Benefits of Booking Early Antenatal Care

benefits of booking early antenatal care
benefits of booking early antenatal care

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
B- Beliefs
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.

Article by: Dr Chioma Nwakanma


By Imadojiemu Marietta O.

I had just returned from the School Health Education Empowerment Tour at Morit International School, Ajegunle, Lagos, Nigeria, organized by us at Smile with me Foundation and my phone was beeping non-stop while i allowed it stay glued, deep down in my handbag to prevent unnecessary phone loss stories.

Finally, I got home and got the phone out to see what the ‘buzz’ was about. Alas! 8 of 10 direct messages asked, “Marietta, how can I Volunteer too? Why do you volunteer anyway?”. I laughed to myself at thought of what must have gone through the minds of the people who asked the latter question- “This lady must be crazy, giving services for free in this ‘harsh’ Nigerian economy?”. Thanks to them though, this post was overdue!

Volunteering simply means freely offering to do something or work for an organization without getting paid. It involves contributing meaningfully, in some cases, while working with other individuals, to make communities better. The business times puts the value of a volunteer’s work to be just above $20 per hour. In reality, ‘A good Volunteer is priceless’ and no price tag can effectively reward work done. Moreso, payment comes in other very satisfying ways for an informed volunteer.


WORLD HEPATITIS DAY 2019 |What You Need To Know About Hepatitis

Important facts you must know about viral hepatitis
A blog post Important facts you should know about Viral Hepatitis by SMILE With Me Foundation

Hepatitis is an overall term for the inflammation of the liver. The liver is a vital organ in the human body which performs several functions that aid in metabolisms such as the breakdown of certain nutrients, activation of enzymes, toxin filtration, blood protein and clotting factors syntheses.

Inflammation of the liver could be self-resolving or progressive leading to cirrhosis, cirrhosis or liver cancer. The most common cause of hepatitis is viruses, which accounts for about 50% of all cases. However, certain medications, excessive alcohol intake and other toxins could also lead to liver inflammation. Also, the body itself could produce antibodies against the liver, thus leading to autoimmune hepatitis.

Statistics About Hepatitis

By the end of 2015, according to the WHO, approximately 325 million people were living with chronic hepatitis and 1.34 million deaths were recorded in the same year due to viral hepatitis, which is more than those caused by HIV. Nigeria is one of the 11 countries which carry 50% of the burden of the global burden of chronic hepatitis with about 13.7% (20-30 million people) of the population affected by the disease.

However, hepatitis is highly preventable via safe practices and vaccines. Treatment and management strategies are also available.

Viral Hepatitis

This is caused by viruses and is the most common presentation of hepatitis. There are 5 main hepatitis virus strains; A, B, C, D, E. Only about 7% of existing cases in every year are actually reported. These viruses could lead to acute or chronic hepatitis and there are various ways these viruses are transmitted.

Hepatitis A (HAV)

Formerly known as infectious hepatitis because of the ease of transmission between individuals, HAV causes acute hepatitis. It is spread mostly via the consumption of infected food and water or the fecal-oral route. It can also be spread through the exchange of oral secretions (as in intimate kissing) and through sexual (anal-oral route).

Most of the worldwide spread of this virus happens in areas with low socioeconomic status, poor hygiene or common fecal-oral contact, like daycare centres. The incubation period is 2 to 6 weeks and there are safe and effective vaccines to prevent Hepatitis A.

Hepatitis B (HBV)

This is one of the most common forms of hepatitis. The HBV virus is transmitted via body fluids like semen, blood from an infected person. This could be through sexual contact, drug-injection equipment like needles, sharp objects like razors or from mother-to-child during birth. The effect of this virus could be short-term or chronic. The risk for chronic infection is related to age at infection as 90% of infected infants become chronically infected, compared with 2%–6% of adults. The incubation period is 2 to 5 months and vaccination is available to prevent HBV infection.

Hepatitis C (HCV)

HCV can be transmitted via the percutaneous contact with blood which could be via blood transfusion, shared needles in drug abusers or haemodialysis, among others. Viral transmission is possible via perinatal or sexual means, but this is rare. Together with HBV, Hepatitis C constitute the most common source of liver cancer and cirrhosis. The incubation period is 2 weeks to 6 months and HCV has no vaccines available yet.

