Instructional Plan For A Healthy Pregnancy

INSTRUCTIONAL PLAN FOR A HEALTHY PREGNANCY ( WHAT TO EXPECT WHEN YOU’RE EXPECTING? )

A. ASSESSMENT

I. SETTING The health teaching site constitutes an important dimension of health education and promotion programs towards meeting learning needs, efficacy, and effectiveness. The health education setting will take place at Benguet State University Gymnasium at Kilometer 6, La Trinidad, Benguet. Specifically, the learners and health educators will gather at the gymnasium distant the last gate. The said setting can be described as conducive to learning because it expresses concern for the health, convenience, and comfort for both the learners and health educators. The gymnasiums’ structure expresses a cheering setting for the learners and health educators. The construction, equipment, and facilities will add to enlightening ideas for the health teaching process. The light-painted walls of the gymnasium will be suitable for learning since it will reduce confrontation and anxiety, thus it promotes a sense of well being. Comfortable seats and spacious work place will also be recognized. Learners will have an adequate working space and will have a good environment with the wooden floor. Cleanliness will

also be practiced through out the learning practice with the availability of trash cans inside the learning area. The setting will also consider practical lighting. Natural sunlight will provide a balance view that is optimal for the learning. The windows, doors, and the main entrance will be kept open for the sunlight and also for ventilation. Fresh air will be able to pass through the corners of the learning area. The gymnasium will be conducive to learning. The said setting will be enlightening and idea generating. It allows sharing between the learners and the health educators that draws to excitement, happiness, and learning for both II.POPULATION

a. Type The health teaching will be directed to expectant mothers. Specifically, they will be mothers who are expected to be on their first child pregnancy. These expectant mothers will be coming from nearby Barangays of La Trinidad. Barangays near the setting will be preferred. Expectant mothers will be coming from Barangay Balili, Betag, and Poblacion, La Trinidad, Benguet. The health educators presumed the learners to be at least high school graduates thus, they could be able to comprehend with the discussion. b. Health Status The learners would be coming from semi-modernized community therefore presumed that they have knowledge in proper hygiene. Proper sanitation is also being monitored in the learner’s community which

contributes to cleanliness of their environment. The learners have easy access to Rural Health Units(RHU’s) and hospitals for them to have a regular monitor of their health. c. Population Number Since the learners would be coming from three barangay’s, the health educators anticipates fourty(40)-fifty(50) participants for the said health education.

III. PLAN a. General Objective The learners will be able to know appropriate ways on how to deal with proper and healthy pregnancy. b. Specific Objectives 1. The learners will be able to state what to expect at their

first prenatal visit. 2. The learners will be able to know what to expect during the first, second and third trimester of pregnancy. 3. The learners will be able to state some of the common symptoms during pregnancy and can give solutions to it. 4. The learners will be able to know the importance of nutrition during pregnancy and enumerate some of the nutrients needed by the mother. B. DIAGNOSIS a. Knowledge deficit: foods to avoid during pregnancy related to lack of information.

b. Knowledge deficit: possible effects or complications during pregnancy related to lack of exposure. c. Knowledge deficit: proper ways of cooping with unusual signs and

symptoms of pregnancy related to misinformation. d. Knowledge deficit: proper nutrition or nutrients needed to take during

pregnancy related to lack of information.

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C. PLANNING a. Materials and Equipment •

Guide card

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Ball pen

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Pencil with eraser

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Coupon bond

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Marker

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Manila paper

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Posters

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Video clips

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CD

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Universal Serial Bus (USB)

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White Screen

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Liquid-Crystal Display (LCD)

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Adhesive Tape

b. Funding/ Budget

The health teaching activity requires a total of 500.00 Php (approximation). The proceedings will be foe the snacks, probably

water and banana-que, and also for some materials needed for the health education practice. The fund will be sourced out from contributions of the health teaching team. Voluntary donations and assistance from supporters and other entities will be gladly and greatly appreciated.

c. Scheduling / Time Frame

The health education will be scheduled on the 6th of April, 2009 (Monday). Registration will start at 8:30 in the morning. The activity proper will begin at exactly 9:00 AM and will conclude at 12:00 noon. The health education will be a three-hour learning session. Since that the learners will be expectant mothers, proper choice of time will be recognized. The health educators will consider the preferences of the learners on the suitable time for their learning. For expectant mothers who are morning learners will be able to perform well, concentrate, and focus on the learning, thus this learning practice will be a benefit for them.

d. Language Spoken

The primary medium of instruction to be employed during the health education will be English. Supplementary languages to be used are Filipino and Ilocano. e. Instructional Strategies

i.

