1st Trimester 1
First Trimester Teaching Sheets
INFORMATION ABOUT PREGNANCY:
FIRST TRIMESTER WEEKS 1 – 13
References for listed page numbers are at the end of these sheets.
ABOUT MAKING LIFESTYLE CHANGES AND ADAPTING TO PREGNANCY
1.
I have information about what I should be eating in pregnancy.
 Follow food guide pyramid for healthy diet
o 6 – 11 servings bread, rice pasta, whole grains (serving = 1 slice bread, 1 oz ready-to-eat cereal,
1/2 cup cooked cereal, rice or pasta)
o 3-5 servings vegetables (1 cup raw leafy vegetables, 1/2 cup cooked, or chopped raw vegetables,
3/4 cup veggie juice
o 2-4 servings fruits (1 medium apple, banana orange; 1/2 cup chopped, cooked or canned fruit; 3/4
cup fruit juice
o 3 servings high protein foods[6-8oz protein total] (beans, meat, tofu)(2 – 3 oz cooked lean meat,
poultry of acceptable fish; 1/2 cup cooked dry beans, 1 egg counts as 1 oz lean meat; 2 Tbsp.
peanut butter or 1/2 cup nuts, count as 1 oz of meat)
o 3-4 servings dairy products (1 cup milk or yogurt, 1 1/2 oz natural cheese) Sources of calcium for
Women who don’t drink milk: 3 oz can sardines, 4 1/2 oz salmon (with bones); 3 cups cooked
dried beans, 1 cup tofu, 1 cup collards; 1 1/2 cups kale or turnip greens; 3 English muffins, 11
dried figs, 1 1/8 cup Ca fortified OJ; 3 oz pesto sauce)
o fats, oils, sweets used sparingly
 Daily requirements
o Need approximately 300 extra kcal/day or a total of 2500 calories
o 60 g protein (growth & development)
o 1200 mg Calcium (development of bones & teeth)
o 2 servings vit C rich foods (healing & repair) (50 mg)
o At least one serving of fiber (to help prevent constipation)
o 4 mg (400 µg) folic acid (decreases neural tube defects)
o 8+ glasses of fluid
o 30 mg iron (increased blood volume; decreases anemia)
 Caution with these:
o Avoid alcohol! May cause fetal alcohol syndrome
o Avoid “empty calories” (candy, pop)
o Avoid soft, un-pasteurized cheese or milk
o Avoid undercooked or raw meat
o Avoid raw eggs
o Caution re foods with nitrates or nitrites such as hot dogs, luncheon meats or deli meats
unless they are reheated until steaming hot
o Limit caffeine to 1 – 2 cups per day
o Avoid MSG
o Sweeteners
 Avoid saccharine (crosses placenta, causes cancer in rats)
 Better to use natural fruits and juices as sweeteners
 Aspartame (Equal®, NutraSweet®) is OK in moderation
o Avoid high protein dietary supplements
o Be aware of fish advisory
 Avoid swordfish, shark, and fresh tuna
 Caution re freshwater fish caught in inland lakes due to high mercury levels (bass,
walleye, northern pike, muskie, perch, crappie)…limit to 1 meal/week
 Canned fish is safely eaten (i.e. canned tuna 2x/week is ok)
L&P, p. 369-373
1st Trimester 2
2.
I know how much weight to gain
 Based on pre-pregnant BMI [wt(kg)/ht2(m)] and single births
BMI
Total Wt Gain (lbs.) Total Wt Gain (kg)
Recommended
Recommended
< 19.8
under weight 28 – 40 lbs.
12.5 – 18 kg
19.8 – 26.0 average wt.
25 – 35 lbs.
11.5 – 16 kg
26.0 – 29.0
overweight
15 – 25 lbs.
7 – 11.5 kg
> 29.0
obese
15 lbs.
