Health Teaching to Pregnant Women

Diet

During pregnancy, a woman's appetite increases and she requires more protein, minerals, and vitamins. She needs to maintain her health in addition to giving her body the resources it needs to grow. She and the developing fetus will be healthy if she consumes the proper foods during pregnancy.

Importance of Diet in Pregnancy

• Keeping pregnant women healthy.
• The developing fetus's needs.
• The vigor and power needed for childbirth The preparation for a successful breastfeeding.
• Prevent complications before, during, and after pregnancy.

Due to the increased development of the mother's tissue, the fetus, the placenta, and the increased basal metabolic rate, there is an increased calorie need during pregnancy. Encourage the lady to consume micronutrients such as vitamin A, iodine, iron, folic acid, and calcium.

Macronutrients: carbs, protein

Hygiene

There are more sweating and vaginal discharge during pregnancy because of hormonal activities so she should need to take frequent baths and keeps the body clean. A daily bath is needed in hot weather. Dental, breast care is needed.

Comfortable Clothing and Shoes

The pregnant woman should wear loose and comfortable clothes such as loose blouse or cholo. Her clothes should not be tight. brassieres should support and lift the breast well. A pregnant woman should avoid high heeled shoes. She should wear flat shoes to maintain Centre of balance.

Exercise

Most Nepali women work out plenty taking care of their homes and families. They also work outside, so they don't need to do any extra exercise. The woman needs to exercise if she leads a sedentary lifestyle. The family members must be aware that carrying heavy loads and working too hard can cause an abortion or premature labor.

Antenatal Visit

The woman should be convinced to attend the four prenatal appointments on the planned visit date. She needs to go to the ANC clinic since she is pregnant. The woman should visit a clinic for a minimum of four visits if she is healthy and everything is normal, as per the following schedule:

• 1st visit during 3rd month.
• 2nd visit during 6th month.
• 3rd visit during 8th month.
• 4th visit during 9th month.

But if she is suffering from any disorders or diseases, she should be seen weekly or as needed or admitted to hospital depending on the severity.

Immunization

In Nepal, tetanus is a typical infectious illness. Given the high rate of tetanus-related infant mortality, the pregnant mother should have a tetanus vaccination. The TT vaccine protects both the mother and the newborn. The upper arm receives a 0.5 ml intramuscular dosage. Typically, 2 or 3 TT doses are used during pregnancy.

A woman should advise when the next dosage is due and note TT vaccination on mother card as the first dose is administered between 24 and 30 weeks of pregnancy and the second dose is administered after 4 weeks.

Tetanus toxoid regimen for women who are pregnant or who are breastfeeding as follows

• At 1st contact with woman of childbearing age or at 1st ANC visit, as early as possible: TT1
• At least 4 weeks after TT1: TT2
• At least 6 months after TT2: TT3
• At least one year after TT3: TT4
• At least one year after TT4: TT5

Safe Sex and Sexual Relation

Coitus should be avoided during the first trimester, preferably when there are missed periods as well as in the final six weeks before the expected due date (EDD), to prevent the spread of infection and early labor in the last period. Changes in the sexual position may be necessary as the pregnancy progresses to accommodate the woman's enlarged abdomen or to meet the needs of both partners. To lower the risk of HIV and other sexually transmitted infections, safe sex should be practiced.

Smoking and Alcohol

Alcohol use before and throughout pregnancy must be avoided since it harms a pregnant woman's health by causing low birth weight babies, early labor, and other problems. Fetal alcohol syndrome, which occurs in one-third of cases and is caused by daily ethanol consumption of 30 ml or more, is associated with:

• CNS dysfunction.
• Growth retardation in weight and length.
• Higher incidence of mild trimester abortion.
• Increased perinatal mortality and morbidity.
• Characteristics facial abnormalities, short palpebral fissure, short nose, hypoplastic maxilla.

So pregnant woman and woman planning for pregnancy should counsel to quit smoking and alcohol drinking.

