Pregnancy and Child Birth

Question 1

How do we decide whether to have a child?

Answer 1

· must fully consider the impact of having a child
□ financial impact
□ child care responsibilities
□ change in lifestyle
□ child rearing (e.g. discipline, religion)
· maternal and paternal health
□ emotional, mental and physical
□ age of mother (35+ is a genetic pregnancy)
>35y associated with increased infertility, down syndrome

Question 2

When can pregnancy occur?

Answer 2

· menstrual cycle - 28 days
· ovulation occurs on or around day 14
· sperm viable for up to a week
· ovum (female egg) capable of being fertilized to 48 hours
· pregnancy
day 6 - day 18

Question 3

What are the signs of pregnancy?

Answer 3

presumptive, probable and positive

Question 4

Presumptive signs of pregnancy?

Answer 4

□ missed period
□ morning sickness, fatigue
increase in size and tenderness of breasts

Question 5

Probable signs of pregnancy?

Answer 5

□ increase in frequency of urination (embryo is near bladder)
□ increase in size of abdomen
positive pregnancy test (urinalysis)

Question 6

Positive signs of pregnancy?

Answer 6

□ pregnancy test confirmed by blood test and pelvic exam
□ e.g. cervix softens by the sixth week
□ observation of fetus by ultrasound, fetal heartbeat (see at 5 weeks)
fetal movement - “quickening” - 16-25 weeks like gas in stomach, arm leg movement

Question 7

What are home pregnancy tests?

Answer 7

· accuracy can be up to 99%
· urine: presence of human chorionic gonadotropin (HCG) - occurs at implantation (takes 7-8 days)
· errors usually involve false negatives
· test done too soon
check expiration dates and follow instructions carefully

Question 8

Prenatal care- medical care early and throughout pregnancy?

Answer 8

• monitor health of mother and baby
  ○ e.g. weight gain, BP, size and position of baby
  
  • mother or fetus?
  • early detection of fetal abnormalities
  • Nutritional status, support system?

Question 9

Prenatal care- Obstetrician, Family MD, Midwife, Nurse Practitioner present?

Answer 9

• complete medical history, clinical exam
  
  • prenatal visits:
    ○ monthly to 28 weeks, bi-weekly to 36 weeks,
    …weekly

Question 10

When should an Obstetrician, Family MD, Midwife, and Nurse Practitioner be present during prenatal care?

Answer 10

• Family MD – in normal situation
• Obstetrician – nowadays more common
• Nurse Practitioner – weighing new born baby, looking for body health state
• Partner should be visit commonly.
• Final week for preparation

Question 11

What are the prenatal classes:

Answer 11

□ lifestyle behaviors - healthy pregnancy
□ Labor and delivery - making a birth plan
□ psychosocial issues
○ bonding, parenting
○ body image
○ Social support

Question 12

Prenatal care- baby care?

Answer 12

· feeding, bathing, safety, growth & development
· equipment and supplies
- First time would be really helpful!
- Encourage the client to create a birth plan that is flexible
- Failure to progress? Have worst to prepare first, natural or surgical
Car seat should be implemented in car due to law

Question 13

Prenatal care- Well-balanced diet?

Answer 13

• need for additional kcals, protein, iron, folate, essential fatty acids
  * adequate calcium, vitamin D
  * multi-vitamin (with Iron, folic acid) recommended

Question 14

What are some benefits of a well-balanced diet during prenatal care?

Answer 14

• proper nutrition supports the developing fetus
  * optimal maternal health - preparation for delivery
  * appropriate weight gain (no dieting!)
  ○ 11-16 kgs (25-35 lbs)
• 350-450 kcals
• Deficiency in vitamin D would be negative for permanented women
  Weight gain could be flexible

Question 15

Prenatal care- regular physical activity?

Answer 15

• aerobic, strength training, flexibility
  
  • modifications in type, intensity, duration
    ○ avoid activities that risk balance, trauma, overheating
    avoid exercises on back beyond 3rd month

Question 16

What are the benefits of regular physical activity during prenatal care>

Answer 16

• assists with weight management
  
  • reduces fatigue
  • improves GI function
  • eases delivery & recovery
• Kegel exercises - ¯ risk of urinary incontinence
  Do regular exercise, adjust intensity
  Kegel exercises – training on vagina’s strength to hold urinary incontinence

Question 17

What are some risks factors associated with prenatal care?

Answer 17

Teratogenic effects: causing birth
* alcohol, drugs, toxic exposures, infectious diseases

avoid alcohol
* Fetal alcohol spectrum disorder

no smoking
* ­ risk of miscarriage birth
* ­ risk of premature delivery, low birth weight
* discuss all medications with health care provider
* limit caffeine. Not even 8oz cup
No hot tubs, saunas

Question 18

Prenatal testing - screening?

Answer 18

• Blood tests: e.g. MMS
  
  • pelvic ultrasound
    ○ high-frequency sound waves
    □ Fetal size and position
    can detect some fetal anomalies

Question 19

Prenatal testing - diagnostics?

Answer 19

• amniocentesis
  ○ needle draws amniotic fluid from amniotic sac
  □ test for genetic abnormalities (e.g. Down Syndrome)
  
  • Chorionic villus sampling
    ○ sample of tissue from fetal sac

Question 20

What occurs during fetal development?

Answer 20

• fertilization - outer 1/3 of fallopian tube
• zygote (fertilized egg): first 7 days
• blastocyst: 7-14 days
• embryo: 2-8 weeks
• fetus: 9th week to birth
• Embryo – facial feature
• Could be observe on prenatal women’s skin surface
  20th weeks and beyond start to develop organs. Increase in body size, connect to placenta.

Question 21

Pregnancy?