7 kg, at least
Institute of Medicine, 1992 (as quoted in L&P, 2004, p. 374)



Mothers carrying twins should gain 35 – 45 lbs.
Adolescents should gain near the top end of weight in appropriate category
PATTERN of weight gain
o 1st trimester ~ average gain is 2 – 4 lbs. (1 – 2.5 kg)
o 2nd & 3rd trimester ~ average gain is 0.9 lbs./week (0.4 kg /week) for normal; 0.3 kg/week for
overweight; 0.5 kg/week for underweight
 Inadequate weight gain = <2.25 lbs./month (1 kg/month) normal wt; < 1.1 lbs./month (0.5 kg/month)
overweight; failure to gain weight should be noted as this may be indicative of complications such as fetal
growth retardation.
 Excessive wt gain = > 6 3/4 lbs./month (3 kg/month); especially after 20 weeks gestation; Rapid weight
gain over a short period of time may indicate a complication such as pre-eclampsia (need to evaluate for
fluid retention).
 Either excessive or too little weight gain may result from inadequate nutrition.
 Weight Gain Distribution
o fetus, placental amniotic fluid
9-10.5 lbs.
o uterus, breasts
3-6 lbs.
o blood volume
4-5 lbs.
o maternal stores
4-6 lbs.
o tissue, fluid
3-5 lbs.
L&P, p. 108, 374-377, 381-382, 441-442
3. I have a prescription for prenatal vitamins and know how to take them
 Prenatal vitamins: take one vitamin daily; may take with food or milk if upsets stomach.
 Remember that too much of some vitamins could be toxic to mom or baby (congenital anomalies have
occurred in babies of mothers who took excessive amounts of Vitamin A during pregnancy).
 The nutrient needs of pregnant women, with perhaps the exception of folate and iron, can be met via foods.
 Counseling regarding the need for a diet that is rich in vitamins and minerals should be part of early
prenatal care for every pregnant woman.
 Supplements of certain nutrients, however, are recommended when the woman’s diet is poor or when
significant nutritional risk factors are present (adolescence, poverty, weight loss, low hgb/hct).
 The pregnant woman should understand that taking a vitamin-mineral supplement does not lessen the need
to eat a nutritious, well-balanced diet.
L&P, p. 377-378, 381
4.
I have information about handling common physical and emotional changes of early pregnancy:
Fatigue and sleepiness
 Common during first trimester
 Poor nutrition, anemia and slowed circulation may influence fatigue
 Abnormal if associated with fainting, pallor, breathlessness, and/or palpitations
 Manage your stress:
o Practice relaxation. Take time out for yourself.
o Mild to moderate exercise regularly; avoid overexertion
1st Trimester 3
o
o
o
Improve your diet: Eat a good breakfast (whole grain cereal, fruit, milk). Add more fruits and
vegetables, protein, iron to your diet. May need to increase caloric intake.
Get enough sleep: Have a routine. Go to bed at the same time every night. Take a rest during the
day
Avoid coffee, tea, or caffeinated drinks, especially during the evening
L&P, p. 431
Morning sickness
 Nausea and vomiting; exact cause of nausea and vomiting in pregnancy is not clear
 Some women experience symptoms only in the morning, can occur in afternoon, night or all day
 May also note increased saliva, increased sensitivity to certain smells, and changes in the taste of some
foods.
 If you find that your prenatal vitamin seems to worsen nausea, take it with food instead of on an empty
stomach. Do not change or stop your vitamin supplement without first discussing it with your doctor.
