PREGNANCY - ASPECTS OF ADAPTATION

Every mother reacts to pregnancy in an individual way. Several aspects for the clinician to assess are:

Age / height / pre pregnancy weight

Initial response to pregnancy Was the pregnancy planned?

Desired family size

Perception of how pregnancy will affect present life Coping mechanisms and mood changes

Sexual functioning before and during pregnancy

STDs Expressed interest in self and fetus Preparations made for prenatal classes, place of birth, care of siblings in parents absence Obstetrical history / medical history Present obstetrical status: physical exam findings and labs Diet: food intolerances / cravings; vitamins, minerals, supplements or medications used Elimination / exercise / sleep patterns Educational background and interests

PREGNANCY - ASPECTS OF PERSONAL BELIEF SYSTEM AND LIFESTYLE

Date prenatal care first sought and reasons sought Beliefs regarding pregnancy and childbirth

Cultural / ethnic / racial / religious beliefs

Edelman & Mandle, 2010, Website resource 16H

Role of mother / father / family during pregnancy / labor / child care Perception of needs of fetus / infant Contraceptive history History of tobacco / alcohol / medication and drug use and perceptions of effects on self and fetus Nutritional status Planned method to feed infant

Occupation: hazards, work requirements, stressors

Recreational activities Health-promotion practices (seat belts, handling kitty litter, smoke detectors, mammograms, etc. ) Date of latest physical examination, breast exam, pap test, CXR, dental check up Breast self-exam

PREGNANCY - ASPECTS OF SUPPORT

Living arrangements: housing, access to phone services, moving plans?

Level of education & future education plans Religious preference / involvement Marital status Father of baby / family composition
Edelman & Mandle, 2010, Website Resource 16H

Communication patterns with family / health care personnel

Support system Significant other response to pregnancy & body changes / indicators of abuse Access to transportation

Social service / community agencies involved

Self-concept / body image concept Experience with infants / infant care Feelings about previous pregnancies / labor / postpartum and mothering Knowledge of reproduction, labor and delivery, postpartum periods

PREGNANCY - PERINATAL CARE GUIDELINES FIRST TRIMESTER

Complete assessment to identify risk factors Awareness of subtle or overt physical / sexual / emotional abuse Assess physical and psycho social progress adapting to pregnancy Inquire about physical changes and discomforts associated with pregnancy and explain causes and how to manage Provide anticipatory guidance as needed per patient Provide education per patient needs: hazards during pregnancy - drugs, alcohol, smoking; seat belts; warning / dangers signs to report; nutrition / weight management; sexuality

Edelman & Mandle, 2010, p. 386

PREGNANCY - PERINATAL CARE GUIDELINES SECOND TRIMESTER

Assess

adaptation to pregnancy and fetal well-being Update health history Recognize cultural influences Encourage positive health care practices Continue to review risk factors and when to report Provide referrals / resources when needed Continue to provide health education as needed: oral hygiene, nutrition, safety, pregnancy discomforts and relief measures, childbirth class, breastfeeding class

Edelman & Mandle, 2010, p. 386

PREGNANCY - PERINATAL CARE GUIDELINES THIRD TRIMESTER

Review

/ monitor physiological changes Assess readiness for labor / birth / parenting Review birth plan Identify community resources as needed Explain diagnostic tests ordered Assess educational needs as needed: monitoring for fetal movements, strategies to cope with discomfort, including partner in process

Edelman & Mandle, 2010, p. 386

PREGNANCY PERINATAL CARE GUIDELINES LABOR

Admission to birthing facility 1st Stage: complete maternal / fetal assessments and determine labor progress; assist with comfort measures; monitor fetal heart rate; support and praise family efforts 2nd Stage: offer encouragement; assist with pushing efforts; document activities 3rd Stage: provide care as needed; document placental delivery time; Administer meds as ordered 4th Stage: monitor vital signs; fundus; assess bladder status; encourage parental-infant interaction; monitor newborns well-being; provide perineal care, food, fluids and support to family

Edelman & Mandle, 2010, p. 386

PREGNANCY - PERINATAL CARE GUIDELINES POSTPARTUM

Complete head-to-toe physical assessment: breasts, uterus, bladder, bowels, lochia, emotional status, circulatory status, episiotomy Assess for postpartum blues / depression Encourage bonding and attachment Provide assistance with breastfeeding techniques: position, latch, feeding frequency, hunger cues Provide anticipatory guidance and educational needs as needed: nutrition; fatigue; childcare; immunizations; sexuality; family planning; breast engorgement; family adaptation; follow up care; danger signs to report; sibling readiness for new baby; self-care activities

Edelman & Mandle, 2010, p. 386