First prenatal care. Second prenatal care Prenatal care
In ensuring effective work on perinatal care of the fetus and newborn, a significant role belongs to medical workers of the primary health care service (hereinafter referred to as PHC) by conducting timely prenatal care for a pregnant woman.
1. Prenatal care is the conduct of mandatory preventive visits to a pregnant woman at home in addition to obstetric observations for the purpose of counseling, education, support and preparation of the expectant mother and her family members for the birth of a healthy child.
2. Prenatal care is carried out by a primary health care worker at the pregnant woman’s home twice:
1) immediately after receiving information about the registration of a pregnant woman;
2) at 32 weeks of pregnancy.
3. During a home visit to a pregnant woman, a medical worker gets to know the family of the unborn child and identifies risks that may affect the course of pregnancy and the quality of care for the unborn child, including creating a trusting relationship in order to prevent domestic violence.
4. A medical worker trains family members in order to develop the necessary knowledge and skills to ensure the health and well-being of the mother and fetus, both during the normal course of pregnancy and childbirth, and to develop a clear algorithm of behavior in the event of emergency obstetric conditions or the onset of labor.
5. Particular attention should be paid to pregnant women under 18 or over 35 years of age, who have given birth to more than four children (especially with a short birth interval), with a complicated obstetric history, as well as women with underweight or obesity, since they represent a group the risk of complications or the appearance of threatening signs.
6. During the first prenatal care, a medical worker determines the general condition of the pregnant woman, marital status, working and living conditions, the psychological climate in the family, the level of sanitary culture, bad habits, physical activity, occupational hazards, the presence of diseases (HIV, sexually transmitted infections, tuberculosis, rubella, etc.).
7. During the second prenatal visit, the health worker assesses the condition of the pregnant woman and the mammary glands. Gives recommendations on preparing for breastfeeding and invites a healthy child to visit the office for the purpose of teaching skills in feeding and caring for a newborn. In addition, recommendations are given on preparing a corner for a newborn (place, crib, linen, clothes and other care items).
8. During prenatal care, a medical worker gives advice to a pregnant woman:
1) to comply with the optimal regime of the day, rest, sleep, physical activity;
2) to maintain optimal nutrition;
3) on the preventive use of medications (iodine-containing, iron-containing/folic acid);
4) on the prevention of sexually transmitted infections, including HIV infection;
5) on maintaining personal hygiene and home improvement;
6) about the influence of tobacco smoking, alcohol and drug use on fetal development.
9. During prenatal visits, the health worker pays attention to:
1) compliance by the pregnant woman with the instructions of the obstetrician-gynecologist regarding the daily routine, diet, work, rest, care of the mammary glands, sanitary and hygienic regime and therapeutic and recreational measures;
2) identifying dangerous signs of pregnancy in order to take emergency measures, as well as training family members to recognize dangerous signs and seek emergency medical help.
10.Support and monitoring the pregnant woman’s implementation of recommendations and preparing the family for the birth of a child.
11. During prenatal care, a medical worker should pay attention to alarming signs that threaten the normal course of pregnancy and if one of them is present, the pregnant woman needs urgent medical care:
1) bleeding from the genital tract;
2) convulsions;
3) severe headache, abdominal pain, profuse and incessant vomiting;
It is carried out when a pregnant woman registers at the antenatal clinic within 8–13 weeks. The task of the first prenatal care is to introduce the district nurse to the expectant mother, talk with her about the importance, happiness and great responsibility of being a mother. During the first prenatal care, the district nurse must find out the state of health of the pregnant woman, find out how the pregnancy is progressing, and in what conditions the expectant mother lives and works. Patronage should be particularly scrupulous, striving to identify as accurately as possible all the circumstances that could have a harmful effect on the health of the unborn child. Particular attention should be paid to the possibility of toxic effects on the fetus due to maternal use of nicotine, alcohol and other toxic substances.
Depending on the nature of filling out documentation in children's clinics, files of prenatal visits or development histories of future patients are created. In order to most fully cover all the necessary issues and save the nurse’s time, special schemes are used to carry out prenatal care. When using any scheme, the nurse at the first prenatal care should give the pregnant woman the following advice:
· 1. Eliminate work hazards, if any.
· 2.Alternate work and home, work and rest.
· 3.Try to avoid conflict situations in the family and apartment.
