Health care of pregnant women during third trimester Care Plan
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Mothers and their immediate caregivers are excited and also tensed because of pregnancy. Modern day medicine with good prenatal care have resulted in excellent outcomes even high risk pregnancies. The most important thing for you to understand is that pregnancy is not a disease and you are not a patient; instead pregnancy is a natural and physiological phenomenon in all forms of life.
Good prenatal care includes:
oGood nutrition and healthy habits before and during pregnancy.
oRegular prenatal exams.
oRoutine ultrasounds to detect problems with the baby.
oImmunization such as tetanus toxoid, taking appropriate supplements such as iron and folic acid etc
oRoutine screening for:
-Blood pressure problems
-Blood type problems (Rh and ABO)
-Immunity to German measles (rubella)
-Sexually transmitted infections
The goals of prenatal care are to:
oMonitor both the mother and baby throughout the pregnancy.
oLook for changes that may lead to a high-risk pregnancy.
oExplain nutritional requirements during and after pregnancy.
oExplain activity recommendations or restrictions.
oDiscuss common pregnancy complaints such as morning sickness, backaches, leg pain, frequent urination, constipation, and heartburn and how to manage them, preferably without medications.
oGive support to the pregnant woman and her family.(1)
Below are the common complications you may experience during your pregnancy and how to prevent them:
1.Hyperemesis Gravidarum: Many women have some nausea or vomiting, or "morning sickness," particularly during the first 3 months of pregnancy. However, hyperemesis gravidarum occurs when there is severe, persistent nausea and vomiting during pregnancy-more extreme than "morning sickness." This can lead to weight loss and dehydration and may require intensive treatment.
2.Anemia: Anemia is having lower than the normal number of healthy red blood cells.This can be helped by taking iron and folic acid supplements. Ask your doctor as to when you can start these supplements.Your health care provider will check your iron levels throughout pregnancy.
3.Urinary Tract Infections: It is a bacterial infection in the urinary tract. You may have a UTI if you have:
-Pain or burning when you use the bathroom.
-Fever, tiredness, or shakiness.
-An urge to use the bathroom often.
-Pressure in your lower belly.
-Urine that smells bad or looks cloudy or reddish.
-Nausea or back pain.
Consult with your doctor.
4.Depression:Some women experience depression during or after pregnancy. Symptoms of depression are:
-A low or sad mood.
-Loss of interest in fun activities.
-Changes in appetite, sleep, and energy.
-Problems thinking, concentrating, and making decisions.
-Feelings of worthlessness, shame, or guilt.
-Thoughts that life is not worth living.
Getting treatment is important for both mother and baby. If you have a history of depression, it is important to discuss this with your health care provider early in pregnancy so that a plan for management can be made.
5.Hypertension (High Blood Pressure):Chronic poorly-controlled high blood pressure before and during pregnancy puts a pregnant woman and her baby at risk for problems.The most important thing to do is to discuss blood pressure problems with your provider before you become pregnant so that appropriate treatment and control of your blood pressure occurs before pregnancy. Getting treatment for high blood pressure is important before, during, and after pregnancy.
6.Gestational Diabetes Mellitus (GDM):GDM is diagnosed during pregnancy and can lead to pregnancy complications. It is extremely important to keep your blood sugar level under control during pregnancy. Doing so is important because poorly controlled diabetes increases the risk of:
-Having a big baby which can complicate delivery.
-Having a baby born with low blood sugar, breathing problems, and jaundice.
7.Obesity and Weight Gain: Recent studies suggest that the heavier a woman is before she becomes pregnant, the greater her risk of pregnancy complications, including preeclampsia, GDM, stillbirth and cesarean delivery. Overweight and obese women who lose weight before pregnancy are likely to have healthier pregnancies.
8.Infections:During pregnancy, your baby is protected from many illnesses, like the common cold or a passing stomach bug. But some infections can be harmful to you, your baby, or both. Easy steps, such as hand washing, and avoiding certain foods, can help protect you from some infections.(3)
Pregnancy lasts about 40 weeks, counting from the first day of your last normal period. The weeks are grouped into three trimesters.
