heart beat, human appearance

Called Zygote, up to 2 weeks

Called Embryo

Fetal 9 weeks to birth (38-40 wks. considered

full term)

Called Fetus

Stages of Pregnancy
Trimesters:

First: conception-12 weeks

Second: 13-27 weeks
Third: 28- delivery

4 weeks

3 weeks

8 weeks

12 weeks

16 weeks

Maternal-Fetal circulation

Fetal & Neonatal Circulation

Fetal Circulatory Shunts:

Venosus diverts some blood
away from the liver as it returns from the
placenta and goes to Rt atrium
Foramen Ovale diverts most of the blood
from the Rt. Atrium directly to Lt. Atrium,
rather than circulating to the lungs
Ductus Arteriosus diverts most of the
blood from the pulmonary artery into the
aorta
Ductus

Fetal Circulation
Oxygenated Blood

Umbilical Vein
blood goes to liver
via portal sinus

blood enters
Inferior Vena Cava thru
Ductus Venosus

Fetal Circulation
Blood in Inferior
Vena Cava

Right Atrium
Small amt. blood to
Rt. Ventricle

Most blood passes into

Left Atrium via
Foramen Ovale

Fetal Circulation

Rest of blood from

Rt. Ventricle

Blood from Left

Ventricle

Join thru Ductus Arteriosus

Circulates thru fetal body

Returns to placenta thru Umbilical Arteries

Closure of Fetal Shunts:

Foramen Ovale pressure in Rt. side of heart

s as lungs become fully inflated & now is little
resistance to blood flow

Ductus Arteriosus blood O2 level s

Functional 2 hrs. post birth

Permanent by 3 months
Functional 15 hrs. post birth
Permanent 3 weeks

Ductus Venosus flow from umbilical cord

stops

Functional when umbilical cord is cut

Permanent 1 week

 Conditions

that impede full lung expansion

& decrease blood O2 levels may cause the
Foramen Ovale &/or Ductus Arteriosus to
reopen

Example: Respiratory Distress Syndrome

Can give Prostaglandins to keep open
Can give Indomethacin to help close

Determination of Pregnancy
Presumptive

Signs

Amenorrhea
Nausea and vomiting
Frequent urination
Breast changes
Changes in shape of the abdomen
Quickening
Skin changes
Chadwicks sign: discoloration of cervix
Fatigue

Determination of Pregnancy
Probable

Changes in the Reproductive Organs

Signs

Hegars sign: softening of uterus

Goodells sign: softening of cervix
Chadwicks sign: discoloration of cervix
Ballottement:
Enlargement of uterus

Positive Pregnancy Test

Hegars Sign

Figure 25-5

(From Wong, D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2nd ed.].
St. Louis: Mosby.)

Internal ballottement (18 weeks).

Determination of Pregnancy
Positive

Signs

Visualization: ultrasound. <8 wks, vaginal. >8

weeks, abdominal.
Fetal movement detected by Healthcare
Professional
Auscultation of fetal heartbeat

Determination of Pregnancy
Determination

of the Estimated Date of

Birth (EDB) (EDC)

Normal human pregnancy, counting from the

first day of the last menstrual period, is about
280 days, 40 weeks, or 10 lunar months
(slightly more than 9 calendar months).
Ngeles rule
Start with the first day of the womans last
menstrual period and count back 3 months; then
add 7 days.
Birth Date Calculator : Wheel

Determination of Pregnancy
Determination

of the Estimated Date of

Birth (continued)

If the woman does not keep a menstrual

record, the primary care provider must then
rely on observations such as quickening,
estimation of fetal size by palpation, or
ultrasonic tests, all of which can be unreliable.

Determination of Pregnancy
Obstetric

Terminology

Terms used to describe the number of times a

woman has been pregnant and given birth
Gravida: indicates a pregnant woman; # of
times woman has been pregnant including
present one
Primigravida: one pregnancy; 1st pregnancy
Nulligravida: no pregnancies
Multigravida: multiple pregnancies

Para: woman who has given birth to a

child/children who have reached 20 wks.
gestation
Primipara: given birth to 1st child
Nullipara: no births that have reached 20 wks.
Multipara: multiple births

Abortion: termination of pregnancy before 20

wks. gestation; spontaneous or induced
Gestational Age: prenatal age of developing
fetus calculated from 1st day of LMP
Age of Viability: stage where fetus is capable
of living outside of the uterus; usually 20 wks.
gestation

 TPALM:

TERM, PRETERM, ABORTION,

LIVING, MULTIPLES
FPAL: FULLTERM, PRETERM,
ABORTION, LIVING

Maternal Physiology
Hormonal

Changes

Estrogen and progesterone levels remain

elevated for the first 8 weeks of pregnancy as
a result of hCG.
After this time, the placenta takes over
production and maintains necessary levels.
As long as these levels are high, folliclestimulating hormone (FSH), luteinizing
hormone (LH), and ovulation are suppressed,
as is menstruation.

Maternal Physiology
Uterus

The uterus enlarges during pregnancy as a

result of hormonal stimulus, increased
vascularity, hyperplasia, and hypertrophy.
The nonpregnant uterus is pear-shaped and
weighs about 2 oz. & has a capacity of 10ml.;
@ term weighs 2.2# & has a capacity of
5000ml.
In a nonpregnant state, it is a pelvic organ;
when the pregnancy reaches completion, the
superior aspect of the uterus will be located at
the level of the xiphoid process.

 color & consistency change;

produces mucus plug; thins & dilates near
onset of labor & mucus plug is expelled

Cervix

do not ovulate; corpus luteum

persists until placenta takes over hormone
production (6-7 weeks)

Ovaries

- d blood supply bluish color;

rugae become prominent; mucosa
thickens; d secretions; pH becomes
more acidic

Vagina

Breasts
Hypertrophy of the mammary glandular tissue and
increased vascularization, pigmentation, size, and
prominence of nipples and areola.

Sebaceous glands secrete lubrication for nipples

Respiratory System

d O2 consumption (15%)

Depth increases, slight increase in rate

Dyspnea until fetus descends into pelvis

Swollen mucous membranes; nasal stuffiness; nose

bleeds; voice changes

 Cardiovascular

System

Heart displaced up & to left by uterus

Blood volume s by 45%
HR (10-15 bpm) & cardiac output s
Vascular resistance s
Vena Cava Syndrome
Orthostatic hypotension
Palpitations
Dilutional anemia
Vericose veins
in clotting factors & WBC

Gastrointestinal System

Urinary System

Stomach & intestines displaced

appetite & thirst
d acidity of gastric secretions
d gastric emptying & intestinal motility
Cardiac sphincter of stomach relaxes
Alteration in glucose metabolism (GDM)

GFR s d/t maternal & fetal waste excretion

Renal tubules reabsorption
Bladder capacity s, lead to urinary stasis

Skeletal System

Posture changes; rounded shoulders; back ache

Waddling gait
Joint instability d/t softening of ligaments

Evaluating Fetal Well-being

A variety of technologic and assessment tools

can be used to evaluate fetal well-being.
These tools are used to evaluate maternal and
fetal health problems, fetal congenital
anomalies, and fetal growth and maturity.

Ultrasonography:<8 wk, vaginal. >8wk, abd.

Maternal serum alpha-fetoprotein screening
Chorionic villus sampling
Amniocentesis
Lecithin-Sphingomyelin Ratio
Nonstress test
Contraction stress test
Magnetic resonance imaging
Biophysical profile
Fetal kick count

Figure 25-3

(Courtesy of Marjorie Pyle, RNC, LifeCircle, Costa Mesa, California.)

Transabdominal amniocentesis.

21 week fetus diagnosed with spina bifida undergoing surgery

while still in the womb.

Antepartal Assessment
General

Physical Assessment

Ideally, the woman has been receiving regular

medical attention and is already known by the
health care provider.
On the first visit, demographic data, such as
age, occupation, marital status, and insurance
information, are obtained; this helps the
primary care practitioner identify potential
areas of concern.
A basic family and personal medical history is
obtained; it should include genetic diseases.

Antepartal Assessment

Lifestyle patterns
Basic physical examination
Psychosocial history
Cultural practices & health beliefs that affect
pregnancy
Prenatal labs: Blood type, Rh, Rubella, Hepatitis B,
Syphilis, H&H, HIV, Urinalysis, Urine culture.
New Test: RHD Test- only for Rh- moms, test mom
serum for Rh of infant and infant sex. Mom must be
12wks or > preg.

Antepartal Assessment
Obstetric

Assessment

Information about the womans gynecological,

menstrual, and obstetric history is obtained.
The number of pregnancies and their
outcomes are discussed.

Gynecological

Examination

The gynecological examination is also

performed at this time. Pap, GC, Chlamydia
The nurse is often called on to prepare the
necessary equipment and assist with this
examination.

