Chapter 11 Maternal Adaptation During Nursing

Question 1

Pregnancy

Answer 1

A dynamic & precisely coordinated process involving systemic & local changes in the mother that support the supply of oxygen & nutrients to the growing fetus in utero & in subsequent lactation

Lasts ~280 days (40 weeks)

Question 2

Key Fertilization Basics

Answer 2

Fertilization usually occurs in the outer third of the fallopian tube (ampulla)

Ovum is receptive to fertilization for 24-48 hours after release from ovary

Sperm are viable for 24-72 hours after ejaculation

Once a sperm has penetrated the ovum, further sperm penetration is prohibited

Zygote: Fertilized ovum will begin cell division

Between 6-10 days the blastocyst will implant to the endometrium

Question 3

Gestation

Answer 3

The length of time between conception and birth during which a fertilized ovum matures and grows in the female’s uterus

Question 4

Gestational Age

Answer 4

Age of the pregnancy from the last normal menstrual period (LMP)
- Most references to pregnancy are usually in gestational age rather than fetal age

Question 5

Fetal Age

Answer 5

Actual age of the growing baby

Question 6

Factors that Determine the Success of Pregnancy

Answer 6

1) Fertilization & successful implantation of the developing embryo into the endometrium

2) Development & function of the placenta

3) Adaptation of the maternal physiology to accept the fetal allograft & satisfy its nutritional, metabolic, & physical demands

4) Appropriate growth and functional development of organs & homeostatic systems in the fetus

5) Proper timing of the birth so the fetus is mature enough to survive outside of the uterus

Question 7

What is a pregnancy divided into?

Answer 7

Trimesters

Question 8

How long does each trimester last?

Answer 8

Each trimester lasts 13 weeks

W/in each trimester, numerous adaptations take place that facilitate the growth of the fetus

Question 9

What types of groups have the signs/symptoms of pregnancy been arranged into?

Answer 9

Presumptive, probable, & positive

Question 10

Presumptive (Subjective) Signs

Answer 10

Signs that the mother can perceive

Most obvious presumptive sign: Absence of menstruation
- Skipping a period is not a reliable sign by itself; however, if it is accompanied w/ consistent nausea, fatigue, breast tenderness, & urinary frequency it may be likely

LEAST reliable indicators of pregnancy
- Any one of them can be caused by something other than pregnancy
Ex) Amenorrhea can also be caused by early menopause, endocrine dysfunction, malnutrition,..

Question 11

Probable (Objective) Signs

Answer 11

Signs of pregnancy that can be detected on physical examination by a health care provider

Common probable signs include:
- Hegar Sign: Softening of the lower uterine segment or isthmus
- Goodell Sign: Softening of the cervix
- Chadwick Sign: Bluish-purple coloration of the vaginal mucosa & cervix

Other probable signs include:
- Changes in size & shape of the uterus
- Abdominal enlargement
- Braxton Hicks contractions
- Ballottement: Provider pushes against the woman’s cervix & feels rebound from the fetus

Elevation of hCG corresponds to the morning sickness period of ~6-12 weeks of pregnancy

Although they are more reliable than presumptive signs, they are still NOT 100% ACCURATE!!!!

Question 12

Pregnancy Tests

Answer 12

Also considered to be a probable sign of pregnancy

In-home testing became available in 1977
- Appealing to the general public due to convenience, cost, & confidentiality

Vary in sensitivity, specificity, & accuracy

Influenced by length of gestation, specimen concentration, presence of blood, & presence of some drugs
- Human chorionic gonadotropin (hCG) is detectable in a serum of ~5% of clients 8 days after conception & in more than 98% of of clients by day 11

Most claim 99% accuracy (misleading-> has no bearing on the ability of at-home pregnancy tests to detect early pregnancy)

Question 13

Human Chorionic Gonadotropin (hCG)

