Antenatal Care for an uncomplicated pregnancy is an area,which every practitioner needs to familiarize a pregnant mother with; as it is related to care and treatment during pregnancy.It is a doctor’s duty to ensure that a mother to be, is fully involved in decisions about her care and treatment during pregnancy, in order to make informed decisions. It is also the attending doctor’s duty to ensure a free flow of communication between him/her as the healthcare provider, and the mother to be; this would keep both mother and child in good health. One way of doing this would be, by providing the mother evidence based information and support; in order to be able to make the right choices.
In the month of April 2016, the ‘National Institute for Health Care and Excellence’ came out with updated recommendations on Antenatal Care. The guidelines are an update on the NICE 2008 published work of recommendations.
The major recommendations on Antenatal information given by this guideline are as follows:
Antenatal information to be given to pregnant women at the first contact with a healthcare professional:
- folic acid supplementation
- food hygiene, including how to reduce the risk of a food‑acquired infection
- lifestyle advice, including smoking cessation, and the implications of recreational drug use and alcohol consumption in pregnancy
- all antenatal screening, including screening for haemoglobinopathies, the anomaly scan and screening for Down’s syndrome, as well as risks and benefits of the screening tests.
- At booking (ideally by 10 weeks):
- how the baby develops during pregnancy
- nutrition and diet, including vitamin D supplementation for women at risk of vitamin D deficiency, and details of the Healthy Start programme
- exercise, including pelvic floor exercises
- place of birth (refer to intrapartum care NICE guideline CG55)
- pregnancy care pathway
- breastfeeding, including workshops
- participant‑led antenatal classes
- further discussion of all antenatal screening
- discussion of mental health issues (refer to antenatal and postnatal mental health NICE guideline CG45)
- Before or at 36 weeks:
- breastfeeding information, including technique and good management practices that would help a woman succeed, such as detailed in the UNICEF Baby Friendly Initiative.
- preparation for labour and birth, including information about coping with pain in labour and the birth plan
- recognition of active labour
- care of the new baby
- vitamin K prophylaxis
- newborn screening tests
- postnatal self‑care
- awareness of ‘baby blues’ and postnatal depression.
- At 38 weeks:
- options for management of prolonged pregnancy.This can be supported by information such as ‘The pregnancy book’ (Department of Health 2007) and the use of other relevant resources such as UK National Screening Committee publications and the Midwives Information and Resource Service (MIDIRS) information leaflets. Information should be given in a form that is easy to understand and accessible to pregnant women with additional needs, such as physical, sensory or learning disabilities.
- Information can also be given in other forms such as audiovisual or touch‑screen technology; this should be supported by written information.
- Pregnant women should be offered information based on the current available evidence together with support to enable them to make informed decisions about their care. This information should include where they will be seen and who will undertake their care.
- At each antenatal appointment, healthcare professionals should offer consistent information and clear explanations, and should provide pregnant women with an opportunity to discuss issues and ask questions.
- Pregnant women should be offered opportunities to attend participant‑led antenatal classes, including breastfeeding workshops.
- Women’s decisions should be respected, even when this is contrary to the views of the healthcare professional.
- Pregnant women should be informed about the purpose of any test before it is performed. The healthcare professional should ensure the woman has understood this information and has sufficient time to make an informed decision. The right of a woman to accept or decline a test should be made clear.
- Information about antenatal screening should be provided in a setting where discussion can take place; this may be in a group setting or on a one‑to‑one basis. This should be done before the booking appointment.
- Information about antenatal screening should include balanced and accurate information about the condition being screened for.
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