Antenatal Care Module: Introduction
Introduction to the Antenatal Care Module
According to WHO estimates, more than 1,500 women die from pregnancy or childbirth-related complications every day. Annually, about half a million maternal deaths occur worldwide, and most of these deaths are in developing countries. Globally, there is not much improvement in the maternal mortality ratio (MMR, the proportion of women dying due to complications of pregnancy or childbirth), primarily because of the high maternal deaths in less developed countries. The maternal mortality ratio is less than 10 per 100,000 live births in Western countries and above 1,000 per 100,000 live births in very poor countries. As the Ethiopian Demographic and Health Survey reports showed, the maternal mortality ratio was 871 per 100,000 live births in 2000 and 673 per 100,000 live births in 2005 (European calendar). In short, a woman’s lifetime risk of maternal death is 1 in 7,300 in developed countries, versus 1 in 75 in less developed countries.
The most common causes (about 80%) of maternal mortality in developing countries (unsafe abortion, haemorrhage, eclampsia, infection and obstructed labour – described in detail either in this Module, or in the next one) are either avoidable or treatable. With that understanding, improving maternal health is one of the eight Millennium Development Goals (MDGs) adopted by the international community at the United Nations Millennium Summit in 2000. The Ethiopian government has expressed its commitment to deliver the MDGs, including improving maternal health and reducing maternal mortality by three-quarters (MDG5), and reducing mortality of children aged under 5 years by two-thirds (MDG4).
To make a difference to maternal and newborn health in developing countries, or anywhere else, health promotion, disease prevention and effective healthcare have to begin even before the occurrence of pregnancy. This helps to evaluate the physiological maturity and psychological readiness of the mother, and also her medical fitness to conceive and carry the pregnancy. As a continuum of preconception care, effective antenatal care is a very crucial aspect of the health service. It can detect established medical problems and reduce the occurrence of some pregnancy-related complications; it gives the opportunity for pregnant women and their families to become familiar with the health facility environment and accept home visits by health professionals, such as the Health Extension Practitioners of Ethiopia; it alerts pregnant women to possible danger signs, so that they are aware of pregnancy and delivery-related problems that may arise later, and thus can make practical and financial preparations for possible emergencies ahead of time.
The goal of antenatal care is to have a healthy mother and healthy baby by monitoring the well-being of both the woman and the fetus during pregnancy, and helping them make a smooth transition to labour and delivery. To achieve this goal, your role of providing optimal antenatal care at the Health Post or in the home is immense. Therefore, understanding the concepts and competencies of antenatal care as recommended in this Module, and taught in your practical skills training programme, is crucial for the better health and survival of the pregnant women and newborns in your catchment area, and for the general wellbeing of Ethiopian mothers and their children.
This Module is formulated to equip you with the basic principles and practice of antenatal care at Health Post and home level. It has 22 Study Sessions divided into two parts. In Part 1, you will learn about antenatal care planning and promotion, the anatomy and physiology of the female reproductive system, physiologic changes during pregnancy, routine assessment of the pregnant woman and fetus, and methods of evaluating and identifying the progress of a normal pregnancy and some common maternal and fetal problems. In Part 2, you will learn what focused antenatal care is, and about counselling pregnant women on staying healthy, eating well at low cost, the danger signs to watch for, pregnancy from the perspective of HIV and prevention of mother-to-child transmission, premature labour, hypertensive disorders of pregnancy, abortion, and latepregnancy bleeding, and other common medical problems in pregnancy. Part 2 ends with the theory of two major practical procedures: setting up pre-referral intravenous therapy for women in shock, and inserting a catheter to drain the bladder of a pregnant woman.