ANTENATAL CARE AND COUNSELLING AT COMMUNITY LEVEL

ANTENATAL CARE AND COUNSELLING AT COMMUNITY LEVEL

ANTENATAL CARE

Antenatal care is the care of the woman during pregnancy. The primary aim of antenatal care is to achieve at the end of a pregnancy a healthy mother and a healthy baby. Ideally this care should begin soon after conception and continue throughout pregnancy. In some countries, notification of pregnancy is required to bring the mother in the prevention care cycle as early as possible.

Objectives of antenatal care

The objectives of antenatal care are :

(1) To promote, protect and maintain the health of the mother during pregnancy.

(2) To detect "high-risk" cases and give them special attention.

(3) To foresee complications and prevent them.

(4) To remove anxiety and dread associated with delivery.

(5) To reduce maternal and infant mortality and morbidity.

(6) To teach the mother elements of child care, nutrition, personal hygiene, and environmental sanitation.

(7) To sensitize the mother to the need for family planning, including advice to cases seeking medical termination of pregnancy; and

(8) To attend to the under-fives accompanying the mother.

 

Antenatal visits

Ideally the mother should attend the antenatal clinic once a month during the first 7 months; twice a month, during the next month; and thereafter, once a week, if everything is normal

Schedule of antenatal visit

Visit	Weeks for visit
1st visit	within 12 weeks, preferably as soon as the pregnancy is suspected, for registration of pregnancy and first antenatal check-up.
2nd visit	between 14 and 26 weeks
3rd visit	between 28 and 34 weeks
4th visit	between 36 weeks and term.

The essential elements of a focused approach to antenatal care

• Identification and surveillance of the pregnant woman and her expected child

• Recognition and management of pregnancy-related complications, particularly pre-eclampsia

• Recognition and treatment of underlying or concurrent illness

• Screening for conditions and diseases such as anemia, STIs (particularly syphilis), HIV infection, mental health problems, and/or symptoms of stress or domestic violence

• Preventive measures, including tetanus toxoid immunization, de-worming, iron and folic acid, intermittent preventive treatment of malaria in pregnancy (IPTp), insecticide treated bed nets (ITN)

• Advice and support to the woman and her family for developing healthy home behaviors and a birth and emergency preparedness plan to:

o Increase awareness of maternal and newborn health needs and self care during pregnancy and the postnatal period, including the need for social support during and after pregnancy

o Promote healthy behaviors in the home, including healthy lifestyles and diet, safety and injury prevention, and support and care in the home, such as advice and adherence support for preventive interventions like iron supplementation, condom use, and use of ITN

o Support care seeking behavior, including recognition of danger signs for the woman and the newborn as well as transport and funding plans in case of emergencies

o Help the pregnant woman and her partner prepare emotionally and physically for birth and care of their baby, particularly preparing for early and exclusive breastfeeding and essential newborn care and considering the role of a supportive companion at birth

o Promote postnatal family planning/birth spacing

Antenatal advises

(i) Diet:

Ø  A pregnancy in total duration consumes about 60,000 kcal, over and above normal metabolic requirements.

Ø  Lactation demands about 550 kcal a day.

Ø  On an average, a normal healthy woman gains about 9-11 kg of weight during pregnancy.

A guide for average weight gain in each trimester:

1st Trimester: 900 grams – 1.8 kilograms total.

2nd Trimester: 500 grams/week from 4-6 months to a total of 5-6 kilograms.

3rd Trimester: Around 500 grams/week to at total of 3-5 kilograms.

(ii) Personal Hygiene: Advice regarding personal hygiene is mandatory

Ø  Personal cleanliness: The need to bathe every day and to wear clean clothes should be explained. The hair should also be kept clean and tidy.

Ø  Rest and sleep: 8 hours sleep, and at least 2 hours’ rest after mid-day meals should be advised.

Ø  Bowels: Constipation should be avoided by regular intake of green leafy vegetables, fruits and extra fluids. Purgatives like castor oil should be avoided to relieve constipation.

Ø  Exercise: Light household work is advised, but manual physical labor during late pregnancy may adversely affect the fetus.

Ø  Smoking: Smoking should be cut down to a minimum.

Ø  Alcohol: Alcohol consumption should be

Ø  Dental care: Advice should also be given about oral hygiene.

Ø  Sexual intercourse: This should be restricted especially during the first and  last trimester.

(iii) Drugs: The use of drugs that are not absolutely essential should be discouraged. Certain drugs taken by the mother during pregnancy may affect the fetus adversely and cause fetal malformations.

(iv) Radiation: Exposure to radiation is a positive danger to the developing fetus.

 (v) Warning Signs: The mother should be given clear-cut instructions that she should report immediately in case of the following warning signals:

Ø  swelling of the feet

Ø  fits

Ø  headache

Ø  blurring of the vision

Ø  bleeding or discharge per vagina, and

Ø  any other unusual symptoms.

 (vi) Child Care: Special classes are held for mothers attending antenatal clinics. Mother- education consists of nutrition education, advice on hygiene and childrearing, immunization family planning education, family budgeting, etc.