DISORDERS,STRATEGIES AND LIFESTYLE ADVICE TO THE PREGNANT WOMEN MUHAS ERAI ERASTO MGAYA SCHOOL OF NURSING BSCN 3
GETTING PREGNANT IS LIKE RUNNING A RACE YOU HAVE TO GET YOURSELF IN CONDITION
INTRODUCTION• COMMON DISORDERS OF PREGNANCY– are clinical conditions that the pregnancy woman experience during the course of pregnancy.• These conditions may some time be regarded as normal signs of pregnancy.• Every pregnancy is a unique experience for the woman and each pregnancy that the woman experiences will be uniquely different .
Cont…• It is important for a midwife to acquire knowledge and understanding of the common disorders of pregnancy in order to advice the woman on the strategies that will help her to cope with the condition and minimize the effect of experience.• These condition are regarded as minor conditions but they are far minor to the woman who is experiencing so the midwife must consider them as problem that bring discomfort.
Cont…• The midwife must be able to identify these common disorder when they become medical disorder of pregnancy and refer them to the appropriate medical practitioner.• The midwife is the key person educating the woman about these common disorders of pregnancy and the booking interview therefore the midwife need a knowledge of these common disorders to effectively educate the woman
Cont…• The midwife may use the complementary and alternative medicine for alleviating symptoms caused by these common disorders of pregnancy.• It is important for the midwife to advice the woman to seek advise from a registered health practitioner prior to commencing medication• The signs and symptoms should not be regarded as common disorder of pregnancy.
Nausea and Vomiting• Nausea and vomiting are said to affect 50% of pregnancies( Snell et al 1998).• Their exact is not truly explained but is thought to be a combination of hormonal changes, changes in carbohydrates metabolism, psychological adjustment and neurological factors.• It may also be linked to vitamin B6 and zinc deficiencies.• Eating small frequent meals will help to maintain body’s blood sugar level and having small amount of fluid between meals will help to maintain hydration.
Cont…• Good sources of vitamin B6 and zinc include the whole wheat bread, seeds, nuts, milk, Ginger and chicken.• General nausea and vomiting improve around the 16th week of pregnancy, but until that time may cause such debilitation for the woman as to affect her dairy life.• A small proportion of those women (0.3-2%) will develop a more serious condition known as hyperremesis gravidarum, which require an urgent referral.
Breast changes• Often changes in the breast are one of the first alteration that the woman notices in relation to her pregnancy.• The breasts often become tender and feel fuller because of hormonal changes.• The level of oestrogen increase, which is instrumental in laying down fat stores in preparation for breast feeding.• The vascular circulation is increased and the nipple become larger and the areola more deeply pigmented.
Backache and Ligament pain• Backache is a common disorder that is not restricted to a particular trimester but may span all 3 trimesters and continue into post- natal period.• During pregnancy a woman body undergo many changes and backache can insue from the growing uterus causing a change in posture and the influence of hormone relaxin and ligament.
Cont…• There are simple steps that the midwife can advice the woman to take in order to alleviate the discomfort, such as to maintain good posture, to adopt the appropriate position when lifting either small children or heavy objects and to avoid standing for prolonged periods of time.
Cont…• The growth of the uterus as pregnancy progresses causes stretching of the supporting ligaments in which the woman may experience sharp painful spasm called ‘ligament pain’.• Again advice can be given on avoidance of stretching, taking a warm bath and massaging the area; this will do much to alleviate symptoms.
Leg cramp• Cramp, which is a sudden gripping contraction of the calf muscle frequently occurs during the third trimester of pregnancy.• It is usually for woman to be woken during the night and to be left with the painful calf the following day.• The cause is thought to be lowered serum ionized calcium level and increased level of phosphates.
Cont…• To minimize the risk of night cramps the midwife may advice the woman to do some leg-stretching exercise before retiring to bed.• A dietary adjustment in which the woman reduces her intake of milk, soft drinks and processed food may help to reduce the occurrence of leg cramps• When the woman is troubled by cramps, she should be advised to flex the foot in the opposite direction.
Headache• Frequently women complain of headaches during pregnancy and there are many reasons put forward as to why these should occur, such as hormonal changes, eye strain, sinusitis, fatigue and emotional changes.• Whatever the cause it is important that the midwife is aware of the nature of these headaches and can give advice on how to alleviate them.• Headaches can occur at any stage of gestation, but should they occur during the third trimester together with an increase in blood pressure or proteinurea, or both, then medical aid should be sought urgently.
