Prenatal care diagnosis and measures

The core logic of prenatal care diagnosis and measures is by no means a standardized process. Currently, the clinically recognized core diagnoses focus on three categories: "maternal and child physiological risks/discomforts, abnormal maternal mental status, and lack of social support system." The core principle of the corresponding nursing measures is individualized adaptation, and there is no one-size-fits-all template.

I have been in the obstetrics clinic for almost 8 years, and I have seen too many pregnant mothers relying on the "unified nursing strategies" found online, which made them extremely anxious. For example, Xiao Li, a 32-week pregnant mother who received a consultation last week, had legs that were so swollen that she couldn't wear size 42 slippers. She read on the Internet that she had to stay in bed more because of edema. She stayed in bed for a whole week, but the edema didn't go away and she became constipated to the point of crying. When we came for a prenatal check-up, we tested her blood pressure and urine protein, which was normal. It was simply physiological edema caused by the uterus compressing the inferior vena cava. She didn’t need to lie down at all. She was asked to walk for 20 minutes every day after dinner, and raise her feet 15 degrees when sleeping. When she came back for a follow-up check-up, most of the swelling had disappeared, and she even brought us cookies she baked herself.

Speaking of the care of edema during pregnancy, there are actually different opinions in the industry: conservative old doctors will recommend standing as little as possible and moving as little as possible to avoid aggravating edema.； However, the latest data from evidence-based medicine shows that as long as there are no indications of preeclampsia, 15-30 minutes of low-intensity exercise per day can promote blood circulation, which is much more effective in reducing swelling than lying down all the time, and can also reduce the risk of blood clots. When we provide guidance to pregnant mothers, we will explain the two options clearly and let them choose according to their own physical feelings. We will not force anyone to move or lie down.

The same goes for morning sickness. In the past, it was always said that you should eat light porridge and soda crackers for morning sickness. Our department had a quarrel about this two years ago. Now we are more flexible by referring to the guidelines of the North American Society of Obstetricians and Gynecologists. As long as the pregnant mother does not feel uncomfortable after eating it, you can eat iced lemon tea, sour plums, and even spicy hot and sour noodles. It is better than struggling with morning sickness and not being able to eat anything, which will eventually lead to ketoacidosis. Of course, the premise is that there is no chronic gastroenteritis and it will not cause discomfort. After all, everyone’s physical condition is not the least bit different.

Compared with physical discomforts that can be touched and seen, problems hidden in pregnant mothers' emotions are more likely to be missed. I met a pregnant mother who had her second child. The eldest child was only 2 years old. Her husband traveled all year round. Every time she came to the prenatal check-up, she would hold the eldest child in her arms. When she sat down, she shed tears without saying a few words, saying that she was always afraid of giving birth to the second child and that she would be sorry for the eldest child. In the past, when encountering this kind of situation, we might just say "don't think too much". Now obstetrics departments are regularly equipped with psychological specialists, and they will also provide "family pre-adaptation" guidance to such pregnant mothers: for example, asking the eldest child to touch the mother's belly and talk, taking the eldest child to the neonatal care room of the hospital to see the baby, and even asking the father to learn to change the diaper of the second child in advance, so that the pregnant mother can rest assured that she will not ignore the older child because of the younger child. Of course, many family members think this is "making a fuss out of a molehill" and say that in the past, women did not have so much to worry about after seven or eight babies, but the data does not lie: pregnant mothers with clear prenatal anxiety have a 23% higher risk of premature birth than pregnant mothers with stable emotions, and the probability of postpartum depression is nearly twice as high. This part of care really cannot be spared. Our current tip is to ask pregnant mothers to write down one small thing that makes them happy during pregnancy every week. No need to make a long statement. Even if it is "Today I ate the strawberry that I miss so much", it will be more effective than any amount of chicken soup for the soul.

Many people think that prenatal care only deals with pregnant women and the baby in their belly. In fact, more than half of the problems we encounter have their roots in the family and surrounding environment. Last month, there was a 36-week pregnant mother with high blood sugar and a fetus that was still two weeks older. When I asked her, I found out that her mother-in-law was giving her supplements every day, saying, "Eat more to make the baby stronger and easier to raise." The pregnant mother said she didn't want to eat it several times, and her mother-in-law cried and said she didn't understand good people. The two of them were having a lot of trouble, and the pregnant mother couldn't sleep every day. In this situation, it is useless to just educate the pregnant mother about sugar control. We specially took her mother-in-law to the education room and showed her a 10-minute practical video of shoulder dystocia caused by a large fetus. We explained clearly the risk of diabetes and obesity in the future of macrosomia. Her mother-in-law relented on the spot and said that she would never force her to eat again. There are actually different opinions on whether family members should participate in prenatal care: some people think that "medical treatment is a matter between the doctor and the patient, and family members who do not know how to get involved will cause trouble." However, the statistics of our department for so many years are here: pregnant mothers whose family members participate in prenatal care throughout the entire process have a vaginal delivery rate that is 30% higher than those who have no one to accompany them, and their postpartum recovery speed is much faster.

Finally, let me be honest, don’t believe those “perfect prenatal care lists” on the Internet. I have seen pregnant mothers who are allergic to mangoes follow the guide and take mango supplements for vitamins, but they are allergic and hospitalized. I have also seen pregnant mothers with good physique run marathons in the second trimester of pregnancy, and their babies are born healthy. There is never a standard answer to prenatal care. The core thing is always "you are comfortable and your baby is safe", which works better than any standard. Last week, the mother of two children who came to the prenatal checkup with her eldest son in her arms gave birth to a 6.5-pound little girl the day before yesterday. The eldest son was lying on the bedside singing nursery rhymes to her sister. She was lying on the hospital bed and sending us photos, with a bright smile on her face. You see, if you find the right rhythm that suits you, there won’t be so many hardships that you have to suffer during pregnancy.