Chapter 14
Nursing Care of the Family
During Pregnancy
Copyright © 2020 by Mosby, an imprint of Elsevier Inc.
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Learning Objectives (1 of 2)
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Describe strategies for confirming pregnancy and
estimating the date of birth.
Summarize the physical, psychosocial, and behavioral
changes that usually occur as the expectant mother
and other family members adapt to pregnancy.
Evaluate the benefits of prenatal care and problems of
accessibility for some women.
Outline the patterns of health care used to assess
maternal and fetal health status at initial and follow-up
visits during pregnancy.
Select the typical nursing assessments, diagnoses,
interventions, and methods of evaluation in providing
care for the pregnant woman.
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Learning Objectives (2 of 2)
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Plan education needed by pregnant women to
understand and manage physical discomforts
related to pregnancy and to recognize signs and
symptoms of potential complications.
Evaluate the effect of culture, age, parity, and
number of fetuses on the response of the family
to the pregnancy and on the prenatal care
provided.
Analyze the effects of variations in childbearing
choices, cultural beliefs and practices on care of
women during pregnancy.
Compare the options for health care providers
and birth setting choices that are available.
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Definitions
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Prenatal period: A time of physical and psychologic
preparation for birth and parenthood
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Duration of pregnancy: Gestation
Spans 9 calendar months, 10 lunar months
40 weeks or 280 days
Trimesters
• First: weeks 1-13
• Second: weeks 14-26
• Third: weeks 27-40
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Diagnosis of pregnancy
Signs and symptoms of pregnancy
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Estimating Date of Birth
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Estimated date of birth (EDB)
Accurate dating of pregnancy is vital to promoting
healthy outcomes for the woman and fetus
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Ultrasound
Most accurate assessment of the EDB is based on
ultrasound measurement of the embryo or fetus
during the first trimester of pregnancy
Naegele’s rule to calculate EDB:
• Assumes that the woman has a 28-day cycle and that
fertilization occurs on the 14th day
• After determining the first day of the LMP, subtract 3
calendar months and add 7 days
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Adaptation to Pregnancy (1 of 3)
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Maternal adaptation
Accepting the pregnancy
Identifying with the mother role
Reordering personal relationships:Close
relationships during pregnancy undergo change as
a woman prepares emotionally for her new role as
mother
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Adaptation to Pregnancy (2 of 3)
Identifying with the
Parent Role
Establishing
relationship with the
fetus
Preparing for birth
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Adaptation to Pregnancy (3 of 3)
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Partner adaptation
Accepting the
pregnancy
• Announcement phase
• Moratorium phase
• Focusing phase
Adaptation to
Pregnancy for Same
Sex Couples
Sibling Adaptation
Depends on age and
dependency needs
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Grandparent
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Care Management (1 of 4)
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Prenatal Care:
Goal of prenatal care is to promote the health and
well-being of the pregnant woman, her fetus, the
newborn, and the family
In 2016, 77.1% of women in the United States
received pregnancy care in the first trimester and
6.2% began prenatal care in the third trimester or
had no prenatal care at all
Providers for Prenatal Care; interprofessional
teams
Models of Prenatal Care
• Traditional Model
• Group Prenatal
Care
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Care Management (2 of 4)
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Initial visit
Prenatal interview
• Reason for seeking care
• Current pregnancy
• Childbearing and female
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reproductive history
Health history
Nutritional history
History of Medication and
Herbal Preparation Use
Family history
Social, experiential,
occupational history
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Care Management (3 of 4)
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Initial visit
Prenatal interview
• Mental Health Screening
History or risk of Intimate Partner Violence
– occurs in as many as 20% of pregnancies
Review of systems
• Physical examination
• Laboratory tests
Urine, cervical, and blood samples
Screening and diagnostic tests for infectious diseases
and metabolic conditions
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Care Management (4 of 4)
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Follow-up visits
Interview
Physical examination
Fetal assessment
• Gestational age
• Fetal heart tones
• Health status
• Fundal height
Laboratory Tests
Genetic Screening
Routine Fetal Ultrasound
Examination
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Nursing Interventions:
Education for Self-Management (1 of 3)
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Expected maternal and fetal changes
Nutrition
Personal hygiene
Prevention of urinary tract infections
Kegel exercises
Preparation for breastfeeding
Umbilical Cord Blood Banking
Oral health
Physical activity
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Nursing Interventions:
Education for Self-Management (2 of 3)
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Posture and body
mechanics
Rest and relaxation
Employment
Clothing
Travel
Medications and herbal
preparations
Immunizations
Rh Immune Globulin
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Nursing Interventions:
Education for Self-Management (3 of 3)
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Substance Use
Normal Discomforts
Recognizing Potential Complications
Sexual Counseling
Sexual History
Countering Misinformation
Safety and Comfort during sexual activity
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Psychosocial support
