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.

` C. PLANNING

a. Materials and Equipment

• Guide card
• Ball pen
• Pencil with eraser
• Coupon bond
• Marker
• Manila paper
• Posters
• Video clips
• CD
• Universal Serial Bus (USB)
• White Screen
 • Liquid-Crystal Display (LCD)
• 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.

• Definition and clarification of medical and scientific terms will be

considered.

• Several options will be suggested for the learners to choose on

what courses of action they will prefer.

• A rationale will be given for all that is said and done to help
learners sustain ideas and information and 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.

• 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
 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.

• Urinalysis to screen for sugar, protein, white blood cells, blood,
and bacteria. Blood screens to determine immunity to such
diseases as rubella.
• A Pap Smear for the detection of cervical cancer.
• 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 test-
driving 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. Top Ten Signs A Woman Might Be Pregnant

10. Tender, swollen breasts

One of the early signs of pregnancy is sensitive, sore breasts caused by increasing
levels of hormones. The soreness may feel like an exaggerated version of how the breasts
feel before the period. Thea discomfort should diminish significantly after the first
trimester, as the body adjusts to the hormonal changes.

9. Fatigue

Feeling tired all of a sudden? No, make that exhausted. No one knows for sure
what causes early pregnancy fatigue, but it's possible that rapidly increasing levels of the
hormone progesterone are contributing to sleepiness.

A woman start to feel more energetic once hit second trimester, although fatigue
usually returns late in pregnancy when you're carrying around a lot more weight and
some of the common discomforts of pregnancy make it more difficult to get a good
night's sleep.

8. Implantation bleeding

Some women have a small amount of vaginal bleeding around 11 or 12 days after
conception (close to the time missed period might be missed). The bleeding may be
caused by the fertilized egg burrowing into the blood-rich lining of your uterus — a
process that starts just six days after fertilization — but no one knows for sure.

The bleeding is very light (appearing as red spotting or pink or reddish-brown staining)
and lasts only a day or two.

7. Nausea or vomiting
 Most women, morning sickness won't hit until about a month after conception. (A
lucky few escape it altogether.) But some women do start to feel queasy a bit earlier. And
not just in the morning, either, pregnancy-related nausea and vomiting can be a problem
morning, noon, or night.

About half of women with nausea feel complete relief by the beginning of the
second trimester. For most others it takes another month or so for the queasiness to ease
up.

6. Increased sensitivity to odors

For newly pregnant, it's not uncommon to feel repelled by the smell of a bologna
sandwich or cup of coffee and for certain aromas to trigger gag reflex. Though no one
knows for sure, this may be a side effect of rapidly increasing amounts of estrogen in the
system. Woman may also find that certain foods used to enjoy are suddenly completely
repulsive.

5. Abdominal bloating

Hormonal changes in early pregnancy may leave feeling bloated, similar to the
feeling some women have just before period arrives. That's why clothes may feel snugger
than usual at the waistline, even early on when uterus is still quite small.

4. Frequent urination

Shortly after becoming pregnant, the mother finds herself hurrying to the
bathroom all the time. Why? Mostly because during pregnancy the amount of blood and
other fluids in the body increases, which leads to extra fluid being processed by the
kidneys and ending up in the bladder.

This symptom may start as early as six weeks into the first trimester and
continue or worsen as the pregnancy progresses and the growing baby exerts more
pressure on the bladder.

3. A missed period

If the mother usually pretty regular and the period doesn't arrive on time, the
mother probably take a pregnancy test long before any of the above symptoms be
noticed. But if not regular or not keeping track of the cycle, nausea and breast tenderness
and extra trips to the bathroom may signal pregnancy before realizing the didn't get the
period.

2. Your basal body temperature stays high

 If a mother has been charting her basal body temperature and sees that
temperature has stayed elevated for 18 days in a row, it might be a sign of pregnancy.

1. The proof: A positive home pregnancy test

In spite of what might be read on the box, many home pregnancy tests are not
sensitive enough to detect most pregnancies until about a week after a missed period. So i
decide to take one earlier than that and get a negative result, try again in a few days.
Once you've gotten a positive result, make an appointment with your practitioner.

IV. Common Symptoms during Pregnancy

Nausea or Morning Sickness

It is the nauseous, queasy feeling in the stomach, which can sometimes

lead to vomiting ,so inaccurately 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.
• 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).
 • Be a grazer. Eat six to eight small meals throughout the day rather than
three large squares.
• 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.
• Take prenatal vitamin in the evenings, and make sure it's iron-free, at least
until the nausea passes.
• 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.
• 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.
• Don't wear clothes that constrict your belly.
 • A stick of sugarless gum can reduce excess acid (increased saliva can
neutralize the acid on the esophagus).
• 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.
• 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.
• Regular exercise encourages regular bowel movements.
• Stay away from stimulant laxatives. They might work in the short run, but
they may make you very uncomfortable.
• 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.
• Try to put a warm-mist humidifier in your room to add some nose-soothing
moisture to the air.
• 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

• 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).
• Use these contractions as a chance to practice breathing and visualization
techniques.
• 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.
• (Take a walk (or even better still, several walks) each day, or do some
other form of low-key, circulation-increasing exercises.
• Wear clothes — including underwear — that fit well and don't bind.
• Sleep on the left side to avoid pressure on your main blood vessels, and
keep circulation going strong.

• Don’t strain. Heavy lifting or straining on the toilet can add to vein visibility.
 • 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.
• Eating the best diet possible may also help keep the skin toned.
• 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).

• Try using a warm-mist humidifier in the bedroom at night.
• Plump up the pillows and try sleeping with head slightly elevated.
• Keep an eye on calories to make sure extra weight doesn't contribute to
snoring.
• 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.

• Get to the dentist frequently for checkup and cleaning.
• Skip the sweets, particularly the chewy kind.
• Fulfill the calcium requirement every day for stronger teeth.
• 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.

V. 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.

• 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.

• 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.

• 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.
 • 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.

• 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.

• 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.

• 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.

• 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.

• 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.

VI. 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

Recommendation (Extra = Above Maximum/Total amount

Nutrient
RDA) recommended per day

Increase by 200 kcal (840 kJ) per

Energy RDA
day in last trimester only.

Proteins Extra 6 g per day 51 g per day

Increase in line with energy;

Thiamin 0.9 mg per day
increase by 0.1 mg per day

Needed for tissue growth; extra

Riboflavin 1.4 mg per day
0.3 mg per day

Regular supplementation/diet of
Niacin RDA
substance. No increase required.
 Maintain plasma levels; extra
Folate 300 µg per day
100 µg per day

Replenish drained maternal stores;

Vitamin C 50 mg per day
extra 120 mg per day

Replenish plasma levels of vitamin

Vitamin D RDA
10 µg per day.

Calcium Needs no increase RDA

Iron Extra 3 mg per day needed RDA

Magnesium, zinc, Normal supplementation or

RDA
and copper consumption.

Iodine Extra 100 µg per day. 250 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