Answer 13

Glycoprotein & earliest biochemical marker of pregnancy

hCG level < 5 mIU/mL: Negative
Any hCG level > 25 mIU/mL: Positive

hCG levels in normal pregnancy usually double every 48 -72hrs until they peak ~60-70 days after fertilization
- At this point, they decrease to a plateau at 100-130 days of pregnancy

hCG doubling time is used as a marker by clinicians to differentiate normal from abnormal gestations
- Low levels are associated w/ ectopic pregnancies
- Higher than normal levels may indicate molar pregnancy or multiple-gestational pregnancies

Question 14

Positive Signs

Answer 14

Confirm that a fetus is growing in the uterus

Include:
- Visualizing a fetus via ultrasound
- Palpating for fetal movements
- Hearing a fetal heartbeat
* All signs that make pregnancy a certainty*

If a pregnancy test is (+), a clinical visit SHOULD include an estimation of gestational age so, appropriate counseling can be given
- Should also receive info on normal signs & symptoms of early pregnancy
- Instructed to report any concerns to the provider for further evaluation
- Prenatal visits will be set-up throughout the duration of the pregnancy

Question 15

What are the only signs that can determine a pregnancy w/ 100% accuracy?

Answer 15

Positive signs

Question 16

What does the elevation of hCG correspond to?

Answer 16

Morning sickness period of ~6–12 weeks of pregnancy

Question 17

Reproductive Adaptations During Pregnancy: Uterus

Answer 17

Decrease in uterine vascular and muscle tone

Grows at a steady & predictable rate during pregnancy
- Uterus is normally pear-shaped, the uterus will expand more in length than width-> globe shape
-> Exits the pelvis by 12 weeks gestation
-> Walls thin to 1.5 cm or less

Estrogen stimulates uterine growth-> increases in size, weight, length, width, depth, volume, & overall capacity
- Weight: Increases from 70g to ~1,100-1,200g at term
- Capacity: Increases from 10-5,000 mL or more at term

Uterine growth occurs as a result of both hyperplasia & hypertrophy of myometrium cells (increase in size)
- Major component of myometrial growth occurs after mid-gestation due to smooth muscle hypertrophy via mechanical switch from the fetus

Question 18

Reproductive Adaptations During Pregnancy: Uterine Blood Flow

Answer 18

Increase in blood flow -> blood vessels elongate, enlarge, dilate & sprout new branches to support and nourish growing tissue

As pregnancy progresses, 80-90% of blood flow is directed to the placenta & remainder is distributed between the endometrium & myometrium

Diameter of the main uterine artery ~2X in size
- Enlargement from a narrow to large-caliber vessel enhances the capacity of the uteroplacental vessels to accommodate the increased blood volume needed to supply the placents

Question 19

Reproductive Adaptations During Pregnancy: Uterine Contractility

Answer 19

Uterine contractility is enhanced as well

Braxton-Hicks begin during the 1st trimester of pregnancy
- Continue throughout the pregnancy and become more noticeable during the last month
- Function: To thin out or efface the cervix before birth

Question 20

Braxton-Hicks

Answer 20

Spontaneous, irregular, & painless contractions

Begin during the 1st trimester
- Continue throughout pregnancy, become more noticeable during last month-> Thin out or efface the cervix

Question 21

Reproductive Adaptations During Pregnancy: The Impact of Uterine Changes on the Bladder

Answer 21

Lower portion of the uterus (isthmus) does NOT undergo hypertrophy & becomes increasingly thinner as pregnancy progresses-> forms the lower uterine segment
- Occur during the first 6-8 weeks gestation-> produces most of of the signs (includes Hegar’s sign)

Softening & compressibility of the lower uterine segments results in exaggerated uterine anteflexion during early months of pregnancy
- Adds to urinary frequency by placing pressure on the bladder

Uterus remains in the pelvis in the 1st 3 months of pregnancy, then ascends into the abdomen
- As uterus grows, puts pressure on the bladder

Question 22

Reproductive Adaptations During Pregnancy: Uterine Ascension

Answer 22

Uterus remains in pelvic cavity for the 1st 3 months of pregnancy-> progressively ascends into the abdomen

The heavy gravid uterus in the last trimester can fall back on the inferior vena cava in supine position
- Causes vena cava compression-> reduces venous pressure, CO, & BP, increases orthostatic stress
-> May experience lightheadedness when changing position from sitting to standing

Hypotensive Syndrome
- These changes may be reversed in the side-lying position: displaces the uterus to the left and off the vena cava
- Do not lay on the back!!! (Side-lying or w/pillow)

Question 23

Hypotensive Syndrome

Answer 23

Causes a woman to experience symptoms of weakness, lightheadedness, nausea, dizziness, or syncope

Question 24

(T/F) True or False: It is fine for a pregnant mother to lie in supine position.