· 4. Establish proper nutrition within the limits acceptable for a pregnant woman: raw and cooked vegetables, fruits, milk, cottage cheese, boiled meat, vitamins A, D, etc. as prescribed by the doctor.
· 5.Renovate the premises, purchase in a timely manner everything necessary for the newborn.
· 6. If there are Tbc patients in the family, think about where the mother and child will be for the first two months after discharge from the maternity hospital.
Second antenatal care
The district nurse performs the second prenatal visitation during the pregnant woman’s maternity leave at 31–32 weeks.
Local pediatricians provide prenatal care for pregnant women with severe extragenital pathology, toxicosis, and also in the presence of other indications.
The main goal of the second prenatal care for a pregnant woman is to monitor the implementation of the antenatal clinic doctor’s orders and recommendations given by the nurse at the children’s clinic during the first visit and at the school for expectant mothers.
During the second prenatal care, they find out the well-being of the pregnant woman, whether she has been transferred, if necessary, to light work, and the timing of maternity leave. During the second prenatal care, care for the unborn child is already evident: this includes preparing the mother’s mammary glands for lactation, organizing a corner for the newborn, preparing linen, clothes for him, etc. The address where the mother and child will live is being specified.
Third antenatal care
The third prenatal care is carried out by a local nurse or a local pediatrician, depending on the circumstances. Indications for this patronage are severe somatic pathology of the pregnant woman, poor obstetric history, severe toxicosis of the pregnant woman, as well as unfavorable social and living conditions. The head nurse of the antenatal clinic reports such patients to the children's clinic. In addition, indications for the third antenatal visit are formed on the basis of a study of previous antenatal visits performed by the district nurse. The third prenatal care is purely individual, and therefore is carried out according to an individual scheme for each case.
Based on the results of prenatal visits, the local pediatrician determines the “risk” group among pregnant women, i.e. identifies a contingent of expectant mothers whose children will need to be under especially close attention of the local doctor and doctors of relevant specialties. The “risk” group, of course, should include extragenital diseases of the expectant mother, occupational hazards and alcoholism of parents, acute diseases and surgical interventions during pregnancy, the age of the mother at the time of birth of the child is younger than 18 and older than 30 years (fertile age, according to WHO, from 14 to 49), toxicosis of the first and second half of pregnancy, threat of miscarriage, bleeding, increase or decrease in blood pressure during pregnancy, i.e. factors the presence of which will determine the distribution of children into health groups.
The main tasks of the KZR are(Regulation No. 8 to the order of the USSR Ministry of Health No. 60 dated January 19, 1983):
· promoting a healthy lifestyle in the family;
· training parents in the basic rules of raising young children (regime, nutrition, physical education, hygienic care);
· health education of parents on the issues of hygienic education of children, disease prevention, preparation for admission to preschool education;
· control over children's academic development.
The responsibilities of the KZR nurse include:
· admission of children of the 1st year of life at least 5 times a year, of the 2nd year of life - at least 4 times a year, of the 3rd year of life - at least once every six months, over 3 years of age - once once a year;
· in accordance with doctor's prescriptions:
§ a) consultation of the mother on issues of raising and protecting the health of the child,
§ b) teaching the mother how to conduct massage and gymnastics,
§ c) carrying out control feeding, performing nutrition calculations,
§ d) fulfilling doctor’s prescriptions for the prevention of rickets,
§ f) diagnosing children with mental retardation.
· training parents in the methods and features of feeding;
· coverage of issues related to the prevention of bad habits;
· training in oral hygiene techniques;
· providing parents with teaching materials;
· consultation with district nurses on the issues of education and development of children, physical education and hardening of children, diagnosis of children’s developmental disabilities;
· assisting the local doctor in conducting classes for pregnant women, at school for a young family;
· participation in preparing children for admission to preschool education;
· maintaining constant communication with the local pediatric service;
· maintaining in the history of the child’s development f.112/u - an insert-card for visiting the KZR;
· arrangement of stands and exhibitions on the organization of living conditions, development and upbringing of children in the waiting room of the KZR;
· distribution of new teaching materials on health education issues.