 Lack of sleep and the ability to relax can increase nausea in the morning

“Treatment options”
o Avoid empty or overloaded stomach; eat five or six small meals per day
o Maintain good posture—give stomach ample room
o Eat dry carbohydrate on awakening, remain in bed until feeling subsides; or, alternate dry
carbohydrate 1 hour with fluids such as hot herbal decaf tea the next hour until feeling subsides
o Carbonated beverages such as ginger ale
o Avoid fried, odorous, spicy, greasy, or gas-forming foods
o Avoid odors or factors which trigger nausea
o Herbal teas (ginger, peppermint, chamomile, spearmint)
o Stop smoking
o Consult the primary health care provider if intractable vomiting occurs
L&P, p. 431
Mood swings
 Common to be emotionally labile
 Caused by physical and emotional changes
 Related to feelings of ambivalence
 Ideas to decrease mood swings
o Avoid caffeine
o Exercise
o Get enough sleep
o Talk to someone about feelings
 Symptoms of Depression: feeling down, sleep disturbance, not eating or eating endlessly, prolonged
fatigue, loss of interest-work/play
 If depression symptoms last more than two weeks call your physician
L&P, p. 431
Interest in/safety of sexual activity
 Sexual desire may remain unchanged, or it could change. In general women experience a decrease in sexual
activity r/t:
o Fatigue
o Morning sickness
o Feeling unattractive
o Breast tenderness
o Fear of hurting the baby by causing or inducing a miscarriage, that fetus is watching or aware of
couple having sex, or of causing an infection in the uterus
 Alternatives to intercourse
o Oral sex
o Hugging and kissing
o Stroking or massaging breast, clitoris
1st Trimester 4
o masturbation
o Expression of feelings, preferences and concerns to partner openly
 Intercourse should be restricted and physician notified if:
o Bleeding occurs
o Rupture of membranes
o Partner has a sexually transmitted infection
o Hx of miscarriages or shows signs of miscarriage
o Hx of premature labor or experience signs of premature labor
 There is a wide range of sexual responses, interest and frequency of intercourse
 It is safe to continue to have and enjoy consensual sex during pregnancy
L&P, 435-437
Breast Changes
 Increase in estrogen and progesterone levels
 Fullness, heightened sensitivity, tingling, heaviness
 Nipples and areolae will darken, enlarge
 Montgomery tubercles (glands) enlarge
 Veins are visible
 Stretch marks
 Dark pigmentation of breast will fade after birth and so will the appearance of veins
 Wear a supportive maternity bra with pads to absorb discharge (well-fitting, non-stretch straps may relieve
discomfort)
L&P, p. 355-356, 431
Skin Changes
 Changes induced by hormonal factors, growth of breast and abdominal growth
 Skin thickens
 Extra pigmentation
o Linea nigra: brown line that runs from umbilicus to smphysis pubis
o Chloasma or Melasma: dark pigmentation on cheekbones, bridge of nose; “mask of pregnancy”.
After pregnancy spots fade away but may reappear with exposed to sun and/or with oral
contraceptive use
o Nipples, areola, genitals, and perianal area, may be affected by increase pigmentation
 Vascular changes: Veins expand to carry the increased blood supply of pregnancy
o Spider nevi: tiny, bright red lines that can appear on face, neck, chest, arms, and legs. Fade and
disappear after pregnancy
o Palmar erythema: palms of hands appear pink
 Striae gravidarum: stretch marks; these will fade after delivery. They can be permanent, but may become
barely noticeable. Occurs on abdomen, hips, thighs, breasts. Present in about 50% of pregnancies
 Increase in estrogen and progesterone, ACTH, melanocyte-stimulating hormone, melanocytes activation
 Areola will darken, spread, covered with little bumps (sweat glands)
 Acne: increase of oils r/t hormonal changes. Eliminate and prevent breakouts by drinking water, washing
face two times a day, if consulting a dermatologist make they know you are pregnant. DO NOT USE:
Accutane or Retin-A – harmful to baby!
L&P, p. 362-363
5. I can name the medications I can safely take for colds and flu (nausea, vomiting, and/or diarrhea,
stomachache—not uterine cramps).
 Self-treatment should be discouraged.
 The use of all drugs, including over-the-counter (OTC) drugs, herbs, vitamins, should be limited. Always
discuss prescription & OTC drugs with the health care provider.