Answer 24

FALSE!!

This can cause further compression on the inferior vena cava-> cutting off blood flow

Question 25

Reproductive Adaptations During Pregnancy: Fundus

Answer 25

Uterus becomes ovoid as length increases over width

By 20 weeks, fundus is at the level of the umbilicus & measures 20 cm

Can usually be correlated w/ gestational weeks, most accurately between 8-12 weeks
- Obesity, hydramnios, & uterine fibroids interfere w/accuracy

Reaches the highest level at xiphoid process around the 36-week mark
- Breathing becomes difficult since its pushing against the diaphragm

Between 38-40 weeks, the fundal height drops as baby begins to descend & engage into the pelvis
- Breathing becomes easier from descent
- Pressure on the bladder increases-> urinary frequency

Question 26

Fundus

Answer 26

The top of the uterus

Question 27

Lightening

Answer 27

The fetal head begins to descend & engage into the pelvis

Occurs by the 40 week mark
- In women w/1st pregnancy, occurs ~2 weeks before onset of labor
- In women w/ subsequent pregnancy, occurs at the onset of labor

Question 28

Reproductive Adaptations During Pregnancy: Cervix

Answer 28

Between weeks 6-8, cervix begins to soften due to vasocongestion & influence of estrogen (Goodell’s sign)

Endocervical glands increase in size & number & produces more cervical mucus

Under progesterone influence: Thick mucus plug is formed & blocks the cervical os & protects opening from bacterial invasion

Increased vascularization occurs at the same time-> bluish-purple coloration of the cervix (Chadwick’s sign)

Cervical ripening occurs ~4 weeks before birth

Connective tissue change elasticity & strength to prep for birth

Question 29

Cervical Ripening

Answer 29

Softening, effacement, & increased distensibility

Question 30

Cervical Effacement

Answer 30

The thinning & shortening of the cervix

Question 31

Reproductive Adaptations During Pregnancy: Vagina

Answer 31

Vascularity increases due to estrogen-> pelvic congestion & vaginal hypertrophy
- Prep for distentsion needed for birth

Vaginal mucosa thickens, connective tissue begins to loosen, smooth muscle begins to hypertrophy & vaginal vault begins to lengthen

Secretions tend to become more acidic, white, & thick

Leukorrhea: Increase in vaginal whitish discharge
- Normal, except when accompanied w/itching-> Candida albicans (monilial vaginitis)
- Can be passed from mother-> baby (oral thrush)
-> White patches on mucous membranes of mouth

Treatment: Local antifungal agents

Question 32

Reproductive Adaptations During Pregnancy: Ovaries

Answer 32

Increased blood supply to ovaries-> Enlarge until, ~12-14th week of gestation
- Cannot be palpated after due to the uterus filling up the pelvic cavity

Ovulation ceases: Elevated estrogen & progesterone block follicle-stimulating hormone (FSH) & luteinizing hormone (LH)

Ovaries in charge of hormone production until, week 6-7
- Corpus luteum regresses & placenta takes over hormone production

Question 33

Reproductive Adaptations During Pregnancy: Breasts

Answer 33

Increase fullness, become tender & enlarged throughout pregnancy via estrogen & progesterone

Become highly vascular (veins are seen under the skin)

Nipples become larger & more erect
- Both nipples & areola are deeply pigmented

Tubercles of Montgomery (sebaceous glands) become more prominent-> keeps nipples lubricated for breast feeding

Stretch marks appear due to changes in connective tissue
- Initially pink-purple lines on the skin but, gradually change to silver (never fade away)

Produce colostrum: Creamy yellowish fluid that produces nutrients for the baby

Question 34

General Body System Adaptations During Pregnancy: GI System

Answer 34

Mouth & Pharynx: Gums become hyperemic, swollen, & friable. Tend to bleed easily & saliva production increases

Esophagus: Decreased lower esophageal sphincter pressure and tone, which increases the risk of developing heartburn.

