Chapter 8: Nursing Care During Pregnancy

Nursing Care During Pregnancy begins by outlining the diagnostic process, distinguishing between subjective presumptive signs, objective probable signs, and definitive positive signs—such as fetal heart tone detection and ultrasound visualization—that confirm the presence of a fetus. Determining the estimated date of birth is explored through methods like the Naegele rule and first-trimester ultrasound measurements, emphasizing that accurate dating is vital for clinical decision-making and monitoring fetal growth. The narrative extensively covers maternal adaptation, highlighting the complex social and cognitive learning required to attain the mother role, alongside the three distinct phases of establishing a relationship with the unborn child. Parallel to this, partner adaptation is examined through developmental phases—announcement, moratorium, and focusing—while also addressing the unique emotional and adjustment needs of siblings and grandparents. Clinical care is detailed from the intensive initial prenatal visit, which includes a thorough obstetric history using the GTPAL system and baseline physical assessments, to subsequent follow-up visits that monitor fundal height, fetal well-being, and maternal physiological changes. Critical health promotion topics include nutritional counseling, safe exercise parameters, the prevention of supine hypotension through proper positioning, and the importance of oral health and immunizations like Tdap and the influenza vaccine. The chapter also addresses specialized care for diverse populations, including LGBTQIA couples, adolescents, and those of advanced maternal age, while managing the increased risks associated with multifetal gestations. Finally, it reviews options for perinatal education, the role of labor doulas, and the creation of birth plans within various settings such as hospitals, birthing centers, or the home environment.