Antepartal Care
Health

Promotion

Pregnancy is a time in life when most women

see the importance of regular medical
supervision and are more willing to make
changes in their habits than any other time.
Once pregnancy is diagnosed, prenatal care
is instituted.
Early in pregnancy, the woman often begins
to seek information and make choices
regarding how and where she wishes to give
birth.

Health Promotion (continued)

Routine care during pregnancy begins with the initial

examination and history.
Appointments are recommended once a month
through the seventh month (28 wks), once every 2
weeks for the next month (29-36 wks), and then once
every week until delivery(36-40 wks).
Smoking, doing drugs, and drinking alcoholic
beverages during pregnancy are contraindicated.
Taking any medications during pregnancy, including
over-the-counter drugs, should be taken only under
the direction of a doctor.

 Danger

Signs During Pregnancy

Visual disturbances
Nursing Action:
Stress to the pregnant
Headaches
woman to contact her
Edema
care provider
Rapid weight gain
promptly if she
develops any of these
Pain
signs!
Signs of infection
Vaginal bleeding or drainage
Persistent vomiting
Muscular irritability or convulsions
Absence or decrease in fetal movement once
felt

Maternal Nutrition:
Benefits

of optimal nutrition during pregnancy:

risks of complication
premature deliveries
rate of low-birth weight babies

Nurse

must teach pregnant women that

nutrient needs increase more than calorie
needs (select nutrient-dense foods)

Pregnant woman additional 300 calories

Lactating woman additional 500 calories (from
prepregnant intake)

 All

women of childbearing age should be

encouraged to consume a healthy diet &
use care in the consumption of alcohol &
caffeine because:

Many women are unaware of the pregnancy

during the 1st few weeks after conception
Most women dont attend prenatal information
classes until the later months of their
pregnancy

Protein
Intake

= 60 g.
Importance = metabolism, growth & repair
of maternal & fetal tissues
Sources = meat, fish, poultry, dairy
products

Calcium
Intake

= 1200 mg.
Importance = bones, proper nerve &
muscle function
Sources = dairy products, enriched cereal,
legumes, green leafy veggies, broccoli,
dried fruits, canned salmon & sardines

Iron
Intake

= 30 mg.
Importance = d production of RBCs,
fetus must store iron supply to meet needs
for 1st 3-6 months
Sources = red & organ meats, whole
grains, dark green leafy veggies, dried
fruit, fortified cereals & breads

Folic Acid
Intake

= 400 mcg.
Importance = incidence of neural tube
defects; formation & maturation of RBCs
& WBCs
Sources = liver, lean beef, kidney & lima
beans, potatoes, fresh dark green leafy
veggies, whole wheat bread, peanuts,
fortified cereals, dried beans

Fluids during Pregnancy

Drink

8-10 glasses (8oz.) per day

Most of fluid intake should be water
Limit caffeinated & high-sugar drinks

Recommended weight gains:

Women of normal weight: 25-35 #

Underweight women: 28-40 #
Overweight women: 15-25 #
Distribution of weight gain:
Uterus = 2.5#
Breasts = 1.5-3#
Fetus = 7-7.5#
Blood volume = 3.5-4#
Placenta = 1-1.5#
Extravascular fluid = 3.5-5#
Amniotic Fluid = 2#
Maternal reserves = 4-9.5#

 Pica
This is the craving and eating of substances that
are not normally considered edible.
Substances such as clay or laundry starch are
commonly ingested.
They are not toxic but may interfere with iron
absorption, resulting in anemia.
Large amounts of clay may cause constipation.

Common Discomforts of
Pregnancy:

Ptyalism(Excessive salivation)
Nausea

Hyperemesis gravidarum

Constipation
Pyrosis (heartburn)
Hemorrhoids
Urinary Frequency
Fatigue
Backache

Common Discomforts (cont.)

Varicose

veins

Dyspnea
Leg

cramps
Edema
Nasal stuffiness

Skin Changes during Pregnancy

Linea

nigra: dark line midline of abdomen

Chloasma: the mask of pregnancy
Striae gravidarum: stretch marks
Spider nevi: dilated capillaries on the skin
Palmar erythema: reddened palms
Hirsutism: excessive body hair

 Hygiene

Practices

Bathing and showering during pregnancy

should continue as part of routine hygiene.
Increased perspiration is common, and good
personal hygiene is important to prevent body
odor.
Some primary care practitioners restrict tub
baths in the last month, because the cervix
may have dilated. No bath once ROM.
Most primary care practitioners recommend
that women avoid using hot tubs, sauna
baths, and spas during pregnancy.

