Nutritional status of woman – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Assessment of Nutritional status of woman:
midwife’s assessment of the woman’s nutrition would start with an assessment of the woman’s general wellbeing, her energy levels her tiredness levels, general examination, assess for pallor in the subconjuctiva as a sign of anaemia, woman’s height and weight and current weight need to need to be take. Form this the midwife can calculate the woman’s pre – pregnancy body mass index (BMI) can be calculated
Body Mass Index
It is used to estimate a person’s total amount of fat and it is an approximate of the best weight too health.
Knowing the pregnancy BMI is a guide to advising on pregnancy weight gain.
Measurement of Body Mass Index (BMI)
BMI= weight in kg/(Height in meters )2
Example – koly’s weight 55kg. her height is 160 cm.
So, her BMI = 55 /(160)2
= 55/256
=21
A healthy BMI = for an adult is between 20-25. if the BMI is –
1. Below16 = the person is undernourished
2. 16-18 = the person is under weight and possible malnourished
3. 18.5 -20 = under weight and need to gain weight
4. 20-25 = healthy weight range for abults
5.26-30 = over weight
6. over 30 = the person is obese.
Outline Framework for initial Antenatal visit
At this visit the midwife collects information, identifies potential problems and forms a relationship between the woman and the midwife for safe pregnancy, labour, birth and postnatal experience of the woman and her baby. It includes –
1. Information gathering (including taking history)
2. Examination and assessment.
3. Tests and screening.
4. Decision making.
5. Health promotion/information and education.
1. Information gathering
- At this initial antenatal visit, the midwife will gather basic social/ personal data and
- socio-economic information (name, birth date, living status etc)
- Gather information on the woman’s environmental issues.
- Symptoms of discomforts related to pregnancy.
- Gather information to confirm pregnancy and calculate EDD and current gestation.
2 . Examination and assessment:
- Height and weight.
- Blood pressure check.
- General appearance.
- Physical health status.
- Nutritional status & examine for pallor or (anaemia).
- Breast examination.
- Vaginal discharge/bleeding.
- Examined for oedema.
- Assessment of uterine size.
3. Tests and screening:
- Blood tests for pregnancy, grouping,Hb%, CBC & diseases screening (Hepatitis B, yphilis)
- Urine tests for hCG to confirm pregnancy albumine etc.
4. Decision Making:
- Antenatal care.
- Place of birth; advocate for birth in a health facility.
- Birth preparedness.
- Emergency readiness.
- Antenatal risk assessment.
- prevent all Complication of mother & baby.
5. Health promotion /information and education:
Antenatal visit are an important to share and discuss information which will improve health and wellbeing of mother and fetus for a healthy mother and baby after birth. It includes –
- Immunization for woman particularly tetanus toxoid.
- Other interventions such as iron, folic acid, malaria prophylaxis.
- Self care and nutrition.
- Cleanliness and safe water intake.
- Importance of breast feeding for infant health & mother.
- Explain about complication of pregnancy.
- Advice to inform doctor or nurse or midwife any complicated condition during pregnancy, labour and post partum period.
A history at the 1st antenatal visit
Taking a comprehensive history at the first antenatal visit is an important role of the midwife. There are many areas of information to find out. These are –
1. Family history – Ask regarding family history of illnesses conditions which is related to woman’s& her baby health. eg- diabetes, Hypertension etc.
2. Medical history Ask about medical or health conditions which may affect the pregnancy.eg- Hypertension, Heart disease, Jaundice, Mental illness, etc.
3. Surgical history – Ask about previous surgery including hip, pelvic, uterine, Spinal surgery etc.
4. Medications and drugs – Ask about if the woman is taking any prescribed medications or drugs.
5. History of previous pregnancy – Ask the woman about her history of being pregnant and how each pregnancy ended. History of gravida (Pregnant) and para (having birth), abortion etc.
6. Menstrual and Gynecological history – Ask about menstrual history, age at menarche, regularity of menstrual cycle, Duration of menses. Ask about history of vaginal infections, STIs, fistula history, infertility or treatment for infertility.
7. History of current pregnancy – Ask about her LMP, Calculate the EDD, current gestation, Feelings of pregnancy or signs & symptoms of pregnancy and current physical conditions.
8. Nutritional status- Ask about appetite, weight, type of diet, folic acid supplement and intake of habit eg. Tobacco or alcohol and passive smoking.
Read More….