Prenatal (Antenatal) care in Pregnancy: appointments schedule, guidelines and benefits

What is Prenatal Care?

It is the medical care given to a pregnant woman to ensure that pregnancy is carried to time of delivery with the baby and mother being healthy, without developing complications. It is also called Antenatal care. Prenatal care helps to check that a baby in the womb is developing normally and that the mothers health is not compromised and helps the woman in preparing towards giving birth. Prenatal care also helps to check if there is any aberration to the health of the mother and if there is, then prompt treatment is carried out.
Antenatal care is vital to any pregnancy and should be encouraged. It is best commenced when you suspect you are pregnant. Once you notice the signs of being pregnant, it is advisable you confirm it in the hospital and book for antenatal care immediately.

Types of Prenatal/Antenatal care

1. Traditional Antenatal care
2. Focused Antenatal care (FANC)

Traditional Antenatal care

In this type of Antenatal care, the pregnant woman routinely visits the health center based on appointments according to her age of pregnancy. Traditional Antenatal care does not consider individual pregnant women but rather schedule the same visits for all women and all pregnancies whether the pregnancies are complicated or not.

In the traditional Antenatal care, the woman is first booked the day she presents to the Antenatal clinic. Routine tests are done and depending on her gestational age, she will be given an appointment for the next antenatal care visit based on the gestational age of the pregnancy.

Schedule of Appointments inAntenatal care Visits

The age of the pregnancy (known as the gestational age) is used for calculating how often the pregnant woman needs to visit the clinic. The number of visits and schedules are listed below. The age of the pregnancy is calculated in weeks.

When the woman comes for booking and her pregnancy is not more than 28 weeks, she will be given an appointment of 4 weekly intervals until she gets to 28 weeks of pregnancy. Her first visit is called the booking visit and tests are done (see the tests below). After the tests, the doctor tries to ask her about her pregnancy and other pregnancies. He will try to know more about her health and previous medical conditions and surgeries. The process by which the doctor tries to know about the pregnancy and other medical conditions is known as history taking.

When your detailed medical history is taken, you will be examined. During the examination, the doctor tries to know if your baby is lying well and check if the baby is growing. To know whether your baby is growing in the womb, the doctor has to keep serial measurements of the baby by using a measuring tape to check for the height of the upper most part of the womb. If the height is increasing, it means your baby is growing; if it is increasing in excess, it means there is a problem.

When the doctor is done checking the pregnancy, you are then given 4 weeks appointment to come back again and the same thing is done again.

Pregnancy of 28 weeks to 36 weeks

As the pregnant woman keeps visiting the clinic every 4 weeks, the schedule is then changed to every 2 weeks once she reaches 28 weeks. The closer the woman is to giving birth, the more frequent the checks and visits. She will keep coming every 2 weeks until the pregnancy gets to 36 weeks of age. For every 2 weekly Antenatal care visit, the same history, examination and any investigation if the woman has complaints are done and treated appropriately.

Pregnancy of 36 weeks to delivery

The pregnant woman from 36 weeks of gestation will keep coming for Antenatal care visit weekly until she delivers.

These are the schedules for the traditional Antenatal care, but it was found that it does not meet the needs of every pregnant woman because every pregnancy is different. Some women were having complicated pregnancies while others were uncomplicated. Other women have associated medical conditions such as HIV/AIDS, diabetes mellitus, hypertension and other diseases. Such women need specialized care apart from the normal antenatal care rendered to all the women; this led to the introduction of the Focused Antenatal Care (FANC).

The traditional Antenatal care is not recommended because it became a burden to both the women and the health facility as it was based on routine rather than individual needs of the pregnant women.

In developing countries such as Nigeria, the traditional Antenatal care is still being practiced.

A doctor using a tape to measure the height of the uterus during prenatal visit: this shows if the baby is growing in the womb.

Focused Antenatal care (FANC)

The FANC was introduced to reduce the number of visits and provide quality Antenatal care by skilled health professionals such as doctors, midwives, nurses or community officers. It emphasizes on care that is based on evidence rather than routine. The Focused Antenatal care has a total of 4 visits.

Schedule of appointmentsin Focused Antenatal care

1. The first visit is at 16 weeks of pregnancy age or whenever the woman notice she is pregnant
2. The second visit can be anytime from 20 to 24 weeks
3. The third visit is from 28 to 32 weeks
4. The fourth visit is any time after 36 weeks

The goals of the FANC

1. For early detection of any pre-existing medical condition in the woman that might affect the pregnancy
2. For early detection of complications that may arise during pregnancy and appropriately treating it.
3. Making plans towards delivery

Students of Chikava primary school in Zimbabwe creating enlightenment on the importance of Prenatal care (https://www.youtube.com/watch?v=wBHKgDlcXN0)

Importance/Benefits of Prenatal care

1. You will get to know the gender of your baby whether you are carrying a girl or boy
2. You will also know if you are carrying twins or multiple gestation
3. You will meet other women and you could form breastfeeding groups that will help to properly breastfeed your baby.

Aims and Objectives of Antenatal care

1. To ensure the mother is healthy while being pregnant
2. To detect and treat complications in pregnancy
3. To ensure the healthy being of the baby while in the womb
4. Helps the mother to discuss any issues and concerns with her doctor
5. To assess the risk associated with pregnancy

Components of Antenatal care

1. Booking and registration of pregnancy
2. Education of the pregnant woman
3. History taking
4. Examination
5. Investigations

Booking and registration in Prenatal care

This is your first visit to the clinic after the pregnancy has been confirmed. Your Bio data are collected such as number of children; number of pregnancies, the age, the weight, the blood pressure are all taken and recorded in your medical records. You will also be given an antenatal card for recording of the day you first visited, the number of visits, your last menstrual period and more.