Hepatitis D (HDV)

Hepatitis D usually occurs concomitantly with HBV because the virus cannot survive without the presence of HBV.  A combination of both viruses usually leads to faster disease progression and a more difficult treatment regimen. It is usually transmitted in similar ways as HBV.

Hepatitis E (HEV)

This is mostly contracted through the oral intake of fecal matter present in contaminated water and food. It is usually self-limiting and does not result in chronic infections. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

Other viruses

Hepatitis G Virus (HGV) has been found to be present as a co-infection in Hepatitis B and C but clears in 75% of the infection.

Cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), and varicella-zoster virus (VZV) may also cause inflammation of the liver, but they do not primarily target the liver.

Common Symptoms Of Hepatitis

Most people with HAV, HBV and HCV infections usually have little symptoms or are asymptomatic. When the symptoms do occur, they are usually similar across viruses and are usually flu-like. They include;

Loss of appetite, nausea, vomiting, abdominal pain, fever, weakness.

Other symptoms include; yellowing of eyes or skin (which may be jaundice), dark urine, light coloured stools, unexplained weight loss.

 Diagnosis Of Hepatitis

Prior to any laboratory investigations, the doctor will take a comprehensive history of the patient’s health to determine signs and risk factors. Acute viral hepatitis is commonly confirmed by blood tests after the presence of the aforementioned symptoms has been ascertained.

However, chronic infections are usually asymptomatic or have mild non-specific symptoms, hence, patients could remain undiagnosed for years.

There are three types of blood tests for evaluating patients with hepatitis: liver enzymes, antibodies to the hepatitis viruses, and viral proteins or genetic material (viral DNA or RNA).

An abdominal ultrasound may be requested and is useful for differential diagnosis. a liver biopsy may also be done to see the extent of liver tissue damage.

Prevention of Viral Hepatitis

Like other diseases, prevention of hepatitis is preferable to treatment.

Increased hygiene practices such as proper refuse disposal, thorough washing of food, proper handwashing practices, should be encouraged and promoted in communities.

Precaution should be taken to protect oneself from bodily fluids of others. Having unprotected sex with multiple partners is highly discouraged. Personal effects such as toothbrushes should not be shared. Unnecessary exposure and careless handling of sharp objects like razors, needles must be minimized.

Vaccination is available for HAV, HBV (consequently, HDV) and HEV. When given to infants, children and adults who have not been exposed to the virus, they provide protection from the disease for a long time. Hepatitis B vaccines are 90% effective in infants and 95% effective in adults

Immunoglobulins could also be given to people who have been exposed to the virus to prevent infection. There are different types for the viruses.

Treatment/ Management of Hepatitis

This is usually dependent on whether it is an acute or chronic phase of/ the disease. Alcohol intake and smoking should be totally eliminated and drug use minimized. These could hasten the progression of the disease.

Hepatitis A

This is usually acute and self-limiting, hence, it mostly requires a symptomatic resolution until it resolves. For example, hydration and proper nutrition after vomiting. Care should be taken when giving the patient med

Hepatitis B

The acute phase is not treated with drugs but the chronic phase is treated with antiviral medication.

Chronic Hepatitis B is treated with prescription-only antiviral medication. They may be taken for a long time and the regimen requires monitoring. Vaccines are available, for all ages, to protect against this disease.

Hepatitis C

Antiviral drugs are used to treat both acute and chronic forms of the disease. A combination of drugs may be needed for effectiveness.

Due to the constant development of safer, more effective antiviral drugs for hepatitis B and C, the drug regimen is likely to be reviewed every year.

Hepatitis D

There is no antiviral treatment regimen available currently but a 2013 study has suggested the use of alpha interferon. However, this has been effective in about 25% to 30% of all cases.

Hepatitis E

Currently, there are no medical therapies for this disease. However, it usually resolves on its own. Patients are advised to stay hydrated, get enough rest and avoid alcohol.

Autoimmune Hepatitis

Corticosteroids such as prednisolone and budesonide are usually effective in about 80% of cases. Immunosuppressants like azathioprine and budesonide are usually very used alone or in combination with corticosteroids.

Hepatitis could lead to complications such as cancer (hepatocellular carcinoma), liver cirrhosis, liver failure and possibly death. on the other hand, the prognosis is usually as virtually all patients with acute HAV infection and over 95% of adults with acute Hepatitis B recover fully.

Do you know your Hepatitis status?

Get screened and/or vaccinated today!