Lecture For the purpose of instruction, the health educator will verbally transmit information about the topic what to expect when you’re expecting directly to the learners. The educator can easily highlight the main ideas and can present unique ways of viewing information through lecture. The ideas and information can be imparted across the large number learners at the same time as well as within e relatively reasonable time frame.

ii. Power Point Presentation The use of the Computer Assisted Instruction will allow the educators to systematically present and discuss the topic. Graphics and pictures about the topic may be flashed via the projector. On the part of the learners, they will be able to easily follow and thus facilitate spontaneous delivery of the topic. iii. Other instructional for short-term learning •

Group discussion sessions will be incorporated during the learning process. The learners will have time for exposure and time for sharing. It will be a short-term acquaintance for the learners with the health educators.

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Definition and clarification of medical and scientific terms will be considered.

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Several options will be suggested for the learners to choose on what courses of action they will prefer.

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A rationale will be given for all that is said and done to help learners

sustain

ideas

and

information

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to

insure

understanding and fulfillment. •

Negative reactions from the learners shall be expected considering they are expectant mothers that they have a sudden change in mood.

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Summary or rundown of all the activities and discussions will be done at the end of the session to freshen up the learners on the topics tackled.

D. INTERVENTIONS

a. Activities

i. Group Discussion The use of group discussion would foster interest in the topic and learning in general are increased. A modified sample that would possibly be done is group sharing. The learners will be divided into groups. In each group, there will be discussion and sharing about pregnancy experiences.

ii. Ice-breaker An ice breaker will interfere during the health education to break the monotony for example. Jokes could be presented to stimulate the learners’ alertness. Brain-teasers could also be introduced to stimulate the learners’

interest and thinking skills. The jokes and brain-teasers to be presented would still be related and based on the topic discussed.

iii. Work-out / Exercise A work-out or an exercise would also be introduced during the health education. Yoga will be introduced to the learners. This will help the learners relax and gain more balance state of mind and body. Yoga will also help lessen the learners’ anxiety. The learners would easily grasp information and ideas with a relaxed mind and body.

iv. Discussion Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female.

I. What to expect at the first prenatal visit? A complete medical history will be taken, and certain tests and procedures will be performed. Confirmation of Your Pregnancy The practitioner will want to check the following: the pregnancy symptoms; the date of the last normal menstrual period, to determine the estimated date of delivery (EDD); the cervix and uterus, for signs and approximate age of the pregnancy. A Complete History

To give the best care, the practitioner will want to know a great deal about the mother. Come prepared by checking home records and refreshing her memory, as necessary, on the following: personal medical history (chronic illness, previous major illness or surgery, medications presently taking or have taken since conception, known allergies, including drug allergies); your family medical history (genetic disorders and chronic illnesses); your social history (age, occupation, and habits, such as smoking, drinking, exercising, diet; and factors in your personal life that might affect your pregnancy. A Complete Physical Examination This may include: assessment of the mother’s general health through examination of heart, lungs, breasts, abdomen; measurement of the blood pressure to serve as a baseline reading for comparison at subsequent visits; notation the height and weight, usual and present; inspection of extremities for varicose veins and edema (swelling from excess fluid in tissues) to serve as a baseline for comparison at subsequent visits; inspection and palpation of external genitalia; internal examination of the vagina and cervix (with a speculum in place); examination of the pelvic organs bi manually (with one hand in the vagina and one on the abdomen) and also through the rectum and vagina; assessment of the size and shape of the bony pelvis. A Battery of Tests Some tests are routine for every pregnant woman; some are routine in some areas of the country or with some practitioners, and not others; some are performed only when circumstances warrant. The most common prenatal tests include: •

A blood test to determine blood type and check for anemia.

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Urinalysis to screen for sugar, protein, white blood cells, blood, and bacteria. Blood screens to determine immunity to such diseases as rubella.

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A Pap Smear for the detection of cervical cancer.

