This note discusses on certain complications pregnant women encounter during their pregnancy, labor and birth. Appropriate patient education is necessary in prepregnancy, ante partum, labor and delivery settings to address complications and risk factors that could harm the mother and infant during labor and birth. Several of these risk factors can be eliminated by proper patient education. Nurses are not simply health care providers and caregivers; they also functions as patient educators with a high obligation to provide patients and their family members with all vital information ranging from simple to complex health matters, preventive measures, nutrition, exercise and medications. Competent in patient education, nursing techniques, and client teaching, professional nurses are effective communicators and can help make a marked change in the clinical status of a patient. Below are a list of complications commonly seen in pregnancy, labor and birth. This note also discusses the nurse’s role in patient teaching with such complications.
Hypertension

High blood pressure (BP) or hypertension happens when arteries carrying blood from the heart to the body organs are constricted. This leads pressure to advance in the arteries (ACOG, 2014). In pregnancy, this can make it difficult for blood to reach the placenta, which provides nutrition and oxygen to the fetus. Low blood flow can reduce the growth of the fetus and put the mother at higher risk of preterm labor and preeclampsia. Pregnant women require education to allow them to monitor blood pressure, recognize symptoms of high blood pressure and management of hypertension during pregnancy (ACOG, 2014).

Women who have high blood pressure before they get pregnant could benefit from teaching on monitoring and controlling high blood pressure, with medications if necessary, throughout their pregnancy. Treating diabetes and losing weight as preventive measures for hypertension is important. Regular monitoring of BP and physician follow up is also necessary. Likewise, it is crucial to teach women to eat healthy during pregnancy, lower the use of salt, and perform regular exercises. If high blood pressure appears in pregnancy is called gestational hypertension (ACOG, 2014) and must be treated.

Preeclampsia

Preeclampsia in pregnant women is a serious medical condition that can cause preterm delivery and death (ACOG, 2014). It is marked by elevated blood pressure in pregnant women who have not had high blood pressure issues in pre pregnant state. The cause is unknown, but there are many risk factors associated. The risk factors include prior pregnancy with preeclampsia, first pregnancies, diseases of kidney, diabetes and hypertension in pre pregnant state, advanced maternal age, multiple pregnancies, and obesity (ACOG, 2014). The education process includes explanations of measures to control hypertension by diet, exercise, medications and regular follow up visits with physician. Women with risk factors need specific attention to control and treat high blood pressures during pregnancy. These women need instructions and reinforcements on the dangerous complications of preeclampsia, management of high blood pressure and diabetes, weight loss if obese, signs and symptoms of preeclampsia and when to seek emergency help if needed (ACOG, 2014).

Women who have had preeclampsia can develop seizures and risk of recurrent preeclampsia in future pregnancies. The condition can worsen and progress into hemolysis, elevated liver enzymes, and low platelets (HELLP) which can be fatal. Women should be instructed to report immediately if they develop swelling of face or hands, pain in upper abdomen, sudden weight gain, and any distress in breathing (ACOG, 2014).

Gestational Diabetes (GD)

Gestational diabetes is a clinical condition wherein a woman who did not have diabetes before pregnancy develops the condition during pregnancy (ACOG, 2017). Treating gestational diabetes by following a treatment plan established by a health care provider is the appropriate way to lower or prevent problems associated with high blood sugar during pregnancy. If appropriate blood sugar is not maintained, GD can progress to high blood pressure from preeclampsia and puts the mother at risk of having a large size infant, which advances the risk for cesarean delivery. Babies born to GD mothers are also at risk to develop breathing and jaundice. Hypoglycemia in the first day is a common occurrence in these babies. Large babies born to GD mothers can experience birth trauma, suffer from low blood sugar and require intensive care monitoring (ACOG, 2017).

Patient teaching should include assisting the patient to understand the disease process, education on home blood sugar monitoring, signs and symptoms of altered blood sugars, and how to manage it. Teaching on healthy diet and exercise during pregnancy is crucial. Regular follow up with the physician and compliance with plan of care needs to be reinforced shoud also be provided (ACOG, 2017).

