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Antenatal Care In Pregnancy

Is antenatal care really a necessary part of your birth journey?

In my own private practice I chose to see my clients on a long standing routine of monthly until 28 weeks, fortnightly until 37 weeks and then weekly until birth. This may vary on a person to person basis and I don’t simply do it for the standard reasons of checking wellbeing. In fact it forms a very minor part of my visit and sometime none of it.

The majority of the visit is to establish a good rapour, gain mutual trust and to talk through fears and expectations surrounding birth. I also have lots of resourses such as books, DVD’s, pictures, doll and pelvis to help the learning process. So by the time of birth the woman is totally aware of her body and is ready to take on the joy and responsibility of birthing her baby.

The initial appointment is to get a total grasp of the clients health and wellbeing. I also take time to go through all the available tests so each family can make an informed choice of what they require and potential outcomes so they are well informed about what is available whether they chose it or not.

This was a study done on routine antenatal care.

Is routine antenatal care worth while?

Hall MH, Chng PK, MacGillivray I.

An analysis of the rate at which asymptomatic problems are diagnosed, missed, and overdiagnosed in a total population of pregnant women attending specialists and general practitioners for antenatal care indicated that detection of some problems is incomplete and that overdiagnosis is common. The productivity of routine antenatal care in respect of prediction and detection of obstetric problems is extremely low, and it is suggested that the number of visits for this purpose could be considerably reduced for women without special problems.

Palpation of the baby certainly isn’t essential but can assist the midwife discover the lay and growth of the baby. Most women are well connected with their baby, but it makes a good opportunity for partners and siblings to become more aware of the magic of life growing inside her.

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Listening to the baby can also be part of this. Some women don’t want doppler but are more than happy for the baby to be heard through a pinard or fetoscope. If baby movements are strong this is another of the procedures that isn’t strictly necessary. Women often want to hear their baby and for those who do it’s a great option.

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This came from the BMJ on blood pressure during pregnancy:

Hypertensive disorders in pregnancy, and particularly pre-eclampsia, remain major causes of maternal and perinatal mortality,accounting for 15% of maternal deaths and 4% of perinatal deaths. Therefore, a key aim of modern antenatal care is the timely detection and management of pre-eclampsia. A traditional belief is that this is best achieved by regular, and increasingly frequent, antenatal visits, allowing for both blood pressure measurement and dipstick urinalysis to detect new-onset proteinuria. This strategy underpins the schedule of antenatal care. However, it has been apparent for some time that the frequency of visits could be safely reduced without adversely affecting outcomes.

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abdominal girth on a woman with twins

These are the RCOG guidelines on antenatal care. It is a huge document which covers every aspect of expected care. Simply put, the midwife learns all about you and your baby. She can help you with everything from the minor ailments of your pregnancy to your diet. She isn’t responsible for this you are, but she can facilitate your knowledge and growth. Care is organic and individual. It can’t be summed up in a document.

So,can you manage without it? Of course you can. Any care that you receive should be because you are fully infomed and have decided that it’s best for you and your baby. The majority of women will birth a healthy, beautiful baby. Women who birth unassisted have excellent outcomes. However the best outcomes world wide appear to be with a known birth attendent.

5 responses to “Antenatal Care In Pregnancy”

  1. Sarah Stewart

    Collecting names and stories of inspiring midwives for International Day of the Midwife

    Who is the midwife who inspires you?

    As a response to a post I wrote about the midwives who have inspired me over the years, I am collecting names and stories that will be published in the journal of the International Confederation of Midwives to celebrate International Midwives Day.

    So please feel free to leave me the name of the midwife who inspires you and why, either on my blog or by email: sarahstewart(at)gmail.com

  2. Anonymous

    Hello Lisa,

    Thnaks for your blog :)

    About this last sentence though:
    “However the best outcomes world wide appear to be with a known birth attendent.”

    I’m not so sure we can either prove this or even begin to compare Third World countries unassisted births with well nourrish, educated women who choose to give birth autonomously in a safe environement.

    There’s no study that I know of that analyse the outcomes of UC in women who choose this path…

    I give birth unassisted. For the last one I had a complete unassisted preg.

    This time around though, I needed to see someone that could do official paperwork for me because of the kind of work I am doing. So I went to see a registred midwife (lay midwives can’t do official paperwork) and I realised I put her in a strange situation since I don’t want this ‘relationship’ with her, I don’t even want her to touch my belly. I just want this paper…

    I guess us UCers are in some kind of a dilemna… I sometimes wish their would be this community of respect between the medical world, midewifery and us so we can work together when needed.

    Desa

  3. Lisa Barrett

    What a shame that the midwife felt that much possession over birth. I have helped UC’s obtain paperwork. I don’t know where you are but there are ways around it here.

    I wouldn’t want to defend what I feel is partly WHO and partly my own opinion on care providers. I think that as long as you own your birth, whatever way you think you should go is probably right for you.

    I have lots of angst with midwives who critisise UC while proclaiming the virtues of informed choice. This makes them just another form of the system.

    Thanks for reading the blog. I don’t think I made midwives sound essential to the plot but a great addition.

  4. midwife of the plains

    Thank you for this post Lisa. I also have a post on antenatal care:
    http://plainmidwife.blogspot.com/2008/04/prenatal-nurturance.html
    I have had to unlearn a few things I was taught in my apprenticeship in order to find a less controlling, more freeing way of practicing. I am continually amazed at the beauty of women birthing. I’ve not been attending for 20 years, but I have been attending homebirth for 10 1/2 years. And I continue to be in awe.
    The organic process of pregnancy and birth does not go hand in hand with one size fits all prenatal “care”.
    Thanks again for your wisdom.
    Love
    Brenda

  5. DeT

    @Anonymous: “I’m not so sure we can either prove this or even begin to compare Third World countries unassisted births with well nourrish, educated women who choose to give birth autonomously in a safe environement.”

    I’m planning a UC in a Third World country, I’m well nourished and trying to become as informed and as educated as I possibly can in the time frame I have. I have chosen to UC because I do not trust the midwives here. I do not want a person showing up in my home who is carrying an aid provided pack with forceps and epsiotomoy scissors and the mentality that American Obstetrics is the God of birth, which is what the home birth midwives here have been schooled to believe. I’d prefer to just go to the hospital because they have so many women and few staff, the chances of them being able to do damage are minimal. However, I will stay at home, the hospital is near-by and I can easily transfer if I feel that they can actually help me or my baby.