General

It is possible to assist the expectant mother in attaining healthier and safer behaviours. In this regard, she can keep her personal hygiene and make herself and her developing foetus feel comfortable with what she has. Of course, you can help her with modifications of certain activities such as skin, hair, breast and dental cares; bowel elimination, vaginal douching, and wearing clean clothing necessary for the health of the pregnant mother. Under this topic, we will cover health concepts which need to be taught to the pregnant mother, so that she enjoys her pregnancy to the fullest while still providing care for her healthy baby (see next for detail).

Personal Hygiene

a) Skin care: the glands of the skin may be more active during pregnancy for the women tend to perspire more. Hence, frequent baths or showers are recommended.

  • Baths can be therapeutic. It relaxes tensed and tired muscles, helps counter act insomnia, and makes the pregnant woman feel fresh and comfortable. However, care should be taken by the pregnant woman not to fall when getting in, out and moving around in the shower.
  • The possibility of infecting the vaginal tract as a result of tub baths does not seem true. Tub baths are only contraindicated after rupture of the membranes.

b) Hair care: the hair tends to become oily more frequently during pregnancy due to over activity of oil glands of the scalp. It also grows faster. Hence, frequent shampooing and cutting more often is recommended although many women do not allow the latter.

c) Breast care: it is important to begin preparing the breast for breastfeeding during the prenatal period.

  • A well-fitting support bra should be worn at all times. This will provide good support for the enlarging breasts. As the breasts enlarge, an increase in bra and cup size should be also made.
  • Pads may be worn inside the bra cups to absorb possible colostrum leakage from the nipples. The pads should be changed if they become wet from leakage. Prolonged moisture against the nipples due to the pad may lead to tenderness and cracking especially when the new born infant begins sucking.
  • The breasts should be washed daily (without soap) to remove dried colostrum and to prevent irritation to the nipples. Lanolin may be applied to the nipples to prevent evaporation of perspiration, thereby softening the skin. Wet tea bags may be placed on the nipples, as the tea will release tannic acid, which will toughen the skin. The nipples should be air dried or blow dried after washing to help toughen them.

d) Dental care: the women must maintain normal, daily dental care. There is no documentation that supports increased dental cavities during pregnancy.

  • Minor dental work, such as fillings and simple extractions, may be done during pregnancy; however, the woman needs to be advised to avoid use of anesthesia.
  • Major dental work, such as dental surgery should be postponed until after delivery because of the need to use anaesthesia as anaesthesia and the analgesics that she takes to suppress the pain may affect the developing foetus.

e) Bowel elimination: mothers who normally had no problems with bowel elimination habits will usually experience little or no change in the daily routine. But those with tendency of constipation may develop noticeable irregularity during pregnancy because of:

  • Decreased physical exertion.
  • Relaxation of bowel as a response to hormone.
  • Pressure on the bowel from the gravid uterus.
  • Constipating effect of iron supplements.

(To prevent or to relieve constipation, you should encourage the mother to eat a diet high in fiber, maintain an adequate fluid intake and do exercise especially walking.)

f) Vaginal douching: explain to the mother that normal vaginal secretions are usually intensified during pregnancy due to increased circulation and hormone production. Vaginal douching should only be done with a physician's order for treatment of a specific condition. There is tendency for introduction of infection and development of air embolism. Vaginal douching should never be done after a rupture or even suspected rupture of the membrane.

g) Clothing: during pregnancy, the clothes should be given more attention than at other times. It should be light weighted, well fitting, adjustable and absorbent as well as comfortable.

The shoes should be also well-fitting and easy to apply especially in the last trimester when it is difficult to bend over to tie the shoes. They should also have a good solid base of support (broad flat heel). Avoid high heel shoes as they may cause tottering and fall.

f) Bathing: during pregnancy, there should be no fear of bath water entering the vagina.Even swimming is allowed to some extent. However, diving should be avoided because of possible trauma. A woman in the last trimester of pregnancy needs to be careful when showering as she may have a tendency of impaired balance and so may fall in the tab water/shower.

