prenatal care
TRANSCRIPT
Angeles University Foundation
Angeles City
College of Nursing
SY 2010-1011
Written Report
PRENATAL CARE
Submitted by:
Mylene Angelie M. Bognot
Aaron Josh D. Bondoc
Carla Joy T. Manaloto
Of BSN II- 5; Group 24
Submitted to:
Hydee A. Medina, RN MN
September 23, 2010
INTRODUCTION
Women are convinced by the media, their physicians, relatives, etc., that prenatal
care means going to the doctor for regular checkups. Frequent examinations are
required by physicians to check for sugar in the urine, blood count, edema, etc. These
"complications" are considered by conventional standards to be normal and therefore
need to be checked for. Instead of avoiding these complications by right living, these
abnormalities are tested for throughout pregnancy. What women are not told is that all
these tests (especially vaginal exams) are very weakening and should be avoided and,
in fact, visits to physicians are not only needless but filled with many dangers for both
mother and offspring.
The medical establishment conducts many tests on pregnant women to discover
trouble only after it is developed. They have no ways of guiding women to health—they
deal with pathological effects, not causes. Normally, physicians utilize drugging, which
adds to the harm, to "remedy" the "problems" they maintain to discover with their tests.
Prenatal care, however, does not mean visiting your obstetrician at all. It means
providing the healthful conditions so as to produce and maintain better health and
development in the unborn child. In other words, the child is very much so "at the mercy
of the mother" for all the requisites of development and growth and freedom from
harmful toxins.
Prenatal care includes wholesome outdoor exercise, pure air, rest and sleep,
sunshine, freedom from worry or anxiety, absence of overwork, and most importantly,
proper food. The unborn child is totally dependent upon the mother to provide these
things prudently.
Pregnant women need not eat more food than they did prior to pregnancy as is
commonly asserted. They need only eat the best of foods—raw fruits, vegetables, nuts,
and seeds. These foods will provide an abundance of minerals, vitamins, and high-grade
proteins for both mother and baby. Good foods are the raw materials for better eyes,
better bones, better teeth, a better nervous system, a better brain, and better
development all around the baby. Proper foods also improve the health and comfort of
the mother and allow, for greater ease in delivery and healthier nursing.
Good food is not enough, however. A pregnant woman must secure the best
conditions for efficient utilization (assimilation) of her food. She must observe food
combining rules, eat only when hungry, never overeat or eat when emotionally upset or
physically tired, never drink with her meals, etc.
Terms:
Prental care- The medical and nursing supervision and care given to the
pregnant woman during the period between conception and the onset of labor
Gravida- a woman who is or has been pregnant.
Primigravida- a woman who is pregnant for the first time.
Multigravida- a woman who has had two or more pregnancies.
Nulligravida- a woman who has never been pregnant.
Para- the number of pregnancies that reached viability, regardless of wheter the
infants were born alive or not
Primipara- a woman who has giv en birth to a child past age of viability.
Multipara- a woman who has given birth to two or more children past the age of
viability.
Viability- the earliest age at which fetuses could survive if they were born at that
time; generally accepted at 24 weeks or weighing more than 400g.
Tpal- a system for classifying pregnancy status attempts to further detail
pregnancy history.
T: The number of full term infants born (infants born at 37 weeks or after).
P: The number of preterm infants born (infants born before 37 weeks).
A: The number of spontaneous or induced abortions.
L: The number of living children.
Porturient
- a woman in labor
Puerpera
- (a woman who has just delivered (win 6 weeks after delivery )
Skillbirth
- (an infant born without signs of life)
Prenetal care (antenatal care)
- refers to the health care given to a woman and her family during pregnancy
essential for ensuring the overall health of newborn and mothers a major strategy for
helping reduce complications of pregnancy.
If a woman has a good health coming into pregnancy, it will help ensure a good
pregnancy outcome
Purposes of Prenatal Care:
Establish baseline of present health
Determine gestational age of the fetus
Monitor fetal development and maternal well-being
Identify women at risk for complication
Minimize the risk for possible complication by anticipating and preventing
problems before they occur
Providing time for education about pregnancy, lactation and newborn care
ADAPTATIONS IN PREGNANCY
A. Systemic Changes
1. Circulatory/Cardiovascular
*Beginning the end of the first trimester there is a gradual increase of about
30%-50% in the total cardiac volume, reaching its peak during the 6 th month.
This cause a drop in hemoglobin and hematocrit values since the increase is
only in the plasma volume = physiologic anemia of pregnancy.
