Each pregnancy is unique. Health workers especialy midwives need to acquire knowledge and skill on how to take care of them.

1. DISORDERS,STRATEGIES AND LIFE
STYLE ADVICE TO THE PREGNANT
WOMEN
MUHAS
ERAI ERASTO MGAYA
SCHOOL OF NURSING
BSCN 3

2. GETTING PREGNANT IS LIKE RUNNING A RACE
YOU HAVE TO GET YOURSELF IN CONDITION

3. INTRODUCTION
• COMMON DISORDERS OF PREGNANCY– are
clinical conditions that the pregnancy woman
experience during the course of pregnancy.
• These conditions may some time be regarded
as normal signs of pregnancy.
• Every pregnancy is a unique experience for the
woman and each pregnancy that the woman
experiences will be uniquely different .

4. Cont…
• It is important for a midwife to acquire
knowledge and understanding of the common
disorders of pregnancy in order to advice the
woman on the strategies that will help her to
cope with the condition and minimize the effect
of experience.
• These condition are regarded as minor conditions
but they are far minor to the woman who is
experiencing so the midwife must consider them
as problem that bring discomfort.

5. Cont…
• The midwife must be able to identify these
common disorder when they become medical
disorder of pregnancy and refer them to the
appropriate medical practitioner.
• The midwife is the key person educating the
woman about these common disorders of
pregnancy and the booking interview
therefore the midwife need a knowledge of
these common disorders to effectively
educate the woman

6. Cont…
• The midwife may use the complementary and
alternative medicine for alleviating symptoms
caused by these common disorders of
pregnancy.
• It is important for the midwife to advice the
woman to seek advise from a registered
health practitioner prior to commencing
medication
• The signs and symptoms should not be
regarded as common disorder of pregnancy.

7. COMMON DISORDERS OF
PREGNANCY

8. Nausea and Vomiting
• Nausea and vomiting are said to affect 50% of
pregnancies( Snell et al 1998).
• Their exact is not truly explained but is thought to be a
combination of hormonal changes, changes in
carbohydrates metabolism, psychological adjustment
and neurological factors.
• It may also be linked to vitamin B6 and zinc
deficiencies.
• Eating small frequent meals will help to maintain
body’s blood sugar level and having small amount of
fluid between meals will help to maintain hydration.

9. Cont…
• Good sources of vitamin B6 and zinc include the
whole wheat bread, seeds, nuts, milk, Ginger and
chicken.
• General nausea and vomiting improve around the
16th week of pregnancy, but until that time may
cause such debilitation for the woman as to affect
her dairy life.
• A small proportion of those women (0.3-2%) will
develop a more serious condition known as
hyperremesis gravidarum, which require an
urgent referral.

10. Breast changes
• Often changes in the breast are one of the first
alteration that the woman notices in relation to
her pregnancy.
• The breasts often become tender and feel fuller
because of hormonal changes.
• The level of oestrogen increase, which is
instrumental in laying down fat stores in
preparation for breast feeding.
• The vascular circulation is increased and the
nipple become larger and the areola more deeply
pigmented.

11. Backache and Ligament pain
• Backache is a common disorder that is not
restricted to a particular trimester but may
span all 3 trimesters and continue into post-
natal period.
• During pregnancy a woman body undergo
many changes and backache can insue from
the growing uterus causing a change in
posture and the influence of hormone relaxin
and ligament.

12. Cont…
• There are simple steps that the midwife can
advice the woman to take in order to alleviate
the discomfort, such as to maintain good
posture, to adopt the appropriate position
when lifting either small children or heavy
objects and to avoid standing for prolonged
periods of time.

13. Cont…
• The growth of the uterus as pregnancy
progresses causes stretching of the supporting
ligaments in which the woman may
experience sharp painful spasm called
‘ligament pain’.
• Again advice can be given on avoidance of
stretching, taking a warm bath and massaging
the area; this will do much to alleviate
symptoms.

