Prenatal care-check ups during pregnancy.
Many health centers and midwives encourage pregnant women to come for regular prenatal (before birth) check-ups and to talk about their health needs. If you are pregnant and have the chance to go for these check-ups, you will learn many things to help you prevent problems and have a healthier baby.
If you are a midwife, you can provide an important service to mothers to be (and babies to be) by inviting them to come for prenatal check-ups or by going to see them. It is a good idea to see them once a month for the first 6 months of pregnancy then twice a month during month 7 and 8 and once a week during the last month.
HERE ARE SOME IMPORTANT THINGS PRENATAL CARE SHOULD COVER
- Sharing information : Ask the mother about her problems and needs. Find out how many pregnancies she has had, when she had her last baby, and any problems she may have had during pregnancy or childbirth.
Talk with her about ways she can help herself and her baby be healthy including;
- Eating right : Encourage her to eat enough energy foods, and also foods rich in protein, vitamins, iron and calcium.
- Good hygiene.
- The importance of taking few or no medicines.
- The importance of not smoking, not drinking alcoholic drinks.
- Getting enough exercise and rest.
- Tetanus vaccination to prevent tetanus in the newborn (this is given at 6th, 7th and 8th month if it is her first time of pregnancy. If she has been vaccinated against tetanus before, give one booster during the 7th month).
- Nutrition : Does the mother look well nourished? Is she anemic? If so, discuss ways of eating better. If possible, see that she gets iron pills preferably with folic acid and vitamin C. Advise her about how to handle morning sickness and heartburn. Is she gaining weight normally? If possible, weigh her in each visit.
Normally she should gain 8 to 10 kilograms during the nine month of pregnancy. If she stops gaining weight, this is a bad sign. Sudden weight gain in the last months is a danger sign. If you do not have scales, try to judge if she is gaining weight by how she looks or make a simple scale.
- Minor problems : Ask the mother if she has any of the common problems of pregnancy. Explain to her that they are not serious and give her what advice you can.
- Signs of danger and special risk : Check for each of the danger signs. Take the mother’s pulse each visit. This will let you know what is normal for her in case she has problems later (for example shock from toxemia or severe bleeding).
If you have a blood pressure cuff, take her blood pressure and also weigh her. Watch out for signs of toxemia of pregnancy like sudden weight gain, swelling of hands and face, marked increase in blood pressure. And then other signs like severe anemia and any kind of bleeding.
Some midwives may have appear dip sticks or other methods for measuring the protein and sugar in the urine. High protein may be a sign of toxemia. High sugar is a sign of diabetes. If any of the danger sign appear, see that the woman gets medical help as soon as possible. Also check for signs of special risk. If any are present, it is safer if the mother gives birth in a hospital.
- Growth and position of the baby in the womb : Feel the mother’s womb each time she visits or show her how to do it herself. Normally, the womb will be 2 fingers together higher each month. At 4½ months, it is usually at the level of the navel.
Each month, write down how many fingers widths the womb is above or below the navel. If the womb seems too big or grows too fast, it may have more water in it than normal. If so, you may find it more difficult to feel the baby inside.
Too much water in the womb means greater risk of severe bleeding during childbirth and may mean the baby is deformed. Try to feel the baby’s position in the womb. If it appears to be lying sideways, the mother should go to a doctor before labor begins because an operation may be needed.
- Baby’s heartbeat (fetal heartbeat) : After 5 months, listen for the baby’s heartbeat and check for movement. You can try putting your ears against the belly but it may be hard to hear. It will be easier if you get a fetoscope. If the baby’s heartbeat is heard loudest below the navel in the last month, the baby is head down and will probably be born head first.
But if the heartbeat is heard loudest above the navel, it means the baby’s head is probably up. It may be breech birth. A baby’s heart beats about twice as fast as an adult’s. If you have a watch with a second hand, count the baby’s heartbeats.
From 120 to 160 per minute is heard normal. If less than 120, something is wrong. Or perhaps you counted wrong or head the mother’s heartbeat. Check her pulse. The baby’s heartbeat is often hard to hear. It takes practice.
- Preparing the mother for labor : As the birth approaches, see the mother more often. If she has other children, ask her how long her labor lasted and if she had any problems. Talk with her about ways to make the birth easier and less painful.
You may want to have her practice deep, slow breathing, so that she can do this during the contractions of labor. Explain to her that relaxing during contractions and resting between them will save her strength, reduce pain and speed labor.
If there is any reason to suspect the labor may result in problems you cannot handle, send the mother a health center or hospital to have her baby. Be sure that she is near the hospital by the time of labor.
HOW A MOTHER CAN TELL THE DATE WHEN SHE IS LIKELY TO GIVE BIRTH
Start with the date the last menstrual period began, subtract 3 months, and add 7 days.
For example, suppose your last period began May 10.
May 10 minus 3 months is February 10,
Plus 7 days is February 17.
The baby is likely to be born around February 17.