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This is the modern method of caring for women during pregnancy, where the best interests of the woman and her fetus are considered above those of the hospital or clinic staff. Mother friendly care is good care.
Maternal care during pregnancy should be individualised.
With individualised (personalised) care, every effort is made to ensure that the same health worker sees the same patient at each visit. This may be easy to achieve in rural areas with few health workers and smaller numbers of pregnant women. However in peri-urban and urban areas with many health workers and large numbers of patients, good organisation is required to achieve this goal.
Individualised care also means that the specific needs of each woman are considered when her antenatal care is planned. The needs of all pregnant women are not the same. The needs of different individuals often vary.
Individualised care results in better care.
In addition to the medical history routinely taken during antenatal care, attending an antenatal clinic provides a woman with the opportunity to talk about her home, partner, fears and wishes. Assessing the woman’s emotional status is important as it may identify women at increased risk of postnatal depression and anxiety. Emotional or physical abuse, economic problems or drug abuse may also be identified.
Excessive fear and anxiety during a vaginal examination may suggest previous bad experiences. It is important to allow women to speak about any previous births. Taking a brief psychiatric history is important, especially to screen women for features of anxiety or depression. Most women at risk of postpartum depression will have warning symptoms during their pregnancy. Early diagnosis and treatment of depression gives a better outcome. Women on antidepressants must not stop their treatment because they are pregnant.
Women should be encouraged to play a more active roll in the management of their pregnancies.
Women should contact or go to the delivery centre as soon as they recognise danger signs or go into labour.
Evidence based care is the clinical management of a patient where the treatment is decided by the results of carefully done clinical trials. This is far better than care based on prejudices, unconfirmed beliefs and traditions. It is important to question every aspect of patient care. Only in this way can unhelpful practices be rejected and effective care introduced.
Whenever possible, care in pregnancy should be evidence based.
Pregnancy should be an exciting time for women and their partners. The best way of enjoying a pregnancy is to keep physically and emotionally well, and to share the experience with others. To build confidence and understand the changes taking place in her body, women should learn as much as they can about pregnancy.
All mothers should be encouraged to learn about the changes that are taking place in their bodies during pregnancy. Most mothers learn from speaking to their friends and family members. Books, magazines, the radio and TV are also sources of information. One of the best ways of learning about one’s pregnancy is to attend antenatal classes.
There are many advantages of attending antenatal classes, including:
Education is a very important part of good antenatal care.
Women must be encouraged to share their pregnancies with their partner and support one another during this special time. Therefore, it is important that partners also learn about pregnancy, labour and delivery. If they are unable to bring a partner, they should invite a family member or friend who could be with them during labour.
Emotional support from a friend or family member is important in pregnancy.
It is important to keep physically active during pregnancy. Most women are able to continue their routine activities throughout most of pregnancy. Keeping fit through mild to moderate exercise is recommended.
Many women continue to work until the last weeks of pregnancy. The social support and financial income are benefits. Some women feel very tired during the first and last weeks of pregnancy, and a rest during the day may help. Long periods of standing should be avoided in the last trimester.
Many women worry that sexual intercourse will harm their unborn infant. However, full sexual relations can usually be enjoyed by most pregnant women unless there is a risk of preterm labour.
Multiple partners and unsafe sex are particularly dangerous as HIV infection acquired during pregnancy carries a high risk of transmission to the fetus.
Many women find is very helpful to receive written material which gives the information discussed at antenatal clinics. Sometimes it is easier to understand if a message is read. A lot of what is spoken about in a class is forgotten unless reinforced by information sheets or leaflets. Pamphlets should list the danger signs in pregnancy and stress the importance of breastfeeding, and giving kangaroo mother care in low birth weight infants. Information must be presented in a simple, clear way.
As soon as the pregnancy is confirmed. One of the common errors made by both women and health care workers is to delay booking for antenatal care for weeks or months after the pregnancy is confirmed. Early booking helps to establish the correct gestational age, enables problems to be identified as early as possible, and enables women to get the information they need during pregnancy.
Women should book for antenatal care as soon as their pregnancy is confirmed.
Patients that appear healthy and are asymptomatic may already have a dangerous pregnancy complication that will become worse with time, e.g. untreated syphilis or pre-eclampsia. It is important that the first contact with the antenatal clinic is a positive experience. This will help to get the woman to attend regularly.