Infections

Infections during pregnancy include several types of sexually transmitted diseases that may occur during pregnancy or delivery and may progress to complications for the pregnant woman, the pregnancy, and the infant after delivery (Friel, 2019). There are certain infections that can transfer from mother to infant during delivery when the infant passes through the birth canal; several other infections can transfer to the fetus during the pregnancy. The majority of these infections can be prevented or treated with appropriate preconception, prenatal and follow-up care. Maternal infections that can harm the fetus include cytomegalovirus infection, herpes simplex virus infection, rubella, toxoplasmosis, hepatitis B, and syphilis (Friel, 2019).

Patient education here focuses on addressing the infection and directing the patient to treatment and follow up visits (Villines, 2018). Reinforcing the significance of adequate treatments on infections during pregnancy is important. Pregnant women should be educated about complications like miscarriage, pre term delivery, ectopic pregnancy, various types of birth defects, newborn diseases, maternal complications, and stillbirth associated with infections during pregnancy. It is equally important to instruct women before getting pregnant to receive vaccines for chicken pox and flu (Villines, 2018).

The Centers for Disease Control and Prevention (CDC) provide some strategies to reduce the risk of developing an infection during pregnancy (Villines, 2018). They include frequent hand washing, avoiding contact with people having infectious or contagious diseases, no use of unpasteurized foods, no direct exposure to cat litter, testing...…be taken to lower uterine contractions in women who had prior cesarean sections who received oxytocin infusion for induction of labor by administering tocolytics (Lowdermilk et al., 2018). Prompt explanation of high risk factors associated with uterine rupture is important. Emotional support and preparing mom for newborn morbidity is also important. Notify women with high risk for uterine rupture, to alert health care professional for sudden sharp abdominal pain or bright red hemorrhage. Supporting the woman and the family, updating status, advising of possible infant morbidity or mortality associated in actual rupture, and the nature of emergencies should be addressed (Lowdermilk et al ., 2018).

Amniotic fluid embolus

Amniotic fluid embolus (AFE) is a severe complication linked with pregnancy, caused by a foreign substance that is introduced in the blood circulation, resulting in hypoxia, hypotension, cardiovascular collapse and disseminated intravascular coagulopathy (Moore, 2019). AFE occurs during pregnancy, during labor, or immediate postpartum. Rapid labor, meconium stained amniotic fluid and uterine injury or tears can contribute AFE. Advanced maternal age, induced labor, eclampsia, cesarean delivery, forceps or vacuum assisted delivery, placenta previa or abruptions are also in the list of contributing factors (Moore, 2019).

AFE is an emergency clinical situation that needs intensive care monitoring, mechanical ventilation, fluids, blood transfusion, and treatment with inotrops (Moore, 2019). Updating status and emotional support of the woman’s family are essential. Education should include teaching the woman on the warning signs of AFE at any point during pregnancy, labor and birth. It is crucial to instruct the woman to report breathing difficulty, restlessness or any signs of chest discomfort immediately and to seek emergency treatment. Women with risk factors for AFE need education and awareness of this possible, mostly fatal condition and how to be alert (Moore, 2019).

Conclusion

Nurses play a critical role in the education of pregnant women in antepartum units, doctor’s offices, clinical settings, delivery and care of babies, and they usually assist the childbirth process. As health care professionals, nurses must be proficient, educated, and trained to think critically, make appropriate nursing judgments, and act quickly. There are several risk factors associated with pregnancy, labor and delivery. Nurses are often responsible for working with doctors to establish a personalized birthing plan for each pregnant woman to ensure that each delivery is safe for the mother and the baby and that they receive optimum quality care. Before delivery, nurses often look into complications of labor and the delivery process, risk factors, the mother’s potential for complications, and discuss the childbirth process with the mother while providing guidance about what to expect. Labor and delivery nurses work in a variety of clinical settings such as hospitals, private clinics, birthing centers, and even in-home settings, and they must participate in educating the pregnant women about the healthy management of the pregnancy. The nurses are frequently required to provide the needed education specifically to pregnant women in antepartum settings when there are obvious risk factors that could complicate the pregnancy, labor and delivery.

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