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Health Promotion 411 Introduction

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Course Description:
• This course is focused on health promotion as it relates to
the continuum of care across the lifespan. Normal growth
and development from conception to middle adulthood is
addressed
• Maternal/child health,
• Mental Health
• People with physical and developmental disabilities
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411 - Learning Outcomes:

• Identify normal patterns of G&D from conception 
adulthood
• Provide examples of public health services available to
these client groups & pregnant women in the community
• Describe health promoting strategies for the postpartum
client and newborn
• Provide examples of mental health/illness services
available to clients in the community
• Describe how culture may impact utilization of mental
health resources
• Compare the level of mental health services from urban to
rural areas
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Learning Outcomes con’t.

• Explore examples of harm reduction activities
• Discuss disparities in the delivery of community health
services in BC, including LBGTQ2 care
• Identify and describe health promotion activities for clients
living with mental illness and those living with disabilities
• Analyze the impact of cultural safety and trauma-informed
practice to support mental health
• Give examples of teaching and learning strategies for
care in the community
• Discuss the impact of immunization in health promotion
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Exams:
• Midterm (30%)
• Content
• Unit 1-6

• Final (30%)
• Content
• Unit 1-11
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Assignment 40%

• Part 1 Due Date: ______________Written

• Part 2 Due Date: _______________presentation
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Review
• What is health promotion?

• What is disease prevention?

• What is harm reduction?

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PNSG 411- Unit 1 Prenatal Care august 2016

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Objectives
• Discuss the promotion and maintenance of health for the
normal adult woman who is pregnant
• Identify holistic health promotion strategies
• Identify family resources and supports for this client group
• Identify and implement risk management strategies for
this client group
• Discuss the impact of culture on prenatal beliefs and
practices
• Compare resource allocation and inequities across the
province, including LGBTQ2 clients
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Pregnancy and Pre-natal care

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Pregnancy
Pregnancy is a normal process that affects the woman both
physically and psychologically

Three trimesters each a 3 month period

There are 3 phases

1. Antepartum
2. Intrapartum
3. Postpartum
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Signs of Pregnancy
May be divided into three groups:

1. Presumptive
2. Probable
3. Positive
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Presumptive Signs of Pregnancy

“I am not sure but I think….”
• Amenorrhea
• Nausea and vomiting
• Frequent urination
• Breast changes
• Fatigue
• Pigmentation changes
• Quickening
• Between 16 and 20 weeks
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Probable Signs of Pregnancy

“We are pretty sure, but not diagnostic”
• Pelvic signs
• Goodell’s sign =
• Hegar’s sign =
• Chadwick’s sign =
• McDonalds sign=
• Braxton-Hick’s Contractions (may begin 2 nd trimester)
• Increased Pigmentation (mask of pregnancy, linea nigra)
• Ballottement
• Striae
• Positive Pregnancy test
• Presence of hCG in urine or blood
• Abdominal englargement
• Fetal outline
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Positive Signs of Pregnancy

“ No doubt exists”

• Fetal heartbeat
• Visualization of the Fetus
 Ultrasound

• Fetal movement
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Quick Quiz
1. List 2 presumptive signs of pregnancy
2. List 2 probable signs of pregnancy
3. List 2 positive signs of pregnancy
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Endocrine: Physiologic Changes

Many hormones during pregnancy are produced initially by
the corpus luteum, later by the placenta
• Estrogen & progesterone – maintain the pregnancy
• HpL- increases maternal insulin resistance; facilitates
energy supply of the fetus
• Prolactin
• Prepares breast for milk production
• Oxytocin
• Uterine contractions and let-down reflex (inhibited by progesterone
during pregnancy)
• Others
• Increase in Thyroxine- increase in HR and BMR
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Physiologic Changes
• Uterus
• Grows from pear size (2oz) to 2 lb. organ capable of
holding 5L
• Cervix
• Creates a mucus plug
• Ovaries
• Ovulation ceases
• Corpus luteum present for 6-7 weeks to produce
progesterone (then placenta produces progesterone)
• Vagina
• Breast
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Cardiovascular: Physiologic Changes