 Safe meds: Sudafed®,, plain Robitussin® , Vicks® cough syrup (not DM formula), regular strength Tylenol®,
and Kaopectate®
 Treatment options for colds and flu
o Get plenty of rest (12 hours/night),
1st Trimester 5
drink extra fluids (8 – 10 glasses/day)
home remedies such as warm bath, salt water gargle, eating chicken soup
6 small meals instead of 3 regular meals may be easier to tolerate
Try a liquid diet (water, Jell-O, broth, tea, popsicles, flat pop) if you hare having nausea,
vomiting and/or diarrhea
o Monitor temperature. Notify health care provider if temp >100.6 degrees F for >24 hours.
o Notify health care provider if you cough up green/yellow sputum
L&P, p. 429; YYB&U, p. 13
o
o
o
o
6.
I am satisfied that I can manage career/job/school/family responsibilities during pregnancy
o Recognize that you can’t be “superwoman” ~ you can’t do it all, especially in the beginning
o Decide on what your priorities are; what things will work best for YOUR family
o Learn to compromise: if job, husband and baby are top priorities, an immaculate house may not be the
top priority
o Learn to ask for and accept help (from dad, baby’s grandparents, other relatives, play groups, etc)
o May need to make job adjustments as abdomen enlarges with growing baby (i.e. decrease heavy
lifting, minimize prolonged standing)
L&P, p. 672
7.

I have information about exercise, activity and posture during pregnancy
Exercise:
o Reduces stress, enhances mood, promotes a feeling of well-being
o Improves circulation, helps condition muscles and reduce back pain
o Maintains cardiac and respiratory fitness
o Improves or maintains physical fitness
o Useful exercise during pregnancy: aerobics, calisthenics, relaxation techniques, and kegel
exercises
 Start activity slowly. Increase exercise slowly after a couple of minutes a day. Never exercise to the point
of exhaustion.
 ACOG recommends exercise every day for pregnant women for 30 consecutive minutes.
 Remember to warm up (at least 5 minutes) and cool down (at least 5 minutes) after activity to reduce risk
of injury to muscles and joints; 20 minutes of active exercise to increase heart rate to 70 – 85% of
maximum heart rate [To calculate: subtract woman’s age from 220, then multiply by 70% or 85%]
 Know when to stop: shortness of breath, dizziness, numbness, tingling, pain of any kind, more than 4
uterine contractions in an hour, decreased fetal activity, vaginal bleeding, lightheadedness, tachycardia, or
palpitations; difficulty walking. loss of muscle control; headache; increased swelling of hands, ankles, face.
 Avoid exercises which put too much strain on your lower back (double straight leg raising, sit-ups with legs
straight). You should NOT arch your back with exercises.
 Posture: Good posture is important to your well-being during pregnancy.
o Tuck in buttock muscles, use abdominal muscles to straighten out spine
o When standing for a length of time position one foot higher on a stool
o Shoes should provide support and have heels less than one inch.
o Keep shoulders back
o Bend at the knees
L&P, p. 109, 124, 382, 424-425, 440-441
8.
I know how to safely bend, lift and stretch during pregnancy.
a. Squat, bend at the knees to reach objects on or near floor
b. Do not bend at waist
c. Lift with the legs; lift the weight holding it close to the body and never higher than the chest
L&P, p. 425
9.
I know what to expect of 1st trimester care:
a. Appointments with a physician, midwife, or nurse practioner every 4 weeks plus extra visits
if my health or my baby’s health requires them
1st Trimester 6
b. Complete blood count, pap smear, cultures and urinalysis in the first trimester (usually 1st visit,
and at 28 weeks).