Stomach: Decreased tone and mobility with delayed gastric emptying time, which increases the risk of gastroesophageal reflux and vomiting.
-Decreased gastric acidity and histamine output, which improves symptoms of peptic ulcer disease.

Intestines: Decreased intestinal tone motility with increased transit time, which increases risk of constipation and flatulence.

Gallbladder: Decreased tone and motility, which may increase risk of gallstone formation.

Question 35

Ptyalism

Answer 35

Excessive salivation

May be caused a decrease in unconscious swallowing by the woman when nauseated

Typically resolves spontaneously but, can remain in some women throughout pregnancy

Temporary relief via chewing on gum or sucking on hard candies

Question 36

Risk of Gingivitis

Answer 36

Dental plaque, calculus, and debris deposits increase during pregnancy

Vascular permeability and possible tissue edema are both increased

It is reported that as many as 50% to 70% of pregnant women will have some level of gingivitis during pregnancy as a result of hormonal changes that promote inflammation

Previous studies linked periodontal disease with:
- Preterm birth
- Preeclampsia
- Low-birth-weight risk
- Stillbirth
- Early-onset neonatal sepsis

Question 37

General Body System Adaptations During Pregnancy: Cardiovascular System

Answer 37

Blood volume: Marked increase in plasma (50%) and RBCs (25–33%) compared to nonpregnant values.
-Causes: hemodilution AEB a lower hematocrit and hemoglobin.

CO and HR: CO increases from 30% ->50% over the nonpregnant rate by the 32nd week of pregnancy.
-Associated w/ an increase in venous return and greater right ventricular output, especially in the left lateral position.
- HR increases by 10–15 bpm between 14 and 20 weeks’ gestation, and this increase will persist to term.

BP: Diastolic pressure decreases typically 10–15 mm Hg to reach its lowest point by mid-pregnancy
- Then gradually returns to nonpregnant baseline values by term.

Blood components: The number of RBCs increases throughout pregnancy to a level 25–33% higher than nonpregnant values.

Both fibrin and plasma fibrinogen levels increase, along with various blood clotting factors-> make pregnancy a hypercoagulable state.

Question 38

Interventions to Reduce the Risk of Developing Varicosities

Answer 38

Elevating both legs when sitting or lying down

Avoiding prolonged standing or sitting; changing position frequently

Resting in the left lateral position

Walking daily for exercise

Avoiding tight clothing or knee-high hosiery

Wearing support hose if varicosities are a preexisting condition to pregnancy

Question 39

General Body System Adaptations During Pregnancy: Respiratory System

Answer 39

Enlargement of the uterus shifts the diaphragm up to 4 cm above its usual position.

As muscles and cartilage in the thoracic region relax, the chest broadens w/ conversion from abdominal breathing to thoracic breathing.
-This leads to a 50% increase in air volume per minute.

Tidal volume (or the volume of air inhaled) increases gradually by 30–40% (from 500 to 700 mL) as the pregnancy progresses

Question 40

General Body System Adaptations During Pregnancy: Renal/Urinary System

Answer 40

The renal pelvis becomes dilated. The ureters (especially RT ureter) elongate, widen, and become more curved above the pelvic rim.

Bladder tone decreases and bladder capacity doubles by term.

Glomerular filtration rate increases 40–60% during pregnancy.

Blood flow to the kidneys increases by 50–80% as a result of the increase in CO

Question 41

General Body System Adaptations During Pregnancy: Musculoskeletal System

Answer 41

Distention of the abdomen with growth of the fetus tilts the pelvis forward, shifting the center of gravity.
-Compensates by developing an increased curvature (lordosis) of the spine.

