What is the antenatal period?

The antenatal period is defined as the period between conception of the fetus and delivery.

What is antenatal Care?

Antenatal care is defined as specialized health care that should be received by all women who are pregnant. Antenatal care is generally provided in the form of clinics that are manned by doctors, midwives, nurses and other health care workers such as nutritionists etc.

Usually the mother suspects that she is pregnant when her regular menstrual flow fails to occur at the expected time. This leads to the anxious mother to confirm the presence of pregnancy shortly after a missed period.Some women wait for a longer time before confirming their pregnancy.

The utilization of antenatal care is now routine in most developed countries, unfortunately it is not so in most developing countries.

Factors that contribute to the lack/ under- utilization of antenatal care facilities in developing countries are:

i) Illiteracy

ii)Bad roads

iii)Poverty

iv)Limited medical institutions.

However there is a strong co-relation between the level of education of the woman and the degree of utilization of antenatal care. The more educated a woman is the greater the chances of utilization of antenatal care.

Is it necessary that a pregnant woman must be seen by a doctor during pregnancy or delivery?

No it is not necessary that all women should see a doctor during antenatal care or during delivery. Midwives can manage well on their own, including the delivery. Pregnancies managed by midwives even reduces interventions. They call in the doctor only when necessary.

What is Shared Antenatal Care?

In shared antenatal care a team provides the antenatal care, instead of a single doctor, or a midwife. The team which provides the antenatal care to a pregnant lady involves mainly the obstetrician, family practitioner and the midwife.

The most important reason why we should have shared antenatal care is to decongest the hospitals  and therefore allow hospital doctors to spend more time with women who have obstetric problems. This approach is also very convenient to the mother as she can continue her antenatal care at a local clinic closer to her house.For shared antenatal care to be effective there should be no communication barrier. The “Antenatal Card” or “Co-Operation card” is the main method of communication. This can be supplemented by letters, telephone calls,e-mails etc.

Aims/Objectives of Antenatal Care:

The main objective of antenatal care is to ensure a healthy mother and infant at the end of the pregnancy.

1) Health Education: The antenatal care can provide the right opportunity for health education. These health talks can cover topics such as physiological changes during pregnancy, nutrition, hygiene, care of the teeth, coitus, immunization, relaxation,travel and exercise after during pregnancy and after delivery. One can also use this opportunity to dispel any myths and fears about pregnancy.

2) Monitoring of fetal well being.

3) Screening to detect fetal abnormalities.

4) Detection and treatment of complications of pregnancy.

5) Detection of possible problems in labour ,before the labour commences.

How many times do I need to make antenatal visits during a pregnancy?

The total number of antenatal visits to be made by a pregnant lady varies. It depends on the risk factors (  Like previous history of stillbirth etc), the woman might have.

If the visits are made less frequently, it might be difficult to identify complications. If visits are made too frequently, it might increase the number of interventions.

For a pregnant lady with no risk factors, the following visits are recommended:

i) The booking (First visit) around 12 to 14 weeks of pregnancy, ideally in a hospital antenatal clinic.

ii) Every 4 weeks up to 28 weeks of pregnancy.

iii) Every 2 weeks up to 36 weeks

iv) At 36 weeks the woman should be assessed again in the hospital clinic by the obstetrician.

v) Until 40 weeks, she can be seen at again her local clinic, every week.

vi) At 40 weeks the woman should be seen again by the obstetrician in the hospital antenatal clinic.

What is the booking visit?

This is the first antenatal visit, and it should be comprehensive. Ideally a thorough history and examination should be done on every pregnant woman in the first visit. This is to identify any risk factors if present. It is also expected that if a translator is necessary for the history taking, he/she should not be a relative (Confidential issues).

The history, examination and the relevant investigations to be carried out during the booking visit, will be covered in another article.

References

i) Textbook of Obstetrics and Gynaecology for the Medical Student- Volume II -By Akin Agbola and Numerous contributors.

ii) Oxford Handbook of Clinical Specialties

iii) Essential Antenatal Care- A Guide for the Trainee

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