Consequences of increased total cardiac volume are:
• Easy fatigability and shortness of breath because of increased workload
of the heart.
• Slight hypertrophy of the heart, causing it to be displaced to the left,
resulting in torsion on the great vessels ( the aorta and pulmonary
artery ).
• Systolic murmurs are common due to lowered blood viscosity.
• Nosebleeds may occur because of marked congestion of the
nasopharynx as pregnancy progresses.
*Palpitations are due to:
• Sympathetic nervous system stimulation during the first half of
pregnancy.
• Increased pressure of uterus against the diaphragm during second half
of pregnancy.
*Because of poor circulation resulting from pressure of the gravid uterus on
the blood vessels of the lower extremities:
• Edema of the lower extremities occurs. Management: raise legs above
hip level. Important : Edema of the lower extremities is normal
during pregnancy; it is not a sign of toxemia.
• Varocosities of the lower extremities can also occur. Management:
> Use/wear support hose or elastic stockings to promote venous
flow
> Apply elastic bandage – start at the distal end of the extremity
and work toward the trunk to avoid congestion and impaired
circulation in the distal part; do not wrap topes so as to be able to
determine adequacy of circulation ( principle behind bandaging :
blood flow through tissues is decreased by applying excessive
pressure on blood vessels ).
> Avoid use of constricting garters, e.g., knee-high socks.
*Because of poor circulation in the blood vessels of the genitalia due to the
pressure of the gravid uterus, varicosities of the vulva and rectum can
occur. Management: side-lying position with hips elevated on pillows and
modified knee-chest position.
*There is increased level of circulating fibrinogen, that is why pregnant women
are normally safeguard against undue bleeding. However, this alson
predisposes them ton formation of blood clots (thrombi). The implication
is that pregnant women should not be massaged since blood clots can be
released and cause thromboembolism.
2. Gastrointestinal changes
* Morning sickness – nausea and vomiting during the first trimester is due to
increased human chorionic gonadotropin (HCG). It may also be due to
increased acidity or even to emotional factors. Management: Eat dry toast
or crackers 30 minutes before arising in the morning (or dry, high
carbohydrate, low fat and low spices in the diet).
* Hyperemesis gravidarum = excessive nausea and vomiting which persist
beyond 3 months; results in dehydration, starvation and acidosis.
Management: D10NSS 3000 ml in 24 hours is the priority treatment;
complete bed rest is also important.
* Constipation and flatulence are due to displacement of the stomach and
intestines, thus slowing peristalsis and gastric emptying time. It may also
be due to increased progesterone during pregnancy.
*Management:
•Increased fluids and roughage in the diet
•established regular elimination time
•Increased exercise
• Avoid enemas
• Avoid harsh laxatives like Dulcolax; stool softeners, e.g., Colace, are
better.
• Mineral oil should not be taken because it interferes with absorption of
fat-soluble vitamins.
* Hemorrhoids are due to pressure of enlarged uterus. Management: cold
compress with witch hazel or Epsom salts
* Heartburn, especially during the last trimester, is due to increased
progesterone which decreases gastric motility, thereby causing reversed
peristaltic waves which lead to regurgitation of stomach contents through
the cardiac sphincter into the esophagus , causing irritation.
Management:
• Pats of butter before meals
• Avoid fried, fatty foods
• Sips of milk at frequent intervals
• Small, frequent meals taken slowly
• Bend at the knees, not at the waist
• Take antacids (e.g., milk of Magnesia) but never sodium bicarbonate
(e.g., Alka Seltzer or baking soda) because it promotes fluid
retention.
3. Respiratory changes - shortness of breath
*Causes
• Increased oxygen consumption and production of carbon dioxide during
the first trimester.
• Increased uterine size causes diaphragm to be pushed or displaced,
thus crowding the chest cavity.
• Management: Lateral expansion of the chest to compensate for
shortness of breath oxygen supply and vital lung capacity.
4. Urinary changes
*Urinary frequency, the only sign in pregnancy seen during the first trimester,
disappears during the second and reappears during the third trimester.
Early pregnancy is due to increase blood supply to the kidneys and to the
uterus rising out of the pelvic capacity; in the last trimester is due to
pressure of enlarged uterus on the bladder, especially with lightening
(descent of the fetus into the pelvic brim.)
*Decreased renal threshold for sugar due to increased production of
glucocorticoids which cause lactose and dextrose to spill into the urine;
also an effect of the increased progesterone. (Implication: it would be
difficult to diagnose diabetes in pregnancy based on the urine sample
alone because all pregnant women have sugar in their urine.)