Medical documentation KZR
1. Registration form No. 112/u - insert card for visiting the office for raising a healthy child.
2. Registration form No. 039/у - doctor’s working time sheet.
3. Registration form No. 038/у - nurse’s time sheet.
KZR equipment
Equipment for a healthy child’s office and necessary teaching materials:
| No. | Name of equipment (equipment) | Amount |
| 1. | Table | |
| 2. | Chair | |
| 3. | Electronic scales for children under one year old | |
| 4. | Scales | |
| 5. | Equipment for infrared therapy | |
| 6. | Germicidal air irradiator | |
| 7. | Aids for assessing the psychophysical development of a child | on demand |
| 8. | Stethoscope | |
| 9. | Medical thermometer | |
| 10. | Blood pressure tonometer with cuff for children up to one year old | |
| 11. | Putty knife | on demand |
| 12. | Changing table | |
| 13. | Massage table | |
| 14. | Container for collecting household and medical waste | |
| 15. | Container for disinfectants | on demand |
Examination of a newborn baby
Period newborns- one of the most important periods of childhood. This is the period of adaptation of the child to new living conditions. Providing optimal care during the neonatal period newborn, improving methods of diagnosis and treatment of already existing diseases is necessary for the formation of health in all subsequent years.
General newborn examination has great diagnostic value. During inspection The doctor gets a general idea of the child’s health, his development, and promptly identifies possible deviations.
If child If he is sleeping, you should not wake him up at the beginning of the examination. This will make your heart rate and breathing data more accurate.
To count breathing, the doctor brings the phonendoscope to the nose. baby and records the time. The respiratory rate is calculated in one minute, due to irregular breathing and periodic stops - apnea. The average respiratory rate is 40 per minute during sleep and 60 during wakefulness.
The examination is carried out on a semi-rigid changing table, at an ambient temperature of at least 22 degrees Celsius.
Newborn are examined no earlier than an hour after feeding, which allows you to create comfortable conditions for the child and carry out a thorough examination.
With warm hands and careful movements they completely undress him.
Bye child calm, examine the cardiac region. The apex beat is palpable. Auscultation of the heart is carried out according to a generally accepted method, at typical points. Heart sounds are clear and rhythmic. Quite often, a short systolic murmur is heard in the region of the heart, due to the development of hemodynamics.
Heart rate newborn is approximately 140 beats per minute.
The lungs are heard in symmetrical areas on both sides along the anterior and lateral surfaces. Breathing newborn vesicular, somewhat weakened. Breathing is then heard over the posterior surface.
The abdomen has a rounded shape and actively participates in the act of breathing. During quiet wakefulness, the abdominal organs are palpated. The anterior abdominal wall is elastic and elastic, the abdomen is soft.
The edge of the liver is palpated along the midclavicular line. Protrudes from under the costal arch by 1-1.5 centimeters.
The spleen is identified in the left hypochondrium - normally it is not palpable.
The condition of the umbilical wound is assessed, which heals by the end of the second week of life. The umbilical veins and umbilical arteries are not normally palpable.
The skin is examined in detail. Palpation of the skin is carried out in different areas. Skin coloring newborn bright pink due to the thin epidermis and a well-defined network of capillaries. The skin is examined sequentially from top to bottom. Be especially careful behind the ears, in the folds of the neck, in the armpits, and in the groin areas - where diaper rash can develop.
Skin feel newborn soft, elastic, velvety. Physiological erythema disappears by the end of the first week of life.
The elasticity of the skin is checked: when you try to collect it, the fold instantly straightens out.
The development of subcutaneous fat is checked visually and by palpation on the limbs, on the abdomen and under the shoulder blades.
Soft tissue turgor is checked by feeling resistance when compressed on the inner surface of the shoulder and thigh.
INDEPENDENT WORK OF STUDENTS:
1. Work in the office of a local pediatrician. Rules for drawing up a form for the first patronage of a newborn.
Assignment for independent work:
1. Conducting the first prenatal care (together with the patronage nurse)
Prenatal care
Patronage is especially widely carried out in institutions for the protection of mothers and children. Patronage is carried out by doctors, district (patronage) nurses of children's clinics and rural medical stations, paramedics and midwives of antenatal clinics and feldsher-obstetric stations.
During pregnancy, a woman should be observed in a antenatal clinic or at a feldsher-midwife station; during its physiological course, a woman should visit an obstetrician-gynecologist on average 14 times.
Visit these institutions once a month until the 21st week of pregnancy, then twice a month until the 33rd week, then every week thereafter. When a pregnant woman visits a antenatal clinic, the doctor and midwife have the opportunity to assess her condition based on the dynamics of body weight gain, blood pressure levels, urine tests, etc.