14. Leg cramp
• Cramp, which is a sudden gripping contraction
of the calf muscle frequently occurs during the
third trimester of pregnancy.
• It is usually for woman to be woken during the
night and to be left with the painful calf the
following day.
• The cause is thought to be lowered serum
ionized calcium level and increased level of
phosphates.

15. Cont…
• To minimize the risk of night cramps the midwife
may advice the woman to do some leg-stretching
exercise before retiring to bed.
• A dietary adjustment in which the woman
reduces her intake of milk, soft drinks and
processed food may help to reduce the
occurrence of leg cramps
• When the woman is troubled by cramps, she
should be advised to flex the foot in the opposite
direction.

16. Headache
• Frequently women complain of headaches during
pregnancy and there are many reasons put forward as
to why these should occur, such as hormonal changes,
eye strain, sinusitis, fatigue and emotional changes.
• Whatever the cause it is important that the midwife is
aware of the nature of these headaches and can give
advice on how to alleviate them.
• Headaches can occur at any stage of gestation, but
should they occur during the third trimester together
with an increase in blood pressure or proteinurea, or
both, then medical aid should be sought urgently.

17. Fatigue
• Fatigue is a condition that affect the woman not
only during pregnancy but also during post-natal
period.
• During the post-natal period it can be attributed
to the stress of labour and the physical demand
of caring for a new baby, which will include
disturbed sleep patterns.
• During first trimester it can be attributed by
hormonal changes and the organogenesis that is
taking place.

18. Cont…
• This factors cause the woman to have feelings
of overwhelming sleepiness
• During the third trimester the fatigue can be
related to the increase in weight, making
mobility difficulty and increase in metabolic
demands of the body in preparation for labour
and breastfeeding.

19. Constipation
• Constipation can be a very distressing and
uncomfortable condition and the midwife
should be able to advice woman on how to
avoid, and measures to deal with, this
common complaint.
• The woman may also be prescribed oral iron
therapy for anemia, which is the common
cause of constipation.

20. Cont…
• A diet that reach in fiber will help to prevent the
condition and will also help in resolving it.
• It is important that the woman also as an
adequate fluid intake, which will keep the stool
soft and easy to pass and she should exercise
regularly.
• The midwife should inquire about many changes
in the frequency and consistence of the woman’s
bowel movements and offer advice accordingly.

21. Cont…
• The woman should be advice to eat whole
grains, raw unpeeled fruits and vegetables.
• Bananas are good for bulking and honey for
lubrication.
• Abdominal massage with mandalin oil or
acupressure along a line from pubic bone to
the umbilicus may also facilitate defaction.

22. Cont…
• If constipation persists then haemorrhoids
may develop, caused by straining at
defecation, which can subsequently cause
particular difficults during the birth process.
• Haemorrhoids can be particularly painful and
may bleed therefore avoidance of this
condition should be the aim of management
of constipation.

23. Heartburn
• This is a burning, irritating sensation in the
oesophagus.
• The relaxing effect of progesterone causes
retarded peristalsis and the relaxation of the
cardiac sphincter of the stomach.
• The enlarging uterus increases the intra-
abdominal pressure.
• The increased intra abdominal pressure and the
relaxation of cardiac sphincter are the causes of
the reflux of gastric acid into the oesophagus.

24. Cont…
• To minimize this effect fatty meals should be
avoided
• It may be better to take smaller meals more often
and foods cause heartburn should be excluded
from the diet.
• Following meals the woman should not lie flat
but use one or more cushion for support
• Antacids may be prescribed by physician but
sodium bicarbonate must be avoided because it
mat cause electrolyte and acid-base
abnormalities.

25. Vaginal discharge
• An increased vaginal secretion is common
• It is the result of the hyperplasia of the
cervical epithelium and increased mucous
production by the endocervical glands
• Usually the secretion is white and mucoid in
appearance
• It is a physiological phenomenon.

26. Candidiasis
• This is a fungus infection caused by Candida albicans.
• The discharge is very irritating and causes pruritis
• on examination the discharge is thick and milky and
often attached to the vaginal wall.
• Antifungal preparations are effective.
• Advice the woman to be scrupulous about perineal
hygiene, to use perineal pads, if necessary, and to
report pruritus ,foul odour or blood.
• The woman should not douche or use tampons.

