Question

Q1: . Discuss the types of contractions and its features in the first stage of labor ?

Q2:. Describe the nursing management of a woman with postpartum blues ?

Q3: Discuss the physical and psychological changes during postpartum period ?

Q4: Discuss the common discomforts during pregnancy and its management ?

Q5: Describe the possible newborn complications and its management ?

Answer 1

1: a) FALSE LABOR (BRAXTON-HICKS CONTRACTION)

Around your fourth month of pregnancy, you may start to notice your uterus contracting from time to time. This tightening is known as Braxton Hicks contraction.

They are usually infrequent and irregular. They are your body’s way of preparing the uterine muscles for delivery day.

What do they feel like?

These contractions…

• are generally painless
• are concentrated in your abdomen
• make your belly feel tight
• may be uncomfortable at times

Most important? They don’t get stronger, longer, or closer together. They also don’t cause changes to your cervix.

You may get these contractions when you’re tired, dehydrated, or on your feet too much. False labor will usually ease up if you change what you’re doing.

Before you call your doctor, try some of the following coping techniques to see if the contractions calm down or go away completely:

• drink plenty of water
• change positions (like from standing to sitting)
• stop what you’re doing and rest (preferably on your left side)

If you’ve tried these things and you’re still having frequent Braxton-Hicks contractions, it’s a good idea to call your doctor to rule out preterm labor.

b)PRE TERM LABOR

Regular contractions before 37 weeks may be a sign of premature labor.

The timing of regular contractions means that they follow a pattern. For example, if you’re getting a contraction every 10 to 12 minutes for over an hour, you may be in preterm labor.

During a contraction, your entire abdomen will get hard to the touch. Along with tightening in your uterus, you may feel:

• a dull backache
• pressure in your pelvis
• pressure in your abdomen
• cramping

These are signs that you should call your doctor, especially if they are accompanied by vaginal bleeding, diarrhea, or a gush of watery discharge (which may signal your water breaking).

Some risk factors for preterm labor include:

• multiples pregnancy (twins, triplets, etc.)
• abnormal conditions of the uterus, cervix, or placenta
• smoking or using drugs
• high stress levels
• history of preterm birth
• certain infections
• being under- or overweight before pregnancy
• not getting proper prenatal care

It’s important to pay attention to the duration and frequency of your contractions, as well as any secondary symptoms. You’ll need to provide this information to your doctor.

There are various treatments and drugs your medical team can use to try to stop labor from progressing.

1st stage of labor :

Unlike Braxton-Hicks contractions, once true labor contractions begin, they do not slow down or quiet with simple measures like drinking water and resting. Instead, they get longer, stronger, and closer together.

They’re working to dilate the cervix.

Early labor

Contractions at this stage are still somewhat mild. The tightening you’ll feel lasts anywhere from 30 to 90 seconds.

These contractions are organized, coming at regular intervals of time. They may start out spaced far apart, but by the time you’re nearing the end of early labor, they should be close to just five minutes apart.

During early labor, you may also notice other signs that help you realize it’s the real deal. As your cervix begins to open, you may see tinged discharge from your mucous plug, also known as the bloody show.

Your water may break as either a small trickle or a huge gush of fluid from your vagina.

2.Nursing interventions includes:

• Assist the woman in planning for her daily activities, such as her nutrition program, exercise, and sleep.
• Recommend support groups to the woman so she can have a system where she can share her feelings.
• Advise the woman to take some time for herself every day so she can have a break from her regular baby care.
• Encourage the woman to keep in touch with her social circle as they can also serve as her support system.

Evaluation

• The patient engages more in social activities.
• The patient can express her feelings and insecurities.
• The patient can perform her activities of daily living.
• The patient recognizes the importance of counseling and regularly attends one.

The psychological health of a mother has as much impact as well as her physical health. Her well-being must also be ensured because she is the number caregiver of the infant, and the bonding between mother and child would only be possible if both of them are in a state of good holistic health.

3.New mothers experience numerous psychological and physiological changes after the birth of a child. The most common psychological problems in new mothers during the postpartum period are depression, anxiety, and insomnia.

The term “postpartum depression” describes depression that persists or occurs after the tenth postpartum day and may extend to the first postpartum year . Women who report depression and depressive symptoms have higher rates of long-term adverse infant and child outcomes including developmental and cognitive impairments, low self-esteem, and self-regulation and temperament difficulties. Factors related to perinatal and postpartum depressive symptoms are well established and include a history of depression, perceived poor health, alcohol and cigarette use, unemployment, low socioeconomic status, young maternal age, being unmarried , and ethnicity minority status .

Anxiety disorders without the comorbidity of depression are particularly common in childbearing women , and the onset of many anxiety disorders is in early adulthood ,a time when many women are considering childbirth and motherhood .

New mothers commonly report insomnia, reduced sleep duration, and poor sleep quality. A longitudinal study of the effects of pregnancy on mother’s sleep conducted by Hedman and colleagues reported that sleep characteristics changed from the first trimester (increased deep sleep), through the second and third trimesters (progressively less total sleep), and the poorest sleep quality was reported during the first three months postpartum.

4.

