Prenatal care diagnosis and measures

The current common clinical prenatal care diagnosis mainly focuses on three categories: physical discomfort, emotional disturbance, and insufficient coping ability. There is no universal optimal plan for the corresponding intervention measures. All strategies must be adjusted around the individual situation and subjective wishes of the mother, giving priority to both evidence-based evidence and the mother's comfort, rather than rigid implementation of nursing standards.

This is not just a slogan. I have been in the obstetrics department for almost 6 years, and I have seen too many cases where problems arise when using a nursing manual. For example, a 32-year-old pregnant mother with a second child who came for a prenatal checkup last month. She was 34 weeks pregnant. As soon as she sat down, she complained that her pubic bone hurt so much that she couldn't sleep, and her legs were so swollen that she couldn't put on shoes. The novice nurse taught her stretching exercises according to the routine and told her to go home and raise her feet before sending her away. As a result, when she came back next week, her symptoms were not relieved at all, and her eye circles were even darker.

Let’s start with the most common physical-related nursing diagnoses. Most of them are “pain related to hormonal changes during pregnancy and uterine compression, sleep disorders, and edema.” The corresponding measures are really not just those few standard answers. For example, when it comes to pubic bone pain, many people recommend abdominal support belts, but I have met several pregnant mothers who said that wearing them makes them more painful. When I asked, I found out that the narrow ones they bought cost more than ten yuan, and they could not hold the lower edge of the uterus at all, but they tightened the belt. Choose a style that can support the entire bottom of the uterus and have adjustable shoulder straps. Wear it when you lie down, stand up, and adjust the tightness to enough to fit a finger in, so that it can really work. There is also edema, so I always say that I should lie flat and elevate my feet. However, some pregnant mothers say that raising the feet will cause acid reflux and make them more unable to sleep. When lying on the side, put your legs on the pregnancy pillow. The effect is the same. There is no need to stick to the standard position.

Oh, yes, there is also the issue of prenatal exercise that has been particularly hotly debated on the Internet recently. It happens to be a very typical point of controversy: one group says that climbing stairs in late pregnancy can help facilitate a natural birth, while the other group says that climbing stairs will increase the burden on the knee joints and may also induce premature rupture of membranes. In fact, there are no unified clinical requirements. If you have exercise habits before pregnancy and do not have contraindications such as a low-lying placenta or cervical insufficiency, then it is no problem to do yoga for pregnant women, Kegel exercises, or walk slowly for half an hour every day. ； If you usually sit in an office and rarely move, you really don’t have to climb stairs to have a normal delivery. Taking a walk for 20 minutes after meals every day is enough, and it is safer.

Compared with visible pain, many people tend to ignore prenatal emotional problems. This is also an increasingly high priority category in nursing diagnosis. Most of them are classified as "emotional disorders related to fear of childbirth and anxiety about role change." Nowadays, there are many schools of intervention. Some hospitals offer mindfulness-based childbirth courses to teach mothers how to live with the pain of uterine contractions. ； Some hospitals offer virtual delivery experiences to familiarize mothers with the delivery room environment and procedures in advance. ； Others rely on midwives to chat one-on-one. I really can’t say which one is better. Last time, a pregnant mother who was born after 1995 arranged a mindfulness class for her. She felt that sitting was too boring. Instead, she accompanied her to read the real delivery vlogs of two obstetrics bloggers. When she saw the whole process of finger opening and painless injection filmed by others, she breathed a sigh of relief and said, "It turns out that this is how everyone got here." Later, her mood was particularly stable throughout the third trimester of pregnancy.

Another point that is easily missed is that many pregnant mothers seem to be unwell, but the root cause is that the support system cannot keep up. The corresponding nursing diagnosis is generally "ineffective coping related to insufficient family support and cognitive bias in childbirth knowledge." Let’s talk about the second-pregnant mother at the beginning. After I chatted with her for half an hour, I found out that her eldest daughter had just started elementary school and needed homework help. Her mother-in-law kept whispering in her ear every day, “The first pregnancy went well and the second one will be fine, don’t be so squeamish.” Her husband worked overtime until 11 or 12 o’clock every day and couldn’t take care of home. Naturally, the symptoms of pain due to lack of rest could not be relieved. Later, we invited her family members to do a 10-minute briefing. My husband took the initiative to pick up the eldest child from school, and my mother-in-law no longer talked about the natural birth. Within a week, she came for a prenatal check-up and said that she felt much more relaxed and that most of the pain had been relieved.

Oh, by the way, another common diagnosis is nutritional imbalance, either too much supplementation or too strict control. Nowadays, two voices are quarreling fiercely on the Internet. The elders say, "One person should eat and two people can take supplements." They should drink chicken soup and take supplements every day. ； Young pregnant mothers are afraid of stretch marks and high blood sugar, and they wish they could eat no staple food. In fact, the evidence-based conclusion is that in the second and third trimester of pregnancy, just eating 200 more calories a day is enough, which is about the same amount as one egg plus a carton of whole milk. There is really no need to eat a big meal of fish or meat, and there is no need to even dare to eat rice to control sugar. If you are really unsure, ask a nutrition department for an individual assessment, which is much more reliable than guessing on your own.

In fact, after doing prenatal care for so long, my biggest feeling is that there are no fixed diagnoses and measures that are omnipotent. The nursing manual in our hands is a reference, not a standard answer. Squatting down more and listening to what the pregnant mother has to say is more useful than following the 10,000 steps of the process. After all, she is the one who is pregnant, and only she knows best whether she is comfortable or not.