Fatigue• Fatigue is a condition that affect the woman not only during pregnancy but also during post-natal period.• During the post-natal period it can be attributed to the stress of labour and the physical demand of caring for a new baby, which will include disturbed sleep patterns.• During first trimester it can be attributed by hormonal changes and the organogenesis that is taking place.
Cont…• This factors cause the woman to have feelings of overwhelming sleepiness• During the third trimester the fatigue can be related to the increase in weight, making mobility difficulty and increase in metabolic demands of the body in preparation for labour and breastfeeding.
Constipation• Constipation can be a very distressing and uncomfortable condition and the midwife should be able to advice woman on how to avoid, and measures to deal with, this common complaint.• The woman may also be prescribed oral iron therapy for anemia, which is the common cause of constipation.
Cont…• A diet that reach in fiber will help to prevent the condition and will also help in resolving it.• It is important that the woman also as an adequate fluid intake, which will keep the stool soft and easy to pass and she should exercise regularly.• The midwife should inquire about many changes in the frequency and consistence of the woman’s bowel movements and offer advice accordingly.
Cont…• The woman should be advice to eat whole grains, raw unpeeled fruits and vegetables.• Bananas are good for bulking and honey for lubrication.• Abdominal massage with mandalin oil or acupressure along a line from pubic bone to the umbilicus may also facilitate defaction.
Cont…• If constipation persists then haemorrhoids may develop, caused by straining at defecation, which can subsequently cause particular difficults during the birth process.• Haemorrhoids can be particularly painful and may bleed therefore avoidance of this condition should be the aim of management of constipation.
Heartburn• This is a burning, irritating sensation in the oesophagus.• The relaxing effect of progesterone causes retarded peristalsis and the relaxation of the cardiac sphincter of the stomach.• The enlarging uterus increases the intra- abdominal pressure.• The increased intra abdominal pressure and the relaxation of cardiac sphincter are the causes of the reflux of gastric acid into the oesophagus.
Cont…• To minimize this effect fatty meals should be avoided• It may be better to take smaller meals more often and foods cause heartburn should be excluded from the diet.• Following meals the woman should not lie flat but use one or more cushion for support• Antacids may be prescribed by physician but sodium bicarbonate must be avoided because it mat cause electrolyte and acid-base abnormalities.
Vaginal discharge• An increased vaginal secretion is common• It is the result of the hyperplasia of the cervical epithelium and increased mucous production by the endocervical glands• Usually the secretion is white and mucoid in appearance• It is a physiological phenomenon.
Candidiasis• This is a fungus infection caused by Candida albicans.• The discharge is very irritating and causes pruritis• on examination the discharge is thick and milky and often attached to the vaginal wall.• Antifungal preparations are effective.• Advice the woman to be scrupulous about perineal hygiene, to use perineal pads, if necessary, and to report pruritus ,foul odour or blood.• The woman should not douche or use tampons.
Ptyalism• The cause of increased production of saliva is not known• Certain mouthwashes and chewing gums may improve the condition.
Blocked nose and epistaxis• The increased oestrogen levels may cause hypertrophy and hyperaemia of the nasal mucosa.• This may cause blocked nose and increased nasal secretion or bleeding• Bleeding is rarely severe.• Nasal drops should be avoided.
Dyspnoea• This is a common symptom between 34 and 38 weeks, sometimes earlier, and is the result of pressure by the enlarging uterus on the diaphragm• Hormonal changes may also be a contributory factor• Sleeping in the Fowler’s or lateral position may help.
Varicose veins• Varicose veins are aggravated during pregnancy by• Pressure of the enlarging uterus on the iliofemoral veins• The relaxing effect of progesterone• These two factors increase stasis of blood in the lower extremities, causing gradual attenuation of the wall of the blood vessels and eventually varicose veins
Cont…• These women usually complain of heaviness, tiredness or pain in the legs• Any clothes or garters that exert pressure on the thighs or legs should be avoided and the legs should be elevated during rest.• Elastic stocking support the veins and should be worn as often as possible and the woman must avoid sitting with her leg crossed.• If varicose veins of vulva occur, a cushion may be placed under the hips, to enhance veinous drainage• Regular exercise will also improve the circulation of blood in the legs.
Oedema of the lower extremities• Oedema of the lower extremities is often physiological• Standing for long period and high temperatures aggravate the condition• Regular rest period are effective and whenever possible the woman should elevate her legs by means of cushion or foot stool.• The importance of regular dorsi-flexion of the feet to enhance circulation must be stressed• The woman must be evaluated regularly by the midwife to exclude pathological oedema and support hose, as for varicosis, should be recommended.