• Blood flow increases to uterus and kidneys
• Slight cardiac enlargement and displacement
• Blood volume slowly increases to about 45% more than
pre- pregnancy
• Pulse increases 10-15 bpm
• BMR increases
• Increase in clotting factors
• Stasis in lower extremities due to uterus pressing on
veins
• BP decreases during 2nd trimester due to progesterone
• Pseudoanemia of pregnancy
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Cardiovascular Implications

• With the increase in blood volume why would you not see
an increase in BP?

• Why do we recommend that women do not lay on their

back later in pregnancy?
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Respiratory: Physiologic Changes

 Depth of respirations
increase
 Enlarged uterus presses
upward on the
diaphragm (chest
diameter increases to
compensate)
 Dyspnea may occur until
fetus descends into
pelvis (lightening)
 Estrogen causes edema
and vascular congestion
of the nasal mucosa
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Musculoskeletal: Physiologic Changes

 Relaxation of pelvic joints
 Center of gravity
changes
• Greater curve of
lumbosacral spine
(lordosis)
• “waddling gait” near
end of pregnancy
(slight separation of
symphysis pubis)
• Low backache
• Diastasis Recti
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• Knowing about these musculoskeletal changes, what

advice would you provide to a pregnant woman?
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GI: Physiologic Changes

• Nausea and sometimes vomiting
• Nausea begins about 4 weeks post LNMP; usually improves by end of
20th week
• Estrogen causes delayed gastric emptying and decreased
peristalsis
• Stomach and intestines are displaced
• Pyrosis
• Glucose metabolism is altered
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Physiologic Changes
Urinary
• Frequency
• GFR and tubular reabsorption increases
• Decreased peristalsis to bladder

Integumentary
• Linea nigra
• Chloasma
• Striae gravidarum
• Wt gain
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Integumentary Changes
Linea nigra and
Mask of Pregnancy
striae gravidum
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Placenta
• Fully functional by 12th week
• Fetal circulation (unit 3-411)
• Connects fetus to mother –
• Produces hormones to sustain pregnancy

Amniotic fluid
• Cushions fetus from external sources
• Provides a constant temperature
• Fluid for fetus to swallow
• Allows fetus to move
• Lubricates the membranes and fetus
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Quick Quiz
1. List 2 physiologic changes in the reproductive system in
pregnancy
2. List 2 cardiovascular changes in pregnancy
3. List 2 common complaints in pregnancy due to GI
changes
4. List 2 common urinary symptoms during pregnancy
5. List 2 hormones that are suppressed in pregnancy but
have an active role later on*

You-tube Parturition - pregnancy, hormones, giving birth

(10:14) https://www.youtube.com/watch?v=lsSbSKlThgQ
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Psychological Challenges
in Pregnancy
First trimester:
• Anxiety awaiting pregnancy confirmation/diagnostic procedures
• Ambivalence
• Emotional lability

Second trimester:
• Quickening makes pregnancy/fetus a reality
• Focus on developing fetus & changing body image (narcissism)
• Process of maternal attachment
• Possible changes in sexual relationship w/ partner

Third trimester
• Pronounced alteration in/ perception of body image and discomforts
• Mood swings reflect vulnerability & dependence
• Preoccupation with birth
• Concerns for health of baby
• Plans for childcare and impact on life-style
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Psychosocial Impacts of Pregnancy

• Father
• Teen (& possibly grandparents)
• Older woman or couple (“elderly primip”)
• Single woman
• Siblings
• LGBTQ2 (lgbtqparentingnetwork.ca)
• Pets
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Prenatal Care
Ideally, prenatal care should start prior to conception.
Why?
What is included in prenatal care?

