How to provide antenatal care

as a health worker you know that good care during pregnancy is vital for the health of the mother and her unborn baby medical aid films has produced this film about focused antenatal care otherwise known as Frank to explain how good practices during antenatal care can help prevent maternal and neonatal deaths we’ll also look at how and why it is important to carry out each stage of antenatal care correctly here’s a midwife to tell us more Frank is the model of antenatal care which aims to improve the health of the mothers and babies through targeted antenatal care assessment focus is placed on the quality of which assessment rather than the quantity a pregnant woman may receive a holistic individualized approach is adopted for each visit with the aim of four comprehensive assessments being made at recommended intervals of the pregnancy unless the woman is identified for specialized care due to classifying health conditions and or other risk factors so part of the first assessment involves identifying any pre-existing risk factors and deciding if referral for more specialized care is needed if no risk factors are identified then the mother will be eligible for the standard component of funk the woman’s model of care is reassessed at each of her appointments and she can be referred for specialists care at any time should you identify the need to do so up to half of maternal deaths due to causes such as hypertension eclampsia and obstetric hemorrhage through funk all these can be identified and treated before they become life threatened in addition good fun care and advice can help to prevent so many newborn deaths from complications such as prematurity which can be brought on by preterm labor from infections in pregnancy birth asphyxia and newborn sepsis which can result from poor education and lack of skilled care at delivery and congenital abnormalities called for example by syphilis forecasts antenatal care provides an opportunity to eliminate or minimize the risk of these occurring so now we understand how vital it is for pregnant women to attend all their fico pointment but what should you do when they arrive at the appointment as the health worker an important part of your role is to advise on and promote healthy behavior highlight the importance of skilled birth attendants and teach women and their partners how to prepare for this the goal of funk is to help women give birth safely in many cases the care and advice you give can dramatically improve the pregnancy outcomes and can save many lives you can save lives by identifying and reacting appropriately to women with specific risk factors or hearth conditions we can specialized care such as women who are anemic detecting problems early and providing evidence-based treatment and management of this such as preeclampsia providing interventions and guidance for disease prevention such as sleeping under image to prevent malaria promoting healthy behavior through education such as healthy eating establishing a supportive relationship with women and their families educating pregnant women about planning for a safe birth and how to deal with

emergencies during pregnancy an important part of your role is to explain and encourage women receiving funk to seek care at a health post outside their days of appointment if they have any problem and it should always advise women and their partners and family members where they can easily access help seven days a week 24 hours a day women identified as being at increased risk of complications during pregnancy I refer to specialized care within the clinic or elsewhere this is likely to require more assessments than the forefront visits it is also important that you identify women who may need additional support such as women who are living in poverty living alone very young or experiencing violence so now we understand what fact sets out to achieve but how does this actually work the standard component of [ __ ] consists of four visits the first visit should be before 16 weeks and ideally before twelve weeks if possible the second visit is around 26 weeks the third visit around 32 weeks and forth at 36 to 38 weeks some visit provide an opportunity and encourage women to choose the skilled birth attendants front for the birth and also for any emergencies I’d ever visit I will do the following physical examinations measure the woman’s abdomen I the first visit this is to estimate the delivery date at subsequent visits this is to check her estimated delivery date is still correct and check for any abnormal growth of the fetus that may be a sign of complications for the mother and baby it is best practice to measure the fondo height which is the measurement from the symphysis pubis to the top of the fundus of the uterus in centimeters fetal heart rate should be retained to from as ill as 18 weeks depending on the equipment you have you should also recent if woman asked you to or if they are no or reduced fetal movements or you have any other consent puppet her abdomen this is most important after the two weeks format for pregnancy and most important at the refer to its former presentation check the woman’s blood pressure to ensure no signs of hypertension or preeclampsia are developing as if there’s been any bleeding in pregnancy as this is a trick designed to escalate care at each visit look for signs of severe anemia enemy affects almost half of women and increases the chance a woman who died from hemorrhage the first visit should be before 16 weeks and ideally before 12 weeks if possible this timing is important because some tests and interventions are most effective and who have the best impact on mothers and babies health if they are started early in pregnancy for example early treatment of syphilis for their mother will protect the fetus from syphilis infection starting an supplementation early and preventing anemia during pregnancy can help reduce the risk of death from hemorrhage one of the main causes of maternal death and also contribute to a good outcome for her newborn when a woman arrives for her first Frank appointment you need to identify if she has any health conditions or risk factors for complications requiring specialized care the World Health Organization recommends use of their classifying form but there may be slight modifications to this form in various countries here’s an example of a classifying form it helps you to identify the factors of the woman’s obstetric history current pregnancy or their general health which requires special care and it will provide you

