Caring for Women During Pregnancy, Childbirth, and Postpartum (PDF)

‫ صاحب كاظم مراد‬.‫ د‬/1 ‫الرعاية الصحية االولية الجزء العملي‬ Caring for women during pregnancy, childbirth, and postpartum: )‫(رعاية المرأة أثناء الحمل والوالدة وما بعد الوالدة‬ Pregnancy: It is a functional and physiological process that begins from fertilization until the birth of the integr...

‫ صاحب كاظم مراد‬.‫ د‬/1 ‫الرعاية الصحية االولية الجزء العملي‬ Caring for women during pregnancy, childbirth, and postpartum: )‫(رعاية المرأة أثناء الحمل والوالدة وما بعد الوالدة‬ Pregnancy: It is a functional and physiological process that begins from fertilization until the birth of the integrated fetus. Fertilization: It is the process of the sperm nucleus uniting with the egg nucleus and forming the fertilized egg. Usually one sperm unites with the egg in one of the fallopian tubes. After fertilization takes place, the egg and sperm become one cell. It begins to divide from (2 - 4 8- 16) and continues like this until it becomes a spherical mass. The period it takes in its journey from the fallopian tube to the uterus ranges. from (3-4) days When it enters the uterus, the egg is ready to implant (implantation) in the inner lining of the uterus, where it makes a simple scratch through which it enters and is nourished by the blood that comes out of it. After (13) days of entering the scratch, it begins to form placental villi for itself, which do not contain blood, but rather have the property of absorbing food (blood) from the tissues surrounding them, where these villi grow and develop to form the placenta Duration of pregnancy and its calculation: Pregnancy lasts for an average period of (9) nine full months, i.e. (280) days or forty weeks, followed by childbirth How to calculate pregnancy duration (EDD) Estimated Date of Delivery: 1-The date of the first day of the mother’s last menstruation is recorded and (7) days are added to it, then (9) nine months are added to the month in which that menstruation occurred (Gregorian date) 2-As for (Hijri date) + 14 days + 9 months 3-As for (through in vitro fertilization), it starts either from the day of egg retrieval, adding 40 weeks. or from the date of injecting the egg into the uterus, adding 38 weeks. 4-If the cycle is irregular, it depends on the ultrasound(U/S) Purpose of mother's care: 1-To reduce the number of deaths that occur to some mothers during pregnancy 2-To avoid miscarriages and premature births (preterm birth) 3-Adapting to the stage of pregnancy Health care for pregnant mother: First: In the health center The pregnant woman visits one of the available centers as follows 1-One visit every month during the first six months 2-One visit every two weeks during the seventh and eighth months 3-One visit every week during the ninth month 4-Visit the health center when sudden symptoms of illness appear The purpose of these visits: 1-To confirm the occurrence of pregnancy 2-To perform a complete physical examination 3-For comprehensive guidance on pregnancy, childbirth and postpartum Procedures taken during visits: 1-Taking a family medical history to identify genetic diseases. 2-Taking the pregnant woman’s medical history from childhood until her current condition, surgeries, and vaccination history 3-History of pregnancy, previous births and their complications, number of. miscarriages and their causes, and infant deaths. 4-Measuring blood pressure and measuring weight. The pregnant woman’s weight gain throughout the pregnancy should range from 9-13 kg, as well as knowing the type and blood group of the pregnant mother laboratory tests: )A) Blood tests to determine: -Rh incompatibility factor -Rubella test -Virus hepatitis B (B) Urine analysis -)The presence of pus ) microbial infection in the urinary tract -)The presence of protein (what is known as the albumin test) -(The presence of glucose in the urine) what is known as urine sugar analysis C) Cervical smear As well as performing routine examinations, including: 1-Dental examination and treatment of infections and caries. 2-Examination of the pregnant woman’s limbs, hands, and face to see if she is complaining of varicose veins or swelling legs. 3-Pelvic measurement, especially for a virgin, to determine the firmness of the pelvis for natural birth 4-Measuring the height of the uterus to know the stages of fetal development and its position inside the uterus 5-Giving the pregnant woman the necessary vaccines for the period of pregnancy(toxoid) 6-Nutritional supervision of pregnant women 7-Providing health education and quality 8-Providing the pregnant woman with the necessary information in the event of an emergency birth or medical complications and how to reach the hospital or health center Nutrition for pregnant women Folic acid: It is necessary for the formation of the nervous system and brain in the fetus and to avoid any congenital neurological abnormalities in the fetus (meningocele) and is also important for the safety of the nervous system of the pregnant mother Iron: Giving iron from the end of the third(beginning of 4th month) month of pregnancy until six weeks after birth - 30 mg every day. A combined supplement of iron and folic acid can be consumed Vit.D: It is very important for the formation of the fetus’s bones and for maintaining the integrity of the mother’s bones, as at this stage the size of the fetus doubles and the need for calcium increases to build bones Vit.C: Helps absorb iron Vit. E: prevents premature birth Evaluating the nutritional status of the pregnant woman: This is done by knowing its weight using a scale(Balance) If a scale is not available for pregnant women, the mother’s nutritional status can be estimated by measuring her mid-arm circumference If it is less than 20 cm, the mother is severely malnutrition If it is between 20 cm and 23 cm, she is suffering from moderate malnutrition If it is larger than 23 cm, this indicates that the mother is not suffering from malnutrition If the mother's height is less than 145 cm, this may be the result of malnutrition during the mother's childhood The mother’s blood must be tested on her first visit, and if she does not suffer from anemia (normal hemoglobin is 11g% or more), the mother is given iron and folic acid compounds on the second visit, and then the blood is tested