PPN301 Weeks 1 & 2 PDF
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Summary
This document, PPN301 Weeks 1 & 2, explores the social determinants of health, focusing on social justice, reproductive rights, and reproductive justice. It discusses maternal and infant health inequities, and challenges related to anti-Indigenous racism in perinatal populations.
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WEEK ONE - Promoting the Health of Childbearing Individuals and Populations Black Maternal Mortality in US Black women/ African American are 3-4 times more likely dies from Pregnancy and Childbirth related complication Maternal and Infant Health Inequities Healt...
WEEK ONE - Promoting the Health of Childbearing Individuals and Populations Black Maternal Mortality in US Black women/ African American are 3-4 times more likely dies from Pregnancy and Childbirth related complication Maternal and Infant Health Inequities Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. Health inequities are unfair and could be reduced by the right mix of government policies Social Justice Social justice focuses on the advantage that some groups or individuals have relative to others; the need to understand root causes of inequities; and the need to take responsible action to eliminate inequities Reproductive Rights “basic rights ofall couples and individuals to decidefreelyand responsibly the number, spacing and timingof their children and to have the information and means to do so, and theright to attain the highest standardof sexual and reproductive health. It also includes theright to make decisions concerning reproductionfreeof discrimination, coercion and violence, as expressedin human rights documents.” (ICPD, Para 7.3) Reproductive Justice “ is the completephysical, mental, spiritual, political,economic, and social well-beingof women and girls,and will be achieved when women and girls have theeconomic,social and political power and resources to make healthy decisions about our bodies, sexuality and reproduction for ourselves, our families and our communities in all areas of our lives. (Asian Communities of Reproductive Justice) POWER Critical Social Theory Perspective Understand the root causes of inequities are historical and socio-politically situated Examines relationships of power and the underlying structures in society that produce population inequities Understand health inequities from Micro, Meso, and Macro by asking WHY Challenges social inequities and injustices, and its impact on populations health FOCUS IS SOCIAL JUSTICE Critical Race Theory Rooted in the understanding that race is a social construct, and that racism is a central feature of society embedded within systems and institutions. Challenges race as a biological construct in the understanding of health disparities Analyzes the historical and sociopolitical structures contributing to differential health outcomes between races and for certain groups Reframe health disparities away from pathologizing marginalized communities. Engages with the problem to bring about transformation W ork with individuals, family, and multi sector collaboration to influence policy and address structural and systemic determinants of health Explicit commitment to social justice Intersectionality “Intersectionality considers how systems such as racism, classism, sexism, homophobia and other forms of discrimination overlap and interact with one another to advantage some and disadvantage others at an individual and social-structural level.” Intersection of social identities Anti-Indigenous Racism in Perinatal Populations Colonization and dominance of the biomedical model – lack of culturally appropriate perinatal care Isolated communities – need to travel to deliver baby (‘forced evacuation’ imposed by federal government) Before 2017, women delivered alone, without family or community support, because escorts were not deemed medically necessary In 2017, policy change: federal government now provides funds for travel companion for Indigenous women leaving communities to give birth Feelings of loneliness when forced to leave home communities and families Lack of traditional practices or ceremonies incorporated into birth experiences / newborn care Racial Disparities in Birth Outcomes in Canada Structural racism and weathering hypothesis ○ Repeated exposure to socioeconomic adversity, political marginalization, racism, and perpetual discrimination can harm health ○ Allostatic load: refers to the physiological effect of chronic or repeated exposure to stress. ○ Stress induces the secretion of cortisol, norepinephrine, and epinephrine ○ High