The condition of the fetus is judged by ultrasound and other special studies.
First visit to a pregnant woman
The midwife usually spends the first half of pregnancy; during the second visit (in the second half of pregnancy), she checks the implementation of these recommendations, asks the pregnant woman about her state of health, and explains what needs to be prepared for the newborn.
Goals of the first prenatal care: establish contact between the children's clinic and the expectant mother, get acquainted with the living conditions of the unborn child, assess the social status of the family, its psychological climate, the hygienic condition of the apartment, find out the state of the mother's health, pay attention to heredity, the presence of bad habits
If there are deviations from the norm during pregnancy, visits should be more frequent. The midwife should visit the pregnant woman at home twice in order to familiarize herself with her living conditions, conduct a conversation about antenatal care of the fetus, personal hygiene (preparing the nipples of the mammary glands for feeding the baby, using a prenatal bandage). In addition, the midwife explains some laws and government regulations to protect women's rights and health. When a somatic or obstetric pathology is detected, the frequency of visits increases. If a woman comes to the antenatal clinic irregularly or does not visit the doctor on time, especially if there is a pregnancy pathology, the midwife provides patronage, i.e. visits her at home, finds out the reason for her absence, measures her blood pressure and invites her to see a doctor. Patronage is also carried out if a woman refuses hospitalization. In this case, the doctor or midwife explains to the woman or her close relatives the danger that violations in the health of the woman and the fetus can lead to, and also reminds them of the responsibility for refusing hospitalization.
Prenatal care for pregnant women is also provided by nurses at the children's clinic. Information about pregnant women in the children's clinic comes from the antenatal clinic. The nurse visits the pregnant woman twice: the first time within 10 days after receiving information about her from the antenatal clinic, the second time - at the 31-32nd week of pregnancy.
Pregnant women infected with HIV are observed by an obstetrician-gynecologist at the antenatal clinic together with an infectious disease specialist, who prescribes courses of appropriate therapy in consultation with the territorial center for the prevention and control of AIDS and determines the hospital for delivery.
Tasks of the first patronage:
1.Identification of risk factors (collection and assessment of genealogical, biological and social history data);
2. Forecast of the health and development of the unborn child (risk group); carrying out prognosis and prevention of hypogalactia;
3. Informing the pregnant woman about the identified risk in the unborn child;
5. Hygienic training and education of future parents (promotion of a healthy lifestyle, a positive psychological attitude towards the birth of a child, formation of motivation for long-term breastfeeding, attending classes at the school of future parents);
6. Determination of the period of the second prenatal care.
During the first prenatal care, all unfavorable factors that can negatively affect the fetus are identified, and an action plan to protect the fetus is drawn up. A pregnant woman who has identified risk factors is registered for control, monitoring and assistance.
The following risk groups for pregnant women are conventionally identified:
1. Women under 18 years of age and primigravidas over 30 years of age;
2. Women with a body weight of less than 45 kg or more than 91 kg;
3. Women with more than 5 pregnancies and women with multiple pregnancies;
4. Women with a threat of miscarriage (having a history of premature or post-term pregnancies);
5. Women with a burdened obstetric history (abortions, miscarriages, stillbirths, narrow pelvis, uterine malformations, uterine scars.);
6. Women with extragenital pathology (diabetes mellitus, bronchial asthma, chronic pyelonephritis, heart defects);
7. Women with social risk factors.
During the first visit, the midwife gets acquainted with the living conditions and sanitary condition of the pregnant woman’s home, and, if possible, finds out the nature of the relationships in the family. During patronage, it is important to continue the health education work begun by the doctor, to tell the pregnant woman and her family members about the need to observe the rules of personal hygiene, good nutrition, and regular visits to the doctor.
The second prenatal care is carried out at the 32nd week of pregnancy.
Purpose of second patronage- check how the previous prescriptions and recommendations are being carried out by the antenatal clinic doctor and pediatrician, how the family is prepared for the birth of a child, whether there is everything necessary to care for the newborn, as well as preparation for the postpartum period.
Particular attention is paid to visiting a pregnant school for young mothers and classes on psychoprophylactic preparation for childbirth. Also, at 32 weeks of pregnancy and before childbirth, patronage of women is carried out by the nursing staff of the children's clinic. The doctor is obliged to ensure the timely transfer of information about registered pregnant women to the district children's clinic.
