Preconception Care Is the Promotion of the Health and Well-Being of a Woman and Her Partner

Chapter12

■■■ Key Concepts

•Preconception care is the promotion of the health and well-being of a woman and her partner before pregnancy. The goal of preconception care is to identify health problems, lifestyle practices, or social concerns that might unfavourably affect pregnancy.

•A primary aspect of nursing management during the antepartum period is educating and counselling the pregnant woman and her partner to promote healthy outcomes for all involved.

•The nurse needs to maximize opportunities for health promotion during pregnancy. The nurse can help women and family members make sense of the information that is currently available.

•Women who have prenatal care, do not live in poverty, and are more educated are more likely to have successful pregnancy outcomes. For women who experience health inequities,the nurse’s role may be that of an advocate for needed programs and services.

•A thorough history and physical examination are performed on the initial prenatal visit.

•Symphysis–fundal height is measured when the uterus arises out of the pelvis to evaluate fetal growth; the fundus reaches the level of the umbilicus at approximately 20 weeks.

•Symphysis–fundal height should approximately equal the number of weeks of gestation until week 36.

•Prenatal screening has become standard in prenatal care to detect NTDs and genetic abnormalities.

•All pregnant women need to be able to recognize warning signs in pregnancy so that they can take appropriate action and contact their maternity care provider.

•At each visit the woman is asked whether she is having any symptoms of preterm labour, which include uterine contractions, dull backache, pressure in the pelvic area or thighs, increased vaginal discharge, menstrual-like cramps, and vaginal bleeding.

•The nurse should address common discomforts that occur in each trimester and provide realistic suggestions to promote comfort for the woman.

•The pregnant woman can better care for herself and the fetus if she has the opportunity to ask questions and if anticipatory guidance is incorporated into each prenatal visit.

•Since pregnancy is an opportunity for health promotion, nutritional assessment, nutritional information (such as Canada’s Food Guide), and sometimes referral to a nutritionist are recommended.

•The recommended weight gain during pregnancy depends on the woman’s pregnant BMI.

•Iron and folic acid supplementation is needed during pregnancy because the increased requirements at this time are usually too great to be met through diet alone.

•Pregnancy may be an opportunity for smoking cessation, and the nurse should ask about smoking, advise or strongly urge pregnant women to quit, assess their willingness to make a quit attempt, assist women with quitting, and arrange follow-up as needed (the five A’s).

•The focus of perinatal education has broadened to include preparation for pregnancy and family adaptation to parenting.

•Childbirth education began because of increasing pressure from consumers who wanted to become more involved in their birthing experience. The four childbirth education approaches currently available in Canada are Lamaze (psychoprophylactic), Bradley (partner-coached childbirth), HypnoBirthing, and Birthing From Within.

•The great majority of women in Canada are healthy and can consider the full range of birth settings: hospital, birth centre, or home setting.

•Pregnancy, childbirth, and early parenting are important transitions for families. To provide culturally competent nursing care the nurse needs to remain open to learning about many cultural beliefs, values, and practices and advocate for woman- and family-centred, culturally safe maternity care.