We are always delighted by news of a pregnancy, the family and expectant parents are always thrown into a paradox state of anxiety and joy. All this anxiety can be managed by the availability of the right information and have the expectant mother started on focused antenatal care program with immediate effect. In this issue, we pay particular attention to focused Antenatal care (FANC) that is geared towards providing individualized care for expectant mothers with the aim of reducing the impact of high-risk complications during pregnancies. FANC has been reinforced by recent recommendations from World Health Organization on a positive pregnancy experience. A positive pregnancy experience aims at maintaining physical and sociocultural normality whilst maintaining a healthy pregnancy for mother and baby including preventing or treating risks, illness and death, having an affective transition to positive labor and birth, achieving positive motherhood. This holds for tenets of antenatal care aimed at giving an expectant mother emotional support, quality medical care, relevant and timely pregnancy information.
A Goal Based Approach to Antenatal Care for a positive pregnancy experience.
Antenatal health care (ANC) is the general health care given to pregnant women to promote and maintain optimal health of the expectant mother throughout the pregnancy, labor and post-delivery period with the aim of delivering and rearing a healthy baby. Historically, the traditional antenatal care service model was developed in the early 1900s based on the assumption that frequent visits and classifying pregnant women into low and high risk by predicting the complications ahead of time, is the best way to care for the mother and the fetus. The traditional approach was replaced by focused antenatal care (FANC) a goal-oriented antenatal care approach, which was recommended by researchers in 2001 and adopted by the World Health Organization (WHO) in 2002. FANC emphasizes the quality of care rather than the quantity. For normal pregnancies, this goal-oriented model recommends only four antenatal assessments by or under the supervision of a skilled attendant. A mother should have their first visit by the 12th week or when a woman thinks she is first pregnant referred to as the booking visit. The Second visit at 24-28 weeks or at least once in the second trimester, third visit: At 32 weeks, the fourth visit at 36-38 weeks. Other visits can take place in case of a complication, follow up or a referral is needed or when the provider changes the frequency of the visits based on the findings. In the case of late enrollments and missed visits, mothers starting particularly after 32 weeks should have all recommended first visit activities and those which correspond to the present visit. The health provider should take more time than regular and identify the reasons for the missed appointments On 7th November 2016, the World Health Organization released its comprehensive recommendations on antenatal care for a positive pregnancy experience. These recommendations provide readdress to the challenges faced by the FANC despite the strides it has achieved in an increase of ANC utilization in low- and middle-income countries.
Therefore, the new guidance recommends a minimum of eight contacts between the pregnant woman and the health care providers. The positive pregnancy experience places emphasis on the fact that contact with the expectant mother with her healthcare provider should be more than the regular ANC visit but should be an opportunity for good quality care including medical care, support, and timely and relevant information throughout pregnancy. The new model recommends pregnant women to have their first contact during the first 12 weeks’ gestation, with following contacts taking place at 20, 26, 30, 34, 36, 38 and 40 weeks’ gestation. As soon as you get to know that you’re pregnant it’s important that you visit a healthcare facility. Most women have their first and longest antenatal check- ups between weeks 8 and 12 of pregnancy with continuous follow-ups. The earlier you start attending antenatal check -ups the better. Increasing maternal and fetal assessments to detect complications, improving support and communication between healthcare providers and pregnant women, increases the likelihood of positive pregnancy outcomes. Taking a woman-centered approach ensures that a pregnant woman’s social, emotional, physical, psychological, spiritual & cultural needs and expectations are considered and respected. The positive pregnancy experience is aimed to serve beyond the gestation period to ensure safe delivery and quality postnatal care for the mother and newborn. The socio-economic, cultural and health systems have to be integrated and strengthened to deliver this positive experience.
Goals of Antenatal Care.
The major goal of antenatal care is to help women maintain normal pregnancies ensuring safe delivery of the new-born. During the course of antenatal care, the focus is placed on the supervision of maternal and fetal well-being during pregnancy. The health provider is obligated to identify and treat conditions that may threaten the health of the fetus/newborn and mother whilst making avail-able all appropriate choices, providing all necessary support and preparations for a high-quality life after birth. These efforts give the mother a positive pregnancy and birth experience.
