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Heart & Hands Chapter 2
Terms in this set (66)
What is the cornerstone of effective midwifery practice?
Prenatal assessment: the better we do our work prenatally, the less we are surprised by long, drawn-out labors
Assessment is particularly crucial during what period of pregnancy?
The last 6 weeks
What is crucial to establish from the very beginning of your relationship with a client?
The mother's responsibility for her own experience
What is your most important task in the initial interview?
Determining whether you and the mother are suited to working together
Social instincts include:
The need to belong, to be a member of a group, and to be recognized by that group; these instincts lead us to make socially recognized/accepted choices
Biological instincts include:
Need for survival and self-realization
What must you disclose to your client at the initial prenatal visit?
Your training, philosophy, style of practice, and expectations of clients
Early in caregiving, the two most serious emergencies _____ and _____, require detailed discussion.
Hemorrhage; fetal distress
Medical history can be taken by _____ or provided by the mother via a _____.
Interview; take-home form
Preexisting conditions that contraindicate home birth:
Preexisting diabetes, hypertension, thyroid disease (hyper), chronic lung disease, severe asthma, epilepsy, clotting disorders, congenital heart disease (grades 2-4), and kidney disease
Conditions arising in pregnancy that rule out homebirth:
Rh- antibodies, severe anemia unresponsive to treatments, and acute viral infections (depending on when in pregnancy they occur) such as rubella, cytomegalovirus, toxoplasmosis, chicken pox, herpes
History of previous childbirth losses requires attention to _____ and _____
Physical factors; mother's emotional recovery
Any history of abortion should be discussed when?
As soon as the mother is ready
Psychological issues for a mother desiring VBAC are:
formidable. She may have been told she needed surgery because her bones were too small, her hormone levels too low, or she failed to progress. Such comments leave devastating scars & before VBAC is attempted, some healing must occur
The prime symptom of uterine fibroids is:
Painless bleeding with intercourse
Which benign uterine masses vary in size but tend to grow considerably during pregnancy?
Depending on whether they are internal or external, fibroids may affect pregnancy in what ways?
Reduced intrauterine space, disrupted placental implantation, immediate postpartum hemorrhage
If the mother has had a cone biopsy, slowed dilation may be caused by:
Cervical cauterization and cryosurgery are less traumatic than cone biopsy, but the cervix should still be checked for what?
What will soften scar tissue when massages gently into the cervix in the last few weeks of pregnancy?
Evening Primrose Oil (EPO)
LEEP, a laser procedure similar in effect to cone biopsy, has been correlated to _____ and _____.
Incompetent cervix; premature labor
If a mother had an IUD prior to conception, she may be _____ due to excess menstruation and should be checked for this as soon as possible.
What can be scarred by an IUD, which can predispose to ectopic pregnancy, irregular implantation of the placenta, and third-stage hemorrhage?
Pelvic Inflammatory Disease (PID) has been correlated to:
Ectopic pregnancy, irregular implantation of the placenta, third-stage hemorrhage
If the mother used hormonal contraceptions immediately prior to pregnancy, she may be deficient in _____ and should be advised to begin supplementation at once.
Any incidence of _____ or _____ is significant and should be closely tracked by both mother and midwife.
The window for ectopic rupture is _____ to _____ weeks gestation
If a woman reports bleeding or spotting combined with nonrhythmic pain, the midwife should do what?
Immediately consult with backup to rule out tubal pregnancy
Generalized edema experienced before conception or prior to 24 weeks should be:
If bleeding during pregnancy becomes chronic, what should you rule out?
Missed abortion and molar pregnancy
If a woman experiences bleeding in late pregnancy, what should you rule out?
Generalized edema occurring late in pregnancy possibly indicates what condition?
In the case of generalized edema at any stage of pregnancy, what should you immediately have the mother change about her diet?
Eliminate heavily processed foods, plenty of high-quality protein, fresh veggies, salt to taste, and ample fluids
Headaches may be occasionally caused by what 2 normal things in pregnancy?
Hormones and circulatory changes
What is a persistent headache, particularly in combination with signs of preeclampsia?
This is a medical crisis that needs immediate referral.
What are the urgent warning signs of preeclampsia?
Visual problems, upper abdominal pain, epigastric pain found particularly on the right side.
Any history of flu-like symptoms such as swollen glands, extreme fatigue, or generalized body aches, should be noted as they could indicate what?
Acute viral infection
What is a fairly common infection (60% of the general population has antibodies) that, if contracted during pregnancy, is most damaging in the first trimester?
Toxoplasmosis is known to cause severe neurological damage to the fetus, but only when contracted after when in pregnancy?
Mothers can minimize their risk of contracting toxoplasmosis by avoiding what two things?
Uncooked meat and contact with cat feces (litterboxes)
A report of painful vaginal sores combined with flu-like malaise in early pregnancy may indicate a prime outbreak of what?
In case of a suspected initial herpes outbreak, what should you do?
Check the mother's history, do a visual inspection, take cultures, and immediately consult back up
What is the standard of care for delivery if a mother has active herpes lesions at the onset of labor and why?
Cesarean section, as neonatal infection can lead to CNS damage and death
Any history of vomiting in pregnancy should be carefully explored to rule out what?
Hyperemesis gravidarum (HG)
What condition prevents a mother from retaining food or liquid and must be restabilized with IV therapy before she can eat and drink again?
Hyperemesis gravidarum (HG)
If chronic vomiting persists beyond the first trimester, what should you do?
Consult with a colleague or physician back up
What is the only condition for which conventional medicine acknowledges emotional underpinnings?
Hyperemesis gravidarum (HG)
Beyond the first trimester, dizziness, nausea, and what combined may indicate anemia?
What causes the characteristic signs of UTI to potentially be absent during pregnancy?
Progesterone's softening effect on the urethra
UTI can lead to pyelonephritic (kidney infection), which can lead to what?
The blood-brain barrier, which usually protects the brain from harmful substances, is _____ in the fetus.
Women should avoid OTC medications with the same vigilance they avoid what other 2 substances?
Alcohol; recreational drugs
What is the name for any substance that can harm the fetus or cause anomalies?
Unless she has had one within the past year, what should every woman have early in her pregnancy?
How is Naegele's Rule calculated?
Count back 3 months and add 1 week to get EDD
The Mittendorf Study should the average length of human gestation to be how long?
41 weeks and 1 day
What percentage of women give birth on their due date?
Nichols Rules takes into account what?
Variations in cycle length and previous childbearing
Before proceeding to physical assessment during the initial prenatal visit, you should do what?
Ask permission and clearly obtain the mother's consent
Assuming a woman's starting or prepregnancy weight was normal for her height and frame, an average gain is about what?
A pound per week
Ketones in urine signal what?
Inadequate food intake or dehydration
Blood or urine found in urine requires what action from you?
Repeat clean-catch to rule out contamination from vaginal discharge
What levels of protein in urine may indicate preeclampsia?
Anything trace or over
_____ or _____ in urine are suggestive of UTI.
Blood or nitrates
The systolic (top) reading indicates pressure in the arteries when _____.
The heart is actively pumping.
The diastolic (bottom) reading indicates pressure in the arteries when _____.
The heart is at rest.
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