What should the nurse teach the patient in relation to braxton hicks contractions?

Pregnancy ultimately builds up a woman. It is the pinnacle of life wherein women become more than just women; they become mothers. The journey of pregnancy is also a tough one but is meaningful and wonderful. The discomforts a woman would undergo are just bumps along the road of fulfillment once she has delivered her child.

• Discomforts during the First Trimester
  • Breast Tenderness
  • Palmar Erythema
  • Constipation
  • Nausea, Vomiting, Pyrosis
  • Fatigue
  • Muscle Cramps
  • Hypotension
  • Varicosities
  • Hemorrhoids
  • Heart Palpitations
  • Frequent Urination
• Discomforts during the Second and Third Trimester
  • Backache
  • Dyspnea
  • Ankle Edema
  • Braxton Hicks Contraction

Discomforts during the First Trimester

There are a number of discomforts that can be felt during the first trimester. This is the time when the body is just starting to adjust to the pregnancy, and hormones are still in chaos. The woman must be educated on how to ease these discomforts to help her adjust slowly.

Breast Tenderness

Breast tenderness is one of the first symptoms that the woman would notice in early pregnancy. The tenderness may vary between women; some hardly notice the sensation at all.

• Advise to wear a bra with a wide shoulder strap. The support it gives helps ease the tenderness.
• Dress warmly and avoid cold. She should also dress warmly as exposure to cold increases the tenderness.
• Get examined. Women who experience intense pain should have to examine the presence of nipple fissures or breast abscess to rule out these conditions.

Palmar Erythema

Palmar erythema is the constant itching and redness of the palms but is not considered an allergy. Increased estrogen levels possibly cause the pruritus.

• No it’s not an allergy. Educate the woman that she has not developed an allergy, and this is normal during pregnancy.
• Calamine lotion to the rescue. To soothe the itchiness, calamine lotion can be applied.
• Disappears naturally. Palmar erythema would naturally disappear once the body has adjusted to the increased estrogen levels.

Constipation

Constipation is caused by slow peristalsis due to the pressure from the growing uterus.

• Increase fiber in the diet. Encourage the woman to move her bowels regularly and increase the fiber in her diet.
• Drink water. Advise her to drink at least 8 to 10 glasses of water every day.
• Iron supplements. Educate her that iron supplements can cause constipation but need not be stopped because it helps build up fetal iron stores.
• Don’t use mineral oil. The use of mineral oil to relieve constipation is not advisable because it absorbs the fat-soluble vitamins A, D, K, and E.
• Don’t use enemas. Enemas are also prohibited as it may initiate labor.
• So as OTC laxatives. Over-the-counter laxatives are also contraindicated unless prescribed.
• Avoid gas-forming foods. Advise the woman to avoid gas-forming food to prevent excessive flatulence.

Nausea, Vomiting, Pyrosis

Nausea and vomiting are also one of the earliest symptoms of pregnancy. Pyrosis or heartburn typically occurs when the woman ate a large meal.

• Small frequent feedings. Advise the woman to take small, frequent meals and avoid greasy foods.
• Upright position after. Encourage her to keep in an upright position after meals to avoid reflux.

Fatigue

Pregnant women experience fatigue mostly in early pregnancy because of increased metabolic requirements.

• Rest and sleep. Advise her to increase the amount of rest and sleep and to continue with her normal nutrition intake.
• Take short breaks. For women who still work, advise her to take short breaks, especially if her work involves being up and about the whole day.

Muscle Cramps

Muscle cramps are caused by decreased serum calcium levels, increased phosphorus levels, or interference in the circulation.

• Lie down. Advise the woman that when this happens, she should lie on her back and extend the affected leg while she keeps her knee straight and dorsiflexes the foot.
• Magnesium citrate or aluminum hydroxide gel. Magnesium citrate or aluminum hydroxide gel is prescribed to women who have frequent and unrelieved muscle cramps.
• Raise those feet. The woman should elevate her lower extremities frequently to promote circulation.

Hypotension

When the woman lies on her back and the uterus presses upon the vena cava, supine hypotension might occur, impairing blood return to the heart.