Relaxation and increased mobility of joints occur due to the hormones progesterone and relaxin
- Lead to the characteristic “waddle gait” that pregnant women demonstrate toward term

Question 42

General Body System Adaptations During Pregnancy: Integumentary System

Answer 42

Hyperpigmentation of the skin is the most common alteration during pregnancy
-Most common areas include: the areola, genital skin, axilla, inner aspects of the thighs, and linea nigra.

Striae gravidarum(or stretch marks) are irregular reddish streaks that may appear on the abdomen, breasts, and buttocks in about half of pregnant women.

The skin in the middle of the abdomen may develop a pigmented line called the linea nigra, which extends from the umbilicus to the pubic area.

Melasma (“mask of pregnancy”) occurs in up to 70% of pregnant women. It is characterized by irregular, blotchy areas of pigmentation on the face, most commonly on the cheeks, chin, and nose.

Question 43

Linea Nigra

Answer 43

A dark line that develops on the abdomen during pregnancy
-Usually extends from the umbilicus to the pubic area

Caused by an increase in hormones and fades once the baby is born

Question 44

Melasma

Answer 44

AKA “Mask of Pregnancy”

A skin condition that causes patches and spots, usually on the face, which are darker than natural skin tone
- Commonly on cheeks, chin, & nose

Question 45

General Body System Adaptations During Pregnancy: Endocrine System

Answer 45

Controls the integrity and duration of gestation by maintaining the corpus luteum via hCG secretion; production of estrogen, progesterone, hPL, and other hormones and growth factors via the placenta

Release of oxytocin (by the posterior pituitary gland), prolactin (by the anterior pituitary), and relaxin (by the ovary, uterus, and placenta).

Question 46

Human Chorionic Gonadotropin (hCG)

Answer 46

Responsible for maintaining the maternal corpus luteum, which secretes progesterone and estrogens with synthesis occurring before implantation

Production by fetal trophoblast cells until the placenta is developed sufficiently to take over that function

Basis for early pregnancy tests because it appears in the maternal bloodstream soon after implantation

Production peaks at 8 weeks and then gradually declines

Question 47

Human Chorionic Somatomammotropin (hCS)

Answer 47

Preparation of mammary glands for lactation and involved in the process of making glucose available for fetal growth by altering maternal carbohydrate, fat, and protein metabolism

Antagonist of insulin: Decreases tissue sensitivity or alters the ability to use insulin

Increase in the amount of circulating free fatty acids for maternal metabolic needs and decrease in maternal metabolism of glucose to facilitate fetal growth

Question 48

Relaxin

Answer 48

Secretion by the placenta as well as the corpus luteum during pregnancy

Thought to act synergistically with progesterone to maintain pregnancy

Increase in flexibility of the pubic symphysis, permitting the pelvis to expand during delivery

Dilation of the cervix, making it easier for the fetus to enter the vaginal canal; thought to suppress the release of oxytocin by the hypothalamus, thus delaying the onset of labor contractions

Question 49

Progesterone

Answer 49

AKA “Hormone of Pregnancy” because of the critical role it plays in supporting the endometrium of the uterus

Supports the endometrium to provide an environment conducive to fetal survival

Produced by the corpus luteum during the first few weeks of pregnancy and then by the placenta until term

Initially, causes thickening of the uterine lining in anticipation of implantation of the fertilized ovum;
- Then, it maintains the endometrium, inhibits uterine contractility, and assists in the development of the breasts for lactation

Question 50

Estrogen

Answer 50

Promotes enlargement of the genitals, uterus, and breasts, and increases vascularity, causing vasodilatation

Relaxation of pelvic ligaments and joints

Associated with hyperpigmentation, vascular changes in the skin, increased activity of the salivary glands, and hyperemia of the gums and nasal mucous membranes

Aids in developing the ductal system of the breasts in preparation for lactation

Question 51

Thyroid Gland Adaptations

Answer 51

Enlarges slightly & becomes more active during pregnancy as a result of increased vascularity & hyperplasia

Increased gland activity-> increase in thyroid hormone secretion during the 1st trimester
- Levels taper off w/in a few weeks & return back w/in normal limits after birth

Critical for fetal brain development, neurogenesis, & organizational processes prior to 20 weeks (low levels)

