Focused Antenatal Care Planning and Providing Care During Pregnancy by cometjunkie44


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                      Focused Antenatal Care
                      Planning and Providing Care During Pregnancy
The MNH approach emphasizes quality over quantity in antenatal visits.

                       Antenatal care, the care a woman receives              basic care and monitoring for complications. The
                       throughout her pregnancy, is important in helping      Program does not recommend relying on certain
                       to ensure that women and newborns survive              measures and risk indicators that are routine in
At the core of the
MNH Program’s          pregnancy and childbirth. The traditional approach     traditional antenatal care (such as height, ankle
approach to            to antenatal care, which is based on European          edema and fetal position before 36 weeks),
antenatal care are     models developed in the early 1900s, assumes           because they have not been proven to be effective
focused visits with    that more is better in care for pregnant women.        in improving pregnancy outcomes.
a skilled provider,
                       Frequent routine visits are the norm, and women
aimed at ensuring
the healthiest         are classified by risk category to determine their     Goal-Directed Interventions
possible outcome       chances of complications and the level of care         The MNH Program’s approach focuses on
for every mother       they need. Many developing countries have              evidence-based interventions that address the
and baby.              adopted this approach without adjusting the            most prevalent health issues that affect mothers
                       interventions to meet the needs of their particular    and newborns. Each focused antenatal care visit
                       populations, taking into account their available       includes interventions that are appropriate to the
                       resources or evaluating the scientific basis for       woman’s stage of pregnancy and that address her
                       specific practices.                                    overall health and preparation for birth and care
                                                                              of the newborn.
                       The Maternal and Neonatal Health (MNH)
                       Program promotes an updated approach to                Detection and Prevention
When the
Kasongo Project        antenatal care that emphasizes quality over            The skilled provider interviews and examines the
Team studied           quantity of visits. The approach, focused antenatal    woman to detect problems that might affect the
3,614 women in         care, recognizes two key realities: First, frequent    woman’s pregnancy and require additional care.
an antenatal clinic    visits do not necessarily improve pregnancy            Conditions that could severely affect the mother
in Kasongo, Zaire,
                       outcomes, and in developing countries they are         or baby if they are left untreated include HIV,
in 1984, they
found that 71%         often logistically and financially impossible for      syphilis and other sexually transmitted diseases,
of the women           women. Second, many women who have risk                malnutrition and tuberculosis (especially in
who developed          factors never develop complications, while women       populations where HIV is common). Also,
obstructed labor       without risk factors often do. So, when antenatal      conditions such as severe anemia, vaginal bleeding,
were not identified
as “at risk,” while
                       care is planned using a risk approach, scarce          pre-eclampsia/eclampsia, fetal distress and
90% of women who       healthcare resources may be devoted to unnecessary     abnormal fetal position after 36 weeks may cause
were identified        care for “high-risk” women who never develop           or be indicative of a life-threatening complication.
as “at risk” did not   complications, and “low-risk” women may be             Early treatment of these conditions can mean the
develop obstructed     unprepared to recognize or respond to signs of         difference between death and survival for the
                       complications.                                         woman and her newborn.

                       Following the World Health Organization’s lead,        In addition to early detection and treatment of
                       the MNH Program takes the view that every              problems, two simple preventive interventions
                       pregnant woman is at risk for complications and        have proven effective in reducing maternal and
                       that all women should therefore receive the same       neonatal deaths. The first, tetanus toxoid, is a
stable, inexpensive vaccine that helps to prevent       getting the support she will need from her provider,
neonatal and maternal tetanus. Tetanus causes           family and community, and making arrangements
about 500,000 neonatal deaths and 30,000 maternal       for her newborn. The skilled provider and the
deaths each year. The second intervention, iron         woman should plan for the following:
and folate supplementation, helps to prevent iron
deficiency, the single most prevalent nutritional       • A skilled provider to be at the birth
deficiency affecting pregnant women. Iron               • The site for the birth and how to get there
deficiency can lead to severe anemia, which             • Items needed for the birth, whether it will be
is associated with preterm delivery, inadequate           at home or in a healthcare facility
intrauterine growth, and maternal and fetal deaths.     • Money to pay for the skilled attendant and any
                                                          needed medications
The MNH Program also supports the following             • Support after the birth, including someone to
preventive treatments in areas where the diseases         accompany the woman during the birth and
or deficiencies are common: intermittent                  someone to take care of her family while she
preventive treatment for malaria, presumptive             is away
treatment for hookworm, vitamin A supplementation
and iodine supplementation.                             In addition, since 15 percent of all pregnant
                                                        women develop a life-threatening complication
Counseling and Health Promotion                         and most of these complications cannot be
Focused antenatal care visits should include time       predicted, every woman and her family must be
for providers and women to talk about important         ready to respond to such a problem. Every
issues related to nutrition and health during                                                                     For more information
                                                        woman should have a plan for the following:               about the MNH
pregnancy, including the following:                                                                               Program visit our
                                                        • A person designated to make decisions on her            website:
• Danger signs of complications during pregnancy          behalf, in case she is unable to make them
    and labor: how to recognize them, what to do        • A way to communicate with a source of help
    and where to get help                                 (skilled attendant, facility, transportation)           This publication was made
                                                                                                                  possible through support
•   Nutrition: the importance of good nutrition to      • A source of emergency funds                             provided by the Office of
    the health of the mother and baby; how to get       • Emergency transportation                                Health and Nutrition, Center
    enough calories and essential nutrients for a       • Blood donors                                            for Population, Health and
    healthy pregnancy; micronutrient supplements;                                                                 Nutrition, Bureau for Global
                                                                                                                  Programs, Field Support and
    importance of iron intake                           Focused Antenatal Care                                    Research, U.S. Agency for
•   Risks of using tobacco, alcohol, medications        in the MNH Program                                        International Development,
    and local drugs                                                                                               under the terms of Award No.
                                                        The MNH Program promotes focused antenatal                HRN-A-00-98-00043-00.
•   Rest and avoidance of heavy physical work           care as one of a group of essential maternal and          The opinions expressed herein
•   Family planning: benefits of child spacing to       neonatal care interventions that are evidence-            are those of the author(s) and
    mother and child; options for family planning                                                                 do not necessarily reflect the
                                                        based and that build on global lessons learned            views of the U.S. Agency for
    services following the baby’s birth                 about what works to save the lives of mothers             International Development.
•   Breastfeeding: health and practical benefits;       and newborns. Focused antenatal care is an integral
    exclusive breastfeeding; importance of              part of the Program’s learning materials, including
    immediate breastfeeding after birth                 two technical manuals endorsed by the global health
•   HIV and other sexually transmitted diseases:        community: Managing Complications in Pregnancy and
    the use of condoms for dual protection from         Childbirth: A Guide for Midwives and Doctors (published
    pregnancy and disease; other measures for           by the World Health Organization) and Basic
    prevention; availability and benefits of testing;   Maternal and Newborn Care (forthcoming from
    and specific issues related to mother-to-child      JHPIEGO with substantial contributions by the
    transmission and living with AIDS (after a          American College of Nurse-Midwives and BASICS).
    positive test result)                               The important role of antenatal care in helping
                                                        women prepare for birth and possible complications
Birth Preparedness and                                  is illustrated in the MNH Program’s behavior change
Complication Readiness                                  intervention aid, Birth Preparedness and Complication
Focused antenatal care includes attention to a          Readiness: A Matrix of Shared Responsibility (available
woman’s preparations for childbirth, such as            on the MNH Program website).

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