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A gestational diabetic screening test to check for any tendency toward diabetes, particularly for women who have previously had an excessively large baby or gained excessive weight with an earlier pregnancy.

II. Possible Changes during Pregnancy First Trimester of Pregnancy During this trimester, the mother may not look pregnant yet, but she feels it. That's because a flood of pregnancy hormones is prepping on her body to play baby hostess for the next nine months. It means she could be in line for a bunch of wacky pregnancy symptoms from breast changes to bloating to fatigue to flatulence. In this trimester, the baby changes from a single fertilized cell (a zygote) to the embryo that implants itself in the uterine wall to a peach-sized bundle of growing limbs and body systems: organs take shape, baby starts to move (around week eight of pregnancy), and hair follicles and nail beds form. More major first-trimester milestones include the formation of muscles, the production of white blood cells to fight off germs, and the development of vocal cords. Moreover, for the mother, she’ll likely have a routine ultrasound to make sure things are progressing as they should, and a screening (done through a blood test between 11 and 14 weeks of pregnancy) to look for chromosomal abnormalities such as Down syndrome and congenital heart disease. By week five of pregnancy, the mother may be well into morning-sickness malaise (which, unfortunately, doesn't just strike in the morning!). By week six, the there will be enlargement of the breast of the mother. Pregnancy mood swings may hit by week seven, leaving a feeling up, then down, then up.

Second Trimester of Pregnancy In this next three months of pregnancy the baby is very, very busy. For one thing, he's sprouting hair, his ears and eyes are moving into their correct positions, and he's starting to suck and swallow. By week 18 of pregnancy, he weighs about as much as a chicken breast, he can yawn and hiccup and he's got fingerprints on those tiny digits. By week 21 of pregnancy, the mother should be able to feel his newly coordinated arms and legs and in week 22 of pregnancy , his developing senses start to smell, taste, see, and hear. By six months, the baby takes a cue from the mother and starts to pack on the pounds. Capillaries are forming to carry blood through his body and those little eyes are starting to open. By the end of your second trimester, you'll have a two-pound human in your belly! For the mother, the start of the second trimester often means less queasiness and more energy. Certain symptoms may persist (such as heartburn and constipation). She is also congested (may even snore) or mildly swollen around the ankles and feet. There will also be sensitivity of gums, leg cramps, dizziness, and an increased appetite. Other possible pregnancy symptoms include skin changes, pain in the lower abdomen, and varicose veins and/or hemorrhoids. Moreover, Pregnancy can wreak havoc on the mother’s sex life. The mother will also expect routine monitoring for the next several weeks. Her practitioner will check her weight, the size of your uterus, height of your fundus (top of your uterus), and the baby's heartbeat. Between 14 and 22 weeks of pregnancy she’ll likely have a quad screening as well; this blood test measures the levels of four substances produced by your baby and passed into your bloodstream. The results can indicate increased risk factors for chromosomal or congenital abnormalities such as Down syndrome or neural-tube defects. Amniocentesis, during which amniotic fluid is extracted and analyzed for genetic

abnormalities, is typically performed between weeks 16 and 18 of pregnancy. The mother is advised to eat well, exercise regularly, and get plenty of rest. Third Trimester of Pregnancy In this trimester, it is expected that the mother’s belly is already big. In week 28, the baby is about 2 1/2 pounds and 16 inches long. He'll also be testdriving some nifty skills like blinking and dreaming and regulating his own body temperature. By week 31 of pregnancy he'll get signals from all five senses, perceiving light and dark, tasting what she eats and listening to the sound of the mother’s voice. During week 34 of pregnancy a baby boy's testicles start their downward journey from abdomen to scrotum. In week 38, the baby sheds his vernix (the waxy substance that protects his skin from your amniotic fluid) and lanugo (the hairy coat that keeps him warm in there). In this trimester, the mother will be experiencing (totally normal) abdominal achiness and maybe even a few Braxton Hicks contractions. There may be some varicose veins and stretch marks. She may also have some crazy dreams and some clumsy moments, along with a temporary lack of bladder control. The breasts may also leak and she may experience false labor symptoms.