Pre-existing health conditions are usually identified as part of the initial assessment when the expectant mother visits the healthcare facility she is examined for signs of chronic conditions and infectious diseases. Pre-existing health conditions such as HIV, malaria, syphilis and other sexually transmitted diseases, anemia, heart disease, diabetes, malnutrition, and tuberculosis may affect the outcome of pregnancy and usually require an immediate and more intensive level of monitoring and follow-up care over the course of pregnancy.
On Early Detection of Complications, the health provider should explain to the woman the state of her condition and the fetus. Further examination should be done to detect if there are any problems with pregnancy that might need treatment and closely monitor the mother’s and fetus’s health. Conditions such as anemia, infection, vaginal bleeding, hypertensive disorders of pregnancy, and abnormal fetal growth or position after 36 weeks may be or become life-threatening if left untreated.
Counseling about important issues affecting a woman’s health and the health of the newborn is a critical component of ANC. A mother should get information that will help her to make informed choices about her pregnancy. Your midwife or doctor should always give you information regarding the how to recognize
danger signs, what to do, and where to get help.
Things to Avoid During Pregnancy
Drugs, alcohol, and cigarettes– All three of these bad habits have proven to cause birth defects, develop-mental impairment, and health issues for baby and mom. Even partaking in alcohol just once can have dire consequences.
Exposure to toxins– Secondhand smoke is toxic to you and your baby. Avoid being around it if at all possible. Other toxins to avoid include paint fumes, pesticides, herbicides, fungicides and harmful household cleaners.
Stress– Stress is a part of everyday life, but the more anxiety you can avoid the better you and your baby will be.
Extreme heat– Drink plenty of water in warm conditions to keep you and your baby hydrated. This is not the time to frequent saunas or hot tubs that can raise your body temperature too high and harm the baby.
X-Rays– There is a small risk that x-rays may harm the health of your baby, so if it must be done consult your doc-tor or dentist about using low radiation exposure. Waiting to have the x-ray done after the baby is born is best.
Don’t skip prenatal visits– Make doctors’ visits a priority during this time. Avoiding them may mean that you miss something very important regarding the health of your developing baby.
Eating unhealthy– Remember that each morsel and drop you put in your body also goes to your little one. Good nutrition during pregnancy and enough of it is very important for your baby to grow and develop. You should consume about 300 more calories per day than you did before you became pregnant.” This does not mean 300 calories extra of pure junk food though!
Over exercising– Maintaining a regular workout pro-gram during your pregnancy is excellent for you and the baby. Regular exercise can help with your posture as well as fatigue. However, certain types of high impact physical activity may not be recommended. Speak to your midwife first to make certain that the exercise plan you choose is appropriate.
Taking Drugs not prescribed by a physician– Taking drugs not prescribed by a physician can be very dangerous for the future of your child. Some drugs can cross the placenta and cause miscarriage, stillbirth or early birth.
Not Getting an adequate amount of rest- sleep is vital for your body to carry out the needed processes to keep functioning as well as allowing your baby to grow healthily.
Goals of Antenatal Care
The danger signs of pregnancy include persistent abdominal pain, severe and persistent vomiting, vaginal bleeding including spotting, sudden gush of fluid from vagina, change in the fetal movements (absence, reduced or vigorous), severe headache, oedema (swelling) of hands, feet, legs and face, high fever greater than 37.7 degrees, Dizziness and blurred vision or double vision. If a mother is properly informed of these common danger signs she is able to react to the situation in a calm manner which enables her to get help in good time and recovery faster.
The mother has been to advise on how to keep good nutrition which is key to the normal growth of the fetus and keeping her in a healthy condition for a normal and safe delivery. The emphasis on the importance of rest, having good hygiene, infection prevention practices, a constant reminder of risks of using tobacco, alcohol makes up for the information packages that are shared with the expectant mother.
The birth preparedness and complication readiness is another key component of antenatal care. Approximately 15 per-cent of women develop a life-threatening complication, so every woman and her family should have a plan for the skilled and trained attendant at birth, place of birth and how to access the facility including how to obtain emergency transportation if needed. The key Items needed for the birth commonly referred to as a mama kit in Uganda.
The socio-economic factors have also to be taken into accounts for instance money saved to pay the health care and support during and after the birth from family and friends. This is a good moment to think of taking on a health insurance plan with good maternity options.
All pregnant women should receive immunization against tetanus, Iron and folate supplementation, Presumptive treatment of worms, voluntary counseling and testing for HIV, Protection against malaria through intermittent preventive treatment and insecticide-treated bed nets and protection.