First trimester (week 1-week 12)
During the first trimester your body undergoes many changes. Hormonal changes affect almost every organ system in your body. These changes can trigger symptoms even in the very first weeks of pregnancy. Your period stopping is a clear sign that you are pregnant. Other changes may include:
oTender, swollen breasts. Your nipples might also stick out
oUpset stomach with or without throwing up (morning sickness)
oCravings or distaste for certain foods
oConstipation (trouble having bowel movements)
oNeed to pass urine more often
oWeight gain or loss
Second trimester (week 13-week 28)
You might notice that symptoms like nausea and fatigue are going away. But other new, more noticeable changes to your body are now happening. Your abdomen will expand as the baby continues to grow. And before this trimester is over, you will feel your baby beginning to move!
As your body changes to make room for your growing baby, you may have:
oBody aches, such as back, abdomen, groin, or thigh pain
oStretch marks on your abdomen, breasts, thighs, or buttocks
oDarkening of the skin around your nipples
oA line on the skin running from belly button to pubic hairline
oPatches of darker skin, usually over the cheeks, forehead, nose, or upper lip. Patches often match on both sides of the face. This is sometimes called the mask of pregnancy
oNumb or tingling hands, called carpal tunnel syndrome
oItching on the abdomen, palms, and soles of the feet
oSwelling of the ankles, fingers, and face
Third trimester (week 29-week 40)
Some new body changes you might notice in the third trimester include:
oShortness of breath
oSwelling of the ankles, fingers, and face
oTender breasts, which may leak a watery pre-milk
oYour belly button may stick out
oThe baby "dropping", or moving lower in your abdomen
oContractions, which can be a sign of real or false labor
As you near your due date, your cervix becomes thinner and softer. This is a normal, natural process that helps the birth canal (vagina) to open during the birthing process. Your doctor will check your progress with a vaginal exam as you near your due date. Look forward the final countdown has begun!(2)
(A) (B) (C)
Fig.2. Diagram of a fetus during the (A) First trimester (week 1-week 12), (B) Second trimester (week 13-week 28), (C) Third trimester (week 29-week 40).
It is important to eat the right kind of food for a healthy mother and the growing baby. Try to incorporate 6-7 small meals/snacks during the day; this will help with nausea, morning sickness and heartburn.
Generally, all food items can be classified into six major groups as shown in the Maternal Food Pyramid.(7)
Immediate Diet Plan
1. Include lots of fresh, seasonal, local and if possible organic Fruits and Vegetables in your daily diet.
2. Add plenty of Whole Grains such as whole wheat flour, brown rice, whole beans etc. to the diet.
3. Choose foods high in Good Fat such as olive oil, peanut oil, fatty fish, walnuts, flaxseeds. If you do not eat fish, talk to your doctor about taking fish supplements.
4. Include foods rich in Calcium, as this is an important nutrient for development of bones in the baby. Milk, yoghurt cheese, green cabbage, mustard greens, black eyed peas are some examples of calcium rich foods.
5. Your doctor might have already recommended folic acid supplements. But along with that, also include foods rich in Folate, an important nutrientduring pregnancy. Dark green leafy, vegetables, dairy products, meat, pulses and whole grains are rich sources of folate.
6. Rich sources of Iron such as meat, seafood, pulses, apples, dried figs and iron fortified foods should be part of the diet.
1. Say NO to all Sugary beverages and foods. Do not add any extra sugar to beverages like tea coffee etc. Especially important if one has gestational diabetes.
2. Refined ingredients like white rice, white flour, maida should be completely omitted from diets. Especially important if one has gestational diabetes.
3. Avoid combination of sugary and refined foods like cakes, pies, ice creams as they do the most harm. Especially important if one has gestational diabetes.
4. Avoid Unhealthy Fats such as Cholesterol, Saturated and Trans Fat. Stay away from egg yolks, cream, butter, ghee, coconut, deep fried items, whole milk, dalda, vanspati.
5. Slash down any intake of carbonated, caffeinated or alcoholic beverages.
6. Avoid spicy or acidic foods as they tend to increase heartburn.
7. During pregnancy, stay away from raw or undercooked meat and unpasteurized milk.
Sample Diet Plan
Below is a sample Diet Plan for a pregnant woman. Make sure to check the correct portion/serving sizes for each food item by going to these links.(8), (9)
Include a variety of foods in your diet and refrain from fasting. For cooking, try to use either Olive oil or peanut oil.
Eat Right and Don't forget to Exercise through your Pregnancy.