27. Ptyalism
• The cause of increased production of saliva is
not known
• Certain mouthwashes and chewing gums may
improve the condition.

28. Blocked nose and epistaxis
• The increased oestrogen levels may cause
hypertrophy and hyperaemia of the nasal
mucosa.
• This may cause blocked nose and increased
nasal secretion or bleeding
• Bleeding is rarely severe.
• Nasal drops should be avoided.

29. Dyspnoea
• This is a common symptom between 34 and
38 weeks, sometimes earlier, and is the result
of pressure by the enlarging uterus on the
diaphragm
• Hormonal changes may also be a contributory
factor
• Sleeping in the Fowler’s or lateral position
may help.

30. Varicose veins
• Varicose veins are aggravated during
pregnancy by
• Pressure of the enlarging uterus on the
iliofemoral veins
• The relaxing effect of progesterone
• These two factors increase stasis of blood in
the lower extremities, causing gradual
attenuation of the wall of the blood vessels
and eventually varicose veins

31. Cont…
• These women usually complain of heaviness, tiredness
or pain in the legs
• Any clothes or garters that exert pressure on the thighs
or legs should be avoided and the legs should be
elevated during rest.
• Elastic stocking support the veins and should be worn
as often as possible and the woman must avoid sitting
with her leg crossed.
• If varicose veins of vulva occur, a cushion may be
placed under the hips, to enhance veinous drainage
• Regular exercise will also improve the circulation of
blood in the legs.

32. Oedema of the lower extremities
• Oedema of the lower extremities is often physiological
• Standing for long period and high temperatures
aggravate the condition
• Regular rest period are effective and whenever
possible the woman should elevate her legs by means
of cushion or foot stool.
• The importance of regular dorsi-flexion of the feet to
enhance circulation must be stressed
• The woman must be evaluated regularly by the
midwife to exclude pathological oedema and support
hose, as for varicosis, should be recommended.

33. Haemorrhoids
• These are varicose veins of the lower rectum and
anus.
• Because of the same factors that cause varicose
vein, the incidence of haemorrhoids is also
increased during pregnancy.
• Haemorrhoids are also exacerbated by the high
incidence of constipation during pregnancy.
• Haemorrhoids developing during pregnancy
usually become asymptomatic and disappear
during the post-partum period,but may take a
while.

34. Cont…
• In case of external haemorrhoids,replacement
alleviates the condition.
• The woman is tought to replace the
haemorrhoids using a lubricant, while lying in the
lateral position.
• Constipation should be avoided.
• Other alleviating procedures such as ice
packs,warms sitz-baths cream and suppositories
as prescribed by physician may be of value.

35. Dizziness and Fainting
• Certain women are prone to fainting spells especially if they
enter a warm, crowded room.
• The cause is a combination of different factors:
-The change in the blood volume, with vasomotor instability.
-The relaxing effect on the blood vessel walls.
-Compression of the vena cava inferior by the uterus in the
supine position causing decreased blood return to the
heart and the brain.
-Stasis of the blood in the lower extremities.
-The pregnant woman must always change position slowly.
-If she feels faint, she should sit or lie down in a left lateral
position.

36. Physiological skin changes
• Common skin changes include chloasma, stria gravidarum
and acne.
• The midwife should assure the woman that the changes to
her skin will gradually fade away after the birth of the baby
and explain the causes of these changes.
• Lotions will not help to prevent striae because some
women are genetically predisposed to them.
• The woman should avoid exposure to the sun and use
sunscreen lotions to prevent further darkening of
chloasma.
• Acne may decrease after the first trimester.
• The midwife should also explain the usual hygienic
measures to the woman.

37. Emotional factors
• Emotional instability is common during
pregnancy.
• It is due to many factors. There are the hormonal
changes, which influence how the woman feels
and reacts to stimulations, but there is also the
physical discomfort of some of common disorders
of pregnancy to contend with.
• It is important that the midwife is able to
reassure the woman and her family that the
situation is fairly common and normal.