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Variations in Prenatal Care (1 of 2)
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Social and Cultural Influences
• Many cultural variations are found in prenatal care
• Cultural barriers to prenatal care: lack of money, lack of
transportation, language barriers, modesty
• Cultural prescriptions(do’s) vs. cultural proscriptions(dont) can
affect your attitude and response
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Age differences
Adolescents
• Less likely than older women to receive adequate prenatal care
Women older than 35 years considered advanced
maternal age
• Multiparous women
• Primiparous women
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Variations in Prenatal Care (2 of 2)
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Multifetal pregnancy
Puts the mother and fetuses at increased risk for
adverse outcomes
Multifetal pregnancies are more likely to end in
prematurity
Spontaneous rupture of membranes before term is
more common
Counseling needs to be provided for
• Risk of preterm labor
• Modification of weight gain and nutritional intake
• Selective reproduction
• Lifestyle changes
Can place a strain on finances, space, workload, and the
woman’s and family’s coping capabilities
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Perinatal Education
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Goal - to help individuals and family members to
make informed and safe decisions about pregnancy,
birth, infant care and early parenthood .Another goal
is to assist them to comprehend the long-lasting
potential that empowering birth experiences have in
the lives of women and that early experiences have
on the development of children and the family.
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Classes for expectant parents
Education programs consist of a menu of class
series and activities from preconception through
the early months of parenting
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Perinatal Care Choices
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Physicians
Midwives
Certified
nurse-midwives
(CNMs)
Direct entry
midwives or certified
midwives (CMs)
Traditional or lay
midwives
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Doulas
Birth plans
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Birth Setting Choices
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Hospital
Labor, delivery, recovery rooms (LDRs)
Labor, delivery, recovery, postpartum rooms
(LDRPs)
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Birth Centers
Home Birth
Remains a controversial topic in American health
care
Large-scale studies have documented the safety
of planned home birth for healthy, low risk women
who are attended by CNMs and when there is a
system in place for transfer to a hospital facility
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Key Points (1 of 5)
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The prenatal period is a preparatory one both
physically, in terms of fetal growth and
parental adaptations, and psychologically, in
terms of anticipation of parenthood.
Pregnancy affects parent-child, sibling-child,
and grandparent-child relationships.
Discomforts and changes of pregnancy can
cause anxiety for the woman and her family
and require sensitive attention and a plan for
teaching self-management measures.
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Key Points (2 of 5)
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Education about safety during activity and
exercise is essential, given maternal anatomic
and physiologic responses to pregnancy.
Important components of the initial prenatal visit
include detailed and carefully documented
findings from the interview, a comprehensive
physical examination, and selected laboratory
tests.
Follow-up visits are shorter than the initial visit
and are important for monitoring the health of the
mother and fetus and providing anticipatory
guidance as needed.
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Key Points (3 of 5)
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Even in normal pregnancy the nurse must
remain alert to hazards such as supine
hypotension, signs and symptoms of potential
complications, and signs of family
maladaptations.
Blood pressure is evaluated on the basis of
absolute values and length of gestation and is
interpreted in light of modifying factors.
Each pregnant woman needs to know how to
recognize and report signs of potential
complications such as preterm labor.
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Key Points (4 of 5)
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There is an increased incidence of physical,
mental, and verbal abuse during pregnancy.
Culture, age, parity, and multifetal pregnancy
can have a significant effect on the course
and outcome of the pregnancy.
Nurses must ask pregnant women and their
families about preferences, practices, and
customs related to childbearing to provide
culturally sensitive care.
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Key Points (5 of 5)
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Childbirth education teaches tuning in to the
body’s inner wisdom and coping strategies
that enhance women’s ability to cope
effectively with labor and birth.
Perinatal education strives to promote
healthier pregnancies and family lifestyles.
Nurses can assist pregnant women and their
families to make informed decisions about
care providers, birth settings, and labor
support.
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Question
With regard to follow-up visits and the physical
examination for women receiving prenatal care,
nurses should be aware that:
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d.
The interview portions become more intensive as the
visits become more frequent over the course of the
pregnancy.
Monthly visits are scheduled for the first trimester, every
2 weeks for the second trimester, and weekly for the
third trimester.
During the abdominal examination, the nurse should be
alert for supine hypotension.
For pregnant women, a systolic blood pressure (BP) of
130 mm Hg and a diastolic BP of 80 mm Hg is sufficient
to be considered hypertensive
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Answer
C. During the abdominal examination, the nurse
should be alert for supine hypotension.
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