1. The document discusses motivation of couples for planned parenthood through preconception counseling and care. It describes identifying risk factors, providing immunizations and supplements, addressing medical conditions, lifestyle factors, nutrition, and genetic counseling. 2. It also discusses preparing for parenthood by becoming educated about child development and the emotional/lifestyle changes of becoming a parent. The roles and responsibilities of parenthood are explored. 3. The nurse's role in preconception counseling includes conducting assessments, providing education and counseling to address risk factors, and ensuring patients are well-informed and supported in their decision to conceive.

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JG COLLEGE OF NURSING
AHMEDABAD
SUBJECT: OBSTETRICS & GYNECOLOGICAL NURSING
TOPIC: MOTIVATION OF COUPLES FOR PLANNED
PARENTHOOD
SUBMITTED TO, SUBMITTED BY,
Ms. Rekhamol Sidhanar, Ms.Sonal Patel
Assistant Professor, F.Y.M.Sc(N).
J.G College of Nursing, J.G College of Nursing,
Ahmedabad. Ahmedabad.

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MOTIVATION OF COUPLES FOR PLANNED
PARENTHOOD
PRECONCEPTIONAL CARE
 PRECONCEPTION COUNSELLING
When a couple is seen and counselled about pregnancy, its course and outcome well
before the time of actual conception is called pre-conceptional counselling.
 Objective
To ensure that a woman enters pregnancy with an optimal state of health, which would be
safe both to herself and the fetus.
Preconceptual phase is the time to identify any risk factor that could potentially affect the
perinatal outcome adversely. The woman are informed about the risk factor and at the same
time care is provided to reduce and to eliminate the risk factor in an attempt to improve
pregnancy outcome.
 PRECONCEPTION CARE
Identification of high risk factors: it is done by detailed evaluation of obstetric, medical,
family, personal and socio-economical history. Risk factors are assessed by laboratory tests,
if required.
A list of observation-investigation may be required:
 Height and Weight
 Blood Pressure
 Urinalysis
 Stool Sample
 Blood Tests – haemoglobin
 Folic acid and vitamin level
 Rubella immunity
 VDRL
 Haemoglobinopathies
 Lead and Trace elements
 Male – semen analysis
 Female – cervical smear, High vaginal swab
Immunization:
Rubella and Hepatitis immunization is offered in non immune women because
infection can be transmitted to fetus. Rubella can lead cataract, sensory-neural deafness,

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congenital heart defects, microcephaly, meningoencephalitis, dermal erythropoiesis,
thrombocytopenia, and very significant developmental delay.
Body Weight:
It has been well established that fertility and fatness are closely related. Where diet is
restricted or accomplished by high level of training such as bar dancers, athletes, the
menarche can be delayed and secondary amenorrhoea and irregular cycle are common after
menarche. So, ovulation will not occur properly as it requires 22% of body fat content.
Weight gain is required to re-establish ovulation in underweight women.
Fat distribution is also important as an increased waist- hip ratio, where fat
distribution is predominantly around the abdomen as opposed to the hips and the thighs, is
associated with the reduced chances of conception.
Diet:
Advise to eat fresh, whole foods when possible and avoid highly processed foods. If
diet is well balanced need of dietary supplements is reduced. Advise to eat more starchy
food such as cereals and bread, at least five portion of fruits and vegetables, and less fatty
food.
Folic acid supplements:
Folic Acid (also known as 'Folate') is a naturally occurring B vitamin (B9) that can be
found mostly in leafy green vegetable, orange juice and enriched grains. It is important in the
manufacturing of DNA and red blood cells. Taken daily before conception and very early in
pregnancy(4 weeks prior to conception up to 12 weeks of pregnancy) when the neural tube is
developing, it helps prevent babies being born with a serious neural tube defect. Women who
get 400 micrograms (4 milligrams) daily can reduce this risk by up to 70%.
Pre-existing medical conditions:
Women are screened for any pre-existing medical conditions such as diabetes,
epilepsy, phenylketonuria. Proper referral, treatment and health education should be provided
to lead normal labour.
Drugs :
Advise to take only essential medication and check if it is safe to use in pregnancy. If
a lady is on any regular prescription drugs let physician know that she is planning for a baby
incase the prescription needs to be changed because some drugs can lead adverse effect on
pregnancy. For example anticoagulants are checked, warfin is replaced with heparin, oral
antidiabetic drugs are replaced with insulin.
Oral contraception:

