Who Let The Doc Out?! #004: What to expect when you’re expecting

antenatal care

Antenatal care is an integral part of ensuring pregnant women and their unborn children go through pregnancy as safely as possible. As a form of preventive healthcare, it enables healthcare professionals like general practitioners, midwives, and nurses to educate women on healthy behavior during pregnancy while also providing them with social and physical support.

Why is antenatal care important?

Good antenatal care is important for your health and the development of your unborn baby. It reduces the risk of complications from pregnancy and childbirth. It also ensures integrated care delivery during your pregnancy. During your antenatal appointments, your healthcare provider can:

  • Educate you on healthy behavior during pregnancy, including advice on lifestyle changes
  • Teach you which warning signs to look out for during the pregnancy
  • Answer any questions you have about pregnancy such as what happens in each trimester and the process of delivery
  • Provide social, emotional, and psychological support

Even if your pregnancy is going well and you feel fine, regular antenatal appointments are important to allow your GP or midwife to identify any potential risks early and take measures to prevent or reduce them.

When to begin antenatal care

Previously, the WHO recommended that the first antenatal appointment, sometimes called the booking appointment, happened between 8 to 12 weeks of gestation, followed by three additional visits. However, new guidelines recommend starting antenatal care at any point before the 12 weeks of gestation mark, and additionally recommend eight total antenatal contacts at 12, 20, 26, 30,34,36, 38, and 40 weeks.

Over the years, studies have shown that in pregnancies where antenatal care was initiated before 12 weeks of gestation and more frequent antenatal contacts occurred, there were better maternal and fetal outcomes.

Who provides antenatal care?

The provision of antenatal care is a multidisciplinary endeavor that requires the efforts of an entire team. However, the primary healthcare professionals you will interact with during this journey will be a midwife, a general practitioner, and an obstetrician.

While a general practitioner is perfectly capable of providing a high standard of antenatal care, having an obstetrician on board can greatly improve your outcomes in case of any complications.

What happens during the first antenatal appointment?

The booking appointment is the most crucial step in the antenatal care process. It usually lasts longer than the following contacts as it requires your healthcare provider to take a detailed clinical history which involves questions such as your medical and surgical history, history of any illnesses, allergies, or drug abuse, and history of previous pregnancy.

During the first contact, your healthcare provider will:

  • Take a detailed clinical history
  • Do a physical exam, including blood pressure and weight measurements
  • Confirm the pregnancy and Expected Due Date (EDD)
  • Classify you as requiring either standard care or special attention basing on the absence or presence of certain risk factors and conditions
  • Do standard tests like a full blood count, infection screening, and blood typing
  • Treat any conditions and provide preventive measures for others
  • Develop a birth and emergency plan with you
  • Do a psychosocial assessment and provide support

What to expect during routine antenatal care appointments

During each appointment, your healthcare provider will update your clinical examination and do a physical exam. However, the specifics of each appointment will vary depending on your pregnancy’s gestation.

Ultrasound scans

It is recommended that every pregnant woman have at least two ultrasound scans during her pregnancy. The first is done early in the first trimester to confirm the pregnancy. The second scan is usually done between 20 to 24 weeks, and its purpose is to:

  • Estimate gestational age
  • Detect fetal anomalies and multiple pregnancies
  • Enhance the maternal pregnancy experience

Maternal assessment and tests

  • Full blood count to assess anemia
  • Midstream urine culture to check for bacteriuria
  • Urine protein to rule out preeclampsia and eclampsia
  • ABO and Rhesus blood typing
  • Weight measurement
  • Blood pressure measurement to rule out gestational hypertension
  • Blood glucose levels to rule out gestational diabetes mellitus
  • Infection screening for HIV, CMV, Syphilis, Hepatitis B, etc
  • Clinical enquiry about alcohol, tobacco, and drug abuse
  • Clinical enquiry about the possibility of intimate partner violence

Preventive measures and interventions

  • Iron and folic acid supplementation
  • Calcium supplementation in regions with low dietary calcium intake
  • Deworming in areas with high helminthiasis prevalence
  • Antenatal prophylaxis with anti-D immunoglobulin in non-sensitized Rh-negative pregnant women at 28 and 34 weeks of gestation to prevent RhD alloimmunization
  • Intermittent treatment prophylaxis for malaria in endemic areas in Africa
  • Medical advice on lifestyle modifications for diet, alcohol intake, and smoking

Innocent Immaculate Acan is a medical doctor and writer currently working at Adjumani Hospital. She won the Writivism Short Story Prize in 2016 and has published an illustrated children’s book titled The Pearl Trotters in Black, Yellow, Red. She was part of the 2018 class of the Young and Emerging Leaders Project.

Innocent Immaculate Acan