Sometimes pregnant women are not seen at a clinic because only a fixed number of patients are allowed to book for antenatal care on each day. Even arriving very early for the clinic may not guarantee that they will be seen while an unfriendly reception at an antenatal clinic may result in late booking or infrequent visits.
Yes, all pregnant women must be allowed to bring a person of their choice to the antenatal clinic. This will usually be her husband, partner, family member, friend or older child. A companion can provide important support for women who are anxious about attending an antenatal clinic.
Yes. However, the woman should first be asked whether she would like the person to be present or whether she would rather be alone. The woman should be allowed to be seen alone if she wishes. An opportunity to speak privately to the health care giver is important. Grandmothers can sometimes be very dominating and not allow the pregnant woman to speak for herself.
Otherwise health care workers may only focus on the medical management and not address the other needs of pregnant women. A woman’s emotion state can have an effect on the pregnancy and its outcome.
Many women have fears or experience guilt during pregnancy. The pregnancy may not have been planned and may not be wanted. These problems can only be resolved if they are discussed. Staff should never criticise a mother.
The medical, social and emotional needs of pregnant teenagers often differ from those of older women. Therefore, there are many advantages in providing antenatal care to teenagers at a special clinic which pays more attention to their specific problems.
Both smoking tobacco and drinking alcohol are potentially harmful to the pregnant woman and her fetus. The mother should be encouraged to stop smoking and drinking. Marijuana (dagga) should be avoided although the effect on the fetus is uncertain. Hard drugs, such as ‘tik’, heroin, mandrax and cocaine, should never be used, especially during pregnancy.
Most medicines cross the placenta to the fetus. Therefore, medicine should only be taken during pregnancy if there is a good indication. Medicines known to damage the fetus must be avoided.
It is neither mother nor baby friendly to smoke or drink alcohol during pregnancy.
Towards the end of pregnancy, women should plan for their delivery and the first few days after their infant is born (‘birth preparedness’). They need to know when they should report to the clinic or hospital and where to go. A list of clothes and toiletries is very useful. Some delivery units require each woman to bring her own essentials. It is helpful to give women a list of requirements for labour and delivery. The better the woman plans for her delivery, the more relaxed and confident she will be. A visit to the birthing unit before labour will reduce her fear of what a labour ward looks like. Birth preparedness is especially important in areas where transport and communication are poor, and ambulance services limited. Women must plan how they will travel to the clinic or hospital when they go into labour.
Some women with transport problems may move in the last weeks of their pregnancy to stay with friends or family close to the clinic or hospital.
The most important factor in mother friendly care is the correct attitude of the staff.
Staff often need to be supported themselves in order to be friendly and caring towards their patients. A climate of mother friendly care has to be developed over time. Many outdated attitudes and practices have to be changed. Abusive behavior by staff should never be tolerated.
Staff often need to be taught, encouraged and supported before they can give mother friendly care.
Nurses and doctors should always dress in a professional manner in order for them to be recognised as professional health care workers. Sloppy dress suggests sloppy care. A professional appearance shows self respect as well as respect for colleagues and patients.
All these factors will in turn results in better patient care.
Support and care of the staff are essential for a good service.
Although all the above issues can be dealt with at weekly meetings, it is wise to have a separate educational afternoon at regular intervals (i.e. monthly). As staff and management problems tend to overwhelm educational needs, a separate educational exercise solves this problem.
Enabling staff to take pride and responsibility in their own professional growth, through self-help training programmes like PEP, teaches all team members to work and learn together. The principles of peer tuition (teaching each other) and support are of great importance. Learning and agreeing to common protocols of diagnosis, management and referral build a united vision of maternal care.
Learning together teaches people how to work together.
The spirit at the meeting must be constructive and not threatening. The approach must be to learn from omissions, errors made or incorrect management or diagnosis? Blaming of staff members must never be done in a meeting.
The community should be encouraged to support both pregnant women and the services that care for them.
Family and community support for pregnant women is particularly important for teenage mothers, single mothers, working mothers and mothers with large families. The physical, emotional and time demands of pregnancy are often considerable. Help may be needed with home and work responsibilities.