Haemorrhoids• These are varicose veins of the lower rectum and anus.• Because of the same factors that cause varicose vein, the incidence of haemorrhoids is also increased during pregnancy.• Haemorrhoids are also exacerbated by the high incidence of constipation during pregnancy.• Haemorrhoids developing during pregnancy usually become asymptomatic and disappear during the post-partum period,but may take a while.
Cont…• In case of external haemorrhoids,replacement alleviates the condition.• The woman is tought to replace the haemorrhoids using a lubricant, while lying in the lateral position.• Constipation should be avoided.• Other alleviating procedures such as ice packs,warms sitz-baths cream and suppositories as prescribed by physician may be of value.
Dizziness and Fainting• Certain women are prone to fainting spells especially if they enter a warm, crowded room.• The cause is a combination of different factors:-The change in the blood volume, with vasomotor instability.-The relaxing effect on the blood vessel walls.-Compression of the vena cava inferior by the uterus in the supine position causing decreased blood return to the heart and the brain.-Stasis of the blood in the lower extremities.-The pregnant woman must always change position slowly.-If she feels faint, she should sit or lie down in a left lateral position.
Physiological skin changes• Common skin changes include chloasma, stria gravidarum and acne.• The midwife should assure the woman that the changes to her skin will gradually fade away after the birth of the baby and explain the causes of these changes.• Lotions will not help to prevent striae because some women are genetically predisposed to them.• The woman should avoid exposure to the sun and use sunscreen lotions to prevent further darkening of chloasma.• Acne may decrease after the first trimester.• The midwife should also explain the usual hygienic measures to the woman.
Emotional factors• Emotional instability is common during pregnancy.• It is due to many factors. There are the hormonal changes, which influence how the woman feels and reacts to stimulations, but there is also the physical discomfort of some of common disorders of pregnancy to contend with.• It is important that the midwife is able to reassure the woman and her family that the situation is fairly common and normal.
Cont…• However it is important that the midwife is aware of any stressful life event, other than the pregnancy, that may be causing the situation.• Such life events as moving house, death of a close family member or the breakdown of the relationship occurring antenatally may also affect the woman in the postnatal period and predispose to postnatal depression.
GENERAL LIFESTYLE ADVICE EXERCICES• Exercise is important in pregnant women if done in moderation.• The development of complications e.g. pre- eclampsia, threatened abortion, multiple pregnancy, premature labour etc. is an indication for limiting the amount of exercises.• Active exercises during pregnancy has no deleterious effect on the fetus if the woman does exercises to which she is accustomed.• Specific antenatal exercises are of value.
Cont.. EMPLOYMENT• Work in itself is not detrimental to the pregnant women, although much would depend upon the physical activity involved.• However, excessively tiring work should not be undertaken.• Normal employment can probably be safely undertaken in the absence of complications until the 36th week of pregnancy.• The environment should be safe for a developing fetus.
Cont.. TRAVEL• Travel during normal pregnancy is not detrimental.• The biggest problem of travel is that the woman may require the help of physician or midwife once she reaches her destination.• She should therefore always be referred to a colleague.• Air travel in a pressure controlled aeroplane is safe.• Air travel in a non- pressurized aeroplane may be dangerous if altitudes of 3000m are exceeded .• Most modern aircraft are equipped to transport pregnant women.
Cont.• Long journeys during the third trimester are prohibited by most airlines because of the danger of labour ensuring during the journey.• When traveling by air, car or bus the women should avoid sitting for long periods.• A stretch or walk should be scheduled every two hours.• Safety belts should be worn at all times.
Cont.. BATHING• There is no detrimental effects.• During the third trimester the women’s balance may be impaired because of the enlarged uterus.• She may fall and injury herself and /or the fetus.• Bathwater should never be too hot as it may cause the women to become dizzy.
Cont.. CLOTHING• The clothing of the pregnant woman must be practical, loose-fitting and attractive.• During the first trimester special clothing is seldom indicated.• During the second trimester special maternity wear is indicated.• Tight-fitting belts or underwear must be avoided.• Any clothing causing constriction of the veins of the lower extremities must be avoided and the women must wear comfortable shoes.
SEXUALITY DURING PREGNANCY AND POSTPARTUM• Intercourse and orgasm seem to be safe for most pregnant women throughout pregnancy.• Since sexual intercourse cause uterine contraction it is contra-indicated in the following cases: - A threatened abortion - A history of miscarriages - cervical incompetency - multiple pregnancy - premature rupture of membranes - anterpartum haemorrage or placenta praevia. - threatened premature labour.
