Health Promotion: Prenatal Health Maintenance Measures

Health maintenance is an important aspect of prenatal care. Patient participation in the care ensures prompt reporting of problematic responses to pregnancy. Patient responsibility for health maintenance is strengthened by a readiness to learn and by the nurse’s understanding of maternal adaptations to the growth of the unborn child.

The expectant mother needs information about many topics. Be observant, listen, and know the typical concerns of expectant parents to anticipate what questions will be asked and to prompt mothers and their partners to discuss what is on their minds. Provide printed literature to supplement the individualized teaching; women often avidly read books and pamphlets related to their own experience. Read the literature before distributing it, and point out areas that may not correspond to local health care practices. Patients who receive conflicting advice or instruction may grow frustrated with members of the health care team and the care provided.

Topics to discuss with pregnant women may include the following.

Employment

• • Employment of pregnant women usually has no adverse effects on pregnancy outcomes. Job discrimination that is based solely on pregnancy is illegal. However, some job environments pose a potential risk to the fetus (e.g., dry-cleaning plants, chemical laboratories, and parking garages).
• • Discourage activities that require a good sense of balance, especially during the last half of pregnancy.
• • Commonly, excessive fatigue is the deciding factor in the termination of employment.
• • Women in sedentary jobs need to walk around at intervals and should neither sit nor stand in one position for long periods. Activity counters sluggish leg circulation, which can cause varices and thrombophlebitis. Women should also avoid crossing their legs at the knees because this fosters such conditions. Standing for long periods increases the risk of preterm labor.
• • The pregnant woman’s chair should provide adequate back support. Use of a footstool can prevent pressure on veins, relieve strain on varicosities, and reduce swelling of feet.

Clothing

• • Comfortable, loose clothing is best. Washable fabrics (e.g., absorbent cottons) are often preferred. Maternity clothes may be purchased new or found in good condition at thrift shops or garage sales. Tight bras and belts, stretch pants, garters, tight-top knee socks, panty girdles, and other constrictive clothing should be avoided because tight clothing over the perineum encourages vaginitis and impaired circulation in the legs can cause varices.
• • Maternity bras are constructed to accommodate the increased breast weight. These bras have drop-flaps over the nipples to facilitate breastfeeding. A good bra can help prevent neck and back discomfort.
• • Elastic hose are comfortable and promote greater venous emptying in women with large varicose veins. Ideally, the woman should wear the supportive hose when up.
• • Comfortable shoes that provide firm support and promote good posture and balance are advisable. Tall high heels and platform shoes are not recommended because of the woman’s changed center of gravity, which can cause her to lose balance. In addition, the woman’s pelvis tilts forward in the third trimester, increasing her lumbar curve. The resulting leg aches and cramps are aggravated by shoes that do not provide good support.

Travel

• • • Travel is not contraindicated for pregnant women at low risk, but those with high-risk pregnancies are advised to avoid long-distance travel after fetal viability has been reached, to avoid the economic and psychological consequences of delivering a preterm infant far from home.
  • • The second trimester is the ideal time for travel.
  • • Travel to areas where medical care is poor, water is untreated, and malaria is prevalent should be avoided if possible.
  • • Women who contemplate foreign travel should be aware that many health insurance carriers do not cover birth in a foreign setting or even hospitalization for preterm labor.
  • • Pregnant women who travel long distances should schedule periods of activity and rest. While sitting, women can practice deep breathing, foot circling, and alternately contracting and relaxing different muscle groups. They should avoid becoming fatigued.
  • • Although travel in itself is not a cause of adverse outcomes, such as miscarriage or preterm labor, certain precautions are recommended while traveling in a car. The woman should always use automobile restraints, generally a combination lap belt and shoulder harness. The lap belt is worn low across the hip bones and as snug as is comfortable. The shoulder belt is worn above the pregnant uterus and below the neck to avoid chafing. The pregnant woman should sit upright and use the headrest to avoid a whiplash injury.
  • • Maternal death as a result of injury is the most common cause of fetal death. The next most common cause is placental separation. This occurs because body contours change in reaction to the force of a collision. The uterus as a muscular organ can adapt its shape to that of the body, but the placenta lacks the resiliency to change. At the impact of collision, placental separation can occur.
  • • Airline travel in large commercial jets usually poses little risk to the pregnant woman, but policies vary from airline to airline. The pregnant woman is advised to inquire about restrictions or recommendations from her carrier. Magnetometers (metal detectors) used at airport security checkpoints are not harmful to the fetus. Cabins of commercial airlines are maintained at 8% humidity, which may result in some water loss; hydration (with water) should be maintained under these conditions. Sitting in a cramped seat of an airliner for prolonged periods may increase the risk of superficial and deep thrombophlebitis. A pregnant woman is encouraged to take a 15-minute walk around the aircraft cabin during each hour of travel to minimize this risk.