III. Common Symptoms during Pregnancy Nausea or Morning Sickness It is the nauseous, queasy feeling in the stomach, which can sometimes lead to vomiting — so innaccurately dubbed "morning sickness, because it can hit at any time of the day or night, especially in the first trimester. It is caused by the increased level of the pregnancy hormones hCG and estrogen circulating in the body, or the relaxation of the muscles of the digestive tract (making digestion less efficient) due to rising progesterone levels, or the

rapid stretching of the uterine muscles. Skipping meals and food aversions also can contribute to the empty and nauseous feeling.

Things to do about Morning Sickness/ Nausea •

Concentrate on that dynamic duo, protein and complex carbs, which are good for keeping nausea at bay — especially when eaten in combo.

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Stick to foods that appeal, even if it's the same foods over and over and over again. Avoid eating (or seeing, or smelling, or even thinking about) any dishes that trigger the queasies (spicy, fatty, and acidic foods may be particularly challenging, as well as anything with a strong aroma).

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Be a grazer. Eat six to eight small meals throughout the day rather than three large squares.

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Try foods with ginger (scientific study says that it reduces nausea and vomiting in pregnancy), such as ginger snaps, real ginger ale, ginger tea, ginger candies, or ginger drinks.

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Take prenatal vitamin in the evenings, and make sure it's iron-free, at least until the nausea passes.

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Try any of the classic stress-reduction techniques, like meditation or prenatal yoga. Or explore acupuncture, which also has been shown to reduce nausea in some women.

Heartburn The unpleasant sensations expected if a flamethrower stationed in the chest or gut — including burning and discomfort from mouth to stomach to bowel. The cause of this is that the muscle at the top of the stomach that usually prevents digestive acids from backing up into the esophagus relaxes. This allows those painfully acidic digestive juices to splash back up — causing irritation and burning.

Things to do about Heartburn •

Avoid heartburn-trigger foods such as highly seasoned spicy foods, alcohol, caffeinated drinks (such as coffee, tea, and cola, because they also relax the esophageal sphincter), chocolate, mint, and citrus. A diet high in fat can also contribute to heartburn.

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Drink before and after meals instead of with them, or just drink a little. Too much fluid mixed with too much food will distend the stomach, aggravating heartburn.

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Don't wear clothes that constrict your belly.

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A stick of sugarless gum can reduce excess acid (increased saliva can neutralize the acid on the esophagus).

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Don't smoke.

Constipation It is the irregular bowel movements and sluggish intestines that plague some women during pregnancy and bypass others altogether.

Things to do about Constipation •

Rough yourself up. Focus on fiber, the best ally in the fight against constipation: fresh fruits and veggies, whole-grain cereals and breads, legumes (peas and beans), and dried fruits.

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Pace yourself. Don't plunge right into a fiber-rich diet if not used to it. . Instead, wade in slowly — add some fiber to every meal (steamed broccoli and brown rice with chicken), but don't overload on it.

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Regular exercise encourages regular bowel movements.

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Stay away from stimulant laxatives. They might work in the short run, but they may make you very uncomfortable.

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Schedule your bathroom time carefully so you're in the vicinity and won't feel rushed when the mood strikes.

Nasal Congestion and Nosebleeds It is the annoying stuffiness in the nose and the nosebleeds that can accompany it, especially when blowing often. It is caused by high levels of estrogen and progesterone that increase blood flow to all the body's mucous membranes, including the nose, causing them to swell and soften. Things to do about Nasal Congestion and Nosebleeds •

Use the right blowing technique. Use your thumb to close one nostril, and blow gently out the other side. Repeat with the other nostril until you can breathe again.

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Try to put a warm-mist humidifier in your room to add some nose-soothing moisture to the air.

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Dab a little petroleum jelly in each nostril using a cotton swab to combat the dryness of the nose.

Round Ligament Pain It is also called abdominal achiness. It is the experience of “growing pains" around the middle as the uterus expands during pregnancy. It is typically felt as achy or sharp sensations on one or both sides of the abdomen. Things to do about Round Ligament Pain

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Get off your feet, get comfy, and stay there for a while. If that doesn't bring relief, or if the achiness crosses the line into severe abdominal pain, contact the practitioner and let him or her know what you're feeling.

Contractions (Braxton-Hicks) It is like a like a dress rehearsal —the uterine muscles are flexing in preparation for the big job they'll have to do in the near future. The cause is that pregnancy hormones are hard at work, sending messages to the body to start the process of childbirth. Things to do about Contractions •

Change position during a painful contraction —after sitting, stand (and vice versa).

