• Birth and Emergency Planning

It is the process of planning for safe delivery and anticipating the actions needed in case of emergencies. If a woman is well prepared for normal childbirth and possible complications she is more likely to receive the skilled and timely care she needs, protect her overall health and possibly save her life and that of her baby. The health provider and the pregnant woman should make plan for the following:

1. A Skilled Provider

2. The place for delivery

3. Transportation

4. Items needed for the birth 

5. Money/Fund

6. Support

7. Blood Donor

8. Decision Making

Birth and emergency preparedness is important as the time required to make arrangements which could’ve been made before in emergency situation can easily define the line between survival and death for both mother and child.

Three (3) fatal delays have been identified in relation to obstetric management of complications;

1. Delay in decision making e.g. who, why and where,

2. Delay in reaching the appropriate health facility e.g. distance, transport, funds,

3. Delay in receiving help after reaching the service centre e.g. inability of staff to treat condition, lack of equipment or supply, staff absent, or not motivated.

The first 2 factors relate to family/community while the third factor relate to health facility.

3.2 W.H.O’S 2016 ANC MODEL

The 2016 WHO ANC model aims to provide pregnant women with respectful, individualized, person centered care at every contact and to ensure that each contact delivers effective, integrated clinical practices (interventions and tests), provides relevant and timely information, and offers psychosocial and emotional support by practitioners with good clinical and interpersonal skills working in a well-functioning health system. WHO recommends minimum of eight contacts for A.N.C

• One (1) contact in the first trimester,

• Two (2) contacts in the second trimester, and

• Five (5) contacts in the third trimester

The recommended interventions for the WHO 2016 Model

• Routine antenatal nutrition, 

• Provide counselling about healthy eating, and keeping physically active to stay healthy and prevent excessive weight gain during pregnancy

• Provide daily oral iron and folic acid supplementation with 30 to 6 0 mg of elemental iron and 400 μg (0.4 mg) of folic acid to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.

• In undernourished populations, nutrition education and counselling to increase daily energy and protein intake is recommended to reduce risk of low-birth weight new-born.

• Maternal and fetal assessment

• Classify hyperglycemia first detected at any time during pregnancy as either gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy, according to WHO criteria.

• Ask about tobacco use (past and present) and exposure to second-hand smoke as early as possible in pregnancy and at every ANC visit. 

• Ask about use of alcohol and other substances (past and present) as early as possible in pregnancy and at every ANC visit.

• Provider initiated testing and counselling in ANC settings as a key component of the effort to eliminate mother-to-child transmission of HIV;

• Integrate HIV testing with syphilis, viral, or other key tests, as relevant to setting; and strengthen underlying maternal and child health systems.

• Provide one ultrasound scan before 24 weeks gestation (early ultrasound) to estimate gestational age

• Improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve pregnancy experience.

• Full blood count testing is the recommended method for diagnosing anaemia in pregnancy. 

• Replacing abdominal palpation with symphysis-fundal height (SFH) measurement for the assessment of fetal growth is not recommended to improve perinatal outcomes.

• Preventive measures, 

• Provide a 7 day antibiotic regimen for pregnant women with asymptomatic bacteriuria (ASB) to prevent persistent bacteriuria, preterm birth, and low birth weight.

• Provide tetanus toxoid vaccination for all pregnant women, depending on previous tetanus vaccination exposure, to prevent neonatal mortality from tetanus

• In endemic areas, preventive anthelmintic treatment is recommended for pregnant women after the first trimester as part of worm infection reduction programmes.

• Intermittent preventive treatment with sulfadoxine pyrimethamine (IPTp-SP) for Malaria is recommended for all pregnant women in enemic areas.

• Interventions for management of common physiologic symptoms in pregnancy, 

• Nausea and vomiting:-  Ginger, chamomile, vitamin B6, and/or acupuncture for relief of nausea in early pregnancy

• Heartburn:-  Advice on diet and lifestyle to prevent and relieve heartburn in pregnancy, antacid preparations for women with troublesome symptoms not relieved by lifestyle changes

• Leg cramps;  Magnesium, calcium, or nonpharmacological treatment options for relief of leg cramps in pregnancy

• Low back/pelvic pain:- Regular exercise throughout pregnancy to prevent low back/pelvic pain; different treatment options can be used, such as physiotherapy, support belts, and acupuncture

• Constipation:-  Fibre supplements to relieve constipation in pregnancy if the condition fails to respond to dietary modification

• Varicose veins and oedema:- Nonpharmacological options such as compression stockings, leg elevation, and water immersion for management of varicose veins and oedema in pregnancy