• Sleep sideways. Advise woman to rest or sleep on her side, not on her back.
• Rise slowly. Encourage her to rise slowly and dangle feet over the bed for a few minutes; avoid standing for extended periods.

Varicosities

Varicosities are tortuous veins caused by the pressure of the uterus to veins at the lower extremities.

• Raise legs. Advise the woman to rest in Sim’s position or on the back with the legs raised against the wall.
• Don’t cross legs. Discourage sitting with legs crossed or knees bent and the use of constrictive knee-high hose or garters.
• Support stockings do wonders. The use of elastic support stockings is advised to relieve varicosities.
• Exercise and walk. Exercise is also effective through taking walk breaks from chores or from standing or sitting for too long.
• Vitamin C helps. Vitamin C is also recommended to reduce varicosities for the formation of blood vessel collagen and endothelium.

Hemorrhoids

Hemorrhoids are varicosities of the rectal veins that occur because of the pressure of the veins from the weight of the uterus.

• Evacuate daily. Advise the woman to evacuate her bowels daily and resting on a Sim’s position.
• Knee-chest position. Encourage the woman to assume a knee-chest position for 10-15 minutes at the end of the day to relieve the pressure on the rectal veins.
• Stool softener. If the woman already has hemorrhoids, a stool softener would be recommended.
• Relieving hemorrhoids. The pain of hemorrhoids could also be relieved by applying witch hazel or cold compresses to external hemorrhoids.

Heart Palpitations

Heart palpitations may occur when upon sudden movement the woman experiences bounding palpitation of the heart. This is mainly due to circulatory adjustments necessary to accommodate her increased blood supply during pregnancy.

• Slow and steady. Advise the woman to move in slow, gradual movements to prevent heart palpitations.

Frequent Urination

The pressure of the uterus on the bladder causes frequent urination. Frequency occurs early in the pregnancy and late in the pregnancy.

• No fluid restriction. Advise the woman not to restrict her fluids to diminish the frequency of urination, instead; caffeine intake should be diminished.
• Offer assurance. Assure the woman that voiding frequently is a normal occurrence during pregnancy.
• Kegel’s exercises. Kegel’s exercise also helps to reduce the incident of stress incontinence and helps regain the strength of urinary control and strengthens perineal muscles for birth.

Discomforts during the Second and Third Trimester

The last trimesters of pregnancy also have their set of discomforts that you have to differentiate from complications that might arise.

Backache

Lumbar lordosis develops as pregnancy progresses to maintain the balance.

• Low heels. Advise the woman to wear shoes with low to moderate heels to reduce the amount of spinal curvature necessary to maintain an upright position.
• Warm compress. Backache can be relieved by applying local heat on the area.
• Body mechanics. Advise the woman to squat rather than bend over to pick up objects.
• Close to center of gravity. Advise the woman to lift objects by holding them close to the body.

Dyspnea

Dyspnea results from the pressure of the expanding uterus on the diaphragm. Dyspnea is prominent especially when the woman lies flat on the bed at night.

• Proper sleeping position. Encourage the woman to sleep with her head and chest elevated.
• Limit activities. Advise her to limit her activities during the day to prevent exertional dyspnea.

Ankle Edema

Late in pregnancy, some women experience swelling of the ankles and feet. The edema is caused by general fluid retention and reduced blood circulation in the lower extremities.

• Watch out for proteinuria or eclampsia. Assess if the woman has hypertension or proteinuria to rule out eclampsia.
• Sleep on the left side.  Advise the woman to lie on her left side when resting or sleeping.
• Sit. Encourage her to sit half an hour in the afternoon and in the evening with legs elevated and to avoid constrictive clothing.

Braxton Hicks Contraction

From the 8th to the 12th week of pregnancy, the uterus periodically contracts and relaxes, and this is termed as Braxton Hicks contraction.

• Give assurance. Assure the woman that these are not signs of early labor, but they can inform their healthcare provider about them.

A pregnant woman would always want reassurance that her pregnancy is healthy. These discomforts may alarm her, especially if she knows little about the physiology of pregnancy, so it is the role of healthcare providers to guide her and be there for her whenever she needs them throughout the pregnancy.

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