The objectives of the second patronage are:
1. Reassessment of risk factors and direction (obtaining information about the course of pregnancy, previous diseases, the use of medications, changes in working conditions, living conditions, clarification of the expected due date);
2. Monitoring the implementation of previous prescriptions and their effectiveness;
4. Hygienic training and education of future parents (preparing the mammary glands for lactation, preparing the family to welcome a newborn).
5. Briefing includes issues such as:
Organization of an area for child care (places for dressing and changing, clean clothes and linen, bathing, baby first aid kit) and a sleeping area (crib), where a newborn can be safely placed;
Purchasing a dowry for a newborn;
Purchasing a first aid kit for mother and child
Information about telephone numbers of the clinic and pediatric emergency care;
Conversations with the expectant mother and other family members about the needs of the newborn and ways to meet them.
Third patronage
Another visit can be made to the pregnant woman by the local pediatrician. This visit is optional and is scheduled on a strictly individual basis. As a rule, a doctor comes if the pregnancy is complicated and there is a risk of having a child with developmental pathologies or congenital diseases. Increased attention is also paid to disadvantaged families. The need for a third visit is determined by analyzing the information obtained after the previous two visits. Based on the results of the visit to the future parent, the doctor raises the question of the need to register the family. Moreover, after birth, the baby and his mother will be under the close attention of a pediatrician and other specialists.
Newborn patronage
Patronage of a newborn child during the first month of life is carried out by a pediatrician and a pediatric nurse. The first visit to a newborn is carried out by a pediatrician.
If the baby develops normally, is healthy and grows in a favorable atmosphere, visits from the staff of the children's clinic are carried out in the following way:
· first visit – 1-3 days after discharge from the maternity hospital
Second visit - 10th day after discharge from the hospital
· from 1 year to 3 years – once every 3 months
If there were complications at the birth of the child and there are problems with his health, then the nurse comes more often.
The purpose of such patronage consists of assisting the mother in organizing and caring for the newborn. It is important to teach her how to properly perform baby care procedures. During primary care of a newborn, the nurse receives from the doctor a number of specific instructions on the specifics of monitoring this child. When the child is one month old, mother and child are invited to visit the local pediatrician at the clinic.
The visiting nurse also pays attention to the conditions in which the child is:
· availability of a baby cot;
· clean linen;
· daily wet cleaning in the children's room;
· ventilation of the room;
· air temperature in the room;
· living conditions;
· presence of pets and other potential allergens.
The patronage nurse assesses the neuropsychological development (NPD) of the newborn, focusing on a number of indicators:
At ten days: visual analyzer - the child keeps a moving object in his field of vision (step tracking);
At 18-20 days: visual analyzer - the child holds a stationary object in his field of vision; auditory analyzer - the child calms down with a strong sound;
At one month: visual analyzer - the child focuses his gaze on stationary objects, watches a moving object (smooth tracking); auditory analyzer - the child listens to the sound, voice of an adult; general movements - the child, lying on his stomach, tries to raise and hold his head; emotions - the first smile in response to an adult’s conversation; active speech - the child makes individual sounds in response to a conversation with him.
You can select three main tasks who provide primary care for newborns:
1. Examination of the baby
The nurse examines the newborn’s tummy, fontanel, and umbilical wound, and treats it if necessary. The nurse’s task during patronage rounds is to study the living conditions of the baby, his medical examination, during which the condition of the skin, mucous membranes, reflexes, breathing, and sucking activity are assessed. As the child is examined, the course of pregnancy and childbirth is clarified and the discharge summary is studied.
2. Examination of the baby's mother
After a thorough and detailed examination of the baby, the nurse (or doctor) of the district clinic should examine the mother. The nurse examines the mammary glands of a nursing mother and asks questions about her health, well-being, and nutrition. Gives recommendations regarding nutrition, hygiene, and routine. A nursing woman must adhere to a certain diet, which must be properly balanced and not include allergenic foods. A set of products for mom includes lean meat or fish, raw vegetables, fruits, milk or kefir, a small piece of cheese, one egg. Oatmeal and buckwheat porridge are recommended. It is necessary to minimize salt intake. When edema occurs, the amount of fluid decreases.
