Fetal Kick Counts

• Count fetal movement daily
• Find a comfortable position in a quiet place
• Note the time started and count the number of fetal movements
• Document time required for 10 movements
• REPORT immediately if 10 movements are not achieved in 2 hours or if the pattern of fetal movement changes
• Discuss fetal growth and development
• Demonstrate palpation of the uterus for contractions
• Discuss symptoms of preterm labor
• Lower backache
• Increased vaginal discharge
• Bloody show
• Leaking amniotic fluid
• Contractions
• Pelvic pressure
• Differentiate between true and false labor:

  True Labor	False Labor
  Cervix dilates	Cervix unchanged
  Contractions ↑ intensity/frequency	Contractions ↓ with position/activity change Irregular
  Loss of amniotic fluid Bloody show	No change in vaginal discharge

• Encourage childbirth preparation class
• Discuss options for pain control in labor
• Cesarean preparation class, if indicated
• Epidural anesthesia class, if indicated
• Explore preparing for the newborn
• Breastfeeding
• Circumcision
• Choosing a pediatrician
• Car seat safety
• Discuss the discomforts and expected body changes associated with late pregnancy and teach reportable symptoms (in red)

  Discomfort	Patient Education
  Backache	Related to shift in posture due to gravid uterus Encourage low-heeled shoes Avoid standing for long periods Teach pelvic tilt exercises Report constant or rhythmic backache
  Braxton-Hicks contractions	Instruct patient how to palpate for contractions Labor symptoms should not be present until 39 weeks’ gestation Monitor for symptoms of labor Report signs of labor for prompt evaluation
  Constipation, hemorrhoids	Related to decreased gastric motility; iron supplement may worsen constipation Increase dietary fiber and water intake Encourage exercise Discourage enemas and laxatives Report painful or bleeding hemorrhoids
  Faintness	Related to hemodynamic changes Avoid sudden position change Avoid long periods without eating Avoid lying supine Report loss of consciousness
  Heartburn	Related to increased pressure on abdominal organs and sphincter relaxation Encourage small, frequent meals Avoid spicy foods Sit up after meals Report persistent symptoms
  Insomnia	Related to fetal movement, nocturia Teach relaxation techniques Encourage side-lying with pillow support Warm milk/shower before sleep
  Leg cramps	Related to uterine pressure on the pelvic nerves or calcium imbalance Review daily calcium intake Teach signs of deep vein thrombosis Report pain, redness, localized heat
  Peripheral edema	Related to venous return from pressure of the gravid uterus Rest in lateral recumbent position Elevate legs when sitting Continue with 6–8 glasses water daily Report generalized edema
  Pigmentation changes: Linea nigra Chloasma Striae	Related to hormone changes in pregnancy Fade after pregnancy Moisturizers decrease itching, but will not prevent striae Report body rashes
  Round ligament pain	Related to stretching of the round ligament with uterine growth and rotation Change positions slowly Encourage good body mechanics Report abdominal cramping, constant pain, or bleeding
  Shortness of breath	Related to upward diaphragmatic pressure exerted by the gravid uterus Allow more time for strenuous activities Eat small, frequent meals Lightening will lessen symptoms Report unrelieved dyspnea with rest
  Varicose veins	Caused by venous stasis related to pressure from the gravid uterus Wear pregnancy support hose Avoid lengthy standing Change positions frequently Report pain, redness, localized heat to legs