with a list of the key steps at each frank visit you need to confirm the pregnancy and estimate the expected date of delivery calculated from the first day of last menstrual periods this will help you to track the healthy growth of the fetus and indicate when their mother is expected to deliver you should then undertake a complete physical examination including auscultation of the heart and chest it is important that a woman’s privacy and dignity are considered during any physical examination you should take blood samples to check the woman’s blood group race as type and record this on her chart in case she will need a transfusion during delivery and check her haemoglobin if you see signs of anemia it should also test and screen the blood and provide relevant information about HIV and syphilis and other sexually transmitted infections and how to avoid them where resources are available these diseases are associated with increased complications and death among women and babies it is important to know how to refer a mother to specialized services such as HIV TB malaria and family planning this is also your opportunity for preventive interventions the first dose of tetanus toxoid vaccination should be given at the first appointment by giving women two doses during pregnancy you can’t prevent newborn deaths from this disease the second font visit will be around 26 weeks at this visit you should assess the woman and not any changes from her last appointment which may indicate the need for referral you should also carry out the routine checks for the woman as mentioned earlier you should also give the second dose of tetanus toxoid the two doses should be given at least one month apart in malaria endemic areas you should start intermittent preventative treatment for malaria known as IPT for all women during this visit this should be done according to the national guidelines on prevention of malaria in pregnancy and you can also give the woman a deworming treatment which is an additional intervention against anaemia this must not be given before 16 weeks the third visit should be scheduled around to the two weeks again review information assess for ephraim and not any changes since the last visit and carry out the standard checks at this stage of pregnancy you can more accurately assess for multiple pregnancies and then go on to provide and reinforce health information which i described earlier and in malaria endemic areas you should give the second dose of IPT for malaria during the fourth visit at 36 to 38 weeks you should review information assess for referral and not any changes since the last visit Korea under standard checks as required at every visit it is important at this stage of pregnancy to identify multiple pregnancies bridge or Adama presentations and refer at this appointment it is even more important to review the woman’s birth and emergency plan and to document this this ensures that the woman understands the importance of the information you have given her and also ensures the woman has written information on who to call and or where to go in case of labor in case of complications or any other needs he should also advise the woman if she has not given birth by end of week 41 to attend the health post for a checkup at the end of every appointment give their woman and her partner an opportunity to ask questions then schedule for her next appointment remember it is essential that you document all examinations and tests you have carried out along with other findings as well as any conversations you have had on the woman’s records it is recommended that women carry their own frank record as this means they are more likely to attend appointments ask

questions feel in control and the record would be easily available check the woman’s blood pressure to ensure no signs of hypertension or progeria are developing if the woman does have high blood pressure or his renal pelvis or has history of hypertension preeclampsia over transient then check your example for protein and this can be preeclampsia at each visit look for signs of severe anemia anemia affects almost half of women and increases the chance a woman who died from hemorrhage enemy has Daniels for the baby as well increasing the chance a baby will be born prematurely have low birth weight or would die iris or stillbirth or neonatal death sense of anemia include per complexion contact Ava or or mucosa or shortness of breath if you see these symptoms then give an iron and folate supplementation by providing advice on healthy diet you can also help to prevent anemia the second intervention given to prevent anemia is preventing and managing malaria in Africa 25 million pregnancies are threatened by malaria every year and many pregnant women with malaria infection who have no symptoms providing intermittent preventive treatment of malaria during pregnancy according to country deadlines currently just the risk women should also be encouraged to slip under and insecticide-treated net and made aware of danger signs of malaria let’s meet another Midwife who can tell us how she implements Bank I’m Krista Conway I’m a midwife here I provide focus on a broker and should fund with a large group of women each day it is very important and who makes a difference I’m going to give you some information on how you can do the same Bank should happen in a clinic princess like this one which has the appropriate equipment drugs and trained staff available for the Midwife providing Frank she must be familiar with the concepts and principles and aim to provide a high level of care you are approached in Frank assessments should ensure that care is woman friend Ray culturally acceptable and evokes men and families involvement of men and family and Frank is important because they can support and help a woman to care for herself during her pregnancy and help her prepare emotionally financially and fiscally for the birth from a fist fight assessment on once the emphasis is on targeted assessment and individual care for each woman this means early detection and treatment of problems for example hypertension and provision of diseases like malaria health promotion best preparedness and complication readiness helping women and their families to prepare and plan for the birth should begin at the first visit and we discussed at each appointment talk to women about selecting a best location attendant and supporters organising transport care for other children and surprise for her care and the care of the newborn it’s also important to discuss planning for money to cover costs blood donors if applicable and a designated decision-maker in case of emergencies and net of visits are also an opportunity to begin a conversation with women and their partners about the options for family planning Frank sessions also allow you to hold discussions on important education topics including the benefits of good nutrition and rest how to recognize danger signs and how to get help she must know how and why to protect herself from

sti’s and HIV and their risk of using alcohol tobacco and drugs the benefits of early and exclusive breastfeeding should be discussed so by watching this film you will have seen how to engage women in fank this individualized careful process will save lives