The nurse gives recommendations to the child’s parents on feeding the child, caring for him, teaches the mother how to perform the child’s daily toilet, which consists of washing, treating and cleaning the baby’s eyes, ears and nose, and bathing. Swimming is done every evening, at a water temperature of 36-37 degrees. After bathing, treat the umbilical wound with hydrogen peroxide. It is also necessary to trim your newborn’s nails as needed. It is necessary to communicate with him more often, take him in your arms, and cradle him. Tactile sensations are very important for a newborn; he actively responds to stroking, calms down, and smiles. The nurse gives recommendations on feeding, physical and neuropsychic education of the child, massage, hardening, developing hygiene skills, and preventing rickets. Physical education of children in the first year of life includes massage, gymnastics, and hardening. During a home visit, the district nurse monitors the correctness of such procedures. All data obtained during such visits is recorded in the child’s developmental history. It is important that gymnastics and massage are carried out systematically with gradual complication of exercises and massage techniques. Having completed all the necessary procedures, the nurse ends the primary care of newborns. On the second visit, she checks how correctly all recommendations for caring for a newborn are followed.
The Healthy Child Room (CHO) of the children's clinic is a methodological center where all materials on child care and education are collected, intended for both medical workers and parents. The nurse can participate in conducting preventive examinations in the pediatric area and in the clinical care center, helping to increase the efficiency of the pre-medical stage. By monthly assessing the child's mental retardation, the nurse can give parents recommendations on how to stimulate the child.
Basic requirements for caring for newborns at home.
1. Daily toilet. Toileting the skin, mucous membranes, umbilical wound, and washing the baby is carried out according to the same rules as in the newborn ward of the maternity hospital. The oral cavity is treated only in case of thrush. Nails are trimmed with small scissors with blunt ends, pre-treated with 96° alcohol.
2. Swaddling. At the request of parents, you can use blouses and rompers from the first days of life. But if they decide to swaddle the child, the method of free and wide swaddling is used. The essence of free swaddling is to dress the child from the first days of life in a thin vest, and on top of it - a blouse with sewn-up sleeves. At the same time, the child’s hands remain free, the range of their movements increases, which has a beneficial effect on neuropsychic development, as well as respiratory function. Wide swaddling is necessary for the correct formation of the hip joints. With this method, the hips are moved apart and conditions are created for the correct formation of the hip joints.
3. Bathing. Up to 6 months - daily, then you can bathe every other day. The water temperature should be 37-37.5°C, the bath duration should be 5-7 minutes.
Body wash soap is used 1-2 times a week, the perineal area is washed with soap daily.
4. Walks in the open air. In the summer they begin immediately after discharge from the hospital. The duration of the first walk is 15-20 minutes, then the stay on the street is increased by 10-20 minutes daily. In spring and autumn, the duration of the walk is reduced to 10-15 minutes and the duration of stay in the fresh air increases more slowly. In winter, the outdoor schedule is set individually, taking into account the climate, health status and characteristics of the child.
Sanitary and hygienic requirements:
Wet cleaning is carried out 1-2 times a day and it is necessary to ventilate the baby’s room 3-4 times a day. While the room is being cleaned and ventilated, the child must be moved to another room.
Parents must strictly observe the rules of personal hygiene: take a shower regularly, wash their hands before contacting the child, and often change the clothes in which the baby is cared for.
The child’s underwear should be stored and washed separately, and after washing it should be ironed on both sides. Baby soap is used for washing. If possible, it is necessary to limit visits to relatives and friends.
Remove carpets and other objects in which dust accumulates (heavy curtains, sofa cushions, soft toys, etc.) from the child’s room.
Temperature maintenance
1. The ambient temperature should be such that the baby is comfortable and warm. Usually it is 22-24°C. The first sign of cooling is a coldness of the nose, as well as the palms and feet.
2. If the child cools down quickly, additional heating is required when swaddling and toileting the baby. You need to swaddle your baby in warm diapers, as quickly as possible.
Pregnancy changes a lot in a woman's life. Unplanned conception, unfortunately, ends in abortion. Another thing is a desired pregnancy. It marks a new stage in life, troubles, worries and positive thinking. The word “I” ends, the long-awaited “We” appears.
The new state imposes some obligations. The first thing you need to do is register for pregnancy at the hospital. In this article we will tell you what prenatal care for a pregnant woman is by a pediatrician.
Registration
The woman is sent to the antenatal clinic at her place of residence. Contacts the local obstetrician-gynecologist. The doctor creates an individual card where he enters all the necessary data. Duration of pregnancy, examination, condition of the pregnant woman’s organs and her complaints, if any, and tests.
