Antenatal Care ANC Overview Advances in Maternal and

Antenatal Care (ANC): Overview Advances in Maternal and Neonatal Health Antenatal Care: Overview

Session Objectives l Describe the purpose of antenatal care and its role in relationship to Safe Motherhood initiatives l Define current issues related to providing effective antenatal care Antenatal Care: Overview 2

Essential Health Sector Interventions for Safe Motherhood Essential Obstetric Care Postpartum Care Clean/safe Delivery Antenatal Care Postabortion Family Planning SAFE MOTHERHOOD BASIC HEALTH SERVICES EQUITY EMOTIONAL AND PSYCHOLOGICAL SUPPORT Antenatal Care: Overview 3

Objectives of ANC l Promote and maintain the physical, mental and social health of mother and baby by providing education on nutrition, personal hygiene and birthing process l Detect and manage complications during pregnancy, whether medical, surgical or obstetrical l Develop birth preparedness and complication readiness plan l Help prepare mother to breastfeed successfully, experience normal puerperium, and take good care of the child physically, psychologically and socially Antenatal Care: Overview 4

What is Effective ANC? l Care from a skilled attendant and continuity of care l Preparation for birth and potential complications l Promoting health and preventing disease l l Detection of existing diseases and treatment l l Tetanus toxoid, nutritional supplementation, tobacco and alcohol use, etc HIV, syphilis, tuberculosis, other co-existing medical diseases (e. g. , hypertension, diabetes) Early detection and management of complications Antenatal Care: Overview 5

Why Disease Detection and Not Risk Assessment l Risk approach is not an efficient or effective strategy for maternal mortality reduction: l l “Risk factors” cannot predict complications: usually not direct cause of complication What do you do once you identify risks? What about “low risk? ” Maternal mortality is relatively rare in population at risk (all women of reproductive age); “risk factors” are relatively common in same population, these “risk factors” do not appear to be good indicators of which women will experience complications Majority of women who experienced complication were considered “low risk; ” vast majority of women considered to be “high risk” gave birth without experiencing a complication Fortney 1995; Yuster 1995. Antenatal Care: Overview 6

Goal-Directed Interventions Give a Framework for Effective ANC l Disease detection l Counseling and health promotion l Birth preparedness l Complication readiness Antenatal Care: Overview 7

Goal-Directed Components of ANC: Disease Detection l Look for problems requiring additional care Antenatal Care: Overview 8

Goal-Directed Components of ANC: Counseling and Health Promotion l Client-centered and gestational age-specific counseling for women and partners/ supporters on: l Nutrition and micronutrients l Rest and avoidance of heavy physical work l Danger signals of complications and disease/illness l Family planning l Breastfeeding l Malaria prophylaxis l Tobacco and alcohol use Antenatal Care: Overview 9

Goal-Directed Components of ANC: Birth Preparedness l Make plans for the birth: l Prepare the necessary items for birth l Identify a skilled attendant and arrange for presence at birth l Identify appropriate site for birth, and how to get there l l Identify support people, including who will accompany the woman and who will take care of the family Establish a financing plan/scheme Antenatal Care: Overview 10

Goal-Directed Components of ANC: Complication Readiness 15% of all pregnant women develop a life-threatening complication requiring obstetric care l Establish a financing plan/scheme l Make a plan for decision-making l Arrange a system of transport l Establish a plan for blood donation Antenatal Care: Overview 11

Goal-Directed ANC l Goal-directed interventions l Increasing use of systematic review of evidence to evaluate effectiveness of interventions l This effort is now underway and is ongoing Antenatal Care: Overview 12

Summary Antenatal care includes goal-directed interventions l Skilled attendant l Preparation for birth and complications l Health promotion l Detection of complications Antenatal Care: Overview 13

References Fortney J. 1995. Antenatal risk screening and scoring: a new look. Int J Gynecol Obstet 50(Suppl 2): S 53–S 58. Yuster EA. 1995. Rethinking the role of the risk approach and antenatal care in maternal mortality reduction. Int J Gynecol Obstet 50(Suppl 2): S 59–S 61. Antenatal Care: Overview 14