• Assessment of nutritional status

• Identification & reduction of risk factors
• Immunizations
• Folic acid
• Health history (medical, surgical, family, obstetric, etc.)
• Psychosocial history (parenting concerns, support
system, cultural, etc.)
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Prenatal Care
• Knowing what you know about the physiological changes
in pregnancy, your pre-class assignment and your own
experiences with pregnancy………….

• What are the goals of prenatal care?

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Websites work
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Prenatal Topics for Health Promotion

1. Communicable disease prevention (toxoplasmosis,
Rubella, Immunizations, Hep B, C, herpes, HIV)
2. Use of medications, herbal remedies
3. Adequate nutrition including supplements- prenatal
vitamins, folic acid
4. Health weight gain / Food security / Safe food handling
5. Emotional health / adjustment to pregnancy- hx of
depression- perinatal depression
6. Healthy Lifestyle - Exercise and rest
7. Tobacco , alcohol, substance use
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Prenatal Topics for Health Promotion

8. Relationships - Support systems / Violence
9. Resources – housing, finances, community resources
10. Injury prevention- infectious and environmental
hazards
11. Prenatal Knowledge….pregnancy- how to deal with
common discomforts, how to identify potential problems or
complications.
12. L and D Plan - how to prepare for (partner and siblings
and pets)
13. Planning for Parenthood
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Who Provides Prenatal Care?

1. Family physician
2. Midwives
3. Doulas
4. IH prenatal classes
5. Babies Best Chance
6. Private resources

What does each provide?

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BC Maternity Care Pathway (2018)

First vists
• Screen for tobacco, alcohol, cannabis and substance
use
• Recommend folic acid
• Recommend and provide Influenza vaccine

• Prenatal lab tests

• CBC (Hb, MCV)
• Urine C+S
• Hep B, HIV, Chlamydia, gonorrhea, Shypillis
• ABO typing and Rh status
• GBS
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BC Maternity Care Pathway (2018)

Second visit
• Discuss prenatal genetic screening options
• • Recommend Vit D supplementation 600 IU (15 mcg) daily
during pregnancy and lactation and 800 IU daily for women
who live north of 55° latitude (e.g. Dawson Creek).
• Complete lifestyle and social risk assessment
• Perform complete physical examination
• Offer Pap smear following usual screening guidelines.
• Document BMI and discuss healthy pregnancy weight gain
• Discuss nutrition, exercise (walking) a minimum of 30
minutes a day, rest, and stress management
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Prenatal Examination Schedule

• After the first prenatal visit, every 4 weeks till week 28 of
pregnancy
• Every 2 to 3 weeks through week 36 of pregnancy
• Every week during the final month of pregnancy

• Regular follow up (wt., fundal ht measurements,

BP, urine for protein, fetal movement)

• Ultrasound 8-13 weeks and 15-27 weeks; may be

ordered after 27 weeks
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BC Maternity Care Pathway

• Outlines routine care to be offered to all women in BC
and level of evidence for recommendations
• Remember informed consent and woman’s right to decline
• Consider complexity of legal and ethical issues related to
maternal/fetal rights
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Other Tests Ordered by Family
Physician/Obstetrician
• Non stress test (NST)
• Done in 3rd trimester if
deemed necessary
-Contraction stress test
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• Fetal biophysical profile
• Group of 5 tests
Genetic testing
• Amniocentesis
• Chorionic villi sampling
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CULTURAL PRACTICES IN PREGNANCY-

Forum post class

• Many beliefs and practices surrounding pregnancy, even

within the same culture
• There are traditional cultures associated with ethnicity as
well but be careful not to judge based on ethnicity
• eg. there are over 600 First Nation bands in Canada
• Search
• 25 Pregnancy Beliefs from Around the World
• Traditional Practices & Socio-Cultural Norms Affecting the Health of
Pregnant Women in Developing
• Pregnancy & Birth Traditions Around the World