Pregnancy is an exciting yet sensitive journey. While it is a natural human process and no disease… it requires special care to ensure a safe delivery, hence the importance of early, focused antenatal care.
The Booking Visit
This is the first contact with the clinic or maternity after a woman suspects/confirms she is pregnant. The booking visit is best done as soon as the woman is pregnant. A recommendation for most clinics is 8 weeks. In Nigeria, most government owned hospitals book from week 12, however, this is mostly due to under staffing and general weak weak health systems. So my advice to women would be to go as soon as they believe they are pregnant, after preliminary documentation, examinations and tests, she will be counselled on next steps and given a followup antenatal appointment date.
Barriers To Antenatal Care In Nigeria
C- Care Quality
R- Resource Quality
I- Influences from peers
While the first two barriers are systemic problems that will need fixing from the government level, the later have more to do with knowledge and practice.
Let’s start with some quick facts to fix the misplaced beliefs stemming from both internal and external influences;
No matter how many babies you have had, you’re always a New mum with each pregnancy. The ‘See-Finish’ attitude doesn’t apply to pregnancy and Antenatal Care (ANC). No two pregnancies are the same and late ANC Booking visit could be the death of Mom and Baby.
A lot of persons don’t see the need to book early ANC or even book at all. To some, it’s a waste of time or money or for old timers… “Been here, know the drill” (See finish). See guys, the thing is…No two pregnancies are the same from the same woman or different. A woman could be fine in her first pregnancy and in a subsequent pregnancy may have contracted HIV, Hepatitis B or Syphilis .Another woman in her 3rd of 4th pregnancy might have become hypertensive or Diabetic or Anaemic without knowing. Another might have had recurrent miscarriages and unknown to her could be Rhesus incompatibility.
Antenatal Care is so much more than just a routine or a place to ‘pop’ your baby. ANC is beyond Folic acid and supplements or just the awareness classes (Equally important). The best time to go see your Dr is immediately you suspect or know you’re pregnant.
Why Antenatal Care?
– Prevent, detect and manage those factors that adversely affect the health of the mother and baby.
– Provide advice, reassurance, education and support for the woman and her family;
– Deal with the ‘minor ailments’ of pregnancy;
– Carryout general health screenings.
Benefits Of Early Antenatal Care Bookings
Here are some specific benefits of scheduling an early Antenatal care booking visit;
Pregnancy Confirmation; While a urine test is a way of knowing if one is pregnant… it is not a confirmatory test. A blood test is confirmatory and an early ultrasound is Gold standard. These confirmatory tests rule out False/ Pseudo pregnancy or Gestational trophoblastic disease; all symptoms that mimic pregnancy. In GTD, a mole grows in the uterus, triggering symptoms mimicking a developing pregnancy with abnormally high HCG levels, giving a positive PT result. With an ultrasound scan, it can be diagnosed and treated. These moles can be benign or even Malignant. Early detection is key.
Early Detection and Management of Non Communicable Diseases Coexisting With Pregnancy; Women with known NCDs are encouraged to see a Doctor even while planning to get pregnant and also as soon as they are pregnant.Early detection and management of diseases like: Hypertension, Diabetes, Sickle cell disease, Anaemia, Malaria, Fibroids, Ectopic pregnancy and endocrine disorders, including obesity, can improve the outcome of the pregnancy or save life of mother and child. Many women don’t know they have these conditions until these routine tests are conducted. Also chances of NCDs increase with increasing number of pregnancies and advancing age too. So, you see, sometimes, we are our own ‘Village people’. Not every adversity is ‘Spiritually induced’, sometimes all we need is better health seeking behaviour and Early ANC.
Early Detection of Infectious Diseases; Infectious diseases like; HIV, Hepatitis B, Syphilis, Gonorrhea, Clamydia, etc can be transmitted from mother to child and when discovered early from routine ANC screening or testing can inform early management and improve the health outcome of mother child throughout pregnancy and beyond. Studies again show that many women find out for the first time about their infection history during Antenatal care visits
Routine Immunization:⁃ For women who haven’t completed their Tetanus Toxoid Vaccines (5 shots for life immunity), the earlier they come, the earlier they can commence their vaccination, so they can take at least two doses of TT before delivery, to protect them and their babies. – Rhesus Negative (RH-) women pregnant for Rhesus positive men , have higher chances of miscarriages and stillbirths if they are pregnant with a Rhesus positive child.To reduce chances of this condition caused by Rhesus incompatibility, women are given an immunoglobulin…injection (Anti-D/ Rhogam) at 28 weeks of pregnancy and also within 72 hours post delivery. To reduce any sensitization and fetal loss in the ongoing pregnancy and the next. This is done for each pregnancy. Many women who don’t know this, book ANC late, further increasing their chances of having a spontaneous miscarriage.
Ultrasound Scanning: Early ultrasound has so much benefits. Recommendation from the National Institute of Health and Clinical Excellence is that all pregnant women should be offered scans at between 10 and 14 weeks and 18 and 21 weeks.
10-14 weeks: To principally determine, Gestational age, Detect multiple pregnancies and Down’s syndrome.
18- 21 Weeks; Scan primarily screens for Structural anomalies. Scans performed after this stage is based on clinical indication, such as concern for fetal growth or well being. Evidence suggests that the earlier the ultrasound, the earlier the detection & better the management.
Routine medication:This so important and while many women might think they have all the drugs figured out, they might actually need more care, SAFE drugs and observation if they are found to have any diseases or infection coexisting with pregnancy. Also, self medication at this point, more than ever, is dangerous, as a lot of drugs (including antibiotics or even medication for chronic diseases) may now be teratogenic (harmful to the baby).
Now, about Folic Acid; Did you know it even has more benefits when commenced before pregnancy. Once a woman is ready to get pregnant, a hack is to commence on folic acid. Plus, it is especially needed in the 1st trimester for fetal spinal cord and brain development, a period when many women, unfortunately, are yet to confirm their pregnancy or even commence ANC.
In Summary, So how early?
As soon as you know you’re pregnant and confirm with a blood test. Go register at a hospital of your choice. From 8 weeks, a booking visit can be done. Earlier? Still great. Anyone laughing at a woman for registering “Too early” is ignorant. It is not your portion, however, early ANC booking & testing can help identify & start early management of any complication.So, If a hospital says too early, my advice…Find another trusted private owned hospital if you can afford it and go for your preliminary tests and confirmation, and if the other is your preferred (Especially Govt owned) you can go back there when it’s 12 weeks and commence your routine ANC. Cos once you’re pregnant, you need to be screened, scanned and tested early.
Don’t delay, better ‘too early’ than late. Booking late for your ANC is not a sign of maturity/Seniority. It doesn’t make you more qualified or experienced, no two pregnancies are the same and that singular action is putting you and your unborn child at risk.
Also, please register in a verified hospital or maternity and adhere to your the guidelines of your doctors and midwives. Take ANC classes seriously & ask questions if you want to and to our dear Men, please create time to attend ANC with your partners as much as you can. You’re both pregnant. I know things are hard, but please, don’t be penny-wise with your pregnancy. Not every adverse outcome is spiritually induced, sometimes it’s just those deadly delays and little details we took for granted.
Play your part and stay safe, I’m rooting for you.