 Activity/Exercise

Normal activity should continue throughout an

uncomplicated pregnancy discuss exercise
routine with healthcare provider.
Fatigue is common pace activities, dont
overdo it.
Avoid high-risk activities or those requiring a
great deal of coordination or balance.
exercise 4 wks. before due date.
Avoid becoming overheated.
Stop exercising if develop SOB, dizziness,
numbness, tingling, abd. pain, or vaginal
bleeding & contact provider immediately.

 Rest/Sleep

Early in pregnancy, few changes in sleep

patterns are experienced.
As the size of the abdomen increases, it may
become increasingly difficult for the woman to
find a position of comfort.
The supine position is not recommended as a
woman approaches her due date; this may
cause excessive pressure on the aorta and
vena cava and may result in decreased
circulation for the fetus.
Rest periods during the day with the feet
elevated should be encouraged.

Figure 25-7

(From McKinney, E.S., James, S.R., Murray, S.S., Ashwill, J.W. [2005]. Maternal-child nursing. [2nd ed.].
Philadelphia: Saunders.)

During third trimester, pillows supporting abdomen and back provide

a comfortable position for rest.

 Sexual

Activity

Unless there are complications in the

pregnancy or the bag of water has ruptured,
there is no physiological reason to limit sexual
activity during pregnancy.
Many women experience a decrease in desire
as a result of hormonal changes and the
multiple discomforts that may be occurring.
Discussion of various coital positions and
sexual activity that does not include
intercourse is appropriate.
Fears & concerns normal partners need to
communicate these concerns.

 Vaginal

Bleeding

Vaginal bleeding at any time during pregnancy

should be reported to the physician at once.
Sexual activity should cease until the cause of
the bleeding is determined and should be
resumed only when the physician determines
that no danger exists.

 Coping/Stress

Tolerance

All of the physical and hormonal changes of

pregnancy place additional stress on the
woman.
Mood swings and ambivalence are common
as the woman works through her fears and
comes to grip with the reality of pregnancy
and how the pregnancy will affect her life.
Listening and allowing the woman adequate
time to verbalize her fears can also help
reduce anxieties.

 Role/Relationship

Pregnancy introduces a totally new role, that

of a mother & father.
Culture will have much to do with how the
woman will define her role.
Dynamics also change between the woman
and the babys father, particularly with the first
pregnancy. The woman is no longer just a
wife or girlfriend; she is also a mother.
Women will look to family & friends as role
models.

 Self-Perception/Self-Concept

Rapid changes in body shape and size can

lead to changes in self-image.
Many women feel that they are not attractive
when they are pregnant.
They may also feel a loss of control related to
the changes taking place.

Impact of Pregnancy
Adolescents

Older

couple
Single parents
Grandparents

Preparation for Childbirth

Cultural

Variations in Prenatal Care

It is imperative that the practitioner

determine and explore cultural practices
and beliefs with the patient.
Hispanic
African American
Filipino
Japanese
Chinese
Russian
Southeast Asian

Preparation for Childbirth

Prenatal Education special classes offered to help the

childbearing family understand & prepare for the
demands of pregnancy, labor, the newborn, &
parenthood
Review reproductive A&P
Discuss changes during pregnancy
Fetal growth & development
Nutrition
Danger signs
Discussion of analgesia & anesthesia during labor
Care of the newborn
breastfeeding
Sibling preparation & changing family dynamics

Preparation for Childbirth

Childbirth

Preparation Classes

Some classes are general in nature, whereas

others are targeted toward specific groups
such as adolescents, those having cesarean
or vaginal birth after cesarean delivery,
siblings, or grandparents.
Common methods of prepared childbirth
include

Dick-Read
Bradley
Leboyer
Lamaze

Figure 25-8

(From Lowdermilk, D.L., Perry, S.E. [2004]. Maternity & womens health care. [8th ed.]. St. Louis:
Mosby.)

Entire family participating in a childbirth preparation course.

Nursing Process
Nursing

Diagnoses

Body image, disturbed

Nutrition: less than body requirements
Injury, risk for
Activity intolerance
Incontinence, stress urinary
Constipation
Sleep pattern, disturbed
Fatigue

Nursing Process
Nursing

Diagnoses (continued)

Knowledge, deficient
Family processes, interrupted
Fear
Parenting, risk for impaired