Personal Hygiene and Activity Modification During Pregnancy

PERSONAL HYGIENE AND CARE DURING PREGNANCY

Your knowledge about personal hygiene and care of the pregnant patient will help to make her feel comfortable with her own body and less anxious about the effects of external substances on her developing fetus. Some modifications of certain activities may be required. This lesson will cover health concepts, which should be taught to the pregnant patient so that she may be able to enjoy her pregnancy to the fullest while still providing care for a healthy baby.

As a practical nurse, you have the opportunity to assist the expectant mother in attaining healthier pattern of living and to reinforce health-promoting behaviors. Skin care, hair care, breast care, dental care, bowel elimination, vaginal douching, and clothing are all important to the pregnant patient.

Skin Care

The glands of the skin may be more active during pregnancy and the patient may tend to perspire more. Frequent baths or showers are recommended.

Baths can be therapeutic - relaxes tensed and tired muscles, helps counter insomnia, gives the patient sweet smelling and makes the patient feel fresh.
Baths may pose a physical maneuverability problem which increases the chance of falling late in the pregnancy; showers are recommended, but with caution when getting in and out and moving around in the shower.
The possibility of infecting the vaginal tract as a result of tub baths is considered highly unlikely.
Tub baths are contraindicated after rupture of the membranes.

Hair Care

The hair tends to become oily more frequently during pregnancy due to over activity of oil glands of the scalp and may require shampooing more frequently. The hair may grow faster during pregnancy and may require dressing more often.

Breast Care

It is important to begin preparing the breast for breastfeeding during the prenatal period.

A well-fitting support bra should be worn at all times. This will provide good support for the enlarging breasts. As the breasts enlarge, an increase in bra and cup size should be worn.
Pads may be worn inside the bra cups to absorb possible colostrum leakage from the nipples. The pads should be changed if they become wet from leakage. Prolonged moisture against the nipples may lead to tenderness and cracking once the newborn infant begins nursing.
The breasts should be washed daily (without soap) to remove dried colostrum and to prevent irritation to the nipples. Lanolin may be applied to the nipples to prevent evaporation of perspiration, thereby softening the skin. Wet tea bags may be placed on the nipples, as the tea will release tannic acid, which will toughen the skin. The nipples should be air dried or blow dried after washing to help toughen them especially if the patient plans to breastfeed.

Bowel Elimination

Patients who normally had no problems with bowel elimination habits will usually experience little or no change in the daily routine.
Patients who have a tendency toward constipation become noticeably more because of:

Decreased physical exertion.
Relaxation of bowel as a response to hormone.
Pressure on the bowel from the gravid uterus.
Constipating effect of iron supplements.

3. To prevent or to relieve constipation, you should encourage the patient to eat a diet high in fiber, maintain an adequate fluid intake, and to exercise, especially walking.

Photo by Medindia

Vaginal Douching

Explain to the patient that normal vaginal secretions are usually intensified during pregnancy due to increased circulation and hormone.

Vaginal douching should only be done with a physician's order for treatment of a specific condition. There is potential for introduction of infection and development of an air embolism.
Vaginal douching should never be done after a rupture or even suspected rupture of the membrane.
Feminine hygiene deodorant sprays should not be used due to increased chance of perineal irritation, cystitis, and urethritis. Undesirable odors can be controlled with daily use of soap and water.
If a douche is ordered, it should be done slowly using a gravity bag. Bulb syringe and "squeeze" operated pre-packaged douches should be avoided, as they are capable of producing too much force.

Douche while sitting on a toilet to decrease the risk of injury by falling.
The tip is not to be inserted deeper than 3 inches.
The bag should not be higher than 2 feet above the level of the vagina. The bag higher than 2 feet above will increase the force or pressure.

Clothing

During pregnancy, the clothes should be given the same or perhaps even a little more attention than at other times.

The clothes should be lightweight, non-constrictive, adjustable, absorbent, and enhance the sense of well-being of the patient.
No constrictive round garters or girdles should be used due to interference in the blood's circulation from the legs.
The shoes should be comfortable and well-fitting, easy to apply, especially in the last trimester when it is difficult to bend over to tie or buckle. They should also have a good solid base of support (broad heel) to avoid tottering, which may lead to a fall.

