Care of the Mother during Pregnancy
Pregnancy
• Planned Pregnancy- Feeling of intense fulfilment and
achievement.
• Unplanned Pregnancy- Result in an extreme crisis
state.
RESPONSIBILITY OF NURSES
• To help the family maintain a state of WELLNESS
throughout the pregnancy and into early parenthood.
Pregnancy 38 weeks
• It gives time for the fetus to mature and be prepared
for the life outside the protective uterine environment.
• It gives time for the couple to prepare emotionally for
the coming of a new member of the family.
Emotional Responses to Pregnancy
Full of Emotions!
• Grief
• Narcissism
• Mood swings
• Introversion/ Extroversion
• Body Image concerns
• Couvade Syndrome
• Changes in sexual desire
Psychological Tasks of Pregnancy
1. 1st Trimester- Accepting the Pregnancy
2. 2nd Trimester- Accepting the Baby
3. 3rd Trimester- Preparing for Parenthood
Psychological Tasks of Pregnancy
ACCEPTING THE PREGNANCY
1. Emphasize that feelings are normal but they should
work on accepting the pregnancy.
2. Partner should provide emotional support to the
other.
3. Inform couple that most women are able to change
their attitude toward pregnancy by the time they
feel the child move inside them.
4. Seeing a beating heart or a fetal outline during an
UTZ can promote acceptance.
Events that could contribute to difficulty accepting the
Pregnancy
• Loss of job
• Multiple pregnancy
• Fetus has abnormality
• Pregnancy less than 1 year after previous
pregnancy
• Relocation during pregnancy
• Moving away from the family or back to the
family for economic reasons
• Role reversal
• Marital infidelity
Events that could contribute to difficulty accepting the
Pregnancy
• Illness in family
• Loss of SO
• Complication of pregnancy
• Having friends or relatives with child born with
health disorders
• Failure in work
• HX of previous miscarriage or traumatic birth •
Previous fetal or neonatal loss
• HX of rape, incest or domestic violence
Psychological Tasks of Pregnancy
ACCEPTING THE BABY
• Accepting the baby usually happens at
quickening.
• Quickening is the first moment a woman feels
fetal movement.
Signs of Acceptance:
• She eats to meet the baby’s needs.
• Takes vitamins to help baby grow.
• Shows eagerness in knowing about the baby.
• Shopping for baby clothes.
• Setting up the crib and room.
• Following the prenatal instructions.
• Choosing a name for the baby.
PREPARING FOR PARENTHOOD Signs of Preparation:
• Attendance in childbirth classes.
• Seeking information on childcare.
• Realized that her mother becomes more
important to her.
Signs of Pregnancy 3 Classifications:
1. Presumptive Signs
2. Probable Signs
3. Positive Signs
Presumptive Signs of Pregnancy
• Signs that are least indicative of pregnancy.
• They are experienced by the woman but cannot
be documented by the examiner.
Probable Signs of Pregnancy
 Care of the Mother during Pregnancy
• More reliable than presumptive signs.
• They can be documented by the examiner but
they are not positive or true diagnostic findings.
Positive Signs of Pregnancy
1. Demonstration of fetal heart separate from the
mother’s heart
2. Fetal movement felt by an examiner
3. Visualization of fetus by ultrasound
FETAL HEART
• Heart starts beating since the 24th day after
conception.
• Echocardiography can demonstrate a heartbeat
at 5 weeks.
• Ultrasonic Monitoring System can detect fetal
heart sounds between the 10-12th week of
gestation.
• Ordinary stethoscope can be use at 18th-20th
week of pregnancy.
• Best heard at the fetal back and ranges
between 120-160 BPM.
FETAL MOVEMENT
• Movements may be felt by a woman as early as 16th-
20th week of pregnancy.
• Movements can be felt by the examiner at the 20th-
24th week of pregnancy.
VISUALIZATION OF FETUS
• Gestational sac will be revealed on an
Oscilloscope Screen as early as the 4th-6th
week of pregnancy.
• Fetal outline can be seen clearly within the sac
at 8th week.
• Crown-to-rump length can be measured to
establish the gestational age of the pregnancy.
Physiologic Changes of Pregnancy reproductive system
UTERUS:
• Length increases from 6.5 to 32 cm.
• Depth increases from 2.5 to 22 cm.
• Width expands from 4 to 24 cm.
• Weight increases from 60 to 1000 grams • At
the start of pregnancy, the wall thickens from 1
to 2 cm but toward the end of pregnancy it
thins to 0.5 cm.
• The volume of the uterus increases from about
2 ml to more than 1000 ml.
• The uterus can hold a 7-lb (3,175 grams) fetus
plus 1000 ml of amniotic fluid for a total of 4000
grams.
Physiologic Changes of Pregnancy Reproductive System
UTERUS:
There is constant, steady and predictable increase in
uterine size during pregnancy!
Physiologic Changes of Pregnancy EFFECTS OF THE
GROWING UTERUS:
• Pushes the intestine to the side of the
abdomen, elevates the diaphragm & the liver
and compresses the stomach.
• Puts pressure on the abdomen.
• Uterine blood flow changes from 15-20 ml/min
to 500-750 ml/min.
CERVIX:
• Cervix becomes more vascular, edematous and
it changes it color from pink to violet. • Cervix
undergo hypertrophy and hyperlasia and
becomes distended with mucus.
• Operculum/ Mucous Plug- tenacious coating of
mucus in the cervical canal.
VAGINA:
• Vaginal epithelium and underlying tissue
become hypertrophied resulting in white