L&P, p. 413
Complete blood count (CBC)
Hgb
(normal 1st trimester >11 mg/dl
Hct
(normal) 1st trimester >33%
WBC (normal) < 15,000/cc
L&P, p. 918
Blood Group and Rh
Grouped to be A, B, O, and AB
Rh factor is either negative or positive
L&P, p. 1084, 1085
Antibody screen (ABS, also called Indirect Coombs test). Done at the initial visit and at 28 weeks, this
is most significant if the mother is Rh negative. If the ABS is negative, then the mother has not made
antibodies to Rh antigens, which are present on the RBCs of an Rh positive fetus. If the ABS is positive,
the mother’s immune reaction will hemolyze fetal RBCs and may cause intrauterine fetal death (IUFD);
successive antibody titers are drawn to determine if the antibody levels are rising. Maternal Rh negative
blood and a negative ABS titer is an indication for prophylactic Rhogam at 28 weeks gestation.
L&P, p. 1085-1086
Pap Smear & Cervical Cultures
 Pap Smear is done on the initial visit. It is a smear of cells that is sent to the lab for analysis to determine if
changes consistent with cancer are present.
o Negative for malignancy. No cancer is noted.
o Atypia or atypical cells. There are cells that have been exposed to consistent inflammation or
slight changes. Usually the pap is repeated after treatment or colposcopy is done. Colposcopy is
an exam of the cervix with a special microscope to look for abnormal cells, HPV and condyloma.
o Dysplasia. The cells have undergone some changes that are worrisome. The patients are referred
for colposcopy, a microscopic exam of the cervix.
o Carcinoma Insitu. A noninvasive or early cancer of the cervix. Surgery is done on the nonpregnant patient. The pregnant patient would be managed based on gestational age.
o Chlamydia culture. If positive, chlamydia is present; mother and partner(s) should be treated.
o Gonorrhea Culture (GC). If positive, gonorrhea is present; mother and partner(s) should be
treated.
L&P, p. 121, 206-215, 306-310, 413
Urine Dipstick
Urine is tested for glucose, albumin (protein), nitrites and leukocytes at each prenatal visit. The presence of
these may indicate possible complications (e.g., renal disease, pre-eclampsia, infection, diabetes, weight loss,
inadequate nutrition, infection, etc.) and should be reported to the physician. Should the patient complain of
nausea and vomiting, urine is checked for ketones.
Glucose--many women have glucose in their urine and it is considered normal unless the glucose reading is
> 1+.
Protein--many women will have a trace of protein in their urine. However, protein is considered a very
sensitive indicator of pregnancy-induced hypertension, which is seen after 20 weeks gestation. It is important to
know what the protein was on the very first visit, which is a baseline. If the protein is a trace, it probably
represents contamination of the urine by cervical or vaginal secretions, especially if it is present in the first and
second trimester. If the patient develops protein in the urine beyond the baseline, then pregnancy-induced
hypertension must be considered (bleeding is ruled out).
Nitrites--are a break down of gram negative rods. Positive nitrites mean the presence of bacteria and urine
cultures need be to be sent to the lab to determine which bacteria are present.
1st Trimester 7
Leukocytes--WBCs, positive means leukocytes are present, in 3rd trimester is normal but if positive when
nitrites are positive, a urinary tract infection is suggested. UTI’s aren’t always related to gram (-) rods. Large
number of leukocytes with or without symptoms may indicate a UTI. Send culture.
L&P, p. 413
d. Availability of a nurse at visits or by phone for questions about my health or about my educational needs.
Teaching needs - the patient's chart contains a form where the nurse records teaching that has been completed. Prior
to seeing the patient, the chart is reviewed and a tentative teaching plan is prepared. Teaching tools such as booklets,
charts, videotapes, pamphlets regarding childbearing are available to the patient. Each patient should also have a
Patient Preference Sheet filled out and on her chart. This form asks for her preference regarding care during
pregnancy and delivery and also asks her to identify learning needs.
e. HIV Testing (if I desire it; may be required)
Testing usually begins with the HIV-1 and HIV-2 antibody tests, using a sensitive screening test such as the enzyme
immunoassay (EIA). Reactive screening tests are confirmed by an additional test, such as the Western blot or an
immunofluorescence assay. A positive confirmatory test result means that the woman is infected with HIV and is
capable of infecting others.
