First trimester pregnant woman's complaint during COVID-19 pandemic

INTRODUCTION

A common grievance gravidarum emetic; accompanying conception can cause inconvenience, if excessive can lead to hyperemesis that would be bad for mother and fetus.¹ Women on their first trimester pregnancy will experience various kinds of adaptations on their bodily systems, digestive system is one the many adaptations that often disturbed pregnant women. The symptoms of digestive disorder are usually in the form of morning sickness. Various methods are done by pregnant women to ease their morning sickness, for example by distraction or diverting their mind from the pain by doing daily work, taking a walk and sightseeing on green gardens, and by consuming their favorite meal. The COVID-19 pandemic that occurred in 2019 resulted in many pregnant women on their first trimester to get confined indoors, unable to go out for fresh air or to get their favorite meals.² Out of twenty one pregnant women in their first trimester, all experienced pain trying to stabilize their bodies and trying to adapt to discomfort by doing light exercise.

CASE REPORT

The data in current study were collected through in-depth interviews and observations carried out for a month. This case was taken from one of the first trimester pregnant women who underwent her second pregnancy during the COVID-19 pandemic, this woman's first pregnancy was during normal times in 2017. A nurse visits 30 years old pregnant woman Mrs. L, in her first trimester pregnancy of nine weeks.

In her second pregnancy during COVID-19 pandemic, she felt; discomfort such as dizziness, nausea, vomiting and fatigue, causing her to stay in bed for too long without doing any activities. Mrs. L was having some complications in fulfilling her nutritional needs, this was caused by her body conditions that made her nauseous whenever she smells sharp-smelled cooking. She also vomits whenever she consume food that is smelly and cold, and the pandemic have made her unable to get her preferred food due to many of the stores were closed during the pandemic. These complications caused her body weight to decrease from 55 kg to 52 kg. The risk of stress, because she was not allowed to go outside, made her unable to meet other people in person, sightseeing in the parks, visiting markets and going for some outdoor entertainment. The prohibition of her outdoor activities made her unable to divert her nausea and dizziness by doing entertaining activities, boredom turned excessive that it made her stressed.

The results of interview done with her husband showed that the husband had tried to help her by providing the food she wanted, but because of the pandemic situation, many of Mrs. L's wishes cannot be fulfilled, the husband also tried helped her by doing some of the household chores, because there were other work that the husband had to do. The baby sitter has been temporarily suspended in fear that they could transmit the virus from outside into their home.

After having long discussions for her daily activities, the nurses found the nursing implementation as follows: Mrs. L deal with her discomforts such as dizziness and nausea in a non-pharmacological manner, by taking warm baths, using loose soft clothes, laying down on her bed and applying eucalyptus oil or mint flavored oil on her neck, shoulders, stomach and temples of his head, so that she can distract her nausea and dizziness. Meanwhile, for pharmacological, Mrs. L took anti-nausea medication and vitamins from the doctor. Mrs. L's efforts to fulfill her nutritional needs are done by eating small portion but frequent, of the food that does not use any strong spices that smells such as garlic and pepper, to reduce her morning sickness she would often consume ginger-based beverages, she also snacks and consume fresh fruits such as bananas, apples and mangoes that were eaten for every 30 minutes in small portions, she searched the internet for recipes she wanted and asks her mother or in-laws to make them for her. Mrs. L's efforts to reduce boredom and avoid stress are done by doing gardening, cleaning up and tidying her house so that it's clean and neat, watching movies on the internet, praying five times a day, discussing the discomfort felt with the nurses and pregnant friends via whatsapp group for twice a week.

DISCUSSION

There are three disturbance of basic human needs experienced by Mrs. L, who experienced her first trimester pregnancy during the COVID-19 pandemic, namely: the discomfort felt by Mrs. L was the feeling of dizziness, nausea followed by vomiting as well as fatigue which interfered her daily activities, this is in accordance with a research which stated that the increasing levels of chorionic gonadotropin hormone (HCG) originating from the placenta that is essential to maintain adequate hormone production. Estrogen and progesterone from the ovaries, these hormones also caused nausea followed by vomitting, especially in the first three months of pregnancy (first trimester) and will be reduced on the fourth month.³ Mrs. L tried to overcome her discomfort by taking a warm shower, using mint-smelled oil which was applied to the stomach, neck, chest and temples of her head. Nutritional compliance disorders, in which Mrs. L feels nauseous and dizzy whenever she smells strong-smelled food that it discourage her to cook, and then there is complications for her in getting the food she wants during the COVID-19 pandemic because many stores weren't open, so her weight has decreased from 55 Kg to 52 Kg. This will endanger the condition of Mrs L and her fetus, whose both need abundant nutrition for growth and development, this is in accordance with research which states that a pregnant woman will find it difficult to consume food and it will cause malnutrition to happen and can lead to fetal growth to be disturbed.⁴ Fetal development is strongly influenced by the adequacy of maternal nutrients. The efforts that Mrs. L made to meet her nutritional needs were by changing her diet to a small portion but frequent, eating warm or fresh food, drinking 200 ml of ginger based beverages in the morning, making her desired food by herself, and eating fruits for every 30 minutes. Each stage of fetal growth depends on the proper transfer of maternal nutrition, so a balanced diet is very important to avoid fetal complications, fruits and vegetable-based foods that are rich in fibers and can prevent premature birth.⁵ In addition, the essential oil content in ginger can help reduce nausea in pregnant women so that mothers can eat normally.⁶ Empty stomach consist of only of gastric acid it has nothing to digest except the, own walls; sugar is also low because of respite between meal such condition if persists too long can lead to nausea.¹

The risk of stress experienced by Mrs. L due to the COVID-19 pandemic situation which requires the public to stay at home, made her unable to meet her friends, going outside for sightseeing at the parks and other entertainment activities. Even though it is known that prenatal maternal stress can be a risk for the developing fetus and may have a long-lasting effect on the susceptibility of children and adults to somatic and psychiatric diseases.⁷ Stress in pregnant women could affects the fetal behavior, motor and cognitive development.⁸ To overcome this, Mrs. L decided to distract her stress by doing positive activities such as gardening, praying five times a day, cleaning and tidying the house and discussing matters of pregnancy through the whatsapp group with her friends who were pregnant too. Pregnant women felt bored at home and would be happy to meet other pregnant women. This can reduce the anxiety level of pregnant women because they get social support from fellow pregnant women.⁹ In addition, in terms of gardening done by Mrs L, it is in accordance with published report which states that gardening can improve physical, psychological and social health, from a long-term perspective, alleviating and preventing various health problems ahead to be faced.¹⁰

CONCLUSION

First trimester pregnancy is an adaptation process regarding to the change of hormone inside that can increase human corionic gonadotropin (HCG) hormone which could increase pregnancy nausea. Other than that, the unpleasant feelings that could appear are dizziness and fatigue; the nausea could also make the woman to lose appetite. To reduce the unpleasant feelings of pregnant women usually serving their favorite food or doing something enjoyable like walking in the park or meeting friends can be a helpful solution. Situation and condition of COVID-19 pandemic caused the need for pregnant women to stay at home and most cannot meet any of their friends. So to help reduce the problem of the first trimester pregnancy women and also to avoid any stress, activities like gardening, praying, or cooking favoured foods with own ingredients could be good solutions.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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