amounts over time may lead to physiological effect of higher systolic and diastolic blood pressures, high cholesterol levels, HbA1c, and increased waist-to-hip ratio. ○ Leads to greater physiological wear and tear (aging biologically faster) Differences in perinatal outcomes shows Black women had higher rates of: ○ Stillbirths ○ Preterm births ○ Caesarean sections ○ Higher risk of gestational diabetes, preeclampsia, placental abruption, low birth weight, small for gestational age Obstetric Racism “Obstetric racism highlights the forms of violence and abuse that medical personnel—and potentially any personnel within medical institutions—routinely perpetrate against Black women.” Sexual Orientation, Gender Identity, and Pregnancy Many lesbian, gay, and transgender couples become parents Intersecting identities of sexual orientation, gender identity, and race expose racialized 2SLGBTQ people to unique forms of discrimination and stigma They deserve respectful care during the childbearing experience as well as during health screening and wellness care Have the same range of reproductive interests as cis people, and many are at childbearing age at the time of transition Masculinizing and feminizing hormone therapy can have temporary and long-term impacts on fertility HCPs need to discuss both birth control and fertility preservation prior to the initiation of hormone therapy. Cultural Considerations - Female Genital Mutilation (FGM) Female genital mutilation (FGM) involves the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons ○ Type 1, type 2, type 3 Practiced in more than 45 countries, with most of these countries being in Africa Assess for potential FGM during initial prenatal visit, before exam ○ Clear documentation of extent of cutting ○ Listening to how the client refers to this; using same terms when providing care ○ Non-stigmatizing, culturally safe care ○ Providing information throughout pregnancy ○ Ensuring privacy during exams ○ Providing rationale for health provider actions ○ Ensuring that woman and family understand why this request cannot legally be met by HCP Meaning of Pregnancy What meaning does pregnancy, childbirth and parenthood have for people. What is relationship between how someone became pregnant & the meaning of the pregnancy for them What assumptions does society have about pregnancy, childbirth and parenthood ○ Who do we see as pregnant? ○ Who do we see as a ‘parent’? ○ How do we view people who are NOT parents? The impact of pregnancy and parenthood for individuals, families, communities and society. Principles of Family-Centered Maternity and Newborn Care *in slides* no need to memorize, but somewhat understand it Trauma and Violence-Informed Care Trauma and violence-informed approaches are policies and practices that recognize the connections between violence, trauma, negative health outcomes and behaviours. Focus to minimize the potential for harm and re-traumatization, and to enhance safety, control and resilience for all clients ○ To increase attention on the impact of violence on people's lives and well-being ○ To reduce harm ○ To improve system responses for everyone Four Principles for Implementing TVIC Approaches Understand trauma and violence and their impacts on people’s lives and behaviours ○ Acknowledge the root causes of trauma without probing. ○ Listen, believe, and validate victims’ experiences. ○ Recognize their strengths. ○ Express concern. Create emotionally and physically safe environments ○ Communicate in non-judgmental ways so that people feel deserving, understood, recognized, and accepted. ○ Foster an authentic sense of connection to build trust. ○ Provide clear information and consistent expectations about services and programs. ○ Encourage patients to bring a supportive person with them to meetings or appointments. Foster opportunities for choice, collaboration, and connection: ○ Provide choices for treatment and services and consider the choices together. ○ Communicate openly and without judgement. ○ Provide the space for patients to express their feelings freely. ○ Listen carefully to the patient’s words and check in to make sure that you have understood correctly. Provide a strengths-based and capacity-building approach to support patient coping and resilience: ○ Help patients identify their strengths, through techniques such as motivational interviewing, a communication technique that improves engagement and empowerment. ○ Acknowledge the effects of historical and structural conditions on peoples’ lives. ○ Help people understand that their responses are normal. ○ Teach and model skills for recognizing triggers, such as