L&P, p. 203-205
f. Testing for Hepatitis B
A blood test for the presence of hepatitis is done on all patients. There are two types of testing, for antigen (Ag) and
for antibody (Ab). When antigen is positive, the patient has been exposed to the hepatitis virus. When antibodies
are present, then the patient has been exposed to either the disease or the vaccine. Hepatitis B Surface Antigen
(HBsAG) is drawn on all women at the first prenatal visit, regardless of whether they have been tested previously.
The following are combinations that are seen on patients’ charts.
 Ag+ and Ab-; has active disease and is contagious, and can transmit Hepatitis B to the developing fetus.
 Ag+ and Ab+; denotes a chronic carrier state, can transmit Hepatitis B.
 Ag- and Ab + (anti-HBc) but Ab- (anti-Hbs); during the recovery phase after exposure, called the “window
phase”; a patient may continue to be infectious.
 Ag- and Ab+; has been exposed to hepatitis and has built antibodies (signals immunity); most common
reason is because of vaccination.
 Ag- and Ab-; has not been exposed to Hepatitis B.
L&P, p. 202-203
g. Other tests as necessary to evaluate my health or my baby’s
Rubella screen done at initial visit. Rubella is determined using a titer ratio. A titer of 0.900 is negative. A titer of
0.901 - 0.999 is equivocal. A titer of >1.0 is positively immune. If negative or equivocal, the chart is flagged
that patient should be told 1) to notify us if she is exposed to rubella during the pregnancy, and 2) that she needs
to be redrawn postpartum. If immune status has not changed, patient should be revaccinated postpartum.
Random glucose may be drawn at first visit. If BS > 140 mg/dl, a 3º GTT (with 3-day diet prep) will be done.
VDRL is a screening test for syphilis; if it is positive then the blood is sent for FTA, which is a more specific test for
syphilis. A positive FTA indicates the presence of syphilis; treatment is needed for mother, her partner, and baby.
Ultrasound is done to detect structural abnormalities of the developing fetus. Size of the fetus, dating, amount of
amniotic fluid, lung and cardiac activity, and fetal movement can be assessed.
First Trimester Screening (FTS) may be done between 10 and 14 weeks (from the first day of the last menstrual
period). It is designed to identify pregnancies at higher risk for Down syndrome and trisomy 18 (possibly also
trisomies 13, 21, Turner syndrome, cardiac defects and other anomalies; an increase in the rate of fetal loss has also
been reported even in chromosomally normal fetuses, that have an increase in the sonolucent area at the back of the
fetal neck greater than 3 millimeters or the presence of cystic hygroma). It does not diagnose either Down syndrome
1st Trimester 8
or trisomy 18, but provides a risk estimate. This test involves a combination of a special ultrasound examination (to
measure a thin layer of fluid found at the back of the fetal neck, called the nuchal translucency, or NT) and a blood
test (to measure levels of two proteins, called free Beta-hCG and PAPP-A). Results, reported as positive (the woman
has an increased risk to have a baby with Down syndrome or trisomy 18 because the value falls above the cutoff) or
negative (the value, and therefore the risk, is lower than the cutoff), are available in about one week. FTS with a
negative result can never completely rule out a risk of Down syndrome or trisomy 18. Women with a First Trimester
Screening that is out of the normal range may be offered CVS (see below) for diagnostic testing.
