Prenatal care issues and measures

The three most concentrated core problems in the field of prenatal care are improper response to physiological symptoms, lack of psychological and emotional guidance, and cognitive biases in prenatal preparation. The corresponding core intervention directions are individualized symptom management, multi-subject emotional support, and hierarchical accurate science popularization. All measures must be implemented around the core principle of "adapting to the individual situation of pregnant mothers." There is no unified standard that suits everyone.

I have been working in the obstetrics clinic of a tertiary hospital for 8 years, and I have seen too many expectant mothers who followed the standard answers on the Internet and finally tortured themselves. I just received a doctor last week who was 28 weeks pregnant. Her legs were so swollen that she couldn't even fit into a size 42 men's slipper. I heard from an old man at home that soaking her feet would reduce swelling, so she soaked her feet in 45-degree water for half an hour every day. As a result, she was so swollen that she couldn't even walk. When she came here, her blood pressure was as high as 140/90. In fact, there are two different intervention ideas for the treatment of edema during pregnancy: Western medicine first needs to check urine protein and blood pressure indicators. After ruling out the risk of preeclampsia, it is recommended to avoid standing and sitting for long periods of time and to raise the lower limbs by about 15 degrees when resting. Unless it is pathological edema, medication is not recommended. ； In traditional Chinese medicine, under the guidance of a professional physician, you can boil light soup with adzuki beans and drink it, or gently press Zusanli to relieve pain, but you must absolutely avoid acupuncture points such as Hegu and Sanyinjiao that may induce uterine contractions. What I fear the most is to deal with it blindly by myself without checking anything. It is a normal physiological reaction, but in the end it causes problems.

Oh, by the way, there is another mistake that many people secretly make without asking about it: taking supplements blindly. There was a pregnant mother who was afraid that her baby would be lost at the starting line. She took three different brands of multivitamins, DHA, and maternal milk powder at the same time. The final prenatal checkup showed that vitamin A exceeded the standard, which actually increased the risk of fetal teratogenesis. We persuaded her to stop for a long time. You really don’t need to buy blindly. During the prenatal check-up, you can ask the doctor what you need and what you need to make up for it, which is more reliable than the recommendations from Internet celebrities.

Compared with visible swelling and tangible weight gain, the emotions hidden in the heart are easier to ignore. Last month, a 36-week-pregnant mother of her second child came for a prenatal check-up. Her blood pressure fluctuated. She cried after being questioned for a long time. She said that the eldest son had to help with homework every day when he first entered elementary school. Her husband was away on business trips all year round. Her mother-in-law kept saying, "You were able to do everything when you were pregnant with your eldest son. Why are you so delicate now?" She secretly hid in the toilet and cried for almost half a month, even the thought of death flashed across her face. There are actually differences in academic circles on psychological intervention during pregnancy: one group believes that as long as you feel depressed, you must go to a professional psychological clinic and use cognitive behavioral therapy to intervene to avoid developing prenatal depression. ； The other school of thought believes that most mood swings during pregnancy are caused by hormonal changes + life stress. The company of family members and pregnant mothers doing things they like are much more effective than deadlifts and psychological counseling. In our clinical practice, we usually take care of both ends: if you are just irritable or crying occasionally, we first teach the family members to lend a hand and let the pregnant mother take half an hour every day to do her own thing, even if she lies down to watch TV shows or eat some junk food. ； If you can't sleep for more than two weeks in a row and have no interest in anything, you must be referred to a psychological department for evaluation, and you can't just take it hard.

There are still many pitfalls, which are actually caused by miscellaneous information on the Internet. There was a pregnant mother who heard on the Internet that "you need to climb more stairs to give birth naturally." She climbed 20 flights of stairs every day during her 38th week of pregnancy. She eventually suffered premature rupture of membranes and called the emergency department in the early morning. Fortunately, they were sent to the hospital in time, and both mother and child were fine. Some pregnant mothers go to the other extreme. They heard people say that the slightest movement during pregnancy will lead to miscarriage. They lie in bed to nurse the fetus from the time they are pregnant. At 32 weeks of pregnancy, they are diagnosed with venous thrombosis in the lower limbs. Finally, they lie down until the caesarean section, and the postoperative recovery is twice as slow. We now don’t dare to give unified standards for outpatient science popularization. We all say in different levels: If you feel unstable in the first three months, rest more and don’t exercise strenuously. ； If you feel comfortable in the second trimester, you can do swimming, walking, and pregnancy yoga. ； If you have bad knees in the third trimester, don’t climb stairs blindly. Sitting at home and rocking a yoga ball can help the fetal head lower. There is no uniform list of delivery kits. Pregnant mothers are asked to prepare them according to the requirements of the hospital where they gave birth. Don't just buy a bunch of unused things and pile them up at home to take up space.

Oh, by the way, there is another common question: prenatal check-up compliance. Last year, I met a pregnant mother who thought she was young and in good health, but she didn't want to have a small ovary abnormality in her second trimester because it was troublesome. As a result, the child was born with a ventricular septal defect, and she had a heart operation at the age of six months. When the couple cried in the clinic while holding the child, we felt uncomfortable watching it. Don’t bet on yourself and your children. Don’t miss the prenatal checkup even once. Even if you spend a little more money and make two more trips, it’s all worth it.

In fact, after practicing obstetrics for so long, I also feel that prenatal care has never been a cold, standardized process. You are the one who is pregnant, and your feelings always come first. You don’t have to swallow bird’s nests that you can’t swallow for the sake of “the child is nutritious”. You don’t have to force yourself to walk 10,000 steps for the sake of “good delivery”. If you are not sure about anything, just ask your prenatal doctor. Family members can help more and make less demands. This is more effective than any universal nursing formula.