Activity Modifications During Pregnancy

Goals of modified activity during pregnancy are to strengthen the health of the mother and the fetus and to promote relaxation of muscle tones with the purpose to prevent muscle atrophy.

a) Sexual relations: basically, there is concern that intercourse may be responsible for early abortion which is unproven so far. However, there are few adverse consequences that can be attributed directly or indirectly to intercourse during pregnancy (see next). In such cases, coitus has to be avoided for the time being or permanently during gestation:

  • If cramps or spotting follow coitus.
  • Coitus late in pregnancy is suspected to initiate labor, perhaps because of the relaxation of an orgasm that causes uterine contraction.
  • Pelvic rest should be considered for patients who have had previous premature delivery or are currently experiencing uterine bleeding.
  • If the pregnant woman had history of ruptured membranes, vaginal spotting, or had preterm labor and/or history of repeated abortion

b) Employment: with employment, there can be adverse effects on pregnancy. For that matter, whether or not a pregnant mother works during gestation depends initially on the physical activity involved, the industrial hazards, toxic environment (chemical dust particles, gases, such as inhalation anesthesia), medical or obstetrical complications, or employment regulations of the company. Also, activities that are dependent on a good sense of balance should be discouraged especially during the last half of pregnancy.

c) Excessive fatigue is usually the reason for employment termination. This may be prevented by modification of the job requirements temporarily and adequate rest periods during the day. The mother who has a sedentary job need to walk around at intervals and should never sit or stand in one position for long periods. Chairs should provide adequate back support. A footstool can help prevent pressure on veins, relieve strain on varices, and minimise swelling of the feet.

d) Travel: care regarding travel during pregnancy has to be seriously considered. Many mothers think very little about it unless they have a tendency of nausea, previous miscarriage or other problem with the pregnancy which precludes any extensive strain. Hence, although there is little restriction on travel from a medical point of view, extensive travel should be approved by physician. That is, there is no proof for travelling to cause abortion or premature labor. However, there is lowering oxygen level resulting in fatal hypoxia in high altitude areas. There could be fatigue and tension in some woman. In general, the followings are some of the steps pregnant woman should take into account to prevent fatigue, relief tension and increase circulation. Eating balanced food; taking sufficient rest; stopping and taking fresh air every 2 hours if the travel is by auto; taking sufficient fluid to avoid dehydration and constipation. Besides, consideration of travelling by air if the trip is long reduces travel time. It is safe to wear seat belts at all times (see figure 6.1).

Figure 6-1. Seat belt wear.

e) Exercise: During pregnancy, moderate exercise is vital for good maternal health, safe birth, and recovery and should be practised as long as the woman feels comfortable doing them. Physical exercise helps a patient adjust to the hormonal and physical change of pregnancy as well as the emotional and psychological changes. Exercise provides extra support for the growing baby by strengthening abdominal muscles as well as muscles supporting the backbone and the pelvic floor (areas under great stress in pregnancy). Especially, aerobic exercises (in classes) with rest for an hour or so, are advisable as target heart rates are adjusted for age and weight and the routines protect joints and promote flexibility. Those activities with high risk of falling or abdominal trauma (eg, diving, lifting and caring heavy materials) cause physical stress and so should be avoided.

Advise the Mother on the Importance of Proper Nutrition and its Requirements

The maternal nutrition from conception is an important factor in the development of the infant's metabolic pathways and future well-being. The pregnant woman should be encouraged to eat a balanced diet and should be made aware of the special needs for iron, folic acid, calcium, and zinc. In this respect, the average woman weighing 58 kg (127 lb.), require normal dietary intake of 2300 kcal/day. In addition, 300 kcal/day during pregnancy and another 500 kcal/day during breastfeeding is needed (see next for the food items required).

a) Protein: protein intake is essential for embryonic development. The protein need in the second half of pregnancy is 1g/kg plus 20g/day (approximately 80 g/day for an average woman).

b) Calcium: calcium intake should be increased to 1.5 g/day in the later months and during lactation. If calcium intake is inadequate, fetal needs will be met through demineralization of the maternal skeleton which is further drained during lactation.

c) Iron: to avoid iron-deficiency anemia, the IOM recommends supplementing the diet of every pregnant woman with 30 mg/day of elemental iron during the second and third trimester. If iron-deficiency anemia is diagnosed, the therapeutic doses of elemental iron prescribed ranges between 60 and 120 mg/day.

d) Vitamins and minerals: vitamin and minerals preparations are commonly given but should not be substituted for adequate food intake. Folic acid has been shown to effectively reduce the risk of neural tube defects (NTDs). Vitamin B12 supplements are also desirable for vegetarian mothers and those with known megaloblastic anemia.

e) Salt restriction: moderate amounts of foods containing sodium are not harmful during normal pregnancy. In fact, sodium restriction may be potentially dangerous. There is no evidence that rapid weight gain in preeclampsia can be controlled with sodium restriction.

Last modified: Tuesday, 21 February 2017, 4:09 PM