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Use these contractions as a chance to practice breathing and visualization techniques.

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If contractions are quite frequent (more than four in an hour) and/or in a lot of pain or see any kind of vaginal discharge, call a practitioner.

Varicose Veins It is the large, swollen blood vessels found predominantly in the legs, but that can show up almost anywhere in the lower half of the body. The extra volume of blood that is produce during pregnancy is essential to support two growing bodies. It does, however, put extra pressure on the blood vessels, especially the veins in the legs, which have to work against gravity to push all that extra blood back up to the heart. Add to that, the pressure the burgeoning uterus puts on your pelvic blood vessels, and the vessel-relaxing effects of the extra progesterone your body is producing.

Things to do about Varicose Veins •

Keep the blood circulating. Keep legs elevated when sitting. When standing, put one foot on a low stool and alternate legs. Flex ankles every so often, and break the habit of sitting with legs crossed.

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(Take a walk (or even better still, several walks) each day, or do some other form of low-key, circulation-increasing exercises.

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Wear clothes — including underwear — that fit well and don't bind.

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Sleep on the left side to avoid pressure on your main blood vessels, and keep circulation going strong.

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Don’t strain. Heavy lifting or straining on the toilet can add to vein visibility.

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Use pantyhose.

Stretch Marks These are red, pink, or purplish streaks that appear across the belly, hips, thighs, and breasts during pregnancy. They're more pronounced on fair-skinned women. Things to do about Stretch Marks •

Moisturizers, such as cocoa butter. They'll help with the dryness and itching associated with pregnancy-stretched skin.

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Eating the best diet possible may also help keep the skin toned.

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Consult a dermatologist.

Snoring It is caused by nasal congestion and excess weight gain (both common among the pregnant women).

Things to do about Snoring •

Stick on a nasal strip at bedtime (they're completely drug-free).

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Try using a warm-mist humidifier in the bedroom at night.

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Plump up the pillows and try sleeping with head slightly elevated.

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Keep an eye on calories to make sure extra weight doesn't contribute to snoring.

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Ask your practitioner about your snoring and sleep apnea.

Gums (bleeding/ sore) It is the tender, red, swollen, extra-sensitive condition of the gums in the mouth during pregnancy. Hormones cause the gums to swell, become inflamed, and bleed more easily. These same hormones also leave the mouth more vulnerable to bacteria and plaque, both of which make the gums even more tender. Things to do about Bleeding Gums •

Always brush and floss.

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Get to the dentist frequently for checkup and cleaning.

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Skip the sweets, particularly the chewy kind.

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Fulfill the calcium requirement every day for stronger teeth.

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Try chewing a piece of sugarless gum or grabbing (unless you're allergic) a handful of nuts or a small chunk of cheese. All have antibacterial properties.

IV. Other things to be expected during pregnancy Fetal Movement during Pregnancy

Feeling the baby twist, wriggle, punch, kick, and hiccup is simply one of pregnancy's biggest thrills.

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Fetal Movement in the First Trimester

From the first few days and weeks of pregnancy until the end of the third month, the first trimester is a time of astoundingly fast development. But fetal movement is not yet felt in this trimester except the queasiness, the fatigue, and the headaches.

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Fetal Movement in the Second Trimester

Pregnant women will start to feel the movement of the baby. By the fifth month, most women are feeling the fidgets and squirms of their active little tenant. The baby's routines will grow increasingly acrobatic and the punches more powerful as those little muscles get stronger and those fledgling motor skills develop. In the sixth month, the baby picks up the pace. Leg movements will seem more choreographed. The baby is more active when the mother will settle down especially at night because the motion of the body during daily routine can lull the baby to sleep. When relaxed, the movement of the baby is greatly felt.

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Fetal Movement in the Third Trimester

By the seventh month, it starts to get a little cramp in the womb but the baby has still enough room to toss and turn for a little longer. Moreover, babies’ rhythms and patterns of their activity will vary.

Sleep Problems during Pregnancy •

Sleep Problems during the First Trimester

Sleep problems during pregnancy start in this trimester, when frequent trips to the bathroom during the night, to pee, to powder, ruin the night. The mother’s rest starts facing a whole other cast of interrupting characters such as, heartburn, hunger, vivid dreams, nightmares, leg cramps, restless leg syndrome and anxieties.