again on the fourth visit to ensure the feasibility of preventive treatment and take the necessary measures according to the result of the test Smoking: We advise pregnant women to avoid smoking because: 1-Nutritional deficiency in pregnant women due to lack of appetite for food 2-Decrease in the ability of fetal hemoglobin to transport oxygen due to the presence of carbon monoxide 3-The nicotine in cigarettes constricts blood vessels, leading to a decrease in placental blood circulation Surgeries: Pregnancy is not a contraindication for surgical operations, provided that the pregnant woman is not exposed to lack of oxygen or low blood pressure during the period of anesthesia, and the best period is the second trimester of pregnancy Monitoring the growth of the fetus and ensuring its safety during pregnancy: The fetus's well-being can be checked by asking the mother if she feels its movement, starting from the 16th/18th week Listening to the fetal heartbeat starting from the 20th week of pregnancy Postpartum period It lasts for about six weeks, during which many psychological, physiological and social changes occur in the period immediately following birth, and ends with the woman’s systems returning to what they were before pregnancy, except for the breasts, which continue to grow to perform the function of lactation In the case of a home birth, the nurse should visited the postpartum mother daily during the first week after birth and the following activities must be carried out: 1-Monitoring the mother’s temperature and pulse 2-Abdominal examination to detect fundal elevation 3-Examination of the legs Cases for medical consultation during the postpartum stage Bleeding - high temperature - feeling pain in the legs - change in the color or smell of the lochia - the mother’s pulse accelerates - and the size of the uterus does not decrease The mother must be informed of the necessity of visiting a antenatal care clinic six weeks after giving birth to undergo a comprehensive medical examination that includes an examination of the pelvic organs in order to ensure that the uterus has returned to its normal size and position A non-breastfeeding mother should clean her breasts daily with soap and while a breastfeeding mother ، water when bathing without any special care, is advised to clean her nipples with water without soap, knowing that the skin of the nipples cleans itself with a natural antiseptic secreted by the body called lysozyme The mother must not use any drying substance such as alcohol, and she is also required to wash her hands with soap and water before breastfeeding to prevent infection, It is recommended to expose the nipples to the air during the day for (15-30) minutes, because this helps Increases the resistance of the skin and protects it from cracking. Physiological changes during the postpartum period Temperature: It rises during the first (24) hours after birth, but does not exceed (38). An increase in temperature may occur on the third or fourth day after birth as a result of breast congestion with milk Pulse: The pulse decreases from its average during the two days following birth, then returns to normal after the third day urination: The amount of urine increases during the first five days after birth in order for the body to get rid of excess fluids that were retained in the body during pregnancy Defecation: There is a tendency to constipation after childbirth as a result of the relaxation of the intestinal muscles and the loss of a large amount of fluid Breasts: They secrete colostrum during the first three days after birth, which is a yellow liquid that has important benefits Abdominal pain: It occurs after birth as a result of the contraction of the uterus to get rid of the blood or the remains of the membranes or placenta Factors that increase the speed of the uterus returning to normal 1-Frequent breastfeeding 2-Empty the bladder and intestines well 3-A woman who was having her first pregnancy Factors that decrease the speed with which the uterus returns to normal: 1-She was subjected to a prolonged, difficult birth 2-If the pregnancy contains more than one child, the size of the child will increase 3-If the birth was a caesarean section 4- if the mother has already given birth to many births 5-If she was in a bad psychological state after giving birth Postpartum bleeding and secretions During postpartum, secretions from the vagina flow from the woman, which are called vaginal secretions (lochia) , which microscopically consist of blood, cells, remnants of the fetus’s protective membranes stuck in the uterus, pieces of the uterine mucosa, and germs from the vagina It is red between the first and fourth days, serous(yellow) between the fifth and ninth days, then white on the tenth day, and its quantity varies from one woman to another Its content decreases later and may last only two weeks for some women, and for others it may remain for approximately six weeks. Some women feel a labor-like divorce after giving birth.. What is the significance of this thing: Actually, they are uterine contractions, like contractions during labor, and they contribute to the process of blocking the blood vessels inside the uterus and causing capillary bleeding. They increase immediately after birth, then decrease after two hours, and their intensity is great in the case of a second birth, and in the case of enlargement of the uterine glands during pregnancy as a result of an increase in the fluid surrounding the fetus or fetus (amniotic fluid), Elderly, twins, multiple pregnancy, breastfeeding, or stimulation of the reproductive organs The return of menstruation and ovulation for women after childbirth and beyond: In non-breastfeeding women, menstruation returns in 40-45% of women within 6-8 weeks, in 75% of women within 12 weeks, and in 100% of women within six months. The first menstrual cycle is usually an ovulatory, meaning pregnancy does not occur immediately after it For breastfeeding women, menstruation returns after 12 weeks. Therefore, it must be noted that after this period, ovulation and pregnancy may become possible, and that preventing pregnancy through breastfeeding is temporary and insufficient, and contraceptive methods must be used so that a second pregnancy does not occur quickly after childbirth