According to the World Health Organization (WHO), a pregnant woman in a resource-limited setting should expect to see her Obstetrician at least 8 times before delivery
What are the important steps to ensure a safe pregnancy and delivery?
- We suggest healthy meals supplemented with a daily intake of an iron supplement of 30 mg to 60 mg of elemental iron and folic acid 0.4 mg be started at least 3 months before conception. Conception is the formation of the embryo which occurs when the man’s sperm fertilizes the woman’s egg.
- Iron helps to prevent anemia (low blood) and meet the increased iron demand during pregnancy.
- Folic acid is a necessary nutrient for development of the baby’s brain and spinal cord.
- Ideally, a woman should go for blood tests before conception (preconception planning). However, if this was not possible before conception then it is advisable to schedule an appointment with an Obstetrician once pregnancy is confirmed by a blood test.
The first visit to an Obstetrician should take place around 8 to 12 weeks. Later visits should take place at 20, 26, 30, 34, 36, 38 and 40 weeks’ of pregnancy as long as there are no health problems.
If resources are plentiful, the first visit to an Obstetrician should occur between 8 to 12 weeks, then monthly until 28 weeks, then twice a month until 36 weeks, then weekly until delivery.
The newborn baby is a risk of developing tetanus. To prevent this, tetanus toxoid vaccination is recommended for all pregnant women at 27 to 36 weeks of every pregnancy. This vaccine is given as Tdap and also protects the baby from whooping cough.
Fathers are also advised to be vaccinated with Tdap at least 2 weeks before the expected due date.
According to WHO, an ultrasound scan between 20 and 24 weeks of pregnancy is recommended for pregnant women to assess the age of the pregnancy, and to detect any placental, fetal abnormalities, or multiple pregnancies. In countries around the world, the number of ultrasound scans differs. In England, a pregnant woman is offered 2 ultrasounds, at 8 to 14 weeks and 18 to 21 weeks.
Women who are pregnant should not drink alcohol, smoke or use illicit drugs as these substances will affect the health of the baby. Women should eat healthy foods and maintain their physical activity with at least walking of 30 minutes daily.
What to Expect:
Even though pregnancy is a natural state, the purpose of the medical team is to identify any conditions that should be treated earlier to ensure a safe and successful pregnancy and delivery of a healthy baby.
At the visit, blood pressure is checked, urine is tested for protein, a head to toe exam is done, the ankles are checked for swelling, the foetal heartbeat is monitored, and blood tests are drawn.
A pelvic exam may be done and vaginal swabs may be taken to ensure there is no infection.
During the visits, watch for the following warning signs: Elevated blood pressure, protein in the urine and leg swelling which can indicate a medical condition called pre-eclampsia.
This is a condition if untreated can lead to seizures (uncontrollable shaking movements with unconsciousness), an illness called Eclampsia which if not treated promptly may result in the death of mother and baby.
In resource-limited settings, compulsory tests include urine, packed cell volume (PVC), blood group/rhesus factor and genotype.
The other important blood tests advisable to do are Syphilis test, HIV, Hepatitis B tests, and vaginal Swab for Group B streptococcal infection at 35 to 37 weeks of the pregnancy. Treatment should be given to prevent the spread of infection to the baby.
The reason for monitoring pregnancy closely is to diagnose medical conditions like hypertension, diabetes, HIV, Syphilis, and pre-eclampsia so that treatment can be given, as well as to ensure that the baby is healthy and safe.
To ensure a safe delivery and avoid preventable complications such as prolonged labour that can cause serious complications like vaginal fistula, a woman should attend antenatal care and delivery at an approved health facility.
Cost of care
The cost of care varies from hospital to hospital and varies from State to State. There are antenatal packages that will provide pregnancy care and delivery. Packages like this are available from the local general hospital, they start from N19,000 current at the time of this writing, up to higher amounts at urban hospitals. Some hospitals offer Antenatal for N500 for each visit and separate delivery charge eg N25,000. Registration fees vary from N200 to N4,000 and up depending on the location and facility.
Join a pregnancy support group or Mothers’ group so that you can stay informed.
Attend antenatal classes to learn about what to expect during labour and delivery, how to ensure a healthy pregnancy, and how to take care of the baby.
POINTERS FOR PREGNANT WOMEN:
- Register for antenatal care and delivery.
- Take folic acid and iron supplement to ensure the health of her baby.
Wishing you a safe pregnancy and delivery.
Written by Dr. Ngozi Onuoha.
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