calming, centering, and staying present. Cultural Safety and Cultural Humility Cultural Safety ○ Highlights power imbalances in health care relationships Cultural Humility ○ Process of self-reflection to raise awareness of personal and systemic biases How can cultural safety and humility be incorporated into nursing care for childbearing individuals and populations? Inclusive Language Consider the impact of using inclusive versus non-inclusive language during pregnancy Use inclusive terms such as pregnant people (inclusive) versus pregnant women; parent (inclusive) versus mother or father Ask client which pronouns they prefer and which words they use to describe their body Use the client’s preferred words in a respectful & professional manner (eg: breastfeeding versus chestfeeding) Healthy Babies Healthy Children (HBHC) Program The HBHC program is free, voluntary and an OHIP card is not required. HBHC supports individuals & families with: Having a healthy pregnancy ○ ○ Developing a positive relationship with baby and children ○ Promoting child’s growth and development ○ Connecting to resources and programs within the community ○ Working together to give child the best start in life Services provided by HBHC Public Health Nurses include: ○ Frequent and intensive home visiting ○ Support and health teaching during the prenatal period ○ Breastfeeding and infant/child feeding support and teaching ○ Health promotion teaching ○ Referrals to community programs and health services ○ Service coordination Perinatal and Pediatric Nursing Perinatal Nurses ○ Work collaboratively with childbearing individuals and families from the preconception to postpartum period Work Settings ○ Hospitals, community, home, & clinics, ○ Public Health Nurses: Healthy Babies, Healthy Children Program Pediatric Nurses ○ Care for children from birth up to age 18 years Perinatal Healthcare Providers Nurses: ○ Public Health Nurse: Healthy Babies, Healthy Children, Nurse-Family Partnership ○ Hospital Postpartum Nurse ○ Labour & Delivery Nurse Midwives ○ Indigenous midwives: Seventh Generation & Toronto Birth Center ○ Ontario midwives ○ Non-insured clients: Access Alliance Non-Insured Clinic Obstetricians: physicians delivering babies in hospital Doulas/Birth Workers (not covered under OHIP) ○ Indigenous Biidaaban Doula Collective ○ Ontario Black Doula Society ○ Birthmark Doulas (low cost/free services) ○ Queer Spectrum Birth Doulas ASN Entry-to-Practice Competencies for Nursing Care of the Childbearing Family for Baccalaureate Programs in C Nursing Core competencies related to the nursing care of childbearing families that all baccalaureate nursing students in Canada should acquire over the course of their undergraduate education. S et of knowledge, skills, and attitudes that all new nursing graduates should possess related to care of this population, regardless of the specialty area of nursing in which they may elect to practice, while also ensuring that they have the foundation needed to work in perinatal or related areas of nursing. Do not replace jurisdictional entry-to-practice guidelines, but rather to offer national, consensus-based guidelines regarding the depth and breadth of the coverage for all entry-level registered nurses related to nursing with childbearing families in Canada. Week Two - Prenatal Concepts / Antepartum Care P ericonceptional is a critical component of perinatal care. People want to have healthy pregnancy Smoking and can lead to preterm labour increase risk of ectopic gestation, placenta abruption and previa ○ Baby-pre-maturity, low birth weight, birth defect cleft lip, stillbirth or miscarriage, SIDS Alcohol-FASD associated with intellectual and developmental disabilities, hearing defect, heart defect, ○ Folic acid deficiency is associated with neural tube defect-congenital defect of spinal cord and brain (spina bifida –defect that leaves the spinal cord and nerves expose and anencephaly-a baby born without the vault of the skull) Iron deficiency -cesarean section, blood transfusions, abruption, fatigue, and mood concerns in the mother, as well as preterm delivery, low birth weight, and long term cognitive, motor, and memory issues in the new born. Being Overweight or obese during pregnancy place an individual at risk of HBP, preeclampsia, gestational diabetes, miscarriage or stillbirth, increase of having CS ○ Premature birth, neural tube defect, congenital abnormalities of heart, macrosomia Preconception Preconception care involves identifying and modifying risk factors in individuals considering pregnancy in order to improve their health. Risk factors may include medical, behavioural, and social