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Slide 1 - Antenatal Care (ANC): Overview Advances in Maternal and Neonatal Health
Slide 2 - 2 Antenatal Care: Overview Session Objectives Describe the purpose of antenatal care and its role in relationship to Safe Motherhood initiatives Define current issues related to providing effective antenatal care
Slide 3 - 3 Antenatal Care: Overview Essential Health Sector Interventions for Safe Motherhood Postabortion Postpartum Care Family Planning Antenatal Care Clean/safe Delivery Essential Obstetric Care BASIC HEALTH SERVICES EMOTIONAL AND PSYCHOLOGICAL SUPPORT EQUITY SAFE MOTHERHOOD
Slide 4 - 4 Antenatal Care: Overview Objectives of ANC Promote and maintain the physical, mental and social health of mother and baby by providing education on nutrition, personal hygiene and birthing process Detect and manage complications during pregnancy, whether medical, surgical or obstetrical Develop birth preparedness and complication readiness plan Help prepare mother to breastfeed successfully, experience normal puerperium, and take good care of the child physically, psychologically and socially
Slide 5 - 5 Antenatal Care: Overview What is Effective ANC? Care from a skilled attendant and continuity of care Preparation for birth and potential complications Promoting health and preventing disease Tetanus toxoid, nutritional supplementation, tobacco and alcohol use, etc Detection of existing diseases and treatment HIV, syphilis, tuberculosis, other co-existing medical diseases (e.g., hypertension, diabetes) Early detection and management of complications
Slide 6 - 6 Antenatal Care: Overview Why Disease Detection and Not Risk Assessment Risk approach is not an efficient or effective strategy for maternal mortality reduction: “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.
Slide 7 - 7 Antenatal Care: Overview Goal-Directed Interventions Give a Framework for Effective ANC Disease detection Counseling and health promotion Birth preparedness Complication readiness
Slide 8 - 8 Antenatal Care: Overview Goal-Directed Components of ANC: Disease Detection Look for problems requiring additional care
Slide 9 - 9 Antenatal Care: Overview Goal-Directed Components of ANC: Counseling and Health Promotion Client-centered and gestational age-specific counseling for women and partners/ supporters on: Nutrition and micronutrients Rest and avoidance of heavy physical work Danger signals of complications and disease/illness Family planning Breastfeeding Malaria prophylaxis Tobacco and alcohol use
Slide 10 - 10 Antenatal Care: Overview Goal-Directed Components of ANC: Birth Preparedness Make plans for the birth: Prepare the necessary items for birth Identify a skilled attendant and arrange for presence at birth Identify appropriate site for birth, and how to get there Identify support people, including who will accompany the woman and who will take care of the family Establish a financing plan/scheme
Slide 11 - 11 Antenatal Care: Overview Goal-Directed Components of ANC: Complication Readiness Establish a financing plan/scheme Make a plan for decision-making Arrange a system of transport Establish a plan for blood donation 15% of all pregnant women develop a life-threatening complication requiring obstetric care
Slide 12 - 12 Antenatal Care: Overview Goal-Directed ANC Goal-directed interventions Increasing use of systematic review of evidence to evaluate effectiveness of interventions This effort is now underway and is ongoing
Slide 13 - 13 Antenatal Care: Overview Summary Antenatal care includes goal-directed interventions Skilled attendant Preparation for birth and complications Health promotion Detection of complications
Slide 14 - 14 Antenatal Care: Overview References Fortney J. 1995. Antenatal risk screening and scoring: a new look. Int J Gynecol Obstet 50(Suppl 2): S53–S58. Yuster EA. 1995. Rethinking the role of the risk approach and antenatal care in maternal mortality reduction. Int J Gynecol Obstet 50(Suppl 2): S59–S61.