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- 2. ANTENATAL CARE It is a specialized pattern of care organized for pregnant women to enable them attain and maintain a state of good health throughout pregnancy and to improve their chances of having safe delivery of healthy infants at term. This is the supervision of the welfare of the pregnant woman during pregnancy before birth. It can also be defined as the health care and education given during pregnancy. It must be clearly stated that the achievement of optimum health care before and after pregnancy depends on good antenatal care.
- 3. FOCUSED ANTENATAL CARE (FANC) This is an individualized, client-centered comprehensive antenatal care that place emphasis on disease detection rather than risk assessment. In general it consists of healthcare services that pregnant women should receive during pregnancy. It focuses on individualized care to help maintain normal progress of pregnancy. This may include preventive measures, supportive care, health messages and counseling, empowering families for effective self-care, birth preparedness and complications readiness planning.
- 4. Its also viewed as support, instructions, and health promotion given by the health worker (nurse/midwife) to an expectant woman, partners and family during pregnancy, labor and after birth (postpartum period) to ensure that both mother and baby are in good health and that any problems during pregnancy are recognized and treated promptly. Focus antenatal care is poised to achieve the following goals and is presented as follows:
- 5. GOALS FOR FANC 1. Promotion of health and prevention of disease. The basic foundation of achieving this goal rest on good interaction between the provider and the pregnant woman during focused antenatal care visits. This is a time for providers to talk about important issues affecting the womans health, her pregnancy, and her plans for childbirth and newborn period. The main discussions are centered on the following; Nutritional support Detecting danger signs of pregnancy and complications
- 6. Risks of using tobacco, alcohol, medications, local drugs and traditional remedies. Rest and avoidance of heavy physical work. Care for common discomfort such as vomiting and nausea during pregnancy, labor/childbirth and postpartum period, extra care during pregnancy and delivery. Counseling and testing for HIV Hygiene and infection prevention Breastfeeding and breast care
- 7. Sexual relations and safer sex Family planning Newborn care Prevention of tetanus and anemia with tetanus toxoids stable, an inexpensive vaccine that helps to prevent neonatal and maternal tetanus and through iron and folate supplements respectively. Discourage harmful practices while encouraging beneficial traditional practices Presumptive treatment for hookworm infections as they are the major causes of iron deficiency anemia in areas of high prevalence of the disease. Protection against malaria-through the use of insecticide treated nets.
- 8. 2. Detection of existing diseases and treatment: Here, the skilled provider examines her for signs and symptoms of chronic or infectious diseases and conditions that are endemic among the population being served, congenital problems, and other problems that may harm the health of the pregnant woman or the newborn and conditions that can severely affect mothers and babies if they are left untreated. Some of the condition to rule out are discussed below: Syphilis and other STIs HIV/AIDS Malaria
- 9. Tuberculosis Anemia Heart disease Diabetes Malnutrition
- 10. 3. Early detection and management of complications: There is further discussion by the skilled provider with the client and examine the woman to detect problems that might need additional care and survival for the woman and her newborn. This includes performing life-saving measures, if necessary and managing or facilitating management of any complications detected. The following complications are the major causes of maternal and newborn mortality and morbidity that needs to be detected and managed promptly. They are:
- 11. Abnormal fetal growth Hemorrhage Obstructed labor that affects both mother and newborn baby. Pre-eclampsia / eclampsia that affects the woman. Sepsis and infection that affects both mother and newborn baby. Abnormal fetal position after 36 weeks any cause or be indicative of a life- threatening complication Asphyxia (a deficiency of oxygen in the blood and an increase in carbon dioxide in the blood ) thus, to the baby.
- 12. 4. Birth preparedness and complication readiness: Focused antenatal care further includes attention to a womans preparations for child-birth, such as getting the support she will need from her healthcare provider, family, and community, and making arrangements for her newborn. Here, the woman and her family develop a birth plan to ensure that necessary preparations are made well in advance of the estimated date of delivery. This plan includes arrangements for normal childbirth and postpartum/newborn period such as:
- 13. Appropriate place of birth (home, healthcare facility, or referral center) Arrangement of transportation off to the skilled providers. Funds: the woman should save money to be used in emergency Support/birth compassion: it could be husband or any close relative. Items needed for a clean and safe birth and for the newborn. E.g. cot sheets, diapers/napkins, baby dresses, sanitary pads, clean bed sheets, water proof plastic bags, old cloths, etc. Assistance at home with other children when mother is away.