factors, many of which may be modifiable Components of Preconception Care Folic acid ○ reduces the risk of neural tube defects, including anencephaly and spina bifida and associated with lower risk for other birth defects including cleft palate anomalies, cardiovascular and urinary anomalies, and some pediatric cancers ○ Start 2-3 weeks before trying to get pregnant ○ Continue folic acid for the first 3 months Healthy body weight ○ Both low and high preconception Body Mass Index (BMI) can negatively affect pregnancy outcomes. The preconception period is the ideal time to achieve (or progress towards) an optimal weight Mental health ○ Maternal depression and anxiety has adverse effects on outcomes such as premature birth, birth-weight, breastfeeding initiation, and cognitive and emotional development of infants and young children. Physical activity ○ Exercise contributes to overall health, decreasing the risk of chronic conditions, important for weight reduction and maintenance, and has a positive effect on mental health and well-being. Smoking ○ Quitting smoking during the preconception period can eliminate most of the negative impacts on future pregnancies, in addition to providing health benefits for the woman. Immunizations ○ Immunization prior to pregnancy can prevent adverse pregnancy outcomes, prevent infections from being transmitted to the fetus and provide protection during early infancy ○ Tetanus, hepatitis, diptheria Nutrition ○ Healthy eating is a key component to overall health, and the preconception period is an ideal time for women to improve their diet. Nutritional needs change in pregnancy, and a pre-existing pattern of healthy eating helps to optimize maternal and fetal health Environmental hazards ○ A person’s environment includes their home, community, workplace, and other places where exposure to potential chemical and physical hazards may occur. The health impacts of preconception exposure to toxins are complex and difficult to verify onception and Implantation C Functions of Placenta Respiratory: exchange oxygen and carbon dioxide Excretory: excrete waste products Endocrine: functions as an endocrine gland that secretes four hormones necessary to maintain the pregnancy and support the embryo and fetus. ○ human chorionic gonadotropin ○ oestrogen (causes contractions, not needed throughoutpregnancy) ○ progesterone (helps to relax, it maintains the pregnancy) ○ human placental lactogen (hPL) Nutrition: nutrients pass from the mother’s blood into the foetal blood Storage: Carbohydrates, proteins, calcium, and iron for ready access to meet fetal needs Barrier: functions as an efficient barrier harmful substances Definitions: Periods of Pregnancy Antepartum ○ Prenatal period; between conception & onset of labour (also called prenatal, antenatal) Intrapartum ○ Period from onset of true labour todelivery of baby& placenta Postpartum ○ 6-week period between delivery of placenta & membranes and time body returns to nonpregnant state Trimesters of Pregnancy First trimester → 1-14 weeks Second trimester → 14-28 weeks Third trimester → 28-40 weeks Perinatal Continuum of Care S horter hospital stays after birth Childbearing clients discharged home before breastfeeding has been established successfully and before mastering basic baby care activities Many parents lack of sufficient supports at home Obstetrical Terminologies Gravida—A person who is pregnant Gravidity—Pregnancy Nulligravida—A person who has never been pregnant and is not currently pregnant Primigravida—A person who is pregnant for the first time Multigravida—A person who has had two or more pregnancies Parity—The number of pregnancies in which the fetus or fetuses havereached 20 weeksof gestation, notthe number of fetuses (e.g., twins) born. Nullipara—A person who has not completed a pregnancy with a fetus or fetuses beyond 20 weeks of gestation Primipara—A person who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation Multipara—A person who has completed two or more pregnancies to 20 weeks of gestation or more iability—Capacity to live outside the uterus; there are no clear limits of gestational age or weight. V Infants born at 22 to 25 weeks of gestation are considered to be on the threshold of viability. Preterm—A pregnancybetween 20 weeks and 36 weeks6 daysof gestation Late Preterm—A pregnancy that has reached between 34 weeks 0 days and 36 weeks 6 days of gestation Term—A pregnancy from the beginning ofweek 37 ofgestation to the end of week 40 plus 6 daysof gestation Early Term—A pregnancy between 37 weeks and 38 weeks 6 days Full Term—A pregnancy between 39 weeks and 40 weeks 6 days Late Term—A pregnancy