After 28 weeks of pregnancy, a woman receives an exchange card. This is the main document of the expectant mother. Here are the test results and the specifics of the pregnancy. It is a reflection of the pregnant woman’s individual chart. Mommy goes with her to the maternity hospital.
Why do you need to go to an antenatal clinic? To know that the pregnancy is progressing normally and, if necessary, to take action in advance if problems arise. Take an exchange card from which any doctor (in a antenatal clinic, hospital, maternity hospital) will receive the necessary information. Get medical advice on a healthy lifestyle, nutrition, in order to give birth to a healthy child. From this moment on, mommy should visit a gynecologist at regular intervals.
Patronage for a pregnant woman
From the moment you contact the antenatal clinic, a process begins that is called: prenatal patronage for a pregnant woman. This is a very important and necessary step. The obstetrician-gynecologist transmits information about the new baby to the children's clinic for further observation by a pediatrician.
The doctor and nurse also create a personal card and register the woman for further observation.
A local pediatric nurse should visit your home within 10 days. Her goal is to collect all the information about the woman and conduct a conversation.
Prenatal care is divided into terms:
- From the moment of treatment (6-7 weeks) to 30 weeks of pregnancy
- From 31 to 38 weeks of pregnancy.
At the first stage, it is important to establish psychological contact with a health worker. This will help collect a better medical history and more accurately identify prenatal risk factors.
They include three areas:
- social plan,
- obstetrics and gynecology
- other maternal illnesses.
The bad habits of parents, the presence of previous miscarriages in a woman, abortions, and toxicosis must be taken into account.
To assess risks, a scale of prenatal factors is used. If the calculation results in -10 points, then this is a high-risk group; the doctor must take action and develop a plan to eliminate risk factors for pregnancy. With a total score of 5 to 9 points, the risk is average, and 4 is a low level.
Also at increased risk are pregnant women under 20 years of age. Women who have their first birth over 30 years of age, mothers of many children, with multiple births, single.
They pay attention to hereditary burden, family climate and whether the pregnancy was desired. The nurse invites parents to attend the “School for Young Mothers.”
Everything that the nurse managed to collect is recorded in a special history of the child’s development. The pediatrician studies them and gives his recommendations.
The second period of prenatal care by a pediatrician begins from 31-38 weeks of pregnancy, when the woman goes on maternity leave. There are other goals and objectives here. The main thing is preparation for childbirth and the postpartum period.
It is important to collect data on the course of pregnancy, previous diseases and health status. The pediatrician should also monitor how her recommendations were followed. Calculate risk factors again according to the accepted scale.
Teach the expectant mother to care for the mammary glands, prepare for breastfeeding and talk about the prevention of mastitis. Organize a corner for a newborn, pick up a first aid kit.
Interesting observations: New Zealand scientists have concluded that giving birth with a midwife is more dangerous than with a doctor. Complications during childbirth occurred much less frequently in those pregnant women who received prenatal care from a family doctor or an experienced obstetrician-gynecologist.
What questions should a pregnant woman worry about?
Often women are unaware of the existing risks for themselves and their unborn child. Nursing staff may not pay attention to these things. However, they exist and cause many problems.
The nurse may miss such a dangerous disease for pregnant women as (varicose veins). Pathology can worsen placental circulation. May be complicated by thrombophlebitis and external bleeding during childbirth. The main preventive measure is compression therapy. A doctor or an experienced nurse will introduce you to her. Therapy may include topical ointments and gels.
Some regions have iodine deficiency. The doctor’s task is to conduct a conversation and recommend iodized salt to the pregnant woman. Each region has its own doses.
The mandatory list of tests may not include genetic testing. If there is such a threat (hereditary pathology), then it must be carried out. Vitamin therapy is an excellent preventive measure. Vitamins with a high content of folic acid reduce such risks.
The pregnancy monitoring period includes an ultrasound. It should be carried out at 9-11 weeks and at 16-21 weeks. Sometimes it is given to women for free.
Patronage for pregnant women consists of providing a pregnant woman with general information about pregnancy, possible problems she may encounter, the need for hygiene, nutrition, physical activity, as well as the need to visit an antenatal clinic in order to get a doctor’s advice and make sure that the pregnancy is going well and the unborn child is healthy. Patronage for pregnant women in a certain way prepares the expectant mother for the worries and problems that she will face after the birth of the child.