ACTIVITY MODIFICATION DURING PREGNANCY

Goals of modified activity during pregnancy are to promote health of the patient and the fetus, to provide relaxation and diversion, to promote or continue good muscle tone, and to prevent muscle atrophy.

Employment

Many patients continue to work throughout pregnancy. Whether she can or should continue to work depends on the physical activity involved, the industrial hazards, toxic environment (chemical dust particles, gases, such as inhalation anesthesia), medical or obstetrical complications, or employment regulations of the company.
Activities that are dependent on a good sense of balance should be discouraged, especially during the last half of pregnancy.
Excessive fatigue is usually the reason for employment termination. This may be prevented by modification of the job requirements temporarily and adequate rest periods during the day.
Patients who have sedentary jobs need to walk around at intervals and should never sit or stand in one position for long periods. Chairs should provide adequate back support. A footstool can help prevent pressure on veins, relieve strain on varices (varicose veins), and minimize swelling of the feet.

Travel

This is perhaps a detail of prenatal care, which most patients think very little about, unless they have a tendency to become nauseated or have had a previous miscarriage, which precludes any extensive strain. Traveling should be discussed with the physician, even though there is little restriction on travel from a medical point of view. Extensive trips should be approved by the physician. Traveling however is not a cause of abortion or premature labor.
Lowered oxygen levels may cause fetal hypoxia in high-altitude regions.
Fatigue or tension are primary problems due to change in personal habits and diets. The patient should take frequent rest periods; stop and walk around every two hours if traveling by auto. Drink plenty of fluids to prevent dehydration. These steps will help prevent fatigue, relieve tension, and increase circulation.
Consider traveling by air for long trips to reduce travel time.
Wear seat belts at all times

Photo by techstartups.com

Sexual Relation

It has been suggested, but not proven, that premature delivery may be induced by the effect of oxytocin released during maternal response of organs, orgasmic contractions, and prostaglandin in the male ejaculate.
There are no restrictions on sexual intercourse during pregnancy except for those patients who have a history of ruptured membranes, vaginal spotting, or have been treated for preterm labor during this pregnancys.
Patients with a history of repeated abortions may be advised to avoid intercourse during the period of gestation when previous abortions occurred.
Modifications in regard to sexual positions may be required as the pregnancy progresses.
Patients or couples should also be cautioned against masturbatory activities when orgasmic contractions are contraindicated. Studies have shown that orgasm is often more intense when induced by masturbation. The fetal heart rate decreases during orgasm. Fetal distress has not yet been noted.

Alcohol Consumption

Studies now support that alcohol should be avoided during pregnancy to prevent the possibility of fetal alcohol syndrome, which includes growth retardation, mental deficiency and craniofacial or musculoskeletal abnormalities. It is now believed that as little as one to three ounces of alcohol per day may be dangerous.

Smoking

Smoking, or frequent exposure to a smoke-filled environment is harmful to the fetus. Smoking causes vasoconstriction of the blood vessels which includes those of the placenta. It also decreases oxygen and nutrients to the infant.
There is direct correlation between smoking and low infant birth weight. There is a tendency toward depressed growth and low weight gain to continue even after birth.
There is an increased number of upper respiratory infections in the infant during the first year of life.

Exercise

During pregnancy, exercise is vital for good maternal health, healthy birth, and recovery. Exercise has been proven to be safe and healthful as long as the patient feels comfortable doing them. Physical exercise helps a patient adjust to the hormonal and physical change of pregnancy as well as the emotional and psychological changes. Exercise provides extra support for the growing baby by strengthening abdominal muscles as well as muscles supporting the backbone and the pelvic floor (areas under great stress in pregnancy).

Moderate exercise is recommended. Activities continued to a point of exhaustion or fatigue compromises uterine profusion and fetoplacental oxygenation. These activities are discouraged
As pregnancy continues the center of gravity changes so the patient may become clumsy and increase the risk of injury. The amount of exercise is dependent on the health, previous exercise habits, and obstetric history of the individual.
Curtailing an exercise pattern of a previously active patient may be a negative factor in her physical, emotional, and mental health.
Most patients may continue their pre-pregnancy exercise program as long as the pregnancy remains normal.
Once the pregnancy has been confirmed is, however, not the time to start a new exercise program.