Planning a baby or a pleasant surprise. Either way, there is an anticipatory thrill when a pregnancy is confirmed. Care of the baby and mother starts with optimizing preconception care and continues many years of bringing up and parenting a happy, healthy, well-adjusted child.
Antenatal care is an umbrella term for the care of pregnant women until the child is born and is aimed at detecting any existing problems that can develop, which could affect the mother or her unborn baby.
The importance of good antenatal care in pregnancy cannot be overemphasized. It links the mother and her family with a formal health system, increases the chance of a skilled attendant at birth and contributes to good health throughout the life of a woman. Inadequate care during this time breaks a critical link in this care and affects both the woman and her babies.
Various routinely advised screening tests, diagnostic procedures and prophylactic treatments are offered and special tests and procedures are advised for any mother identified to be at risk.
Care for the mother and the baby should begin as soon as pregnancy is planned or confirmed. Cost constraints are often a factor in this but the cost-benefit of early care is not to be doubted.
Your doctor will advise you on many aspects of your pregnancy and childbirth and will be your friend and guide throughout. It is recommended that you choose your Obstetrician while planning a baby.
During the first trimester – 12 weeks or months 1, 2, 3
- Folic acid supplements are recommended even before conception, as they reduce the risk of neural tube defects in the fetus during the first 12 weeks.
- Dietary advice- A well-balanced diet provides the baby with all the necessary nutrients for growth and development. The mother’s health too is important. Weight monitoring of the baby and mother will be a crucial aspect of your care.
- Alcohol, gutkha and smoking tobacco or cannabis derivatives during pregnancy increase the risk of premature delivery and birth defects.
- Certain medications can be extremely harmful to the unborn baby, especially in the early phase when organs are forming. Check the label insert for warnings on all medication and only take any prescribed by your doctor.
- An ultrasound scan is done to observe the development in the fetus and to determine the expected date of delivery. Multiple pregnancies can be identified during the scan.
- Blood tests are done to determine the haemoglobin, blood cell count, blood typing, thyroid screening, infections, diabetes and screening for Rh antibodies.
- First Trimester Screening- this is a combination of ultrasound markers (nuchal translucency, nasal bone, tricuspid regurgitation) along with blood biochemical markers which give a screening report about the risk of chromosomal anomalies and other growth abnormalities further into the pregnancy. This test also gives the risk of the development of hypertensive disorders like pre-eclampsia and placentation disorders.
During the second trimester 13-28 weeks or months 4,5,6
- Until the end of the second trimester, antenatal check-ups will be scheduled every 4 weeks.
- Tests that need to be done during this time include:
- Urine test– Urine sampling to check for blood sugar and protein.
- Blood test– To rule out the possibility of infections, blood cell count and gestational diabetes.
- Ultrasound– Detailed anomaly/ malformation scan is done at 18-20 weeks to look for the structural development of the various organ systems like the central nervous system, the skeletal system (spine, long bones), the heart and lungs, the gastrointestinal system and the genitourinary system. Also, the blood flow from the maternal system to the uterus is analysed to determine the further risk of growth restriction and other placentation disorders. A repeat anomaly scan is also offered again at 22- 24 weeks to look for any other evolving anomalies especially of the heart or kidneys or any other organ systems. An interval growth Doppler scan is offered at 26- 28 weeks to look for the interval growth and also the blood supply to the fetus.
- Measurements– The size and shape of the uterus are measured clinically.
- Blood pressure and weight– The blood pressure and weight is checked at each antenatal visit.
- Supplements– Iron and calcium supplements are started from the early second trimester
During the third trimester 29-40 weeks 7, 8, 9 months
In the third trimester, visits with the obstetrician are scheduled every two weeks and weekly in the last month. This helps identify the position of the fetus as it drops lower down in the uterus in the pelvic cavity in the head-down position, in preparation for the birthing process, towards the end of the trimester.
Without regular antenatal care and follow-up, problems in the placenta, fetal abnormalities and other complications go unnoticed, posing a health threat to both the mother and the unborn child. Even if the mother feels perfectly fine or has gone through healthy pregnancies previously, she still needs regular antenatal care till 6 weeks post-delivery.
Remember, there is no substitute for good antenatal care!