What is patronage for pregnant women?
The main patronage is provided for pregnant women who are about to experience the joys of motherhood for the first time and have absolutely no experience in this matter. Responsibility for caring for a pregnant woman falls on the shoulders of the nurse from the antenatal clinic where the expectant mother is registered. It is the nurse who conveys to the young mother the basic information that she will need to encounter in the future, and for this she must approach this matter with responsibility and understanding of the importance of this information for an inexperienced mother. The obstetrician-gynecologist gives basic recommendations and information to the nurse.
What are the responsibilities of a nurse providing patronage to pregnant women?
- First of all, the nurse providing patronage to a pregnant woman must establish contact with the woman herself, who is preparing to soon become a mother and her family, because further communication and implementation of recommendations by the young family depends on this. The nurse must establish herself as a specialist and pro in this matter, so that the family does not have the slightest doubt about her work. Recommendations should not be voiced in a demonstrative tone; it will be better if they are followed as advice.
- The nurse must inspect the living space of the family in which a new addition is expected, make sure that there are suitable living conditions and further upbringing of the child. If, in the opinion of the nurse, some points do not meet the requirements, then she is obliged to convey this to the future parents.
- The main task of the nurse providing patronage to a pregnant woman is to bring to their attention, by involving all family members, information about the appropriate conditions of stay for a pregnant woman, about her environment, which can affect the health and development of the unborn child.
The main goal of patronage for pregnant women is to reduce the incidence of premature births, the birth of children with pathologies, and to minimize diseases that may appear after the birth of a child.
When caring for a pregnant woman, it is assumed that a registration card must be created, which must contain a questionnaire filled out by a nurse. This card will accompany the woman throughout her pregnancy; data and notes on the course of pregnancy, and then childbirth, will be entered into it.
When the nurse has provided patronage to the pregnant woman and completed the basic tasks of preparing her for the process of childbirth, caring for and raising the unborn child, she transfers the patronage to the doctor who is observing the pregnant woman. The doctor is obliged to give the nurse further instructions on the patronage of the pregnant woman and set a date for her next visit. The doctor can also remove a pregnant woman from patronage, but only if she regularly attends the antenatal clinic, has perfectly understood and complies with all the recommendations and advice received during patronage, or the conclusion of the examinations indicates that the woman does not need further patronage.
Removing from patronage a pregnant woman who ignores the recommendations and prescriptions of the doctor and nurse, and does not attend the antenatal clinic, is considered inappropriate, since practice shows that these are the women who are in greater need of help and support. In this case, it is recommended that the first visit be carried out by a doctor, which will help lay a solid foundation for future cooperation between the expectant mother and the nurse. During the entire pregnancy, patronage can be carried out up to three times, and if necessary, more.
Consequences of lack of patronage for pregnant women
There are cases when, for one reason or another, a pregnant woman did not receive the necessary information and answers to her questions. This could be due to the fact that she did not take her situation responsibly, did not consider it necessary to waste time on examinations by doctors, or simply that in the antenatal clinic where she was registered, patronage was not provided or was carried out inappropriately. Due to these and many other reasons, after the birth of a child, a woman finds herself completely unaware of the issues that concern her now. Therefore, in maternity hospitals, patronage of postpartum women can also be carried out, but without prior mastery of patronage for pregnant women, it will be quite difficult for a woman who has given birth to a child.
After the birth of a child, first of all, patronage is provided for women who suffer from diseases after childbirth, which the doctors in the maternity hospital did not have time to identify. Patronage also extends to women in labor whose body temperature exceeds the required values, and the process is not localized. First of all, women who have been diagnosed with these problems should visit an antenatal clinic as soon as possible. The doctor will help a woman who has recently become a mother identify diseases, prescribe the necessary treatment, which contributes to the treatment of chronic diseases, the spread of infection that was introduced during childbirth, inflammatory processes of the genital tract, which, if not properly treated, can lead to serious problems associated with women's health.
When planning a pregnancy for a young mother, you need to understand the responsibility she bears for the unborn child, as well as the fact that the child’s health directly depends on her lifestyle and attentive attitude to her health. By registering with the antenatal clinic in a timely manner, a pregnant woman will not only be able to ensure the healthy development of the fetus, but also receive prenatal care that can fully prepare her for future childbirth and the problems that she may encounter in the future. You should not refuse prenatal care, because it is in the interests of the expectant mother.
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