Antenatal Care

In former days not much was known about pregnancy and the development of a foetus. The help of a doctor was invoked only at the time of the confinement. Today more knowledge and treatment of early diagnosed problems prevent much trouble for both the mother and her unborn child. That is why screening and antenatal care play an important part in today’s health care.

Just as it makes sense for a woman to find out as early as possible whether or not she is pregnant, so can she start – even before she conceives – taking extra care of herself. Once pregnant, early attendance at an antenatal clinic gives her the best possible chance of normal delivery of a healthy baby. Ideally she should visit her own doctor as soon as she thinks she might be pregnant, and go for her first antenatal check-up by the time she is eight weeks pregnant. The schedule of antenatal check-ups varies from place to place. In general, she will probably be asked to return for check-ups at monthly intervals until she is 28 weeks pregnant, thereafter appointments will be only two weeks apart. During the last month of pregnancy, weekly visits to the clinic are usual.

A newly pregnant woman may feel some anxiety at the thought of her first clinic visit, especially if it is at a hospital and she has never attended a hospital outpatient department before. There is nothing to fear, and if she knows what to expect and why all the various procedures are being carried out, she will feel much more relaxed.

The first visit

This provides the doctor with an opportunity to assess the woman’s general health and detect at an early stage any health problems which might adversely affect the pregnancy. A check is made on how the pregnancy is progressing and to predict whether any problems might arise during delivery, which will affect how and where she has her baby. Most first babies are born in hospital, but if the pregnancy and birth are likely to be uncomplicated, second and subsequent confinements usually take place at home with a midwife in attendance.

First she will probably have a fairly lengthy and detailed interview with either the doctor or midwife to find out personal details and the general medical history. She will be asked if she has, or has had, heart or kidney disease, tuberculosis, diabetes or hepatitis. It is important to know whether the woman has had gynaecological operations, blood transfusions or long-term health problems such as asthma, high blood pressure or anaemia. She will be asked about previous pregnancies, deliveries, miscarriages, whether her previous children are healthy, and whether twins run in the family or any diseases with an inherited bias, such as diabetes. She will also be asked whether she smokes or drinks. Both smoking cigarettes and an excessive intake of alcohol have been shown to retard the normal development of the foetus. Smoking also increases the risk of miscarriage and of stillbirth. As an aid to establishing the duration of the pregnancy, the woman will be asked for the date of her last menstrual period (LMP), and whether it was shorter or lighter than usual. Particular note will be made of whether she was using oral contraceptives and, if so, when she stopped taking them. At what age did she start her periods, what is the normal length of her menstrual cycle, and how long do her periods normally last? From all this the most probable day of conception will be estimated, and thus the expected date of delivery (EDD) is also calculated. This date is important as a base on which decisions may need to be made later in the pregnancy. Finally, she will be asked how she has been feeling since her pregnancy began, and what noticeable changes she has experienced. Next comes a physical examination and assessment. She will probably be weighed and have her height measured. The doctor will listen to her heart and lungs and examine her breasts for the changes that occur during pregnancy and also to see if her nipples are suitable for breast-feeding. If a woman has inverted nipples, it is usually possible to correct this during pregnancy. Her legs will be examined for varicose veins, and her ankles for oedema (swelling). Her blood pressure will also be recorded.

The woman’s urine will be tested. She may be asked to provide a clean, midstream specimen of urine which will be tested for proteins and glucose (in case she is unknowingly suffering from diabetes). At the same time the laboratory will check the specimen for any urinary infection which may exist without symptoms.

A blood sample will be taken to find out if she is anaemic, what her blood group is, including whether she is Rhesus positive or negative, and whether she has, or has had, infectious diseases such as syphilis, hepatitis or rubella (German measles).

The doctor can gain a lot of information by palpating the abdomen, that is, feeling with the hands the position of the uterus and its contents. Although the actual size of the uterus is not a reliable guide to the duration of the pregnancy, the record of its growth throughout pregnancy is a good indication of how the pregnancy is progressing.

An internal, or vaginal, examination is also usually carried out on the first antenatal visit to confirm that a woman is pregnant and that the foetus is developing in the uterus and not in one of the Fallopian tubes. The doctor places two fingers inside the vagina, at the same time feeling the uterus through the abdomen with the other hand. This also allows him or her to check the size of the uterus, and to get a general idea of whether the birth canal formed by the bones of the pelvis is likely to be large enough for a normal delivery. If the woman has any vaginal discharge, tests will be carried out to find the cause so that she can be given appropriate treatment. Usually a cervical smear test is also carried out, which she may find uncomfortable but not painful. The doctor inserts a metal instrument called a speculum into the vagina in order to see the cervix and gently scrape some cells from it. Laboratory analysis will show if any abnormal cells are present. Vaginal examination in pregnancy is not harmful to the baby and cannot cause miscarriage. The next routine vaginal examination will not be until 36 weeks, although the doctor may perform one before then if he or she thinks it necessary.