Answer 21

• gestation period is 40 weeks
  
  • calculated from last menstrual period
• pregnancy is divided into 3 trimester

Question 22

What happens during the first trimester of pregnancy?

Answer 22

• 1st trimester: few observable changes in mother
  
  • may experience:
    ○ fatigue
    ○ frequent urination
    ○ Nausea and vomiting
    ○ breast tenderness
  • minimal weight gain
    38 weeks since ovulation take out.
    Morning sickness – crackers in the morning because of sodium
    Nausea and vomiting are good signs here

Question 23

What happens during the second trimester of pregnancy?

Answer 23

• noticeable changes in mother
  ○ Breast enlargement
  morning sickness typically subsides

Question 24

What happens during the third trimester of pregnancy?

Answer 24

• fatigue, frequent urination
  Weight gain (significantly)

Question 25

What are some complication in pregnancy?

Answer 25

* Ectopic pregnancy * embryo implants outside uterus - usually fallopian tube * Hyperemesis gravidarum * excessive vomiting during pregnancy * miscarriage - spontaneous abortion * loss of fetus before viability * Rh blood incompatibility * Rh-negative mother, Rh-positive fetus ○ maternal antibodies destroy fetal RBC’s - Women should be more accepted when they have miscarriage experience · gestational diabetes * mother does not produce enough insulin to handle increased blood sugar of pregnancy · premature labor: before 37 weeks, low weight of baby * premature rupture of membranes * risk of infection * stillbirth - baby born with no signs of life at or after 28 weeks’ gestation (WHO, 2015).

Question 26

What is labor?

Answer 26

· may be preceded by mild irregular contractions □ Braxton hicks - “false labor” · baby often rotates and drops into the pelvic girdle before the onset of labor - known as “lightening” (one path of least resistance) · labor for a primigravida (first pregnancy) □ usually 12-16 hours (average) - Precipitate labor Repaid labor and delivery

Question 27

What are the stages of labor and delivery?

Answer 27

1. Effacement and Dilation of the cervix 2. Delivery of the body - usually < 1 hour 3. Delivery of the placenta (afterbirth )

Question 28

1. Effacement and Dilation of the cervix ?

Answer 28

□ thinning (effacement) □ opening of the cervix to 10 cm. (dilation) · Amniotic sac ruptures □ spontaneously or artificially (pelvic exam using instrument) - hind water leak: little amniotic fluid · gradual increasing in intensity, duration of contractions( regular 5 minutes part then go to the hospital) · usually the longest phase · final phase is transition - baby prepares to enter birth canal

Question 29

2. Delivery of the body - usually < 1 hour?

Answer 29

· contractions are intense □ baby moves through the birth canal · baby is “crowning” when the top of the head is visible □ usually presents head first □ may be “breech” presentation · Vernix - thick white substance that protects the skin ▪ Vernix is gone after a 38 week pregnancy ▪ Baby's skin will be very dry Sunnyside up position= harder delivery

Question 30

3. Delivery of the placenta (afterbirth )?

Answer 30

usually within 30 minutes

Question 31

Fetal presentations?

Answer 31

cephalic: Path of least resistance 95% time or more breech: Legs up, bottom down 1st time breech pregnancy is more complicated than C section

Question 32

What are caesarean sections?

Answer 32

· C-section (could be from improper positioning) □ surgical removal of the baby through an incision in the abdominal wall delivery through birth canal not optimal or possible: □ Cephalopelvic disproportion (different in size of head and pelvis head too big for inner pelvis) □ Placenta previa - placenta partially or fully covers cervix □ fetal distress - e.g. prolapsed cord or cord compression □ placenta abruption - premature separation of the placenta □ the mother or baby’s health is at risk for any other reason Classical incision - for fast delivery (up and down)

Question 33

What are some drugs in labor and delivery?

Answer 33

· Drug free labor and delivery - “natural childbirth" □ Physical activity, positioning □ massage, breathing techniques · Pain management options: □ regional anesthesia - epidural (freezes from the waist down, freezing around muscle in abdominal floor) □ local anesthesia □ general anesthesia □ pain medications  act systemically (could be transferred to baby)

Question 34

What occurs during postpartum?

Answer 34

· “postpartum”- period of time following delivery □ begins in recovery room (as soon as baby is born) □ Breast feeding initiated early (day 3) □ bonding of mother and baby (baby nursing releases oxytocin to help contraction of uterus) □ first 2-3 days colostrum - rich in antibodies (immunological boost) · first 4-6 weeks: □ family bonding, routine mixed emotions, fatigue

Question 35

What is infertility and what are causes?

Answer 35

· usual causes: □ irregular ovulation (not monthly 128 day cycle), blocked fallopian tubes, hormone imbalance (woman) □ low sperm count, low sperm motility (not fast enough) (man) 10% of infertility cases have no known cause (idiopathic)

Question 36

What are infertility treatments for female and male?

Answer 36

· female: □ hormone therapy to regular ovulation □ cycle monitoring □ surgical procedures to clear blocked fallopian tubes · male: testicles are too warm boxer shorts and periodic cold packs

Question 37

What are some alternative insemination?

Answer 37

· sperm is deposited near the cervical opening or intrauterine · Invitro fertilization (IVF) and embryo transfer · own sperm and eggs, donated sperm or eggs · e.g. medical reasons, single, same sex couple · use of surrogate · inability to conceive or carry to term · male same sex couple Other Options? adoption, foster, parenting

Question 38

What makes a responsible parent?

Answer 38

· what kids need from parents □ unconditional love □ to feel safe and secure □ active interest, involvement & encouragement □ firm rules, boundaries and expectations □ to make age appropriate decisions □ experience the consequences respect authoritative parenting: active interest, involvement & encouragement, and firm rules, boundaries and expectations