in the 41st week Post Term—A pregnancy after 42 weeks GTPAL G → gravidity T → term P → preterm A → abortions L → living children Pregnancy Tests Human chorionic gonadotropin (hCG) is the earliest biochemical marker of pregnancy. Many different pregnancy tests are available: ○ Enzyme-linked immunosorbent assay (ELISA) testing is the most popular method of testing for pregnancy. ELISA technology is the basis for most over-the-counter home pregnancy tests. PresumptiveSigns of Pregnancy (there can be other causes) Cessation of menses (no period) Nausea and vomiting Frequent urination breast/chest tenderness Skin changed Quickening Fatigue ProbableSigns of Pregnancy (can be caused by othercomplications) Enlargement of abdomen Braxton hicks ○ End of 1st trimester Skin changes ○ Striae, increased pigment Positive pragnancy test Hegar’s signs ○ Palpable softening of lower uterine segment → 6 weeks Goodell’s sign ○ Softening of cervix → 8 weeks Chadwick’s sign ○ Blue-violet hue from congestion on vulva, vagina, cervix (vaginal opening) → 6-8 weeks PositiveSigns of Pregnancy Fetal heart is heard ○ Ultrasound → fetal heart motion 4-8 weeks after conception, with doppler → 10-12 weeks Fetal movement felt by examiner between 18-20 weeks Visualization of fetus through ultrasound around 5-6 weeks Adaptations to Pregnancy Uterus ○ Changes in size, shape, and position ○ Softening of lower uterine segment (Hegar’s sign ○ Changes in contractility ○ Uteroplacental blood flow ○ Cervical changes Goodell sign ○ Changes related to fetal presence Ballottement (presence of something in the uterus) ○ Displacement of internal abdominal structures and diaphragm by the enlarging uterus at 20, 28, and 40 weeks of gestation. Vagina and vulva ○ Chadwick sign ○ Leukorrhea Breasts ○ Fullness, heaviness ○ Heightened sensitivity from tingling to sharp pain ○ Areolae become more pigmented ○ Montgomery's tubercles ○ Colostrum during third trimester First breast milk Adaptations to Pregnancy: General Body Systems Cardiovascular system ○ Slight or no change in diastolic pressure ○ Slight decrease to mid-pregnancy (24–32 wk) and return to pre-pregnancy levels by end of pregnancy ○ Blood volume Increases by 1 200–1 500 mL or 40–50% above pre-pregnancy level ○ Hemoglobin level decreases (delusional anemia) ○ Haematocrit level decreases ○ Red blood cell mass increases by 17% ○ Cardiac output increases by 30–50% Respiratory system ○ oxygen consumption increases during pregnancy by 20 to 40% above nonpregnant levels. ○ Change from abdominal to thoracic breathing as pregnancy progresses ○ Increased vascularization in upper respiratory tract due to increased estrogen ○ Nasal and sinus stuffiness, nosebleeds, voice changes Renal system ○ Increased glomerular filtration rate ○ Increase frequency and nocturia ○ Dilation of ureters & renal pelvis increase of pyelonephritis Endocrine system ○ Thyroid – may enlarge; total thyroxine (TT4) may increase ○ Adrenal – Cortisol & aldosterone increase ○ Pituitary – Gland enlarges; Prolactin levels increase. ○ Pancreas – fetus needs glucose ++ for growth and development ○ hyperglycemia & hyperinsulinemia occur after eating (Insulin resistance) ○ Potential for gestational diabetes GI system ○ Morning sickness due to hCG hormone ○ Constipation (progesterone slows everything down) ○ Gas, general discomfort ○ Risk of gallstones ○ Heartburn ○ Hiatus hernia ○ Mouth, gum soreness and bleeding ○ Haemorrhoids (vasodilation, progesterone) MSK system ○ Lumbar lordosis as uterus enlarges and moves upwards and outwands Relaxation of motility of pelvic joints – creates “waddle” ○ ○ Rectis abdominous muscle may separate – diastasis recti ○ Umbilicus protrudes Neurological system ○ Lightheadedness; fainting ○ Carpal tunnel ○ Sensory changes in legs ○ Headaches ○ Some women complain of decrease in attention, concentration and memory; resolves after pregnancy Integumentary system ○ Chloasma (mask of pregnancy) (random pigmentation due to hormonal changes) ○ Linea nigra (discolored line on stomach) ○ Striae gravidarum (stretch marks) Reduced connective tissue strength b/c elevated adrenal steroid levels ○ Thicker hair Determining Gestational Age/Date of Delivery Estimated date of birth (EDB) ○ Accurate assessment is important for obstetrical outcomes ○ First trimester ultrasound is most accurate method to determine EDB ○ Nägele's rule Determine first day of last menstrual period (LMP), subtract 3 months, and add 7 days plus 1 year Alternatively, add 7 days to LMP and count forward 9 months ○ Most women give birth from 7 days before to 7 days after EDB Assumes that ovulation occurs 14 days before the onset of next