38. Cont…
• However it is important that the midwife is
aware of any stressful life event, other than
the pregnancy, that may be causing the
situation.
• Such life events as moving house, death of a
close family member or the breakdown of the
relationship occurring antenatally may also
affect the woman in the postnatal period and
predispose to postnatal depression.

39. GENERAL LIFESTYLE ADVICE
EXERCICES
• Exercise is important in pregnant women if done
in moderation.
• The development of complications e.g. pre-
eclampsia, threatened abortion, multiple
pregnancy, premature labour etc. is an indication
for limiting the amount of exercises.
• Active exercises during pregnancy has no
deleterious effect on the fetus if the woman does
exercises to which she is accustomed.
• Specific antenatal exercises are of value.

40. Cont..
EMPLOYMENT
• Work in itself is not detrimental to the pregnant
women, although much would depend upon the
physical activity involved.
• However, excessively tiring work should not be
undertaken.
• Normal employment can probably be safely
undertaken in the absence of complications
until the 36th week of pregnancy.
• The environment should be safe for a
developing fetus.

41. Cont..
TRAVEL
• Travel during normal pregnancy is not detrimental.
• The biggest problem of travel is that the woman may
require the help of physician or midwife once she
reaches her destination.
• She should therefore always be referred to a colleague.
• Air travel in a pressure controlled aeroplane is safe.
• Air travel in a non- pressurized aeroplane may be
dangerous if altitudes of 3000m are exceeded .
• Most modern aircraft are equipped to transport
pregnant women.

42. Cont.
• Long journeys during the third trimester are
prohibited by most airlines because of the danger of
labour ensuring during the journey.
• When traveling by air, car or bus the women should
avoid sitting for long periods.
• A stretch or walk should be scheduled every two
hours.
• Safety belts should be worn at all times.

43. Cont..
BATHING
• There is no detrimental effects.
• During the third trimester the women’s balance may
be impaired because of the enlarged uterus.
• She may fall and injury herself and /or the fetus.
• Bathwater should never be too hot as it may cause the
women to become dizzy.

44. Cont..
CLOTHING
• The clothing of the pregnant woman must be
practical, loose-fitting and attractive.
• During the first trimester special clothing is seldom
indicated.
• During the second trimester special maternity wear is
indicated.
• Tight-fitting belts or underwear must be avoided.
• Any clothing causing constriction of the veins of the
lower extremities must be avoided and the women
must wear comfortable shoes.

45. SEXUALITY DURING PREGNANCY AND
POSTPARTUM
• Intercourse and orgasm seem to be safe for most
pregnant women throughout pregnancy.
• Since sexual intercourse cause uterine contraction it is
contra-indicated in the following cases:
- A threatened abortion
- A history of miscarriages
- cervical incompetency
- multiple pregnancy
- premature rupture of membranes
- anterpartum haemorrage or placenta praevia.
- threatened premature labour.

46. Cont..
• There are normally changes in the sexual drive during
pregnancy.
During the first trimester
• some women may experience a heightened sexuality, enjoy sex
more and seek it more frequently.
• Other women have a decreased sex drive owing to nausea,
fatigue, breast soreness and other physical changes.
• Women is very aware of her pelvis.
• The filling of fullness, the sharpened sensations and round
ligament twinges, may give rise to some anxiety.
• She should be made aware that intercourse poses no threat to
pregnancy under normal circumstances.

47. Cont..
During the second and third trimester
• The growing uterus may make the usual sexual
position uncomfortable for the couple.
• The enlarged uterus may also cause the women to feel
very unattractive, others feel a sense of heightened
potency.
• The husband may also may have different feelings
towards his wife’s enlarged body.
• Some experience her as more sexy, others are turned
off.
• Emotional lability and other psychological changes in
both the partners may cause changes in their sexual
drives which may be confusing to them.