Question 52

Pancreas Maternal Adaptations

Answer 52

Ideally hormonal changes of pregnancy help meet fetal needs w/out putting the mother’s metabolism out of balance

Women’s insulin needs work on supply vs demand
- As demand to meet the pregnancy’s demands-> more insulin is produced

Maternal insulin does NOT cross the placenta
- Fetus must produce their own supply to maintain glucose control

During 1st trimester of pregnancy most of the glucose in the mother’s body is diverted to the growing fetus-> glucose levels are low

Human placental lactogen & other antagonists increase during 2nd half of pregnancy

Question 53

Adrenal Gland Maternal Adaptations

Answer 53

Rate of cortisol secretion is NOT increased in pregnancy-> cortisol clearance is decreased

Cortisol increases in response to increase in estrogen levels
- Returns to normal levels w/in 6 weeks postpartum

Functions of Cortisol During Pregnancy:
- Helps keep up the level of glucose in the plasma by breaking down noncarbohydrate sources, such as amino and fatty acids, to make glycogen.
- Glycogen, stored in the liver, is easily broken down to glucose when needed so that glucose is available in times of stress.

Breaks down proteins to repair tissues and manufacture enzymes. has antiinsulin, antiinflammatory, and antiallergic actions

Needed to make the precursors of adrenaline, which the adrenal medulla produces and secretes

Question 54

General Body System Adaptations During Pregnancy: Immune System

Answer 54

A general enhancement of innate immunity (inflammatory response and phagocytosis) and suppression of adaptive immunity (protective response to a specific foreign antigen) take place during pregnancy.

-Help prevent the mother’s immune system from rejecting the fetus (foreign body)

• Increase her risk of developing certain infections
  and influence the course of chronic disorders such as autoimmune diseases.

Question 55

What pregnancy outcomes are associated w/ inadequate nutritional intake?

Answer 55

Preterm birth, low birth weight, & congenital anomalies

Question 56

What pregnancy outcomes are associated w/ excessive nutritional intake?

Answer 56

Macrosomia -> lead to a difficult birth, neonatal hypoglycemia, continued obesity in the mother, child has risk for childhood obesity accompanied w/ metabolic syndrome

Question 57

What prescription acts as safeguard against less-than-optimal diets?

Answer 57

Prenatal vitamins

Question 58

Iron and folic acid are needed to…

Answer 58

…form new RBCs for expanded maternal blood volume & prevent anemia

Question 59

Dietary Reference Intakes (DRIs)

Answer 59

27 mg of ferrous iron & 400-800 mcg of folic acid per day

Question 60

Nutritional Guidelines for Pregnant Women

Answer 60

Increase consumption of fruits and vegetables, taking up half the plate with these.

Replace saturated fats with unsaturated ones.

Eat breakfast every day.

Choose whole grains in place of refined grains.

Choose foods with a lot of fiber to prevent constipation.

Avoid hydrogenated or partially hydrogenated fats.

Do not consume any alcoholic beverages.

Limit calories from added sugars and saturated fats.

Use reduced-fat spreads and dairy products instead of full-fat ones.

Eat at least two servings of fish weekly, with one of them being an oily fish.

Consume at least 3 qt of water daily

Question 61

Good Food Sources of Folic Acid

Answer 61

Includes dark green vegetables, such as broccoli, romaine lettuce, and spinach; baked beans; black-eyed peas; citrus fruits; peanuts; and liver

Question 62

Consumption of Fish

Answer 62

Avoid consumption of fish with moderate to high mercury levels (e.g., for 6 to 12 months prior to conception and throughout pregnancy).

Avoid eating shark, swordfish, king mackerel, orange roughy, ahi tuna, and tilefish because they are high in mercury levels.

Eat up to 12 oz (two average meals) weekly of fish known to have low mercury levels, such as shrimp, canned light tuna, salmon, lobster, sole, tilapia, cod, haddock, pollock, and catfish.

