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Module 1: Antenatal care
Introduction
Antenatal care refers to pregnancy care that takes place before birth. This not only includes the care during pregnancy but for those women with a health condition may also mean a pre-pregnancy visit to achieve optimal health before pregnancy begins. A woman needs to have a Lead Maternity Carer (LMC). This is usually provided by a self-employed midwife, and less frequently by a hospital antenatal clinic, GP or private obstetric specialist. Maternity care is free for women who are New Zealand citizens or those who have had permanent residency for 2 or more years and who have midwifery, GP or hospital clinic care. Maternity care is also free for women whose partners are NZ citizens, NZ residents, or fulfil other criteria. Have a look at the MOH website below if you would like to find out more about other women who may also be eligible for free care.
Objectives
By the end of this session you should be able to:
- Understand the New Zealand model of antenatal care
- Take a detailed history as you would at a booking visit
- Explain the importance of a first antenatal visit and the tests done at this visit
- Understand the options for first and second trimester screening for aneuploidy
- Understand common pregnancy symptoms and how these relate to the physiology of pregnancy
- Explain to a pregnant woman and her whänau the importance of vaccinations in pregnancy
- Be able to give simple advice to a pregnant woman on diet and exercise
Readings
Farquhar C, Roberts H, editors. Introduction to obstetrics and gynaecology. 4th ed. Auckland: The University of Auckland, Faculty of Medical and Health Sciences, Dept. of Obstetrics and Gynaecology; 2017.
Read Chapter 5. Antenatal care and common conditions in pregnancy, Chapter 6. Ultrasound, prenatal screening and diagnosis, and haemolytic disease of the fetus and newborn and Appendix 1 Maternal and / or Fetal Obstetric Risk Factors
BPAC NZ. 2011. Routine laboratory testing in pregnancy. https://bpac.org.nz/BT/2011/July/pregnancy.aspx
HealthEd. 2017. Eating for Healthy pregnant women. https://www.healthed.govt.nz/resource/eating-healthy-pregnant-womenngā-kai-totika-mā-te-wahine-hapū
Ministry of Health. 2014. Healthy weight gain during pregnancy
https://www.health.govt.nz/your-health/healthy-living/food-activity-and-sleep/healthy-weight/healthy-weight-gain-during-pregnancy
Ministry of Health. 2013. Your Pregnancy/Tō Hapūtanga. https://www.healthed.govt.nz/system/files/resource-files/HE1420_Your%20Pregnancy_1.pdf
National screening unit. 2013. Screening for Downs syndrome and other conditions. https://www.healthed.govt.nz/system/files/resource-files/HE2382-DS%20Screening%20WEB.pdf
Aims of Antenatal Care
Antenatal care had its origins in the early 20th century and the original focus was to discuss critical problems such as bleeding, eclampsia, and fetal abnormalities that might obstruct labour. The focus was mainly on maternal wellbeing. As medical knowledge and technology has evolved, we are now able to care for both the mother and the unborn baby. The challenge of antenatal care is to identify those women who are at higher risk of complications in pregnancy and to provide specialist care for them, but to also ensure that women with uncomplicated pregnancies continue without unnecessary intervention. Early engagement with antenatal care is a key performance indicator in all DHBs to engage as many women as possible in antenatal care in the first trimester.
Broadly, the aims of antenatal care are:
- Antenatal education, including on normal pregnancy and birth
- Health promotion specific to pregnancy, e.g. healthy eating, exercise, breastfeeding
- Disease prevention, e.g. folic acid supplementation, vaccinations
- Screening for maternal and fetal complications in pregnancy, e.g. abnormal fetal growth, preeclampsia
We will be looking at some these issues as the web course develops and also in your case presentations. Some complications in pregnancy may not be entirely preventable (e.g. preeclampsia), but with optimal antenatal care we hope to prevent or modify the adverse effects of complications. We will discuss this further in module 2.