Varney, p. 627
Chorionic Villus Sampling (CVS) may be done instead of amniocentesis since it can be performed earlier at 10-12
weeks. CVS or amniocentesis is done to detect genetic abnormalities when it is indicated: maternal age greater than
35 years; family history of genetic disease or if parents are carriers of a genetic disorder; exposure to infection such
as rubella or toxoplasmosis; family history of neural tube defects. CVS is performed by removing a sample of
chorionic (placental) tissue via aspiration, either transcervically or transabdominally. The sampling is used to
evaluate the chromosomal, enzymatic and DNA status of the fetus. There is some increased risk of miscarriage and
there have been studies linking CVS to limb anomalies when CVS is done before 10 weeks gestation. The benefits
and risks of the test need to be discussed.
L&P, p. 210, 212, 213, 819, 827-828, 896, 899
10. I have information about the following class offerings (Give them a handout, refer to Women’s resource
center or their local paper. Classes fill up quickly. It is wise to sign up during the 1 st trimester!)
a. Lifestyle changes and nutrition
b. Childbirth preparation
 Lamaze Childbirth Preparation Association of Ann Arbor (734-973-1014)
 Bradley Method of Husband-Coached Birth (734-475-0022)
 Brighton Community Education – Lamaze, Childbirth Preparation Refresher (810-229-1419 or 810-2312820)
 Plymouth Childbirth Education Association (Lamaze) (734-459-7477)
North Campus Nursing Center at the University of Michigan – Childbirth preparation (734-747-1636)
L&P, p. 451-454
c. What is available in my community
o Body & Soul (Prenatal exercise program) (734-668-0304)
o Massage Therapist for Pre- and Postnatal Women (734-482-1841)
o Ann Arbor YMCA (734-663-0536)
o Prenatal Yoga
o Prenatal “Aqua-size”
d. Other
 Infant Massage Classes (734-741-9706)
 LaLeche League 9734-994-0113
 Breastfeeding Class, North Campus (734-747-1636)
 Breastfeeding Class, Plymouth Childbirth Education (734-459-7477)
 Breastfeeding Class, Livingston County Department of Public Health (517-546-9850)
L&P, p. 764-774
ABOUT BUILDING EMOTIONAL ATTACHMENTS
11. I have the information and help I need to deal with my emotions and feelings about pregnancy
 Pregnancy adds new stresses to a women’s life
 Hormonal shifts influence psychological state.
 Emotional changes are also great.
 Instability comparable to PMS, which may include irritability, mood swings, irrationality, weepiness, fear,
joy, and elation
1st Trimester 9




Identify sources of personal and work related stressors
Take a break when you can and rest
Talk to trusted friend or relative, partner
Talk to health care provider if you need additional assistance; referral to social services or a mental health
facility may be appropriate
L&P, p. 398-402, 431-434
12. My partner and I have the information and help we need to deal with our adjustment to pregnancy
 Partner adjustment to pregnancy
o Feeling left out
o Attend monthly visit with spouse
o Participate in exercise with wife, give up junk food, stop smoking, and give up alcohol with wife
o Attend childbirth classes with wife; also father-to-be class.
o Couvade behaviors: partner experiences health symptoms similar to what the mother is experience
 Spouse mood swings
o Patience, not a permanent condition
L&P, p. 402-405
13. I have information about my baby’s growth, development and behavior during pregnancy
End of 1st month:
o tiny tad-pole like embryo
o smaller than grain of rice
o brain, spine, heart, GI, sensory organs, arm and leg buds will form with in the next 2 weeks
L&P, p. 342
End of 2nd month:
o more human looking
o ~ 1 1/4 inch long (1/3 is head); ~ 1/3 ounce
o heart beats, bones start developing
o fingers and toes are beginning to develop
L&P, p. 342
End of 3rd month:
o tiny human
o 2 1/2 – 3 inches long, weighs ~ 1/2 ounce
o more organs developed
o male and female genitalia are recognizable by 12 weeks
L&P, p. 342
ABOUT PROVIDING A SAFE ENVIRONMENT FOR ME AND MY BABY
14. I know how to use a seatbelt during pregnancy.
o Always wear seatbelt.
o Lap belt snug across upper thighs, under growing belly.
o Shoulder strap positioned between breasts.
o If a front passenger in a car with an airbag, be sure to position self as far back as possible.