5. Musculoskeletal changes
*Because of the pregnant woman’s attempt to change her center of gravity,
she makes ambulation easier by standing more straight and taller,
resulting in a lordotic position (“pride of pregnancy”)
*Due to increased production of the hormone relaxin, pelvic bones become
more supple and movable, increasing the incidence of accidental falls due
to the wobbly gait. Implication: Advice use of low-heeled shoes after the
first trimester.
*Leg cramps
*Causes
Increased pressure of gravid uterus on lower extremities
Fatigue
Chills
Muscle tenseness
Low calcium, high phosphorus intake
6. Temperature - slight increase in basal body temperature due to increases
progesterone,but the body adapts after 4th month.
7. Endocrine changes
*Addition of the placenta as an endocrine organ, producing large amounts
of HCG, HPL, estrogen and progesterone.
*Moderate enlargement of the thyroid gland due to hyperplasia of the
glandular tissues and increased vascularity. It could also be due to
increased basal metabolic rate to as much as +25% because of
the metabolic activity of the products of conception.
*Increased size and activity of the parathyroid, probably to satisfy the
increases need of the fetus for calcium.
*Increased size and activity of the adrenal cortex, thus increasing the
amount of circulating cortisol, aldosterone and ADH, all of which
affect carbohydrate and fat metabolism, causing hyperglycemia.
*Gradual increase in insulin production but the body’s sensitivity to insulin
is decreased during pregnancy.
8. Weight
*During the first trimester, weight gain of 1.5-3 lbs is normal
*On the 2nd and 3rd trimesters, weight gain of 10-11 lbs. per trimester is
recommended.
*Total allowable weight gain during entire period of pregnancy, therefore,
is 20-25 pounds (10-12 kgs).
Fetus 7 lbs.
Placenta 1 lb.
Amniotic Fluid 1 ½ lbs
Increased weight of uterus 2 lbs.
Increased blood volume 1 lb.
Increased weight of the breasts ½-3 lbs.
Fat and fluid accumulation
characteristic of pregnancy
4 lbs.
TOTAL: 20-25 lbs.
*Pattern of weight gain is more important than the amount of weight gained.
Distribution of Weight Gain during Pregnancy
9. Emotional responses
*First trimester: The fetus is an unidentified concept with great future
implications but without tangible evidence of reality. Some degree
of rejection, disbelief, even depression. (Implication: when giving
health teachings, emphasize bodily changes in pregnancy.)
*Second trimester: fetus is perceived as a separate entity. It fantasizes
appearance of the baby.
*Third trimester: her personal identification with a real a baby about to
be born and realistic plans for future childcare responsibilities.
Best time to talk about layette and infant feeding method. Fear of
death, though, is prominent. (to allay fears, let pregnant woman
listen to the fetal heart sounds.)
B. Local changes
1. Uterus
*Weight increases to about 1000 grams at full term; due to increase in the
amount of fibrous and elastic tissues.
*Change in shape from pear-like to avoid; enormous change in
consistency of lower uterine segment causes extreme softening,
known as Hegar’s sign, seen at about the 6th week.
*Mucous plugs in the cervix, called operculum, are produced to seal out
bacteria
*Cervix becomes more vascular and edematous, resembling the
consistency of an earlobe, known as Goodell’s sign.
2. Vagina
*Increased vascularity causes change in color from light pink to deep
purple or violet known as “Chadwick’s sign”
* To prevent confusion as to pregnancy signs, arrange the body parts
from “out to in” and the different signs alphabetically. Thus:
•Due to increased estrogen, activity of the ephitelial cell increases.
Thus increasing amount of vaginal discharges called leucorrhea. As
long as the discharges are not excessive, green/yellow in color, foul-
smelling or irritatingly itchy, it is normal. Management: maintain or
increase cleanliness by taking twice daily shower baths using cool
water.
•The pH of the vagina changes from normally acidic (because of the
presence of Doderlein bacilli) to alkaline (because of increased
estrogen). Alkaline vaginal environment is supposed to protect against
bacterial infection; however, there are two microorganisms which
thrive in an alkaline environment.
•Trichomonas, a protozoa or flagellate. The condition is called
trichomonas vaginalis or trichomonas vaginitis or trichomoniasis.
Signs and Symptoms of Trichomoniasis
>Frothy, cream-colored, irritatingly itchy, foul-smelling discharges.
