Focused Ante-Natal Care and Delivery
What is Focused Ante-natal Care?
Ante-Natal period: Is the time beginning from conception and extending to delivery period.
Ante-Natal Care:Those are services offered to a pregnant woman throughout the pregnancy by a skilled attendant.
The importance of Focused Ante-Natal Care to expectant mothers;
- It help in early detection and treatment of problems
- Prevention of complications using safe simple and cost effective interventions
- Birth preparedness and complication readiness
- Health promotion using health messages and counselling
- Provision of care by a skilled attendant
The three common delays that contribute to maternal and new-born deaths includes;
1st delay: Women and families are not aware of the danger signs in pregnancy, childbirth and postnatal period; hence delay in making the decisions to seek care.
2nd delay: Women who live far to health centers and hospitals, or are unable to access health facilities due the cost of transport, poor roads and terrain may delay in reaching care
3rd delay: There is delay in receiving adequate care at the health facilities due to the lack of medical supplies, space, inadequate health care workers and referral systems.
Schedule for Ante-Natal care visits
An expectant mother should attend at least FOUR comprehensive personalized ante-natal care visits.
- First visit less than 16 weeks
- Second visit 16 – 28 weeks
- Third visit 28 – 32 weeks
- Fourth visit 32 – 40 weeks
Common services offered during focused ante-natal care visits are as follow;
History taking, include the following;
Name, age, address, marital status, economic status, education level etc.
Disease and conditions: Tuberculosis, Diabetes, on any medication etc.
Number of previous pregnancies, maternal complications in previous pregnancies, obstetric operations, perinatal complications, gynecological history etc.
- General appearance
- Head to toe examination
- Measuring weight and height – to assess mothers nutritional history
- Measuring of Blood pressure, Pulse & Temperature
- Weight monitoring
- Measuring fundal height
- Foetal presentation and heart sounds
- Inspection of external genitalia to assess for abnormalities
Counselling during focused ante-natal care visits
Each pregnancy is unique so Individualized Birth Plan should be established and client educated on following;
- Expected date of delivery (EDD)
- Danger signs during pregnancy, childbirth, postpartum period & danger signs for the newborn
- The health facility that the delivery will take place
- Companion & contact person in case of an emergency and possible donors in case of haemorrhage
- How to raise funds – transport, delivery charges and essential items
- Family planning
Routine lab investigations done during focused ante-natal care visits includes;
- Urine testing for proteinuria, acetone, sugar and bacteria – check for conditions
- Blood investigations
- Syphillis (VDRL)
- Blood group typing
- Haemoglobin (Hb)
- Counselling and testing for HIV – PMTCT
- Sputum for Acid Fast Bacilli (AFB) – Testing for TB (where applicable)
- Iron – Folic Acid Supplementation (IFAS)
|DOSE OF IFAS||VISITS|
|DOSE 1||1st VISIT|
|DOSE 2||2nd VISIT|
|DOSE 3||3rd VISIT|
|DOSE 4||4th VISIT|
- Tetanus Toxoid (TT) vaccination
|DOSE OF TT||WHEN TO GIVE|
|1||At first contact or as early as possible in pregnancy|
|2||At least 4 weeks after TT1|
|3||At least 6 months after TT 2 or during subsequent pregnancy|
|4||At least 6 months after TT 3 or during subsequent pregnancy|
|5||At least 1 year after TT 4 or during subsequent pregnancy|
Intermittent Preventive Treatment (IPT)
The Ministry of Health Guidelines on Malaria direct to give preventive treatment to pregnant women in endemic malaria areas at least twice during each pregnancy even if there is no physical sign of infection and the haemoglobin is within normal range.
|DOSE OF IPT||WHEN TO GIVE|
|1st DOSE||After quickening-16 weeks|
|1st DOSE||At least 4 weeks after 1st dose|
Curative treatment includes;
Treatment of existing conditions such as syphilis,anemia and urinary tract infection
Danger signs in pregnancy
- Bleeding per vagina
- Drainage of liqour
- Severe abdominal pains
- Severe headaches
- Generalized body swellings
- Reduced foetal movements
- Blurred vision
It is important to provide health education to pregnant mother on following areas;
They are normally performed by tradition birth attendant (TBA) disadvantages with them is that they are not; Trained to perform safe deliveries and how to handle complications . They lack supplies required to ensure the baby is born in as safe,sterile environment. Also they don’t have the supplies needed to manage complications such as medication, needles, syringes and iv fluids. This exposes mother eminent dangers such as post-partum hemorrhage among other. To avoid those dangers ; mother following home delivery should be offered postnatal care at hospital settings.
Postnatal care following home delivery
- Women who deliver at home should be reviewed at a health facility as soon as possible and preferably within 24 hours after delivery
- Community health volunteer (CHV) should refer or accompany the mothers to the health facility
- At the facility the women should receive the standard package of postnatal care.
- All women should be advised to report any health concerns to a healthcare professional
Pregnancy mother should educated important of;
- Receiving care from a skilled birth attendant
- Managing complications arising from her or child effectively and promptly
Which complications are likely to arise during delivery?
(Ask the mothers to share experiences on complications that they may have experienced)
Prompt for examples of:
- Mal-presentation and Mal-position (Eg.) Breech presentation, leading to prolonged and/or obstructed labour
- Post-partum haemorrhage: Bleeding after delivery
- Cord prolapse and presentation: conditions where the umbilical cord lies in-front of the presenting part which is normally the head.
- Uterine rupture
- Foetal distress leading to asphyxia
- Pre-Eclampsia and Eclampsia
What are some of the ways we can keep ourselves healthy?
- Personal hygiene
- HIV/AIDS and PMTCT,
- Against alcohol and tobacco use etc.
- Safe Delivery