menses Calculation: ○ Add 7 days to the 1st day of the LMP ○ Subtract 3 months from that date ○ e.g. Joy’s LMP was Jan 7, 2022 ○ Add 7 days = Jan 14, 2022 ○ Subtract 3 months = October 14, 2022 Gestational Age Fundal height ○ measures size of uterus from pubic symphysis to fundus (top of uterus). Between 22-34 weeks gestational age correlates well with measurements in cm., + or - 3 cm. McDonald method – uses tape measure – cm from top of symphysis pubis to top of uterine fundus Quickening ○ awareness of fetal movements by the pregnant person –usually between 16-22 weeks gestation Primary Hormones of Pregnancy HPL ○ Metabolism regulation–free up glucose for use by fetus Insulin resistance ○ HCG ○ Proliferation of uterus and causes cessation of menstruation Estrogen ○ Maintains, controls, and stimulates the production of other pregnancy hormones. ○ Ensures the proper development of many foetal organs including the lungs, liver and kidneys. ○ Stimulates the growth and correct function of the placenta. ○ Promotes growth of maternal breast tissue (along with progesterone) and preparing the mother for lactation Progesterone ○ Stimulates the growth of existing blood vessels. ○ Stimulates glands of endometrium to produce nutrients to sustain the early embryo. ○ Stimulates thickening of the endometrium for implantation ○ Helping to establish the placenta. ○ Required for proper fetal development. ○ Prevents the uterus from contracting until labour starts ○ Prevents lactation until after pregnancy. ○ Strengthening the muscles of the pelvic wall in preparation for labour Oxytocin ○ Produced by hypothalamus and secreted by posterior pituitary ○ Induces uterine contractions in labour ○ Responsible for “letdown” reflex during lactation ○ Help to eject the milk (contraction) Prolactin ○ Produced by anterior pituitary ○ By term: levels increase up to 10x greater than pre-pregnancy levels ○ Essential for milkproduction Relaxin ○ Produced 1st by corpus luteum then placenta after 6-8 weeks ○ Relaxes pelvic muscles & joints to prepare for birth Physiological Changes in Pregnancy Maternal Nutrition The social determinants of health have an impact on dietary intake Good nutrition before / during pregnancy is an important preventive measure Inadequate nutrition can lead to an increase in: ○ Low-birth-weight (LBW) infants (2500 g or less) ○ Preterm infants The Canada Prenatal Nutrition Program (CPNP) provides funding to community groups to help to improve the health of pregnant women, new mothers and their babies, who face challenges that put their health at risk, such as: ○ Poverty ○ Teen pregnancy ○ Social and geographic isolation Substance use ○ ○ Family violence The Public Health Agency of Canada currently funds 236 CPNP projects serving over 45,000 pregnant people, parents and caregivers across Canada each year Nutrition Care During Pregnancy Nutrition assessment that includes appropriate weight for height (BMI), and adequacy and quality of food and eating habits Identification of issues or risk factors, such as diabetes, phenylketonuria (PKU), and obesity, that require nutritional intervention Individualized intervention based on an individual's dietary requirements and plan to promote appropriate weight gain, ingestion of a variety of healthy foods, appropriate use of dietary supplements, and physical activity Evaluation as an integral part of the nursing care provided to patients during the preconception period and pregnancy, with referral to a dietitian as necessary Recommended Rate of Weight Gain in Pregnancy Pre-pregnant BMI can be classified as: ○ less than 18.5: underweight / low ○ 18.5 to 24.9: normal ○ 25 to 29.9: overweight / high ○ > 30: obese Recommended extra energy intake during pregnancy: ○ 1st trimester: same as nonpregnant ○ 2nd trimester: additional 340 kcal ○ 3rd trimester: additional 452 kcal Nutrient Needs Before Conception The first trimester is crucial for embryonic and fetal organ development A healthful diet before conception ensures that adequate nutrients are available for the developing fetus Folic acid (folate) intake is important in the periconceptual period. N ○ eural tube defects (NTDs) are more common in infants of patients with poor folic acid intake. ○ Low-risk clients: 0.4 mg daily for at least 2-3 months before pregnancy, during pregnancy and postpartum if breastfeeding ○ Moderate or high-risk clients (diabetes, epilepsy, obesity, history of NTDs) – increase amount of folic acid (can be up to 1-4 mg/day) Nutrient Needs During Pregnancy Energy needs – vary during trimesters ↑Protein Fluids Omega 3 fatty acids Fat-soluble vitamins ○ Vitamins A, D, E, and K Water-soluble