Graphic Space b e s t p r a c t i c e s 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 labor. 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: www.mnh.jhpiego.org • 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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