13.1.2 Failings of the traditional approach to antenatal care
Research studies (for example, see Box 13.2) have shown that the more frequent antenatal visits traditionally practised do not improve pregnancy outcomes. In particular, pregnant women labelled as ‘low-risk’ or ‘not at risk’ in traditional antenatal care may not receive counselling on danger symptoms. As a result, it is very common that these women fail to recognise the danger symptoms and do not report soon enough to health professionals.
Box 13.2 Failure to identify ‘at risk’ pregnancies
Taking obstructed labour occurrence as one of indicators, a study in Zaire in 1984 in 3,614 pregnant women showed that 71% of the women who developed obstructed labour were previously categorised as ‘not at risk’, while 90% of women who were identified as ‘at risk’ did not develop obstructed labour. This is one source of evidence to show that most pregnancy problems are unpredictable and late phenomena.
Other examples of unpredictable pregnancy disorders that appear very late in gestation include the top three killers of mothers:
- Hypertensive disorders of pregnancy (hypertension means high blood pressure), specifically eclampsia, which commonly occurs very late in pregnancy, or during labour or after delivery (you will learn about this in Study Session 19).
- Haemorrhage (heavy bleeding), which occurs most commonly in the third trimester (Study Session 21 describes late pregnancy bleeding), or the more often fatal postpartum haemorrhage, which occurs after delivery (you will learn about this in the Labour and Delivery Care Module).
- Pregnancy related infection (postpartum infection of the uterus), which usually develops after delivery (this is described in the Labour and Delivery Care Module).
The traditional approach to antenatal care is unable to identify accurately women who are ‘at risk’ of developing any of these life-threatening conditions. It identifies some women as being ‘low risk’ who subsequently develop danger symptoms that need urgent professional intervention.