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Sleep Problems in the Third Trimester

In the third trimester, just when enough sleep is needed, slumber becomes even more elusive. It is hard to sleep because of frequent urination. This is because; as the uterus flattens the bladder storing an entire night’s worth of urine. Moreover, the kidneys which have to filter up to 50percent more blood than usual, are putting out more urine. •

Tips for getting a Good Night’s Sleep

 Avoid caffeine in all its forms after noon.  Get your eight glasses of water but taper off at night.  Exercise regularly during the day or early evening. A daily workout will help to sleep better, but if it comes too close to bedtime, it could actually sabotage sleep.  Take a warm bath just before bed.  Leave a night-light on in the bathroom. Switching on the overhead is

way too much of a wakeup call and will make it much harder to fall back asleep. Some Pregnancy Complications

Pregnancy complications can be rather rare or relatively common, only mildly concerning significant risks. For many conditions, early detection and good prenatal care can reduce the risks to both the mother and the baby, leading to a perfectly outcome.

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Abdominal Pain (Severe)

Mild abdominal pain during pregnancy (from implantation cramping, ligament stretching in early pregnancy, or uncomfortable Braxton Hicks contractions later on) is considered normal. But when in labor, severe abdominal pain is not normal. Nor is it normal to experience abdominal pain that’s accompanied by spotting, bleeding, fever, chills, nausea, vomiting, fainting, or even pain when urinating. The pain is such that it forces the mother to stop breathing. She may also experience bleeding, fever, high blood pressure and contractions. What to do: Take abdominal pain seriously, especially if it goes beyond the normal comfort level. If the pain is accompanied by any other symptoms, or if it doesn't go away when lying or resting, call a practitioner.

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Chicken Pox

It is a viral infection (the varicella virus) that causes red, itchy, fluid-filled blisters to erupt on the skin. Chicken pox usually starts on the torso, appearing on the abdomen or back first and then spreading to the rest of the body. The rash begins as small, red bumps that then develop into fluid-filled blisters which break and eventually crust over and scab. What to do: If the mother is not immune, she should avoid exposure to the virus during pregnancy. Pregnant women cannot be vaccinated because the vaccine contains live virus.

If not immune and was exposed, the practitioner may recommend an injection of varicella-zoster immune globulin (VZIG), to protect the mother.

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Ectopic Pregnancy

It occurs when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. This usually occurs because something (such as scarring in the fallopian tube) slows the movement of the fertilized egg into the uterus. The symptoms of ectopic pregnancy includes pain on one side of the abdomen (usually beginning as a dull ache that progresses to spasms and cramps) and abnormal bleeding. What to do: Occasional cramping and even slight spotting early in pregnancy is not cause for alarm, but let the practitioner know if crampy pain in the lower abdomen, heavy bleeding, or any of the other symptoms of an ectopic pregnancy is experienced. If one is diagnosed (usually through blood tests, pelvic exam, and ultrasound), the mother will undergo surgery (laparoscopically) to remove the tubal pregnancy or be given drugs (methotrexate or misoprostol), which will destroy the developing cells.

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Miscarriage

It is also called a spontaneous abortion. It is the unplanned end of a pregnancy before 20 weeks gestation. (After week 20, the loss of the developing baby is called a stillbirth.) Eighty percent of miscarriages occur in the first trimester and are usually related to a chromosomal or genetic defect in the embryo, though they can also be caused by an inadequate supply of pregnancy hormones or an immune reaction to the embryo. A miscarriage that occurs between the end of the first trimester and week 20 is considered a late miscarriage. Late miscarriage is usually due to the mother's health, the condition of her cervix or uterus, or to problems with the placenta. The symptoms of a miscarriage can include cramping or pain in the center of the lower abdomen, heavy bleeding (possibly with clots and/or tissue), or light