vitamins ○ Folate or folic acid ○ Vitamin B6 (Pyridoxine) ○ Vitamin C (Ascorbic acid) ○ Vitamin B12 (Cobalamin) Minerals, vitamins, and electrolytes ○ Iron: ↑ requirement ○ Calcium ○ Vitamin D ○ Magnesium ○ Sodium ○ Potassium ○ Zinc ○ Fluoride ○ Vitamin B12 (for vegan diets) Prenatal supplements Foods to Avoid Blue vein cheese-listeria bacteria Unpasteurized milk- harmful bacteria Raw or undercooked eggs- salmonella Raw or undercooked meat- parasites that can cause toxoplasmosis Shark, sword fist etc- high levels of mercury than other fishes Limit intake of tuna and mackerel Limit intake of coffee- high amount associated with low birth weight Alcohol intake should be avoided Limit intake of liver contains high levels Vit A Common Discomforts During Pregnancy Nausea and vomiting Heartburn reast tenderness B Vaginal discharge/bleeding Headaches Nosebleeds Gingivitis Abdominal pain/cramping Fatigue Constipation Urinary frequency Back pain Skin changes (linea negra, chloasma, etc.) Ptyalism Quickening Pica (eating nonfood items) Prenatal Visits 1 visit per month until 28 weeks(1 visit total) Every 2 weeks in weeks 28 to 36 Every week in weeks 37-40 ○ High risk pregnancy requires more frequent visits Assessment - Initial Visit Medications Allergies Substance use/abuse Nutrition history Abuse Father’s relevant health history Cultural beliefs and practices SDH Income, ed. Support Mental health assessment Current pregnancy Obstetric hx Gynecological hx Current & past Medical hx ○ Including RH incompatibility Family medical hx Genetic hx Surgical hx Occupational hx Assessment - Every Visit Weight Vital signs Fetal heart ○ 160-170 beats/minute in early pregnancy ○ 110-160 beats/minute in late pregnancy Fundal size Urine (protein, keytones, glucose, nitrates) Potential complications (bleeding, vomiting, headache, visual disturbances, epigastric pain) Coping/adjustment; support; SDH Domestic violence Screening: 1st Trimester Pap if needed CBC HIV Urine culture Rubella titre ABO & RH typing STI testing ○ Other relevant tests E.g. sickle cell, thalasemia, tay sachs, TB if high risk Ultrasound – for nuchal translucency (NT) (11-14 weeks gestation) combined with serum screening for free B-hCG and for pregnancy associated plasma protein A (PAPP-A) ○ Increased NT, Elevated free B-hCG and reduced PAPP-A suggest aneuploidy (mismatched number of chromosomes (should be 46)) ○ Women with these findings are offered genetic counseling and chorionic villus sampling, or 2nd trimester amniocentesis If negative- no further testing Screening - 2nd Trimester Quadruple screen: blood test – between 15-20 weeks ○ Levels of Alpha fetal proteins (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (UE), inhibin-A (placental hormone) ○ Maternal serum alphaproteins (MSAFP) to assess for neural tube defects and open abdominal wall defects Ultrasound- assess gestational age, growth; abnormalities; heart activity ○ Abdominal or transvaginal ○ First ultrasound is the best for determining age Fetal Assessments Ultrasound ○ First trimester – assess gestational age; number of fetuses, etc.) Assess for problems (bleeding; ectopic) ○ Second/third trimester Confirm gestational age Assess level of amniotic fluid Assess location of placenta Identify presentation Assess cause of bleeding; fetal death Amniocentesis ( prenatal dx of genetic disorders or congenital anomalies) ○ Taking out amniotic fluid (sterile) ○ Centrifuge to see anomalies ○ Done after the bloodwork if needed to rule out congenital anomalies Screening - 3rd Trimester Gestational diabetes – (24-28 weeks) Group B streptococcus – Rectal and vaginal swabs – 35-37 weeks Tests as needed- Fetal health ○ Fetal movement counts (to ensure baby is viable) ○ Non-stress tests ○ Contraction stress test ○ Ultrasound Perinatal Education Goal is to assist individual and family to make informed, safe decisions about pregnancy, birth, and early parenthood Well-supported childbirth experience Health-promotion/ education Methods of childbirth education Birth plans ○ Information about where a person wishes to give birth ○ Who will be at the birth ○ What forms of pain relief a labouring person wishes ○ What types of medical interventions and practices they welcome and do not welcome ○ What the person would like to have happen immediately after the birth with the baby Physical and emotional changes during pregnancy Breastfeeding/Infant feeding Nutrition during pregnancy Working during pregnancy Safety – Zika virus, toxoplasmosis Pain management strategies during labour—pharmacological and nonpharmacological Labour and birth process Becoming a parent Transition to parenting Newborn care
