Antenatal advice refers to the advice that is given to a pregnant woman from the time of confirmation of pregnancy until the beginning of labour.
Prenatal care, also known as antenatal care is a type of preventive healthcare. It is provided in the form of medical checkups and provision of health information regarding the mother’s physiological changes, biological changes, and nutrition which prevents potential health issues throughout the pregnancy.
Systematic supervision( examination and advice) of a woman during pregnancy is called antenatal care and should start from the beginning of pregnancy and end at delivery. It comprises of history taking, examination(physical and obstetrical examination) and advice given to the pregnant women.
Aim of antenatal care
- The aim is to monitor the progress of pregnancy to support maternal health and normal fetal development.
- To prevent or to detect and treat at the earliest any complications.
- To screen the high-risk cases and recognize complications of pregnancy and refer women within the multidisciplinary team.
- To educate the mother about the physiology of pregnancy and labour on an individual basis or a planned program.
- To exchange information with the woman and her family and enable them to make informed choices about pregnancy and birth.
- To discuss place, time and mode of delivery with the couple.
- To motivate the couple about the need for family planning.
Delivery of a single baby in good condition at term with a fetal weight of 2.5 kg or more with no maternal complication is the criteria of normal pregnancy and can be achieved by antenatal advice and care.
Antenatal advice
Mother during her pregnancy should be advised regarding diet, drugs and hygiene to maintain and improve her health status to the optimum till delivery.
When a woman gets pregnant for the first time, she has the fear of the unknown; to remove the fear mother is explained about the changes and events likely to occur during pregnancy and labour. The woman is explained about the following –
Diet
- The diet during pregnancy should maintain maternal health, the needs of the growing fetus and the strength required during labour and successful lactation.
- There is an increased calorie requirement during pregnancy due to increased growth of maternal tissues, fetus and placenta.
- About 2400 calories are required during pregnancy for the health of mother and baby.
- The diet should be in enough quantity to gain the optimum weight of 11 kg and the diet should be of mother’s choice.
- Mother’s diet should include 1 litre of milk per day, plenty of green leafy vegetables and fruits and proteins of animal origin can be consumed if a woman is non-vegetarian.
- Diet should also include vitamin A (vegetables, fruits and liver) and vitamin D (dairy products).
Drugs
- As the Pregnancy advances, dietetic iron is not enough to meet the daily requirement especially in the second half of the pregnancy results in a negative iron balance.
- Supplementary iron therapy is needed for all pregnant mothers from 16 weeks onwards. A woman with 10 gram % Hb should take one tab of ferrous sulphate(60 mg), the dose should be increased if Hb is below the normal(2-3 tabs a day).
- Supplementary vitamins are also given to the mother from the 20th week onwards as the essential vitamins are either lacking in the food or destroyed during cooking.
Antenatal hygiene
The following advice can be given to a mother-
Rest and sleep
- On average, the mother should be advised to take at least 10 hours of rest and sleep in left lateral posture which is the most preferable and comfortable one to reduce vena caval pressure in later months of pregnancy.
- A mother can continue her daily routine activities throughout pregnancy but hard and strenuous work and exercises should be avoided in the first three months and the last 4 weeks.
Bowel patterns
- There is a tendency of constipation during pregnancy due to the relaxation effect of progesterone on the intestine, it may be related to backache and abdominal discomfort.
- Regular bowel movement can be maintained by regulating diet by taking plenty of fluids, vegetables, fruits and milk.
- 2 tsp of Isafgul at bedtime can be taken with warm milk or sometimes mild laxatives are prescribed by a doctor.
Clothing
- The mother should wear loose and comfortable garments.
- Avoid high heel shoes in an advanced pregnancy as there is a chance of imbalance.
Bathing
- Good body hygiene can be maintained by taking a daily bath.
- Mother is advised to take a daily bath but be careful against slipping in the bathroom due to the imbalance.
Care of the breast
- The mother should wear a comfortable and supportive brazier.
- If the nipples are normal, nothing is to be done beyond ordinary cleanliness and if the nipples are retracted, should be corrected by manipulation in the later month of pregnancy.
Coitus (Sexual Intercourse)
- Coitus should be avoided during the first trimester and also the last 6 weeks of pregnancy.
- It is also avoided if there is a risk of abortion, antepartum haemorrhage and preterm labour, otherwise, it is not harmful.
Travel
- Travel is avoided especially in the first trimester and last six weeks of pregnancy.
- Travel by vehicles have jerky movements and better to be avoided.
- The rail route is most preferable to bus and other routes.
- The long journey is to be limited to the second trimester only.
- In cases with placenta previa, severe anaemia and pre-eclampsia, air travel is contraindicated.
Smoking and alcohol
- Smoking and alcohol are injurious to health, it is better to stop during pregnancy and even thereafter.
- Mothers who smoke heavily have smaller babies and there is more chance of abortion.
- Mothers who consume alcohol can lead to fetal maldevelopment or growth restriction.
Immunization
- In developing countries, it is routine to immunize pregnant women against tetanus.
- 0.5ml tetanus toxoid is given IM at 6 weeks interval for 2 such, the first one is given between 16 to 24 weeks. If the woman is already immunized in the past, a booster dose of 0.5 ml IM is given in the last trimester.
- Immunization against tetanus not only protects the mother but also the baby.
Drugs
- Almost all the drugs given to the mother, cross the placenta and reach the baby in the womb.
- While prescribing drugs to a woman possibility of pregnancy should be kept in mind to prevent any harsh effects of drugs on the baby.
- Never take any medicine without a doctor’s prescription.
General advice
- The mother is advised to attain the clinic for an antenatal check up on the scheduled date of visit.
- She is also instructed to report if some untoward symptoms arise such as sudden headache, restlessness, urinary infection, epigastric pain, vomiting and decreased urinary output.
- She is advised to come to the hospital in the following circumstances such as painful uterine contractions, sudden leaking of watery fluid per vagina and vaginal bleeding.
Conclusion
In the above post, we have discussed antenatal care, its aim and antenatal advice given to a pregnant woman.