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It should be stopped at least 3 months and preferably 6 months prior to planning a
pregnancy to allow for the resumption of natural hormone regulation and ovulation.
Smoking:
Pregnancy is adversely affected by smoking. In terms of fertility, in women smoking
can induce early menopause and menstrual problems. During pregnancy there is an increase
risk of spontaneous abortion, preterm delivery, low birth weight and preterm mortality
because of antepartum haemorrhage. Nutritional status tends to be compromise in smokers.
So it is advised to stop smoking before pregnancy for making a woman habitual.
Alcohol:
Alcohol when drunk occasionally or in moderation is a very acceptable social activity,
but when consumed in large quantities it can become problematic, reduce appetite and affect
nutritional status. High alcohol intakes in women have been associated with menstrual
disorders and decreased fertility, even a women who had 5 or fewer drinks a week.
Alcohol is teratogen and fetal alcohol syndrome is used to describe the congenital
malformations associated with excessive maternal alcohol intake during pregnancy. Recent
review shows that women should remain caution and limit alcohol consumption in pregnancy
to no more than one standard unit of drink per day(1 unit = ½ pint).
Exercise:
Moderate exercise is known to be beneficial for health and the benefits of regular
exercise for the healthy pregnant women appear to outweigh the risks. According to Kardel
and Kase, exercise by physically fit women with uncomplicated pregnancy has no adverse
effect on fetal growth. However, exercise intensity should be modified according to maternal
symptoms and should not continue to fatigue or exhaustion. Also, exercise in supine position
should be avoided after the first trimester to avoid supine hypertension syndrome and
activities that require significant balance should be approached with caution.
Workplace hazards and noxious substances:
Human are exposed to many environmental agents that may be hazardous to their
reproductive capacity and much of this exposure may occure at workplace. Exposure to
solvents, radiation and ionising agents and anaesthetic gases is known to be toxic and
associated with central nervous system defects, microcephaly and an increased risk of
miscarriage. Heavy metals are known to be toxic.
Genetic counselling:
Genetic diseases are screened before conception and risk of passing on the condition
to the offspring is discussed. Couples with history of recurrent fetal loss or with family
history of congenital abnormalities are investigated and counselled appropriately.

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 Limitations:
Unfortunately only a small percentage of women take the advantage of preconceptual care.
The important reasons are:
1) Lack of public awareness
2) Many pregnancies are unplanned
PREPARING FOR PARENTHOOD
 Becoming a Parent
It has been suggested that parenting is the hardest job any person will ever have. It also
seems to be the job parents are often the least prepared to begin. Becoming a parent means
their lives are changing and they must prepare for those changes. For example, an expectant
mother must learn about and prepare for the physical changes she will experience during
pregnancy. Perhaps even more important is for those becoming parents to think about and
prepare for the mental and emotional changes or challenges that occur when a child is born.
Becoming a parent is marked by a series of changes in the life of a mother or father. These
changes can be both wonderful and challenging. Some of the positive aspects of a child's
entrance into a family can include:
• Uniqueness of a child - Babies are each special and unique. Parents can learn to enjoy each
new word, little step or cute expression.
• Dimensions of love - The birth of a child offers parents a whole new experience in love that
can be deep and powerful.
• Feelings about oneself - Although some new parents may have doubts, many parents also
come to feel more mature and responsible with a child. Successfully raising a child is a
source of accomplishment and meaning.
• Sense of family - Children often help create a new sense of family connection between
family members.
• Personal growth - Parenthood provides the opportunity to guide, teach and pass on values
to the next generation.
• Closeness to parents - Having a child may help new parents understand their own parents'
love and perspectives.
In addition, there can be some changes which require parents to assume more of the
responsibilities of adulthood. These might include being financially responsible, providing
direct care for their child, changing some of their social involvement and balancing parenting
and work demands.
 The Role of Parenthood

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Becoming a parent involves taking on a new role in life. They may never have played the
role of "parent" on the stage of life before. New parents, however, should expect and plan to
adjust to these role changes in their lives and relationships. A mother may be spending much
less time in the "worker" role and much more time in the "parent" role if she becomes a new
mother.
In thinking about the transition to the role of being a parent, explore two key questions:
1. What will they be doing as a parent?
2. What changes can they expect to occur in their life and relationships?
 What parents Can Do to Prepare for Parenthood
There are some useful lessons to remember for their growth and development in becoming a
parent.
• Their anxiety about parenting reflects how they will manage a child's distress. Children
need to feel a parent's patience and personal confidence. Parents need to see their self as a
parent and develop their skills.
• Learn about child development so they can approach parenting their child with positive and
realistic expectations.
• Parenting becomes difficult when parents are focused on the negatives. Develop a positive
approach toward raising a child and look for positive things to appreciate each day.
• Develop practices that will carry over to parent’s interaction with their child, such as
playing music, singing softly or speaking to their child.
• A marital relationship is often a key parental support system. Parents should focus on
having a mutually positive relationship with their partner and decrease any hostility.
• advise to increase their social support network that can help parents as a new parent, with
spouse, parents, relatives, friends, etc. Learn who parents can look to for help and
understanding and advice.
• Depression can make parents prone to having challenges as a parent. If prone to depression,
seek appropriate medical assistance and get social support for dealing with challenges.
• Consider their own past experiences, and take advantage of opportunities to learn positive
ways of interaction if parents had negative experiences such as mistreatment or abuse.
• Read available materials on preparing for parenthood or caring for a newborn child.
• Check if their local health agency, hospital or other program has materials that discuss
becoming a parent in specific ways.
What changes can a mother expect to occur in her life?