>Vulvar edema and hyperemia due to irritation from the discharges
*Management
Flagyl for 10 days p.o. or vaginal suppositories of trichomonicidal compounds.
Treat male partner also with Flagyl
Avoid alcoholic drinks when taking Flagyl – can cause Antabuse like reactions:
vomiting, flushed face and abdominal cramps.
Dark brown urine a minor side effects
Acidic vaginal douche
( tbsp. White vinegar in 1 quart of water or 15 ml. white vinegar n 1000 ml. of
water) to counteract alkaline- preferred environment of the protozoa. Avoid
intercourse to prevent reinfection.
Candida Albicans, a fungus or yeast.
The condition is called Moniliasis or Candidiasis. Fungus also thrives in an
environment rich in carbohydrates and in those on steroid or antibiotic therapy
when acidic environment is altered. Moniliasis is seen as oral thrush in the
newborn when transmitted during delivery through the birth canal of the infected
mother.
Symptoms
White, patchy, cheese-like particles that adhere to vaginal walls
Irritatingly itchy and foul-smelling vaginal discharges
Management
Mycostatin/nystatin p.o. or vaginal suppositories/ pessaries( 100,000 U) twice a
day for 15 days
Gentian violet swab to vagina
Correct diabetes
Avoid intercourse
Acidic vaginal douche
3. Abdominal Wall
*Striae Gravidarum- increased uterine size results in rupture and atrophy of connective
tissue layers, seen as pink or reddish streaks
*Umbilicus pushed out
4. Skin
*Linea nigra- Brown line running from umbilicus to symphysis pubis
*Melasma or Chloasma- extara pigmentation on cheeks and across the mose due to
increase of production of melanocytes by the pituitary gland
*Sweat glands unduly activated
5. Breasts - all changes due to increased estrogen
* Increased in size due to hyperplasia of mammary alveoli and fat deposits.
Proper breast support with well-fitting brassiere necessary to prevent sagging.
* Feeling of fullness and tingling sensation in the breasts
* Nipples more erect.
* Montgomery glands become bigger and more protuberant
* Areola becomes darker and diameter increases
* Skin rounding areola turns dark
* By the fourth month, a thin, high protein fluid called Colostrum, Is formed. It is
the precursor of breast milk.
6. Ovaries - no activity since ovulation does not take place during pregnancy.
progesterone and estrogen are being produced by the placenta.
Stage Presumptive Probable Positive
First trimester Amenorrhea
Morning sickness
Breasts changes
Urinary frequency
Enlarging uterus
Chadwick’s sign
Goodell’s sign
Hegar’s sign
Positive HCG
Elevation of BBT
Ultrasound
evidence
Second trimester Quickening Enlarged abdomen Fetal heart rate
Increase skin
pigmentation
(chloasma & linea
nigra)
Striae Gravidarum
Braxton hicks
Ballottement
tones
Fetal movement felt
by examiner
Fetal online on X-
ray
C. The Prenatal Visit
a. The provision of prenatal care is the primary factor in the improvement of
maternal and infant morbidity and mortality statistics. To ensure the success of
the prenatal care programs, it should be remembered that the patient’s
understanding of the modalities of care is basic for cooperative action.
b. The duration of a normal pregnancy is 266-280 day, or 380-42 weeksor 9
calendar months or 10 lunar months. Any baby born after 42nd week of gestation
is said to be post-term
c. Diagnosis of pregnancy. Urine examination- Human Chorionic Gonadotropin
(HCG) in the urine is the basis for pregnancy tests. It is from the 40 th day through
the 100th day, reaching a peak level on the 60th day. HCG therefore, is the most
correct 6 weeks after the last menstrual period (LMP). Immunodiagnostic tests
(antigen-antibody reaction) are widely used at present because results pobtain
faster.
d. Components of the prenatal visits
1. History taking
*Personal data- patient’s name, age, address, civil status, and family history
*Obstetrical data
•Gravida- number of pregnancies a woman has had
•Para- number of viable of pregnancies, regardless of number and outcome
•TPAL- number of full term babies (T), premature (P) babies, abortion (A), living
children (L)
•Past Pregnancies
>Method of delivery – normal spontaneous vaginal, or caesarian section
>Where? at home? in the hospital?
>Risks involved
•Present pregnancy
>Chief concern
>Danger signals.