Nausea and Vomiting

• Eat small frequent meals. Going too long without eating during pregnancy can cause nausea or make it worse. If you experience continuous nausea, eat every one to two hours.
• Avoid greasy, high-fat foods. They are more difficult to digest.
• Consume dry starch foods, such as crackers, toast or cereal, in the morning before you get out of bed. Also, it helps if you stay in bed for 20 minutes or so after eating and get up slowly from the bed for a sudden change of position can aggravate nausea.
• Drinking carbonated beverages as well as peppermint, spearmint and chamomile teas may help.
• Eat plenty of carbohydrate-rich foods such as cereal, fruit, bread and rice. They are easy to digest and provide energy.
• Take prenatal vitamins only as directed. If they cause stomach upset, ask your practitioner if you can delay taking them for a few weeks.
• Some foods, such as milk or tea, that are soothing to one woman may be upsetting to another. However, most women find cold foods and beverages easier to tolerate than hot ones.
• Eat a high-protein snack before bed to stabilize blood sugar.
• Limit your consumption of coffee. It stimulates acid secretion, which can make the nausea worse.
• Consume liquids separately from meals, waiting about 20 to 30 minutes.
• Wear sea sickness wrist bands. These can be found at most pharmacies.

Constipation

• Increase the amount of fiber in your diet, eating foods high in fiber such as fruits, raw vegetables, whole grain products, nuts and dried fruits. Choose a breakfast cereal that has at least 5 grams of fiber per serving. These foods help soften the stool and promote natural bowel activity.
• Drink a lot of fluids.
• Exercise, even walking, will help relieve constipation.
• Eat prunes or figs, or drink prune juice. These fruits contain a natural laxative.
• Avoid laxatives. If the problem is not resolved with the above suggestions, let your health care practitioner know. Stool softeners that are safe during pregnancy can be prescribed.
• Iron supplements can aggravate constipation — the prescription for iron can be adjusted if it becomes a problem.

Hemorrhoids

• To help avoid hemorrhoids, prevent constipation by maintaining a diet that is high in fluids and fiber.
• Witch hazel or Tucks pads can be applied to the hemorrhoid area to relieve symptoms.
• Avoid over-the-counter laxatives. If hard stools are aggravating hemorrhoids, stool softeners can be used, but first consult your practitioner for specific suggestions.

Fatigue

This is very common during the first trimester. Get as much sleep or rest as you can — even short naps will help. Your energy level will pick up after the first three months. However, fatigue and insomnia tend to recur in the last months of pregnancy. A warm bath, massage or hot drink before bed often helps you relax and get ready to sleep.

Breast Tenderness

Breast tenderness is most pronounced during the first three months. The breasts enlarge in size and can be quite tender. Wearing a good support bra may help you feel more comfortable.

Frequent Urination

Frequent urination is another pregnancy symptom that is most pronounced during the first trimester as well as the end of pregnancy. Do not restrict fluid intake in an effort to decrease the frequency of urination. As long as you do not experience burning or pain with urination, increased frequency is normal and will go away with time.

Leg Cramps

Cramps in your calf or thigh occur most frequently at night. One remedy may be to increase your intake of calcium. Ask your provider about a calcium supplement. While in bed, stretch with your heels pointed, not your toes. This will help relieve a cramp.

Heartburn

• Try eating smaller but more frequent meals.
• Avoid highly seasoned, rich and fatty foods.
• Do not lie down flat after eating. If you must lie down, elevate your head and shoulders with pillows.
• Carbonated beverages and milk often can help alleviate heartburn.
• Certain antacids are not recommended during pregnancy. Check with your health care provider before using over-the-counter antacid preparations.

Backache

Lower back pain is common during pregnancy. It is caused by the shift in posture necessitated by carrying extra weight in front.

• Try not to stand in one position for too long.
• An exercise called the pelvic rock will help alleviate back pain and strengthen the lower back muscles that experience the most stress.
• Elevating the feet onto a stool while sitting will help.

Dizziness

Dizziness or lightheadedness can be caused by low blood sugar or a sudden change of position. To help avoid this feeling:

• Move slowly when getting up from a sitting or lying position.
• Eat well and frequently. Women who are prone to low blood sugar should carry snacks at all times. Juices and fruit are particularly good choices.

Swelling of the Hands and Feet

Slight swelling of the hands and feet are common in the later stages of pregnancy. Adequate fluid intake is always important. Improve the circulation in your legs and feet by elevating them as often as possible. Lie on a bed or floor and raise your legs up on the wall keeping your knees bent. If you are wearing elastic hose, drain your legs this way before putting them on.

5.

The most common causes of neonatal deaths are preterm birth complications, newborn infections and birth asphyxia. They account for over 80% of all global neonatal deaths. A newborn baby who is born preterm or has a potentially life-threatening problem is in an emergency situation requiring immediate diagnosis and management. Delay in identification of the problem or in providing the correct management may be fatal.

Preterm and/or low birth weight infants need special care, including additional attention to breastfeeding and breast-milk feeding and to keeping them warm at home and in health facilities. Those with preterm birth complications, including respiratory problems, need appropriate treatment in hospitals.

Appropriate care during labour and childbirth combined with neonatal resuscitation, when needed, can substantially reduce mortality due to birth asphyxia. Newborns with severe asphyxia need post-resuscitation care in hospitals.

Early identification of newborn infections with prompt and appropriate antibiotic treatment will substantially reduce mortality due to newborn sepsis and pneumonia. Newborns with serious infections need intramuscular or intravenous antibiotics and supportive care in hospitals. Where hospital referral is not possible, intramuscular antibiotics delivered by skilled health-care providers will save lives.

Other common newborn problems are jaundice, eye infections and diarrhoea, which may be managed at health facilities or hospitals depending on their severity.