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 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. Common Symptoms during Pregnancy

Nausea or Morning Sickness

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

lead to vomiting — so innaccurately 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.

 

IV. 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.

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

NutrientRecommendation (Extra = Above RDA)

Maximum/Total amount recommended per day

EnergyIncrease by 200 kcal (840 kJ) per day in last trimester only.

RDA

Proteins Extra 6 g per day 51 g per day

ThiaminIncrease in line with energy; increase by 0.1 mg per day

0.9 mg per day

RiboflavinNeeded for tissue growth; extra 0.3 mg per day

1.4 mg per day

NiacinRegular supplementation/diet of substance. No increase required.

RDA

FolateMaintain plasma levels; extra 100 µg per day

300 µg per day

Vitamin CReplenish drained maternal stores; extra 120 mg per day

50 mg per day

Vitamin DReplenish plasma levels of vitamin 10 µg per day.

RDA

Calcium Needs no increase RDA

Iron Extra 3 mg per day needed RDA

Magnesium, zinc, and copper

Normal supplementation or consumption.

RDA

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