48. Cont..
• The increased vaginal discharge, backache, increased fetal
movements and other physical changes during pregnancy may
interfere with the couple's sexual activities.
• The following may solve some of the problems:
- Open communication between the two partners about their
feeling.
- Decrease breast fondling
- Use other methods of expressing love like massage,
hugging, together activities etc.
- Become creative with other positions to decrease
discomfort.
- Understand that increased and decreased interest in sex
is normal.

49. Cont..
During labour and delivery
• Some women may experience such a lot of pain and
discomfort that it is impossible for them to find a
connection between this process and sexual energy.
• For other women, however, it is powerful erotic
experience of moving sexual energy.

50. Cont..
Postpartally
• Women are advised to refrain from sexual intercourse
for six weeks.
• There are, however, great variations in the time that
it takes for women to become ready for sexual activity.
• Episiotomy is certainly a cause of sexual concern in
many women, scar takes as long as four months to
reach comfortable state.
• The first resumption of intercourse may be very slow
with care and a lot of lubrication is needed during
penile entry. Even women with caesarian section
experience pain during penetration due to lack of
lubrication and changes in the vaginal and pelvic
tissue.

51. Cont..
Breastfeeding
• may also have an effect on sexual aspect.
• Some women may feel tired and drained, while others
may see breastfeeding as such a wonderfully sensual
experience that they even have orgasms while
breastfeeding.
• The breasts may leak milk during arousal which may
make some couples avoid sex.
• Fatigue, emotional stress and psychological changes
postpartally may further reduce interest in sex.
• Counselling by the midwife, open communication
between the partners and the support from support
system may provide solutions.

52. Conclusion
It is clear from the evidence presented that the content and delivery
of many parent education classes
need to change.
The midwife is the lead professional in normal midwifery and in
educating for parenthood.
The educational role of midwife is integrated into every aspects
her/his work and enters into every communication with the
prospective parents.
There need to be special classes that will meet the needs of
specially identified groups, such as minority ethnic groups of women
and young teenage women.

53. Cont…
• These special group would benefit from
providing education in various formats, such as
video presentations in home or health centers
and in the first language of the ethnic minorities,
or providing teen-only antenatal and parental
and patient education classes.
• Encouraging women and their partners to set the
agenda will address the need of that particular
group and therefore more participation will be
achieved.

54. Cont…
• Being pregnant can be a challenge for a
woman, but also for the spouse, who has to
be supportive all the way until the birth of the
baby. One thing is for sure though: every
woman reacts different when they are
pregnant

55. The way forward
• Midwife have always made an enormous
contribution to improving public health, not
only in terms of reducing maternal and infant
mortality and morbidity but in educating and
assisting mothers and families to achieve
optimum well-being.
• The very essence of midwifery is to promote
long term health for women and babies.

56. Cont…
• Midwives are the prime of carers who advice on
the screening tests that are available, gives
advice on nutrition, exercise and other lifestyles
issues, promote and encourage breastfeeding
and inform and advice on the various phases of
child birth process.
• In recent time there has been a bigger emphasis
on health education and health promotion
strategies in order to encourage individuals to
adopt healthier lifestyles.

57. Cont…
• The post natal period is the time when new
parents are learning their newly acquired role
and this transition to parenthood can be a
time of great anxiety ., at this time the
midwife is able to give much advice and
support to educate parents and lessen their
anxiety.

58. Cont…
• A woman will often suffer ill health after child
birth with condition such as anaemia, urinary
incontinence , backache and tiredness and would
become an opportunity to discuss these often
embarrassing conditions with the person who she
has come to know and respect, her midwife.
• The postnatal period is the time when the
relationship with the midwife is firmly established
and there is respect and cooperation between
the midwife and the mother.

59. Cont…
• In preparing the next generation of parent,
midwives must take account of the changes
within societies, education, employment and
roles that men and women now adopt .
• Targeting parent education session to meet the
needs of the differing client groups and giving
participation ownership of the content is the line
with the midwifery philosophy of care being
woman focused and family centered.

60. Cont…
• It is essential for the midwives that we do not
lose the sight of our important educational
role because it is through this vital aspects
that we can contribute to the improved health
of the community we serve and empower
women for child birth and motherhood.

62. The end