Education and Nutrition during Pregnancy (Nursing)

00:00 Anticipatory guidance we've mentioned before, but what are we going to talk about, what are we going to guide the patient about. We're going to talk about the assessments that are coming up. So we talked about testing that was done at certain points in pregnancy, we want to let the clients know when those are coming up. Next time we're going to do an ultrasound. Next time we're going to draw labs to check you for gestational diabetes or we're going to do a group beta strep culture the next time or next month. So letting them know what's coming up. Talking to the client and if hopefully their support person is there, about labor and what to expect, what are the signs of labor. Asking about how they're going to feed their baby and notice I said how you're going to feed your baby and not making an assumption about breastfeeding, recognizing that clients have a choice and we want to explore the reasons for whatever their choices are. We want to talk about contraception.

00:52 This is usually a really great time to talk about contraception because you get an honest answer. Sometimes right at delivery if that's the first time you've asked about contraception, the answer might be different than what the client might feel any other time. We're going to ask about that early on. We're going to talk also about discomforts. So, is the client experiencing any pain and where is it and is there something we can do to make things better.

01:15 I mean we're going to make sure we talk about prenatal testing. So this obviously has to be done at the very beginning of pregnancy so we don't miss the window. Okay, so thinking about all the information that we want to educate the pregnant client and her support person about, so we're going to go through that next. So the first thing might be nutrition. So, how much should a pregnant patient have everyday? Now, we had an old adage of eating for 2.

01:44 That's not actually true. You're really just eating for 1 and in most countries where there are sufficient amounts of food, in general we eat more than we need. So, the actual amount that we need in a pregnancy is equivalent to maybe half of a sandwich. So it's really not that much more than what we eat in a normal day. So thinking about the actual calorie intake between the second and third trimester is about 340 kilocalories a day increase over a normal diet. In the postpartum period, if the client decides to breastfeed, then the request is that we up that kilocalorie count to 500 kilocalories a day. Generally, again, it is sufficient to eat what we've normally been eating but we need to think about the contents. So are we eating a balanced diet, are we eating healthy foods, are we increasing protein because protein is the building block of all cells and if you think about being pregnant or you think about lactation then we're doing a lot of cell building and so increasing proteins is going to be really important.

02:45 Let's talk about another nutrient, folic acid. Having sufficient amounts of folic acid in the maternal bloodstream at least 3 months prior to pregnancy has been associated with a decreased risk of birth defects specifically related to the spinal cord. The other things a folic acid does is it helps to produce blood and protein for the baby, very important. We are advising patients that they take folic acid even if they're not pregnant, even if they're not really thinking about pregnancy just because they're capable of being pregnant would be a really good idea. So anyone of childbearing age really is a great candidate for folic acid. And when you think about the fact that 50% of pregnancies are unplanned, this is a really great idea. Thinking about the amount of folic acid, 400 mcg per childbearing patients during the preconception period is the recommendation and once they are pregnant this amount goes up to 600 mcg a day. Now, we've talked about things you should have, let's talk about things you should avoid. So, thinking about things we should avoid during pregnancy and the composite, things that are going to have bacteria that may cause problems for the fetus are going to be things to avoid. So keep that in mind as we go through this list. So, no raw eggs, unpasteurized juices or dairy products. If they've been pasteurized then you can drink them or eat them. Undercooked meat, poultry or fish. So if you're a big sushi lover then this might be something that you want to avoid with the raw sushi anyway. So if you're eating a California roll, then that would be okay. Any sorts of deli meats or hotdogs. So if you're going to eat those and you want to cook them to steaming because there is a possibility that a bacteria called listerioris could be hiding there. So if you cook it to steaming, that will kill that off and then it would be safe to eat. We also want to avoid raw vegetables and things like Alfalfa sprouts because they tend to carry bacteria. Soft cheeses and specifically we're talking unpasteurized soft cheeses. So if it's been pasteurized it would be safe to eat.

04:54 It's also important to avoid fish that are high in mercury during pregnancy. So, those fish might be tilefish, some types of mackerel, certain types of salmon. So you may want to look those up to make sure that you know which ones to avoid. And any type of artificial sweeteners or low fat diet options, there's really not a safe or recommended amount in pregnancy so we tend to recommend that patients don't have any.