>Vaginal bleeding, swelling of ace or finger, severe, continuous headache,
dimness or blurring of vision
>Pain in the abdomen
>Persistent vomiting
>Chills and fever
>Sudden escape of fluids from the vagina
>Absence of fetal heart rate they have been initially auscultated on the 4th or
5th month
*Medical data- is there a history of kidney, cardiac or liver disease; hypertension;
tuberculosis; sexually- transmitted diseases
2. Assessment
*Physical examination- a review of system is indicated.
*Pelvis examination
*Internal examination to determine hegar’s Chadwick and goodell’s
*Ballottement- fetus will bounce when lower uterine segment is tapped sharply
*Papanicolau(pap smear)- cytological examination to diagnose cervical cancinoma
*Leopold’s maneuvers
Purpose
To determine presentation, position, and attitude
Estimate fetal size
Locate fetal parts
Preparatory steps
Palpate with warm hands
Use palm not fingertips
Apply gentle but firm motion
Procedure
First Maneuver (Upper pole)
o Examiner faces woman's head
o Palpate uterine fundus
o Determine what fetal part is at uterine fundus
Second Maneuver (Sides of maternal abdomen)
o Examiner faces woman's head
o Palpate with one hand on each side of abdomen
o Palpate fetus between two hands
o Assess which side is spine and which extremities
Third Maneuver (Lower pole)
o Examiner faces woman's feet
o Palpate just above symphysis pubis
o Palpate fetal presenting part between two hands
o Assess for Fetal Descent
Fourth Maneuver (Presenting part evaluation)
o Examiner faces woman's head
o Apply downward pressure on uterine fundus
o Hold presenting part between index finger and thumb
o Assess for cephalic versus Breech Presentation
Vital Signs- temperature, pulse and respiratory rates are important especially during
the initial prenatal visit. more important, however, are the weight and blood pressure
as baseline data to determine any significant increases.
Blood studies
Blood typing
Complete blood count, including HGB, HCT, to determine anemia
Serological test to diagnose for syphilis
Urine examinations
Heat and acetic test to determine albuminuria. An sign of albumin in the urine
should be reported immediately because it is a sign of toxemia
Benedict’s test for gycosuria, a sign of possible gestational diabetes. Urine
shouldbe collected before breakfast to avoid false positive result. Should not be
more the +1 sugar.
Betermination of pyuria. Urinary tract infection has been found to be a common
cause of premature delivery.
Important Estimates
Age of Gestation (AOG)
○ Nagele’s Rule – calculation of expected date of confinement (EDC). Count
back three months from the first day of the last menstrual period (LMP)
the add 7 days. Substitute number for month for easy computation. E.G.,
LMP is September 6 September is the 9th month of the year – 3 = 6(June)
Add 7 days to 6 = 13
EDC – June 13
Problems encountered with the use of LMP
1. Failure to record LMP
2. Menstrual cycle maybe irregular and variable
3. Pregnancy may follow immediately without menstruation in between gestation
4. Implantation bleeding may be mistaken as menstruation
○ MCDonald’s method – determine age of gestation by measuring from the
fundus to the symphysis pubis (in cm.) then divide by 4 = AOG in months.
E.g., fundic height of 16 cm. divided by 4 = 4 months AOG = 16 weeks
AOG
o Estimate fetal weight
-using the fundic height ( Johnson’s rule )
Formula :
FH (cm)- n x K= fetal weight in gms
Where:
N=12 if the fetal head is below the level of the ischial spine (engaged)
= 11 if the presenting fetal part is above the level of the ischial spine
=1 is added to n for patients over 200 lbs
K= 155 (constant)
o Fetal length: (Haase’s Rule) in cm long
First 5 months of pregnancy= Square the number of the month of
pregnancy
From 6th months on multiply the number of the month by 5
○ Bartholomew’s Rule – estimate AOG by the relative position of the uterus in
the abdominal cavity (Figure 4).
