Introduction
Introduction to the Antenatal Care Module ................................................................. 2
1
Introduction to the Antenatal Care
Module
According to WHO estimates, more than 1,500 women die from pregnancy or
childbirth-related complications every day. Annually, about half a million maternal
deaths occur worldwide, and most of these deaths are in developing countries.
Globally, there is not much improvement in the maternal mortality ratio (MMR, the
proportion of women dying due to complications of pregnancy or childbirth),
primarily because of the high maternal deaths in less developed countries. The
maternal mortality ratio is less than 10 per 100,000 live births in Western countries
and above 1,000 per 100,000 live births in very poor countries. As the Ethiopian
Demographic and Health Survey reports showed, the maternal mortality ratio was
871 per 100,000 live births in 2000 and 673 per 100,000 live births in 2005
(European calendar). In short, a woman’s lifetime risk of maternal death is 1 in
7,300 in developed countries, versus 1 in 75 in less developed countries.
The most common causes (about 80%) of maternal mortality in developing
countries (unsafe abortion, haemorrhage, eclampsia, infection and obstructed
labour – described in detail either in this Module, or in the next one) are either
avoidable or treatable. With that understanding, improving maternal health is one
of the eight Millennium Development Goals (MDGs) adopted by the international
community at the United Nations Millennium Summit in 2000. The Ethiopian
government has expressed its commitment to deliver the MDGs, including
improving maternal health and reducing maternal mortality by three-quarters
(MDG5), and reducing mortality of children aged under 5 years by two-thirds
(MDG4).
To make a difference to maternal and newborn health in developing countries, or
anywhere else, health promotion, disease prevention and effective healthcare have
to begin even before the occurrence of pregnancy. This helps to evaluate the
physiological maturity and psychological readiness of the mother, and also her
medical fitness to conceive and carry the pregnancy. As a continuum of
preconception care, effective antenatal care is a very crucial aspect of the health
service. It can detect established medical problems and reduce the occurrence of
some pregnancy-related complications; it gives the opportunity for pregnant
women and their families to become familiar with the health facility environment
and accept home visits by health professionals, such as the Health Extension
Practitioners of Ethiopia; it alerts pregnant women to possible danger signs, so that
they are aware of pregnancy and delivery-related problems that may arise later, and
thus can make practical and financial preparations for possible emergencies ahead
of time.
The goal of antenatal care is to have a healthy mother and healthy baby by
monitoring the well-being of both the woman and the fetus during pregnancy, and
helping them make a smooth transition to labour and delivery. To achieve this goal,
your role of providing optimal antenatal care at the Health Post or in the home is
immense. Therefore, understanding the concepts and competencies of antenatal
care as recommended in this Module, and taught in your practical skills training
2
programme, is crucial for the better health and survival of the pregnant women and
newborns in your catchment area, and for the general wellbeing of Ethiopian
mothers and their children.
This Module is formulated to equip you with the basic principles and practice of
antenatal care at Health Post and home level. It has 22 Study Sessions divided into
two parts. In Part 1, you will learn about antenatal care planning and promotion, the
anatomy and physiology of the female reproductive system, physiologic changes
during pregnancy, routine assessment of the pregnant woman and fetus, and
methods of evaluating and identifying the progress of a normal pregnancy and
some common maternal and fetal problems. In Part 2, you will learn what focused
antenatal care is, and about counselling pregnant women on staying healthy, eating
well at low cost, the danger signs to watch for, pregnancy from the perspective of
HIV and prevention of mother-to-child transmission, premature labour,
hypertensive disorders of pregnancy, abortion, and latepregnancy bleeding, and
other common medical problems in pregnancy. Part 2 ends with the theory of two
major practical procedures: setting up pre-referral intravenous therapy for women
in shock, and inserting a catheter to drain the bladder of a pregnant woman.
3