vaginal discharge throughout pregnancy.
• Change in the vascularity of the vagina results in
change of the color from light pink to violet.
• Change in Ph to prevent bacterial infection.
OVARIES:
• Ovulation stops because of the presence of
estrogen and progesterone all throughout
pregnancy.
 Care of the Mother during Pregnancy
• Corpus Luteum regress between the 16th 20th
week of pregnancy and placenta takes over in
the production of Estrogen and Progesterone.
BREAST:
• At 6 weeks after fertilization breasts become
full, tender and has tingling sensation due to
Estrogen.
• Breast size increases because of hyperplasia of
mammary alveoli and fat deposits.
• Areola darkens and the diameter increases.
• Montgomery Tubercles become prominent. •
Colostrum is present at 16th week of
pregnancy.
Physiologic Changes of Pregnancy SYSTEMIC
INTEGUMENTARY SYSTEM:
• Striae Gravidarum- pink to reddish streaks on
the skin of the abdomen.
• Diastasis Recti- Abdominal muscles separate. •
Linea Nigra- brown line running from the
umbilicus to the Symphysis pubis.
• Melasma- darkened pigmentation on the
cheeks and nose.
• Telangiectasis- small red vascular spiderweb
appearnce on the thighs.
• Palmar Erythema occur from high Estrogen.
RESPIRATORY SYSTEM:
• Nasal Congestion/ Stuffiness due to Estrogen.
• SOB secondary to displacement of the
diaphragm upward.
• Increase RR:
– Total O2 consumption increases by as
much as 20%.
– Low Co2 in the blood.
– Increase O2 in the blood.
TEMPERATURE:
• Body temperature increases until the 16th 20th
week then goes back to normal.
CARDIOVASCULAR:
• Blood volume increase at 30-50% to provide
adequate exchange of nutrients in the placenta.
• Cardiac Output increases by 25-50% and HR
increases by 10 BPM.
• Upward movement of the heart causes
innocent heart murmurs during pregnancy.
• BP increase during the first trimester, decrease
on the 2nd and goes back to 1st trimester BP.
• Supine Hypotension Syndrome
• During the 3rd Trimester, there is decrease
blood flow to the LEs due to pressure of uterus
in veins and arteries leading to varicosities of
the vulva, rectum and legs.
• Clotting Factors and PLT increase to prevent
bleeding.
• WBC increases as a protective mechanism for
the woman.
• Low Protein in the blood causes ankle and foot
edema.
• Blood lipid and cholesterol increases to provide
available energy supply for the fetus.
GASTROINTESTINAL:
• Morning Sickness due to increase HCG,
Estrogen, Progesterone and decrease glucose.
• Heartburn caused by Relaxin and upward
displacement of the stomach by the uterus.
• Decreased gastric motility caused by the
Relaxin.
• Hemorrhoids due to pressure on rectal veins of
the growing uterus.
URINARY SYSTEM:
• Increase urinary frequency due to compression
of the bladder & ureters by the growing uterus,
Estrogen & Progesterone and Increase blood
volume.
SKELETAL SYSTEM:
• Softening of the pelvic ligaments due to Relaxin
and Progesterone.
• Separation of the symphysis pubis at 32 weeks
leads to difficulty in walking. • “Pride of
Pregnancy”- woman change the center of
gravity to make walking easier.
ENDOCRINE SYSTEM:
• Placenta becomes an additional endocrine
organ of the body.
• Produces hCG , Estrogen, Progesterone, hPL,
Relaxin and Prostaglandin.
• Human Chorionic Gonadotropin is secretd by
the Trophoblast which stimulates Estrogen and
Progesterone synthesis in the ovaries.
• Estrogen causes breast enlargement to allow
milk production.
• Progesterone maintain a healthy uterine
environment and prevent uterine contractility.
• Relaxin help prevent uterine activity and softens
the cervix to allow dilation during birth.
• Human Placental Lactogen serves as an
antagonist to Insulin, which allows more
glucose to become available for fetal growth.
• At the end of Pregnancy, Prostaglandin affect
smooth muscle contractility which initiates
labor at term.
PITUITARY GLAND:
• High Estrogen and Progesterone produce by the
Ovaries and Placenta prevent the release of LH
and FSH.
• Increase melanocyte production producing skin
changes.
 Care of the Mother during Pregnancy
• Late in pregnancy, Oxytocin is produced by the
Pituitary gland which initiates labor and
delivery.
• Prolactin prepares the breast for lactation.

THYROID GLAND:

• BMR increases by 20%.

• Emotional changes, tachycardia, palpitations
and increase perspiration occur.
• Parathyroid Gland increase in size to satisfy the
synthesis of increase calcium needed by the
growing fetus.

ADRENAL GLANDS:

• Produce increase aldosterone and

corticosteroids.
• Aldosterone helps to safeguard the increase
blood volume and provide adequate tissue
perfusion.
• Corticosteroids reduce possibility of reducing
foreign proteins of fetus.

PANCREAS:

• Insulin is less effective than normal during

pregnancy, to allow more glucose supply to the
fetus.
• Estrogen, Progesterone and hPL are all
antagonists to Insulin.
– Diabetic woman will need more insulin.
– Prediabetic woman may develop
Gestational diabetes

IMMUNE SYSTEM:

• Immunologic competency during pregnancy

decreases to prevent the body from rejecting
the fetus.
• IgG decrease in amount which makes woman
more prone to infection.
• Simultaneous increase in WBC may help to
counteract the decrease in IgG.