staining continuing for more than three days, as well as a decrease in the usual signs of early pregnancy, such as nausea and breast tenderness. What to do: Not all bleeding or spotting means it is a miscarriage. In fact there are many reasons (other than miscarriage) that could account for the bleeding. If there is spotting, call a practitioner, who will probably perform an ultrasound. If the pregnancy still appears to be viable (i.e., a heartbeat is detected on the ultrasound), the practitioner will likely impose bed rest, your hormone levels will be monitored (rising hCG levels are a good sign), and the bleeding will most likely stop on its own. If the practitioner determines that a miscarriage is inevitable, there's unfortunately little you can do. A miscarriage isn't complete and parts of the pregnancy remain in the uterus or a heartbeat is no longer detected yet. In such cases the practitioner might recommend the mother to undergo a dilation and curettage (D&C) to remove all fetal and placental tissue. Or he/ she might give medications to trigger uterine contractions to expel the pregnancy. A third approach is to wait until the uterus naturally expels the pregnancy.

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Gestational Diabetes

It is a form of diabetes that appears only during pregnancy. It occurs when the body does not produce adequate amounts of insulin (the hormone that lets the body turn blood sugar into energy) to deal with the increased blood sugar of pregnancy. Gestational diabetes usually begins between weeks 24 and 28 of pregnancy . Most women with gestational diabetes have no symptoms, though a few may experience extreme thirst, very frequent and very copious urination, or fatigue. The practitioner will probably screen the mother for gestational diabetes around week 28 of pregnancy. She'll drink a sugary liquid and then take a blood test an hour later. If the blood sugar level is high, she'll take a three-hour glucose tolerance test to determine whether she has gestational diabetes. What to do: Keeping an eye on the weight gain (both before and during pregnancy) can help prevent gestational diabetes.

If the mother is diagnosed with gestational diabetes, scrupulous control of blood sugar levels will mitigate the potential risks associated with the condition. The practitioner will likely put a special diet and will suggest simple exercises to keep the mother’s gestational diabetes under control.

NUTRITION DURING PREGNANCY Proper nutrition during pregnancy has been shown to reduce the risk of birth defects in babies and chronic diseases in adulthood such as heart disease, type 2 diabetes, high blood pressure, and high cholesterol. Likewise, babies born to mothers who gain excessive amounts of pregnancy weight are at increased risk for childhood obesity. A healthy diet helps mothers avoid pregnancy complications such as anemia, high blood pressure, and gestational diabetes. Good nutrition may also minimize morning sickness, fatigue, and constipation. And mothers who eat sensibly during pregnancy are more likely to return to their pre-pregnancy weight sooner. These guidelines will help all mothers make healthy choices for their growing little ones:

Eating for Two Although it is said that pregnant women are “eating for two”, the truth is they are only eating for about one and an eighth. The second one is much smaller and does not have the same calorie needs. The average pregnant woman requires approximately 300 additional calories per day during the second and third trimesters.

Variety is the Spice of Life Eating a variety of food each day will ensure that the mother will get all the vitamins, minerals, and other nutrients needed for her and the baby. Avoid eating the same meals every day. Have fun with the food and try new recipes. Select assorted fruits and vegetables daily. Also, choose products in various colors to provide different nutrients. Vary the proteins by alternating meats, fish, poultry, pork, eggs, beans, and nuts in the diet. And find new whole grains to enjoy beyond the basic bread, rice, and pasta.

Following the Pyramid Like the rest of the non-pregnant world, expecting mothers should look to the Food Guide Pyramid to determine what and how much to eat. It is recommended that pregnant women consume a minimum of 9 servings of breads, cereals, grains, and/or pastas, 4 servings of vegetables, 3 servings of fruit, 2-3 servings of low fat milk, cheese, and/or yogurt, and 2 servings (6oz) of lean meat, poultry, fish, beans, eggs, and/or nuts per day. Each food group provides different nutrients, so eating from all the food groups daily will help ensure a complete diet.

Fresh is Best Select whole foods rather than processed foods when available. Packaged foods often lose many of the nutrients they contain during processing. On the other hand, whole foods are loaded with nutrients and are usually free of preservatives, additives, and sweeteners.

