Needs of a Pregnant Mother

Needs of a pregnant mother
Principles of care: * To impress the patient about the importance of regular checkup. * To maintain and improve the health status of the woman to the optimum till delivery. * To improve and tone up the psychology, explaining the changes and events likely to occur during pregnancy and labour.

Needs of the pregnant mother
The needs of a pregnant mother are as follows: i. Diet ii. Personal hygiene including breast care iii. Rest and sleep iv. Exercise v. Comfortable clothing and shoes vi. Sexual activity vii. Antenatal check-up viii. Immunization ix. Preparation for delivery x. Smoking and alcohol

Diet:
Healthy diet is very important during pregnancy. Dietary assessment and counseling should be an integral part of prenatal care for every pregnant woman. Food requirement increases during pregnancy and she needs to eat more protein, minerals and vitamins to supply fetus.

Importance of diet during pregnancy * Meet the needs of growing fetus. * Maintain and promote the general health of the mother. * Help her acquire the physical strength and vitality required during labor. * Prepare for successful lactation. * Prevent complication during the prenatal, natal, and postnatal.
During pregnancy there is increased calorie requirement due to increased growth of maternal fetus, tissue, placenta and increased basal metabolic rate. The increased calorie requirement is to the extent of 300 over than non-pregnancy state during second half of pregnancy. The pregnancy diet should ideally be light, nutritious, easily digestible and rich in protein, minerals and vitamins.

The following is the guide for pregnant mother
Recommended daily nutrients for woman weighing 50 Kg Nutrient | Non pregnant | Pregnancy second half | Lactation | Kilocalories | 2200 | 2500 | 2900 | Protein | 50 gm | 60 gm | 70 gm | Calcium | 500gm | 1000gm | 1500gm | Iron | 18mg | 40mg | 30mg | vitaminA | 5000I.U. | 6000I.U. | 8000I.U. | Vitamin D | 400 I.U. | 400I.U. | 400 I.U. | Thiamine | 1.1 mg | 1.5mg | 1.5mg | Riboflabin | 1.1mg | 1.5 mg | 1.5mg | Nicotinic acid | 14mg | 15mg | 15mg | Ascorbic acid | 45mg | 60mg | 60 mg | Folic acid | 0.5mg | 1mg | 1mg | Vitamin B12 | 2 mg | 2mg | 2mg |

* During pregnancy, some adjustment should be made for nutritional replacement. Such as- * The mother should take extra protein containing all the amino acids. * Majority of thr fat should be animal type, which contains vitamin a and d * If possible milk should be taken daily 1 litre of milk (1 gm calcium) , 1 egg,plenty of green vegetables and fruits as available. * Salt and salty foods shouls be taken in moderation. * Adequate fluids are important. * Enough roughage food such as pulses, grams, green vegetables are needed to avoid constipation. * The daily amount of food may be splitted over 5 or 6 small meals instead of the usual two big meals. * While giving dietary advice , consideration should be made on socio- economic condition, food habit, taste of the individual, custom and culture, religion, superstition, and food taboos and occupation.

During pregnancy there is negative iron balance and dietary iron supplement is inadequate so therapeutic iron supplement is given from 20 weeks onwards.
An essential vitamins should also be supplemented by providing vitamin tablets containing ascorbic acid, folic acid, thiamine, riboflavin, nicotinic acid from 20 weeks.

Hygiene:
Bathing: There is more sweating and vaginal discharge during pregnancy because of hormonal activation. O, she needs to take frequent baths and keep her body clean. A daily bath is needed in warm weather.
Care of teeth: The usual care after eating should continue. A dental checkup is advisable and any dental carries should be treated. Use soft brush in this period.
Bowel: The bowel action should occur daily without use of laxative.
Breast care: Advise to clean her breast during bath. If the nipples are normal, nothing is to be done. If nipples are retracted, correction should be done but not in the late trimester.

Rest and sleep:
The mother may continue her usual activities throughout pregnancy. However hard and strenuous work should be avoided specially in the first trimester and last 6 weeks of pregnancy.
Rest is very important.In average mother should be in bed for about 10 hours (8 hours at night time and 2 hours at noon).Lateral position, particularly on left, keeping a leg on side pillow is posture of choice.