Education during Prenatal care

• You will be educated on the importance of regular clinic attendance and also how to know the danger signs of pregnancy so that you could detect them and come to the clinic immediately should any sign be observed.
• You will also be educated on the importance of good nutrition as pregnancy increases the demand for calorie and would be advised to eat vegetables and fruits to help in bowel movement and prevent constipation.
• There is also a need to keep the environment clean and improve on personal hygiene to prevent infections which may complicate the pregnancy. You will learn on the risk and effects of smoking, taking of alcohol and drug abuse during pregnancy.
• You will be thought on the importance of immunization to your baby when you deliver and also will be immunized when necessary.
• You will learn about sexually transmitted infections, HIV/AIDS, and other infections that may affect your pregnancy and the baby. You will get to know the mode of transmission of the infections, complications and how you could get infected.
• If you are in malaria endemic areas, you will be educated on the effects of malaria on the pregnancy and how to prevent it. You will also be treated if you have malaria.
• You should dress using free clothing and wear flat shoes
• You will be thought on the benefits of breastfeeding and how to take care of the breast such as washing of the nipple and drawing out of the nipple for inverted nipples so that the baby can suck properly immediately after giving birth.
• Your doctor will enlighten you on the need for exercise and rest.
• During the Antenatal care visit, you will be thought on the importance of Family planning and spacing of children.

History

History taking is just a means by which the doctor gets information about you in order to assess and diagnose your health status. In taking your history, the doctor will ask of the following:

1. Bio-data which includes your name, occupation, religion (especially Jehovahs Witness as they are against blood transfusion), your occupation and address.
2. The date of your last menstrual period is also taken and used for calculating the expected date of delivery (EDD) and estimated gestational age (EGA).
3. The number of deliveries you have had and the number of pregnancies and miscarriages are also asked by your obstetrician or any health professional attending to you during Antenatal care.
4. The doctor gets to ask about your previous pregnancies and all that happened during each pregnancy including any complication or surgery or transfusion.
5. Your last child birth and presence of diseases such as Diabetes mellitus, Hypertension, Sickle cell disease, Epilepsy or renal diseases will all be asked including the history of any similar illness in your family or among your siblings.

A Doctor using a Pinard Stethoscope to listen to the heart beat of a baby in the womb during Antenatal Examination

Examination

During Antenatal care visits, your height and weight will be taken as they are determinants of whether you can give birth by vaginal delivery or by caesarean section (CS). The age of the pregnancy is compared with the age gotten from the examination and ultrasound scan.

The size of the growing uterus (womb) is check during examination and your feet are also checked swelling. The heart rate and heart sound of the baby are checked to see if the baby is in good condition or in distress.

Laboratory tests

In order to further prevent and treat complications in pregnancy, some tests are done to help in management of the pregnant woman during Antenatal care. These tests can be Routine tests or specific tests.

Routine Antenatal care tests

Routine Antenatal care tests are done to every woman during ANC visit. They are very important in prevention of complications. The routine tests include:

1. Packed Cell Volume (PCV): this test helps to check if your blood can carry enough oxygen for the baby and for you. It is a test done to check for Anemia.
2. Blood grouping and Rhesus (Rh) compatibility test: this is done in order to check if your antibodies could react against the cells of your baby should any trauma occur during pregnancy or to check if your blood could react against that of your subsequent babies. The Rh antibody test is important if the woman is Rh negative because if she carries a baby that is Rh positive, the baby could trigger her immune system and she will produce antibodies that will destroy the blood cells of the subsequent Rh Positive babies she may have. The Rh antibody test is done at 20, 24, 28, 32, and 36 weeks of pregnancy for women that are Rh negative.
3. Your genotype will be assessed to help check for sickle cell disease or any abnormality of hemoglobin (the protein responsible for transportation of oxygen in your blood)
4. A HIV test will be done to confirm if you are HIV positive or negative as the Antenatal care given to HIV positive women is different from that of women that are negative.
5. You will also do a urinalysis test to check for presence of urinary tract infection.
6. If you are in malaria endemic areas, malaria parasite test is also done

Specific tests during Antenatal care

1. Ultrasound scanning: this is done to know the age of the pregnancy; it shows the gender of the baby and presence or absence of abnormalities.
2. Screening for infections such as toxoplasmosis, cytomegalovirus (CMV) and hepatitis B virus infection.
3. Alphafeto proteins can help to show if a baby has congenital abnormalities.

These tests and examinations vary from country to country and from one hospital or clinic to another one because some countries have advanced technologies and because of the socioeconomic status of different individuals in different countries. Not all tests are affordable, hence the variation across different health facilities. However, there are guidelines from National Institute for Health and Care Excellence (NICE) for health facilities in the United Kingdom (UK) and recommendations from W.H.Ofor uncomplicated pregnancies

Routine drugs given during Antenatal care

1. Folic acid (5mg daily): this is given to prevent anemia and congenital abnormalities (neural tube defect). It is normally taken once a day
2. Ferrous gluconate (300 mg daily) or Ferrous sulphate (Fesolate, 200 mg daily): this is prescribed for prevention of iron deficiency anemia.
3. Malaria prophylaxis (Sulfadoxine and Pyrimethamine combination - Fansidar) for prevention of malaria in endemic areas.

The role of men in helping women with Antenatal care

1. Provide financial support
2. Accompany the woman to the antenatal clinic and classes
3. Provide emotional support and encourage the woman to attend the antenatal classes and be regular with visits
4. Ensures he remains faithful to the woman to prevent sexually transmitted infections and HIV

Prenatalcare is important for all pregnancies and can help in prevention and prompt treatment of complications during pregnancy.