Foods to Avoid Although most foods are perfectly safe for expecting women, certain foods can be harmful to a growing baby. Avoid following foods during pregnancy: • • • • • • • • •

Alcohol Sushi containing raw fish Shark, swordfish, king mackerel, & tilefish (limit intake of other fish to no more than 12 ounces/week) Raw or undercooked meat, poultry, eggs, fish, & shellfish Smoked seafood & cured ham Soft cheeses such as Brie, blue, feta, & goat cheeses Hot dogs, sausages, & other processed meats containing nitrates Alfalfa sprouts Unpasteurized milk & juices

Think about Your Drink During pregnancy, the amount of fluid in the body increases; thus, increasing the fluid needs. The baby needs fluids as well. Aim for at least eight 8 oz. glasses of fluid per day. This includes water, low fat or fat free milk, 100% fruit

and vegetable juices, decaffeinated coffee and tea, and soup. While juices are a nutritious alternative to soda, they still contain a large amount of sugar, so avoid consuming excessive amounts. Also, limit caffeinated beverages to no more than two per day. Forget Fad Diets Many women worry about having difficulty losing the weight postpartum and will consider dieting or restricting food intake. Pregnancy is not an appropriate time to diet. Dieting will decrease the amount of nutrients your baby receives and will affect the baby’s growth and development. Your baby needs to be nourished consistently throughout the day. Keep in mind, the majority of the weight you gain is not additional body fat. Where does the weight go? • Baby 7-1/2 lbs Your breasts — 2 lbs • Your protein & fat stores — 7 lbs • Placenta — 1-1/2 lbs • Uterus — 2 lbs • Amniotic fluid — 2 lbs • Your blood — 4 lbs • Your body fluids — 4 lbs

Prenatal Vitamins Pregnant women have an increased need for folic acid, iron, and calcium. Therefore, it is recommended that expectant women take a prenatal vitamin to supplement a balanced diet. However, too much of certain vitamins and minerals can be harmful to your baby. Talk with your doctor about an appropriate supplement and avoid supplements providing more than 100% of the daily value for any vitamin or mineral.

Treat Yourself Try to eat a sensible diet. An occasional treat is appropriate and well deserved. When indulge, avoid skipping meals. Continue to eat normal diet.

Recommended nutrients during pregnancy

Nutrient

Recommendation (Extra = Above RDA)

Maximum/Total amount recommended per day

Energy

Increase by 200 kcal (840 kJ) per day in last trimester only.

RDA

Proteins

Extra 6 g per day

51 g per day

Thiamin

Increase in line with energy; increase by 0.1 mg per day

0.9 mg per day

Riboflavin

Needed for tissue growth; extra 0.3 mg per day

1.4 mg per day

Niacin

Regular supplementation/diet of substance. No increase required.

RDA

Folate

Maintain plasma levels; extra 100 µg per day

300 µg per day

Vitamin C

Replenish drained maternal stores; 50 mg per day extra 120 mg per day

Vitamin D

Replenish plasma levels of vitamin RDA 10 µg per day.

Calcium

Needs no increase

RDA

Iron

Extra 3 mg per day needed

RDA

Magnesium, zinc, Normal supplementation or and copper consumption.

RDA

Iodine

250 µg per day

Extra 100 µg per day.

Enjoy a varied diet filled with wholesome, fresh foods to give your baby a healthy start.

E. EVALUATION

The health education on what to expect when you’re expecting was done good and effective. The learners have been well educated and informed about the topic. The learners can now state what they expect at their first prenatal visit and what to expect during the first, second and third trimester of pregnancy. The learners will now be able to state some of the common symptoms that occur during pregnancy and can give solutions to it. The learners also knew the importance of nutrition during pregnancy and enumerate some of the nutrients needed for an expectant mother. The learners were able to easily grasp information and ideas through the interventions done. The learners’ alertness was awaken by the joke. The presented brain-teasers help in stimulating the learners thinking skills. The Yoga was a great help in the learners relaxation. The learners are well accommodated during the learning sessions. Interventions are done to help the learners learn from the health education.

F. REFERENCES http://www.expectantmothersguide.com/library/houston/nutrition.htm http://pregnancy.about.com/cs/nutritioninpregn/a/aaabavoidfood.htm http://www.mamashealth.com/book/preg2.asp http://www.whattoexpect.com/pregnancy/landing-page.aspx http://www.whattoexpect.com/pregnancy/week-by-week/landing.aspx http://www.whattoexpect.com/pregnancy/symptoms-and-

solutions/landing.aspx

http://www.whattoexpect.com/pregnancy/complications/landing.aspx http://en.wikipedia.org/wiki/Nutrition_and_pregnancy