Exercise:
Most Nepali woman get enough exercise looking after their family but those who are on sedentary life style should have exercise.The family members must understand that excessive hard work and carrying heavy loads may result in abortion or premature labour.

Comfortable clothing and shoes:
The pregnant mother should wear loose and comfortable clothes such as loose blouse or cholo. Brassieres should support and lift the breast well. The pregnant mother should be advised to support her whole abdomen and back with patuka.
High heels should be avoided during pregnancy and flat shoes should be worn to maintain centre o balance.

Sexual intercourse:
Coitus should be avoided during first trimester and also during the last 6 weeks to avoid introduction of infection and premature labour in the later period. During other period, infrequent sex without pressing abdomen is advisable.

Antenatal check-up:
The mother should be persuaded to attend four antenatal check-ups positively on the schedule date of visit.She should visit ANC clinic as she is diagnosed as pregnant. Then if the mother is well and everything is normal, she should come to clinic in following manner:

1. Once monthly: for first 8 weeks 2. Every two weekly: From 28th -36th weeks 3. Every weekly: From 36th till delivery

But according to WHO, there should be minimum of 4 antenatal visit with following schedule: 1st visit during 3rd month 2nd visit during 6th month 3rd visit during 8th month 4th visit during 9th month
If she is suffering from any disorder or disease she should visit clinic weekly or as needed or admitted to hospital depending upon severity.

Immunization:
Tetanus is common infectious disease in Nepal. Neonatal death due to tetanus is high so, the pregnant mother should be immunized against tetanus.TT immunization protects both mother and neonate against tetanus. Usually 2 or 3 doses of TT are given during pregnancy. The dose is 0.5 ml intramuscularly at first visit usually 24- 30 weeks and then next dose is given after 4-6 weeks interval. Prophylaxis anthelminthic, Albendazole 400 mg should be given after 12 weeks of pregnancy to prevent anaemia due to hook worm.

Preparation during delivery:
A pregnant mother and her family should start getting ready for the baby from 7-8 months of pregnancy.

i. Preparation of mother for labour: * When and how to bear down in 2nd stage of labour * Diet during labour(mainly liquid diet) * Explain about labour (what to be done , what not to be done) * Delivery position ii. After delivery: * Breast care and breast feeding * The way of handling baby * Baby bath(eye and cord care) * Immunization of baby * Family planning * The needs of the baby * Vulval toileting iii. Items needed for child birth: * Baby wrapper * Bathing soap * Oil for massaging baby * Towel * Baby clothes (vest, bhoto etc) * Napkin * Soft pillow for baby * Blanket iv. Items for mother * Petticoat and sari * Things for morning care * Blouse * Sanitary pads or clean clothes * Food stuff (ghee, rice, dark molasses, meat etc) * If mother is alone ,arrangement for a relative or any oher person should be made who is willing to help her at home during early weeks of puerperium. * Charcoal or woods should be stored for heating the room in the winter season
The TBA and the mid wives should be advised to keep the following things ready: * Clean clothes * Bowls or dekchi * Soap and water * Brush to scrub hands * Sterile scissors or sterile razors * Pools * Two clamps, if available to clamp cord * Thread to tie cord * Mud pot to receive placenta * Cotton and gauze * Syringe, needle and ergometrine

Smoking and alcohol:
Smoking is injurious to health and especially pregnant mother must stop smoking because smoking causes low birth weight, premature labour etc. Alcohol drinking must be stopped during and before pregnancy. Daily drinking of 30 ml or more ethanol containing drink cause foetal alcohol syndrome (FAS), which occur in one third cases with: 1. CNS dysfunction (mental retardation, microcephaly, irritable infant). 2. Growth retardation. 3. Characteristic facial abnormalities, short palpebral fissure, short nose, hypo plastic maxilla. 4. Higher incidence of mid trimester abortion. 5. Increased perinatal mortality and morbidity.