What is antenatal care?
Antenatal care (ANC) refers to healthcare provided to a pregnant woman to ensure best possible health until birth.
Antenatal care provides a platform for important healthcare functions such as screening, diagnosis, health promotion, education, emotional and social support, monitoring of the unborn baby, and disease prevention.
The objectives of antenatal care include the maintenance of health of a mother during pregnancy, identification of high-risk cases, appropriate management, prevention of complications, and decrease in illnesses and death (maternal and fetal morbidity and mortality).
When should it start?
The first visit, also called booking appointment, starts as early as you know or think you are pregnant, ideally when second period is missed which means at 10 weeks amenorrhea (absence of period). Other medical literature suggests starting antenatal care as early as 6-8 weeks of pregnancy to ensure that both the mother and developing baby are off on a good start.
Research also shows that late booking is associated with poor pregnancy outcomes. In South Africa, although more women visit antenatal care clinics and give birth in healthcare facilities, they still have high maternal deaths, and this is accounted for by late booking for various reasons.
How does the antenatal schedule look?
The antenatal care schedule is spread through the entire period of pregnancy. In the first trimester, which is the first 12 weeks of pregnancy, a doctor may be seen once per month.
In the 2nd trimester, weeks 13 to 27, antenatal visits increase to once fortnightly.
In the last trimester, weeks 28 to 40, the visits occur weekly.
Despite this schedule, the number of visits may increase based on the circumstances of the antenatal care user.
Why is antenatal care important?
1. Identification and prevention of recurring complications
The health provider may identify risks and complications from previous pregnancies. The risks include miscarriages, ectopic pregnancy, preterm labour, conditions that develop during pregnancy such as preeclampsia and perinatal deaths. Some of these complications tend to recur and therefore, through antenatal care, their risk of recurrence can be minimized.
2. To ensure good maternal health during pregnancy
The health provider may identify common pregnancy problems such as nausea, morning sickness, heartburn, vaginal discharge, and specific pregnancy associated complications such as vaginal bleeding and urinary tract infections. The mother may be reassured or offered treatment, if necessary. This will ensure that the mother is comfortable and enjoys her pregnancy.
3. Screening
Antenatal care includes screening - looking for signs and symptoms suggestive of potential conditions that can affect the mother and the baby. Such conditions are diabetes mellitus and high blood pressure. Both these conditions can cause serious pregnancy complications that could have otherwise been avoided if identified early.
4. Schedule testing
It includes tests ordered based on the assessments the doctor made. Examples are HIV test, hepatitis B, and other sexually transmitted disease. Should these tests be positive, treatment will be started right away preventing mother to child transmissions and other related complications.
5. Continuous monitoring of the developing baby
The baby’s growth and wellbeing is monitored through pregnancy. If there are any abnormalities with the baby, they can be identified early, and appropriate management will be instituted. An example of an investigation done during antenatal care is an ultrasound scan which can determine pregnancy duration, baby’s growth, detect or rule out multiple pregnancies, and determine any syndromic features (of trisomy 21), or congenital abnormalities.
6. Appropriate Immunization
Safe and important vaccines are given during antenatal care for protection of the baby and mother. Such vaccines include the tetanus toxoid vaccine, covid-19 vaccine, and flu shots.
7. Best nutrition advice
Through antenatal care, pregnant women receive best nutritional advice that in turn results in a positive pregnancy experience whilst also reducing perinatal mortality and birth defects. They receive counselling about healthy diet, keeping physically active during pregnancy, and the prevention of excessive weight gain.
They also receive prescribed vitamins and minerals including:
Iron and folic acid supplements: prevent maternal anemia and puerperal sepsis, low birth weight neural tube defects, and preterm birth
Calcium supplements: reduce risk of pre-eclampsia
Vitamin A supplements: recommended in areas where vitamin A deficiency is extreme. Prevents night blindness.
8. Promoting health education
On the following topics:
Benefits and importance of breastfeeding
Proper care for newborn
Medications that are harmful at different stages of pregnancy (always check label insert for warning)
Lifestyle counselling: tobacco, alcohol, drugs, and substances
9. Antenatal classes
Antenatal classes provide an opportunity for support from healthcare professional, friends, and family. This helps the mother and her partner cope with pregnancy and delivery. Basic education on topics such as preparing for labour and birth, common events in labour and birth, and how to care for a newborn baby is rendered.
What can happen if I don’t attend antenatal care?
ANC plays a vital role in saving lives of mothers and babies by promoting and establishing good health before child birth and early after delivery. Research suggests that there is high maternal and infant morbidity and mortality in developing countries compared to developed countries, and this is associated with poor antenatal care in the developing countries.
According to the World Health Organization (WHO), for every 100, 000 live births, in the country in 2015, 138 women died, due to pregnancy and childbirth complications, in Sweden, fewer than 5 women die for every 100, 000 live births, and in Brazil, about 44 women die for every 100, 000 live births.
Women who receive no or minimal antenatal care have higher incidence preterm births (birth before 37 weeks of pregnancy), low birth weight babies and still births. The negative experience of pregnancy and childbirth cause a lot of women to suffer with perinatal depression (depression occurring in the first year after birth) and failure to give adequate and appropriate care for their newborns.
This article is written by Dr Katleho Tau (MBChB-UKZN)
References:
1. WHO. WHO recommendations on antenatal care for a positive pregnancy experience. [Internet]. Luxenbourg. WHO. 2016. Available from: https://www.who.int/publications-detail-redirect/9789241549912
2. NICE guideline. Antenatal care. [Internet]. NICE national Institute for Health and Care Excellence. 2021. Available from: www.nice.org.uk/guidance/ng201
3. Cronje HS, Cilliers JBF, Du Toit MA, Adam Y, Adam S, Bagratee JS, et al. Clinical Obstetrics, a South African perspective. Pretoria. Van schaik Publishers. 2016
4. Olarewaju R. Advantages of Antenatal Care. [Internet]. Mother & Child Hospitals. Available from: https://motherandchildhospital.com/advantages-of-antenatal-care/
5. Jhaveri R. The Importance of Antenatal Care. [Internet]. Narayan Health Care. 2022. Available from: https://www.narayanahealth.org/blog/the-importance-of-antenatal-care/
6. Smith A. Why mothers aren’t accessing antenatal care early in their pregnancies. [Internet]. Stellenbosch University. 2016. Avail from: https://theconversation.com/amp/why-mothers-arent-accessing-antenatal-care--early-in-their-pregnancies-58344
7. Jacaranda Maternity. 7 Reasons Why Antenatal Care is Crucial During Pregnancy. [Internet]. Jacaranda Maternity. 2021. Available from: https://www.jacarandamaternity.co.ke/post/7-reasons-why-antenatal-care-is-crucial-during-pregnancy
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