- 14. In addition, because every woman and newborn is at risk of developing a complication and most of these cant be predicted, the woman and health provider should be ready and respond timely to any complications that may arise and this includes: Knowledge of possible danger signs and appropriate responses How to access emergency funds How to access emergency transportation Where to go in emergency Possible blood donors
- 15. A person designated to make decisions on the womans behalf, in case she is ill and unable to make decisions herself A way to communicate with a source of help (skilled provider, facility, transportation), e.g. that is getting the number for national ambulances service. Decision making: the skill provider should discuss what should be done when danger signs set in and decision should be taken immediately, e.g. total hysterectomy after postpartum hemorrhage.
- 16. GENERAL PRINCIPLES OF FANC For the goals to be achieved, the following general principles should serve as an integral part to the provision of quality focused antenatal care for pregnant women. They are: 1.Woman and newborn friendly care Making services acceptable to the woman and her family by responding to their beliefs and traditions of their culture as well as gender roles and relations. Family members or other support people are included in the care of the woman and newborn as the woman desires. Empowering the woman and her family to become active participants in their healthcare and supporting them in overcoming obstacles to maintaining or improving their health. All effort should be made to relax the woman in all situation.
- 17. 2. Male involvement/ inclusive of a womans partner: It has been realized that active participation, of males in communication, and partnership in seeking and making decisions about care help to ensure a fuller and safer delivery. This is very important as it makes them feel that they are part of the birthing process and not just spectators/ woman affairs. This can be achieved through the following: Recognizing and working to decrease skilled provider bias against the involvement of male partners. Helping the male partner feels comfortable participating in antenatal, childbirth, and postpartum/newborn care. Making a special effort to include the male partner in planning for birth preparedness and complication readiness. Targeting the couple during, health counseling around topics that are especially pertinent to male partner (e.g. family planning, sexual relations and safer sex, mother-baby-family relationships.
- 18. 3. Culturally appropriate care Every culture has its own rituals, taboos surrounding pregnancy and childbirth. Unfortunately these beliefs and practices are deeply held unto which some may be detrimental to the health of the unborn fetus. Even though, the basic human rights ensure that comfort are given clear priority as well as the womans personal desires and preferences also respected during FANC, there should be consultation with influential people in the community to develop a plan to advocate a change when the need arises.
- 19. AIMS OF ANTENATAL CARE To prepare the mother for labor, lactation and subsequent care of the child physically, psychologically and socially. To detect and treat high risk conditions arising during pregnancy whether surgical, medical or obstetrical. To ensure delivery of full term healthy baby with minimal stress or injury to mother and baby. To help prepare her to experience normal puerperium. To promote and maintain physical, mental and social health of mother and baby by providing health education.
- 20. To offer the mother the opportunity to express any fears or worries about labor. To evaluate the effectiveness of advice or treatment given during a previous visit. To ascertain normal lie and presentation.
- 21. Benefits of good antenatal care It helps to reduce maternal morbidity and prevent complications of pregnancy from becoming life-threatening emergencies. It also enhances the safer delivery of a live healthy baby.
- 22. STANDARD SCHEDULE FOR ANTENATAL VISITS First 10-16 weeks The midwife will discuss the medical and obstetric history so that you are provided with the safest care possible. Your midwife will make sure you know how to contact her and talk about screening and diagnostic tests. Perform basic examinations (pulse rate, blood pressure, respiration rate, temperature, pallor, etc.). Provide nutritional advice Give advice on malaria prevention and if necessary provide insecticide or treated bed nets. Provide specific answers to the woman s questions or concerns, or those of her partner. Second 20-24 weeks This visit provides an opportunity to ask the midwife any question you have and discuss any concerns. Your blood pressure will be checked, and they will check urine for protein and glucose. At this time, the expected date of delivery can be checked (symphysiofundal height is checked).
- 23. Third 28-30 weeks Theres continuous monitoring of the well being of the mother and the fetus. The midwife discusses around your preferences for labour. Visits take place every 2 weeks. Fourth 36-40 weeks Visits take place every week and this is an exciting time as you get ready to meet your baby. At this visit, it is extremely important that you discover women with a baby in breech presentation or a transverse lie and refer her to the nearest health facility for obstetric evaluation.
- 24. Breech presentation is when the baby is head up in the uterus near the end of gestation, with its buttocks, feet or legs pushing down into the mothers cervix. A transverse lie is when the baby is lying sideways across the abdomen
- 25. Reference: Oduro V. K. (2012). Obstetric Nursing. (2nd Ed.) Robee Printing Press: Kumasi). Kesetebirhan A. (2004). Antenatal Care. (8th Ed.). The Open University: Ethiopia..
- 26. Thank You