Check local advisories about the safety of fish caught by family and friends in local lakes, rivers, and coastal areas

Question 63

Underweight Pregnancy BMI

Answer 63

BMI: Less than 18.5

Total Weight Gain Range: 28-40 lbs

Question 64

Normal Weight Pregnancy BMI

Answer 64

BMI: 18.5–24.9

Total Weight Gain Range: 25–35 lbs

Question 65

Overweight Pregnancy BMI

Answer 65

BMI: 25-29.9

Total Weight Gain Range: 15–25 lbs

Question 66

Obese Pregnancy BMI

Answer 66

BMI: 30 or higher

Total Weight Gain Range: 11–20 lbs

Question 67

Pica

Answer 67

A term used to describe the intense craving for and eating of nonfood items over a period of time of at least 1 month

Question 68

Geophagia

Answer 68

Consume soil or clay

Nutritional Implications: Replaces nutritive sources & causes iron-deficiency
- Clay: Produces constipation, can contain toxic substances & cause parasitic infection

Question 69

Pagophagia

Answer 69

Consume ice

Nutritional Implications: Can cause iron-deficiency anemia, tooth fractures, & freezer burn injuries

Question 70

Amylophagia

Answer 70

Consume laundry starch

Nutritional Implications: Replaces iron-rich foods, leads to iron deficiencies, and replaces protein metabolism, thus depriving the fetus of amino acids needed for proper development

Question 71

What usually precedes pica?

Answer 71

Anemia

Question 72

What are the most common maternal responses that are evoked during pregnancy?

Answer 72

Ambivalence
Introversion
Acceptance
Mood Swings
Changes in Body Image

Question 73

Ambivalence

Answer 73

Having conflicting emotions at the same time
Ex) Woman who planned to get pregnant gets pregnant-> happy and nervous at the same time

Mostly common in the 1st trimester
- Usually evolves into acceptance in the 2nd trimester where fetal movements are perceived

Question 74

Introversion

Answer 74

Focusing on one’s self

Common during early part of pregnancy
- Woman may withdraw & become intensely occupied w/ herself & her fetus
- Also may come up again during the 3rd trimester

To ensure a safe environment for both mother & child

Question 75

Acceptance

Answer 75

During the second trimester, the physical changes of the growing fetus, including an enlarging abdomen and fetal movement, bring a sense of reality and validity to the pregnancy

Able to differentiate herself from the growing fetus
- Different sleep & wake cycles

Question 76

Reva Rubin’s “Becoming a Mother Tasks”

Answer 76

Ensuring safe passage throughout pregnancy & birth
- Primary focus of the woman’s attention
- First trimester: woman focuses on herself, not on the fetus
- Second trimester: woman develops attachment of great value to her fetus
- Third trimester: woman has concern for herself and her fetus as a unit
- Participation in positive self-care activities related to diet, exercise, and overall well-being

Seeking acceptance of infant by others
- First trimester: acceptance of pregnancy by herself and others
- Second trimester: family needs to relate to the fetus as member
- Third trimester: unconditional acceptance without rejection

Seeking acceptance of self in maternal role to infant (“binding in”)
- First trimester: mother accepts idea of pregnancy, but not of infant
- Second trimester: with sensation of fetal movement (quickening), mother acknowledges fetus as a separate entity within her
- Third trimester: mother longs to hold infant and becomes tired of being pregnant

Learning to give of oneself
- First trimester: identifies what must be given up to assume new role
- Second trimester: identifies with infant, learns how to delay own desires
- Third trimester: questions her ability to become a good mother to infant

Question 77

Sexual Desire & Pregnancy

Answer 77

1st Trimester: The woman may be less interested in sex because of fatigue, nausea, and fear of disturbing the early embryonic development

2nd Trimester: her interest may increase because of the stability of the pregnancy.

3rd Trimester: her enlarging size may produce discomfort during sexual activity

Question 78

Potential Complications of Sex During Pregnancy

Answer 78

Includes: preterm labor, pelvic inflammatory disease, antepartum hemorrhage in placenta previa, and venous air embolism

Generally, sexual relations are considered safe in pregnancy
- Abstinence ONLY for women who are at risk for preterm labor or for antepartum hemorrhage because of placenta previa

Question 79

Alternative Non-Coital Sexual Expression

Answer 79

Cuddling, caressing, & holding