○ By the 3rd lunar month, the fundus is palpable slightly above the
symphysis pubis
○ on the 5th lunar months, the fundus is at the level of the umbilicus
○ on the 9th lunar month, the fundus is below the xiphoid process
Growth of the fundic height
12 weeks- level of symphysis pubis
16 weeks- halfway between symphysis pubis and umbilicus
20 weeks- level of umbilicus
24 weeks- two finger above umbilicus
28-30weeks- midway between umbilicus and xiphoid process
36 weeks- at the level of xiphoid process
40 weeks- two fingerbreadths below xiphoid, drops at 34 weeks kevek because of
LIGHTENING
D. NUTRITION – most important aspect
Food sources:
•Protein-rich foods – meat, fish, eggs, milk, poultry, cheese, beans, mongo
•Vitamin A – eggs, carrots, squash, all green and leafy vegetables
•Vitamin D – fish, liver, eggs, milk, (Caution: excess Vitamin D during pregnancy can
lead to fetal cardiac problems)
•Vitamin E – green leafy vegetables, fish
•Vitamin C – tomatoes, guava, papaya
•Folic Acid – especially needed to prevent megaloblastic anemia, abruption placenta
and prematurity because, together with iron, folic acid is needed for hemoglobin
formation. E.g. asparagus
•Vitamin B – foods rich in protein
•Calcium/phosphorus – milk, cheese
•Iron – especially important during the last trimester when the pregnant woman is going
to transfer her iron stores from herself to her fetus so that the baby has enough iron
stores during the first three months of life when all he takes is milk (which is deficient in
iron).
- It has a very low absorption rate: only 10% of iron intake can be absorbed
by the body.
- Iron should be given after meals because it is irritating to the gastric
mucosa.
- Foods rich in iron: liver and other internal organs, camote tops, kangkong,
egg yolk, ampalaya, malunggay.
Quantities of Food Necessary during Pregnancy
•Smoking – causes vasoconstriction, leading to low birth weight babies and, therefore,
is contraindicated during pregnancy.
•Drinking – in moderation is not contraindicated but when excessive can cause transient
respiratory depression in the newborn and fetal withdrawal syndrome; besides, alcohol
supplies only empty calories.
•Drugs – dangerous to fetus especially during the first trimester when the placental
barrier is still incomplete and the different body organs are developing. Are teratogenic
(can cause congenital defects) and, therefore, contraindicated unless prescribed by the
doctor.
>Thalidomide – causes Amelia or phocomelia(short or no extremities)
>Steroids - can cause cleft palate and even abortion
>Iodine – contained in many over-the-counter cough suppressants, cause enlargement
of the fetal thyroid gland, leading to tracheal compression and dyspnea at birth.
>Vitamin K – causes hemolysis and hyperbilirubinemia
>Aspirin and phenobarbital – cause bleeding disorders
>Streptomycin and quinine – cause damage to the 8th cranial nerve (nerve deafness)
>Tetracycline – causes staining of tooth enamel and inhibits growth of long bones (not
given also to children below 8 yrs. for the same reasons)
E. Sexual Activity
•Sexual desires continue throughout pregnancy, but levels change:
>During the 1st trimester, there is a decrease in sexual desire because the woman is
more preoccupied with the changes in her body.
>During the 2nd trim., there is an improvement in sexual desire because the woman has
adapted to the growing fetus.
>During the 3rd trim., there is another decrease in sexual desire because the woman is
afraid of hurting the fetus.
•Sex in moderation is permitted during pregnancy but not during the last 6 weeks since
there is increased incidence of postpartum infection in women who engage in sex during
the last 6 weeks.
•Counsel the couple to look for more comfortable positions. Definitely, the missionary
(man-on-top) position is not available.
•Sex is contraindicated in the ffg. situations:
>Spotting or bleeding
>Ruptured BOW
>Incompetent cervical os
>Deeply-engaged presenting part
F. Employment
As long as the job does not entail handling toxic substances, or lifting heavy objects, or
excessive physical or emotional strain, there is no contraindication to working. Advise
pregnant women to walk about every few hours of her work day during long periods of
standing or sitting to promote circulation.
G. Traveling
No travel restrictions but postpone a trip during the last trimester. On long rides, 15-20
minute rest periods every 2-3 hours to walk about or empty the bladder is advisable.
H. Exercises
•Chief aim: To strengthen the muscles used in labor and delivery.
•Should be individualized: accdg. To age, physical condition, customary amount of
exercise (swimming or tennis not contraindicated unless done for the first time) and the
stage of pregnancy.
•Recommended exercises include:
>Squatting and Tailor Sitting – to stretch and strengthen perineal muscles; increase
circulation in the perineum; make pelvic joints more pliable. When standing from
squatting position, raise buttocks first before raising the head to prevent postural
hypotension.
>Pelvic rock – maintains good posture; relieves abdominal pressure and low backache,
strengthens abdominal muscles following delivery.
>Modified knee-chest position – relieves pelvic pressure and cramps in the thighs or
buttocks, relieves discomfort from hemorrhoids.
>Shoulder – circling – strengthens muscles of the chest.
>Walking - said to be the best exercise.
>Kegel – relieves congestion and discomfort in pelvic region; tones up pelvic floor
muscles.
