Antenatal care

In previous steps we have described the burden of maternal deaths around the world and what can be done to prevent these deaths and complications. We will now look at antenatal care, its purpose, and what can or cannot be achieved by mothers receiving it.

What is antenatal care?

The care a pregnant woman receives from a healthcare professional over the course of her pregnancy is referred to as antenatal care (ANC). It is used to detect early signs of complications, followed by a timely intervention if any are found. This care also focuses on educating the pregnant woman on a range of topics, including well-being, birth preparedness, complication readiness, and breastfeeding.

History of antenatal care

ANC has been recommended by the Ministry of Health in the UK since 1929. The recommendation for care is as follows:

• From as early in pregnancy as possible (before or after 16 weeks), with the next visit at 24 and 28 weeks
• From 28 weeks and fortnightly until 36 weeks
• From 36 weeks and weekly until the onset of labour.

During these visits the healthcare professional measures uterine height, checks foetal heartbeat, tests urine, and measures the mother’s blood pressure. This same structure of ANC has been adopted worldwide, and has been adapted today within the Focussed Antenatal Care (FANC) approach, endorsed by the World Health Organisation (WHO) in 2002. FANC is a goal-oriented ANC approach that promotes the health of mothers and their babies through targeted assessments of pregnant women to facilitate:

• Identification and treatment of already established disease
• Early detection of complications and other potential problems that can affect the outcomes of pregnancy
• Prophylaxis and treatment for anaemia, malaria, tetanus, and sexually transmitted infections including HIV and urinary tract infections. Prophylaxis refers to an intervention aimed at preventing a disease or disorder from occurring.
• Individualised care and advice to help maintain normal progress and preparedness for delivery.

Who receives care?

It is widely recommended that women have at least four antenatal care visits during pregnancy but in Sub-Saharan Africa and South-east Asia fewer than half of women receive this number, although almost all women have at least one visit.¹ In the UK, pregnant women receive on average 9-10 ANC visits depending on whether or not they have had a previous pregnancy.²

Figure 1. Coverage of antenatal care visits. Sub-Saharan Africa and South/South-east Asia, DHS Comparative Reports (2011).³

Does antenatal care reduce maternal mortality?

ANC is thought to prevent high-risk complications in pregnancy, but evidence for this is lacking for many outcomes. It is unlikely to impact on some major causes of maternal mortality, such as haemorrhage and obstructed labour. These types of emergencies are prevented through prompt recognition and emergency care, which antenatal care does not provide. It does, however, aim to educate the woman on recognising signs of these types of complications, which can help to save their lives and promote birth preparedness. ANC also provides effective interventions for preventing and treating certain conditions, such as anaemia, pre-eclampsia and eclampsia, external cephalic version to correct a breeched position, and infections, some of which impact on the health of the newborn as well as the mother, e.g. malaria, HIV, tetanus, syphilis, gonorrhoea, bacteriuria. Dowswell et al. state that “It is reasonable to assume that antenatal care does confer some health benefits, although how it does so may be complex and multi-factorial”.⁴