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Every pregnancy is a unique unique experience for a woman and each pregnancy that a
woman experiencing will be new and uniquely different. That is why it is important that she
should have knowledge of changes occurring during pregnancy. She must know the
preliminary signs of pregnancy i.e amenorrhoea, nausea, vomiting, frequent micturation,
breast and nipple changes, morning sickness, uterus enlargement, later period feeling of fetal
movement etc. So that she can adjust with the situation without affraiding of it.
 Deciding factors:
Parents must be aware of following pregnancy deciding factors before
conception,
 Availability of community services or hospitals
 Availability of trained health personnel in their area
 Birth place
 Prenatal care and advices
 Knowledge of methods of delivery
 Knowledge of feeding of baby
 Caring for baby
 Household chores
 Going back to work
ROLE OF NURSE
 Introduce yourself to the couple, and welcome them to beginning of preconceptual
care. Help them feel that care will be individualised.
 During the interview, listen to the woman’s responses to identify unspoken concerns.
Foster communication between nurse and couple.
 Explain them properly that proper understanding between them and patience are
required as it is a long process. Clear their all queries of misconception related to
pregnancy and family planning.
 Collect detailed history by asking questions in non threatening and non judgemental
manner.
 Screen for any hereditary disease or other medical condition .if found, conduct genetic
counselling.
 Conduct physical examination of a women to rule out any problem.
 Advise her on diet, weight control, avoidance of alcohol, smoking etc.
 Know whether they are using any contraceptive method. If yes, give appropriate
advise.
 Give a lady folic acid supplements with proper explanation.
 If any abnormal history or condition is found, couple should be referred to good
physician for further investigation and treatment.
 Proper psychological support should be given to develop positive attitude towards
child birth.
 Proper health education regarding changes during pregnancy and care to be taken
during & after pregnancy should be given.

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 Woman must be encouraged to get immunised against rubella and hepatitis before
conception.
 Couple should be acquainted regarding environmental hazards
 Proper information regarding health services available must be given.
 Explain the sequence and importance of visits during antenatal period.
 Be aware of cultural differences that may affect care in pregnancy and labour.
 Maintain records and reports of couple properly.
BIBLIOGRAPHY
1. Basvanthappa B.T : “TEXT BOOK OF MIDWIFERY AND
REPRODUCTIVE HEALTH NURSING”; first edition 2006, Jaypee
brother publication, New Delhi. Page no; 216-220.
2. Dawn, C.S.(1990) “Textbook ofObstetrics and Neonatology”Culcutta:
Dawn Books.p.p-90-97
3. Dutta D.C : “TEXT BOOK OF OBTETRICS” ; 6 TH Edition , 2004;
New central book agency publication, Calcutta. Page no: 95-110.
4. Jacob Anamma : “A COMPREHENSIVE TEXT BOOK OF
MIDWIFEREEY”;1stedition 2005; Jaypee brother medical publication; New
Delhi, page no:164-172.
5. Kumari Neelam; (2010) “MIDWIFERY AND GYNAECOLOGICAL NURSING”;
S.vikas and company; ; 1st edition; Jalandhar city; Page no :156-164.
6. Myles : “ TEXT BOOK OF MIDWIVES” ; Fourteenth edition,2003 ;
Elsevier publisher, Philadelphia. Page no; 214-230, 167-183
7. Rao Kamini “TEXT BOOK OF MIDWIFERY AND OBSTETRICS
FOR NURSES”; First edition, 2011, Elsevier publisher, Philadelphia.
Page no: 277-281.
8. Pillitteri, Adele.(1995) “Maternal& Child Health Nursing”,(ed-2nd ).
Philadelphia: J.B. Lippincott Company. p.p-303-324, 138.
Internet resources:-
1. http://www.en.wikipedia.org
2. http://www.medscape.com/viewarticle/551032_4
3. http://www.ncbi.nlm.nih.gov/pubmed/19089770
4. http://www.pregmed.org
5. http://www.stanfordchildrens.org/en/topic