Rest and Sleep

The pregnant woman can carry on with her regular routine. However, it is best to avoid demanding employment during pregnancy, especially during the first trimester and the final six weeks. For the preservation of healthy health, rest is crucial. In particular over the past six weeks, she should have needed appropriate rest and relaxation, averaging 10 hours (8 at night and 2 at lunchtime). A preferred posture is lateral, especially on the left. Going on a long, difficult journey toward the end of pregnancy is also dangerous.

Preparation for Delivery

A pregnant woman and her family should start getting ready for the baby from the 7-8 months of pregnancy.Preparation of women for

• Preparation of Women for Labor: The woman should be taught:
  • When and how to bear down in the 2nd stage of labor.
  • Diet during labor – mainly liquid.
  • Explain about labor – what to do and what not to do.
  • Delivery position.
• After Delivery:
  • Brest care and breastfeeding.
  • The way of handling baby.
  • Baby bath-eye and cord care.
  • Immunization of baby.
  • Family planning.
  • The needs of baby as warmth, feeding.
  • Vulval toilet.
  • Items needed for childbirth.
  • Baby wrapper (clean old cloth which should be soft).
  • Bathing soap.
  • Mustard oil massaging the baby.
  • Towel.
  • Baby clothes, vest photo etc.
  • Napkin (made from old soft clothes).
  • Pillow filled with mustard seeds.
  • Blanket for baby.
•  Items for Mother:
  • Petticoat and sari.
  • Things for morning care.
  • Blouse.
  • Sanitary pads, after a few weeks, she may use clean pieces of cloth.
  • Food stuff such as ghee, rice, dark molasses (chaku) meat etc.
  • Charcoal or wood should be stored for heating the room in the winter season.
  • If a mother is alone; an arrangement for a relative or any other person should be made who is willing to help her at home during early weeks of puerperium.
• Items needed for conducting delivery in a home: There are essential items that are needed for delivery. The TBA and the midwife should be advised to keep the following things ready if the delivery is anticipated as home delivery:
  • Clean clothes.
  • Bowls or dekchi.
  • Soap/water.
  • Brush to scrub hands.
  • Sterile scissors or sterile razor.
  • Two clamps, if available to clamp cord.
  • Thread to tie cord.
  • Mud pot to receive placenta.
  • Cotton and gauze.
  • Syringe, needle, and ergometrine.

Drugs

• It is crucial to use a multidisciplinary approach. The majority of communities will have an easily accessible entrance point and a clearly defined drug dependence service.
• Use of cocaine during pregnancy is especially dangerous, and there is no safe alternative. It has been linked to sudden infant death syndrome, spontaneous abortion, placental abruption, preterm delivery, low birth weight, and early birth. The data on prenatal malformations is ambiguous.
• Preterm birth and intrauterine development restriction are more common when opioids are used. Due to this, the rate of low birth weight and perinatal mortality is on the rise. Results are improved by maintenance therapy using an opiate substitute.
• It is important to encourage heroin addicts who want to get pregnant to detox before getting pregnant or, if not, to at least stabilize on methadone. Additionally used as a replacement, buprenorphine appears to have comparable effects during pregnancy.
• All pregnant women in the UK get screened for HIV and hepatitis B, but this is crucial for those who are known IV drug users. In this population, hepatitis C screening is also advised.
• Cannabis use should be avoided because it may harm the developing fetus and is linked to smoking.
• No resounding evidence for psychosocial interventions has been found in Cochrane reviews.

Reference

Memorize. 12.2. 2012. http://memorize.com/antenatal-examination/drlmorice

PatientInfo. 01 December 2015. http://patient.info/doctor/antenatal-examinations

Scribd. https://www.scribd.com/doc/43985359/Antenatal-Assessment

Sweet, B.r., 1989, maye’s midwifery, A textbook for midwives; 11th edition, Bailliere Tindall, London, Philadelphia

Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu