Health Teachings and Childbirth PDF

HEALTH TEACHINGS Nutrition most important aspect Women who need special attention: 1.Pregnant teenagers 2.Extremes in weighing scale – low prepregnant weight and the obese 3.Low income women 4.Successive pregnancies 5. Vegetarians – although with high vitamin intake, are low in proteins and miner...

HEALTH TEACHINGS Nutrition most important aspect Women who need special attention: 1.Pregnant teenagers 2.Extremes in weighing scale – low prepregnant weight and the obese 3.Low income women 4.Successive pregnancies 5. Vegetarians – although with high vitamin intake, are low in proteins and minerals because there are many essential amino acids that can be found only in animal sources Nutritional assessment is based on taking a diet history first: 1.Food preferences/eating habits 2.Cultural/religious influences 3.Educational/occupational level Computation of caloric equivalents Carbohydrates x 4 Proteins x 4 Fats x 9  Food sources Protein-rich foods – meat, fish, eggs, milk, poultry, cheese, beans, mongo Vitamin A – eggs, carrots, squash, all green and leafy vegetables Vitamin D – fish, liver, eggs, milk, (Caution: excess Vit. D during pregnancy can lead to fetal cardiac problems) Vitamin E – green leafy vegetables, fish  Vitamin C – tomatoes, guava, papaya Folic acid – especially needed to prevent megaloblastic anemia, abruption placenta and prematurity because, together with iron, folic acid is needed for hemoglobin formation. E.g. ASPARAGUS Vitamin B – food rich in protein Calcium/phosphorus – milk, cheese  IRON Especially important during the last trimester when the pregnant woman is going to transfer her iron stores from herself to her fetus so that the baby has enough iron stores during the first three months of life when all he takes is milk (which is deficient in iron). Iron has very low absorpotion rate; only 10% of iron intake can be absorbed by the body. Thus, for optimum absorption, give Vitamin C. NOTE: Iron should be given after meals because it is irritating to the gastric mucosa Foods rich in iron: liver and other internal organs, camote tops, kangkong, egg yolk, amplaya, malunggay ***spinach  Malnutrition during pregnancy can result in prematurity: 1.preeclampsia 2.low birth weight babies 3.congenital defects 4.stillbirths. Nutrients Non-Pregnant Women Pregnant Calories (kcal) 2000 +300-400 Proteins (Gm) 46 +30 Vitamin A (IU) 4000 +1000 Vitamin D (IU) 400 +0 Vitamin E (IU) 12 +3 Ascorbic acid/Vitamin C (mg) 45 +15 Folic acid (mg) 400 +400 Niacin (mg) 13 +2 Riboflavin (mg) 1.2 +0.3 Thiamine (mg) 1.0 +0.3 Vitamin B12 (ug) 3.0 +1.0 Vitamin B6 (mg) 2.0 +0.5 Calcium (mg) 800 +400 Phosphorus (mg) 800 +400 Iodine (ug) 100 +25 Iron (mg) 18 +18 Magnesium (mg) 300 +150 Food Active Non-Pregnant Pregnant Women Women Meat 2 servings of meat, fowl or 2-3 servings of meat, fowl fish/day; 3-5 eggs/week or fish/day; 1 egg/day Vegetables specially dark 1 serving/day (at least 1 serving/day green and deep yellow 3/week) Fruits: Citrus and others 2 or more servings/day 2-3 servings/day Breads 1 serving/day 1 servings/day Milk 4 or more servings/day 4 servings/day Additional fluid 1 pint (6-8 oz. glasses /day) 1 quart (2-6 glasses/day)  SMOKING -causes vasoconstriction -leading to low birth weight babies and, therefore, is contraindicated during pregnancy  DRINKING – in moderation is not contraindicated but when excessive can cause : 1.transient respiratory depression in the newborn 2.fetal withdrawal syndrome alcohol supplies only empty calories  DRUGS – dangerous to fetus especially during the first trimester when the placental barrier is still incomplete and the different body organs are developing Are teratogenic (can cause congenital defects) and, therefore contraindicated unless prescribed by the doctor.  DRUGS and effects Thalidomide – causes phocomelia (short or no extremeties) Steroids – can cause cleft palate and even abortion Iodine – contained in many over-the-counter cough suppressants, cause enlargement of the fetal thyroid gland, leading to tracheal compression and dyspnea at birth Vitamin K – causes hemolysis and hyperbilirubinemia Aspirin and Phenobarbital – cause bleeding disorder Streptomycin and quinine – cause damage to the 8th cranial nerve (nerve deafness) Tetracycline – causes staining of tooth enamel and inhibits growth of long bones (not given also to children below 8 years for the same reasons)  SEXUAL ACTIVITY Sexual desires continue throughout pregnancy, but levels change During the first trimester, there is a decreased in sexual desire because the woman is more preoccupied with the changes in her body During the second trimester, there is another decrease in sexual desire because the woman is afraid of hurting the fetus  Sex in moderation is permitted during pregnancy but not during the last 6 weeks since there is increased incidence of postpartum infection in women who engage in sex during the last 6 weeks.  Counsel the couple to look for more comfortable positions. Definitely, the missionary (man-on-top) position is not advisable Sex is contraindicated in the following situations: 1.Spotting or bleeding 2.Ruptured BOW 3.Incompetent cervical os 4.Deeply-engaged presenting part  EMPLOYMENT – as long as the job does not entail handling toxic substances, or lifting heavy objects, or excessive physical or emotional strain, there is no contraindication to working. Advise pregnant women to walk about every few hours of her work day long periods of standing or sitting to promote circulation.  TRAVELING – no travel restrictions but postpone a trip during the last trimester. On long rides, 15-20 minute rest periods every 2-3 hours to walk about or empty the bladder is advisable.  EXERCISES Chief aim: To strengthen the muscles used in labor and delivery -Should be done in moderation -Should be individualized: a.according to age b.physical condition c. customary amount of exercises (swimming or tennis not contraindicated unless done for the first time) d. stage of pregnancy) RECOMMENDED EXERCISES 1. Squatting and Tailor Sitting – to stretch and strengthen perineal muscles; increase circulation in the perineum; make pelvic joints more pliable. Remind: When standing from squatting position, raise buttocks first before raising the head to prevent postural hypotension. 2. Pelvic rock - maintains good posture - relieved pressure abdominal pressure and low backache -strengthens abdominal muscles following delivery  Modified knee-chest position - relieves pelvic pressure and cramps in the thighs or buttocks; relieves discomfort from hemorrhoids Shoulder-circling – strengthens muscles of the chest Walking – said to be the best exercises Kegel – relieves congestion and discomfort in pelvic region; tones up pelvic floor muscles Modified knee -chest position Kegel exercises THE FETAL SKULL A.Importance: From an obstetrical point of view the fetal skull is the most important part of the fetus because it is the: 1.largest part of the body 2.most frequent presenting part 3.least compressible of all parts Cranial bones - the first 3 are not important part of the fetus : 1.Sphenoid 2.Ethmoid 3.Temporal 4.Frontal 5.Occipital 6.parietal Membrane space – suture lines are important because they allow the bones to move and overlap, changing the shape of the fetal head in order to fit through the birth canal, a process called molding. 1.Sagittal suture line – the membranous interspace which joins the parietal bones 2.Coronal suture line – the membranous interspace which joins the frontal bone and the parietal bones 3.Lambdoid suture line – the membranous interspace which joins the occiput and the parietals. Fontanels – membrane covered spaces at the junction of the main suture lines 1.Anterior fontanel – the larger, diamond- shaped fontanel which closes between 12-18 months in an infant 2.Posterior fontanel – the smaller, triangular shaped fontanel which closes between 2-3 months in the infant  Measurements – the shape of the fetal skull causes it to be wider in its anteroposterior (AP) diameter than in its transverse diameter 1.Transverse diameters of the fetal skull Biparietal = 9.25 cm. Bitemporal = 8 cm. Bimastoid = 7 cm.  2.Anteroposterior diameters 1.Suboccipitobregmatic – from below the occiput to the anterior fontanel = 9.5 cm. (the narrowest AP diameter) 2.Occipitofrontal – from the occiput to the mid-frontal boe = 12 cm. 3.Occipitomental - from the occiput to the chin = 13.5 cm (the widest AP diameter)