L&P, p. 428
15. I know that caffeine, tobacco, street drugs and alcohol are harmful during pregnancy and should be
avoided.
o Cigarettes and caffeine can be addicting or harmful to the pregnant woman and her fetus/newborn.
o Quit smoking or at least cut down, since tobacco use effects are dose-related (SGA, apnea, SIDS); second
hand smoke dangers also exist.
o Avoid alcohol during pregnancy (Fetal Alcohol Syndrome).
o Avoid street drugs; harmful effects to growing fetus include miscarriage and early birth (preterm birth).
L&P, p. 430, 964-967
1st Trimester 10
16. I have reviewed with my caregivers the drugs/medication I take to determine what is safe to take during
pregnancy.
o Ask patient what medications they are taking and have physician aware of the medications so s/he can
describe side effects/teratogens with use during pregnancy.
o A careful record should be kept of all therapeutic agents used.
o Greatest danger of drug-caused developmental defects extends from the time of fertilization through the
first trimester (when the woman may not yet know that she is pregnant).
L&P, p. 429
17. I know that I should avoid using hot tubs and saunas during pregnancy.
o Refrain from long stays in hot tub
o Anything that raises body temp over 102 degrees is potentially dangerous to baby
o It usually takes about 10 minutes for body to raise to high temps
o Recommend keeping belly out of water; soak feet & legs
o Most U.S. experts recommend avoiding the sauna
L&P, p. 424
18. I can identify the following problems and report them to my care provider:
o Persistent, severe vomiting lasting more than 24 hours (hyperemesis, dehydration)
o Vaginal bleeding, with or without pain (miscarriage)
o Burning, pain and/or bleeding when I urinate (UTI)
o Temperature about 100.6 degrees F (infection)
o Abdominal pain, or painful and persistent abdominal cramping
o Trauma
L&P, p. 438-439, 817-818, 870-872, 874-876
19. I can identify resources/help for protecting my physical and emotional safety.
 Questions to screen for abuse (If she answers “yes” even once, her partner is abusive!):
o Does your partner put you down and make you feel ashamed?
o Does your partner tell you what to do and who you can see?
o Has your partner ever threatened to hurt you or your family?
o Has your partner ever pushed or hit your, or forced you to have sex?
 Places to call for help:
o The Domestic Violence Project/SAFE House (Washtenaw County) ~ 24 hour crisis line number is
734-995-5444
o The UM Sexual Assault Prevention and Awareness Center ~ 24 hour crisis line number is 734936-3333
o LACASA (Livingston County) ~ 517-548-1350
o National Domestic Violence Hotline ~ 1-800-799-7233 or 1800-787-3224 (TTY)
o Women’s shelter ~ 734-665-6955
L&P, p. 110-111, 112-113, 114, 131-152
20. I know my care providers and how to contact them
o Taubman OB-Gyn Clinic ~ 734-763-6295 (M – F 8am – 4:30pm)
o Women’s Hospital Birth Center, Triage Office ~ 734-764-8134 (24 hours/day – Labor & Delivery)
o UM Emergency Room ~ 734-036-6666
YYB&U, cover page
Prepared by Trudy Esch, MS, RN
Spring 2003
Revised by Linda Hawkins, RNC, BSN
Fall 2004
1st Trimester 11
References
Lowdermilk, D.L., & Perry, S. E. (2004). Maternity and women’s health care (8th ed.). St. Louis, MO: Mosby.
(L&P, abbreviation for citing in above text).
The Regeants of the University of Michigan. (2003). You, your baby & us. Ann Arbor, MI. (YYB&U, abbreviation
for citing in above text).
Varney, H., Kriebs, J. M., & Gegor, C. L. (2004). Varney’s Midwifery (4 th ed.). Sudbury, MA: Jones and Bartlett.