Cont..• There are normally changes in the sexual drive during pregnancy. During the first trimester• some women may experience a heightened sexuality, enjoy sex more and seek it more frequently.• Other women have a decreased sex drive owing to nausea, fatigue, breast soreness and other physical changes.• Women is very aware of her pelvis.• The filling of fullness, the sharpened sensations and round ligament twinges, may give rise to some anxiety.• She should be made aware that intercourse poses no threat to pregnancy under normal circumstances.
Cont.. During the second and third trimester• The growing uterus may make the usual sexual position uncomfortable for the couple.• The enlarged uterus may also cause the women to feel very unattractive, others feel a sense of heightened potency.• The husband may also may have different feelings towards his wife’s enlarged body.• Some experience her as more sexy, others are turned off.• Emotional lability and other psychological changes in both the partners may cause changes in their sexual drives which may be confusing to them.
Cont..• The increased vaginal discharge, backache, increased fetal movements and other physical changes during pregnancy may interfere with the couples sexual activities.• The following may solve some of the problems: - Open communication between the two partners about their feeling. - Decrease breast fondling - Use other methods of expressing love like massage, hugging, together activities etc. - Become creative with other positions to decrease discomfort. - Understand that increased and decreased interest in sex is normal.
Cont.. During labour and delivery• Some women may experience such a lot of pain and discomfort that it is impossible for them to find a connection between this process and sexual energy.• For other women, however, it is powerful erotic experience of moving sexual energy.
Cont.. Postpartally• Women are advised to refrain from sexual intercourse for six weeks.• There are, however, great variations in the time that it takes for women to become ready for sexual activity.• Episiotomy is certainly a cause of sexual concern in many women, scar takes as long as four months to reach comfortable state.• The first resumption of intercourse may be very slow with care and a lot of lubrication is needed during penile entry. Even women with caesarian section experience pain during penetration due to lack of lubrication and changes in the vaginal and pelvic tissue.
Cont.. Breastfeeding• may also have an effect on sexual aspect.• Some women may feel tired and drained, while others may see breastfeeding as such a wonderfully sensual experience that they even have orgasms while breastfeeding.• The breasts may leak milk during arousal which may make some couples avoid sex.• Fatigue, emotional stress and psychological changes postpartally may further reduce interest in sex.• Counselling by the midwife, open communication between the partners and the support from support system may provide solutions.
ConclusionIt is clear from the evidence presented that the content and delivery of many parent education classes need to change. The midwife is the lead professional in normal midwifery and in educating for parenthood. The educational role of midwife is integrated into every aspects her/his work and enters into every communication with the prospective parents. There need to be special classes that will meet the needs ofspecially identified groups, such as minority ethnic groups of women and young teenage women.
Cont…• These special group would benefit from providing education in various formats, such as video presentations in home or health centers and in the first language of the ethnic minorities, or providing teen-only antenatal and parental and patient education classes.• Encouraging women and their partners to set the agenda will address the need of that particular group and therefore more participation will be achieved.
Cont…• Being pregnant can be a challenge for a woman, but also for the spouse, who has to be supportive all the way until the birth of the baby. One thing is for sure though: every woman reacts different when they are pregnant
The way forward• Midwife have always made an enormous contribution to improving public health, not only in terms of reducing maternal and infant mortality and morbidity but in educating and assisting mothers and families to achieve optimum well-being.• The very essence of midwifery is to promote long term health for women and babies.
Cont…• Midwives are the prime of carers who advice on the screening tests that are available, gives advice on nutrition, exercise and other lifestyles issues, promote and encourage breastfeeding and inform and advice on the various phases of child birth process.• In recent time there has been a bigger emphasis on health education and health promotion strategies in order to encourage individuals to adopt healthier lifestyles.
Cont…• The post natal period is the time when new parents are learning their newly acquired role and this transition to parenthood can be a time of great anxiety ., at this time the midwife is able to give much advice and support to educate parents and lessen their anxiety.
Cont…• A woman will often suffer ill health after child birth with condition such as anaemia, urinary incontinence , backache and tiredness and would become an opportunity to discuss these often embarrassing conditions with the person who she has come to know and respect, her midwife.• The postnatal period is the time when the relationship with the midwife is firmly established and there is respect and cooperation between the midwife and the mother.
Cont…• In preparing the next generation of parent, midwives must take account of the changes within societies, education, employment and roles that men and women now adopt .• Targeting parent education session to meet the needs of the differing client groups and giving participation ownership of the content is the line with the midwifery philosophy of care being woman focused and family centered.
Cont…• It is essential for the midwives that we do not lose the sight of our important educational role because it is through this vital aspects that we can contribute to the improved health of the community we serve and empower women for child birth and motherhood.