The community can help make clinics and hospitals mother friendly by helping to create a warm, friendly environment. Clean and attractively painted waiting and examination rooms with colourful curtains and comfortable chairs makes the experience of an antenatal visit more enjoyable. The community can offer time, skills and collect funds. A ‘Friends of the clinic’ group can be formed with community volunteers helping with tasks such as providing tea. The community should take pride in ‘their’ clinic.
A young woman attends an antenatal clinic where she sees a midwife she has not met before. She is not greeted by name but simply asked to lie on the examination couch. Although asked about her health, she is not asked about her other needs. As a result, her anxieties about being thrown out of her home are not discussed. The midwife gives no explanation but says there is no reason to be worried and gives her a date for the next appointment. The woman decides not to come back for her next appointment but to look for another clinic where she is not treated as ‘just another patient’.
No. She is being treated as a number rather than as an individual. She should have been greeted by name and introduced to the midwife. She is not given any details of the examination findings. One would not treat a friend or family member in this uncaring way.
With individualised care, the patient is seen as an individual (not just a number). She is seen by the same doctor or midwife at every visit. Although this is not easy in a busy clinic with staff shortages, it has benefits for both the patient and the health worker.
A relationship of trust and respect develops between the patient and health worker and there is continuity of care. Patients feel they are getting better care and the health worker has more job satisfaction.
The needs of this woman were not addressed as a personal history was not taken. Only taking a medical history may miss important problems, such as social, emotional or financial difficulties.
She could be asked how she feels about her pregnancy and whether she receives support from her family at home.
The woman wants to know whether she and her fetus are in good health. To merely state that there is no reason to be worried in an incorrect and negative approach.
No. She wants a clinic where she is made to feel that the staff are interested in providing her with good care. She needs mother friendly pregnancy care.
She may decide not to have any more antenatal care or only attend another clinic late in her pregnancy. She may also tell her friends about her experience and, as a result, they may not go for antenatal care in their pregnancies.
A primigravid woman and her husband attend an antenatal clinic for the first time. She wants to know more about pregnancy and delivery, and asks where she can get more information. She needs to know about diet, working, exercise and sex during her pregnancy. The midwife is very helpful and refers her to antenatal classes. She is very excited about being pregnant and wants to enjoy her pregnancy and play an active role in her management.
General health education, and in particular education about pregnancy, labour and delivery, is a very important part of good antenatal care. Talks, videos, CDs, books, magazines and pamphlets can all be used for antenatal education. However, antenatal classes are the best way of providing education for pregnant mothers.
Not only do they become more knowledgeable about their pregnancies, but they build their confidence and lose many of their anxieties. She will be able to discuss the important topics of diet, weight, exercise and sex during pregnancy. Meeting and talking to other pregnant women provides an emotional support. This enables women to enjoy their pregnancies. Many of the benefits gained from antenatal classes can still be provided at a routine antenatal clinic.
Yes. He will be able to support her better both during the pregnancy and labour, but also with their newborn infant, if he joins her in the antenatal classes.
By learning how to monitor her own pregnancy. She should be taught the danger symptoms and also how to become aware of fetal movements.
Yes. It is important that women keep fit during pregnancy. Most women can continue to work until the last weeks of pregnancy. However, they often get tired and need to have extra rest during the day.
A teenage girl attends a local clinic to have a pregnancy test as she has missed her period for two months. Her pregnancy is confirmed and she is told to return to book for antenatal care when she reaches 20 weeks of gestation. However, when she returns to book there is a long queue and, after waiting all morning, she is asked to come back the next day. When she is finally seen, the staff are rude. She notices that their uniforms are dirty and they appear uninterested in the care of their patients.
As soon as the pregnancy is confirmed. She should have booked the same day as the positive pregnancy test.
The staff were not able to see all the patients wanting to book. This is a common problem in many clinics, with a shortage of staff, when all new bookings are only done on a single day of the week. Long queues often lead to women booking late or not at all. An urgent plan is needed to clear the backlog of patients as postponing booking does not solve the problem.
Yes. Pregnant teenagers often have social and emotional problems. They are best cared for at a special antenatal clinic for teenagers. The unfriendly way that this patient was managed would be especially stressful for a young woman.
Not really, although health care workers should always treat patient with courtesy and respect. Inadequate staffing rapidly leads to stress, exhaustion and poor staff morale. The poor standard of dress and bad attitude of the staff support the conclusion that there was a poor team spirit.
The staff need help and support. They should be given an opportunity to speak about the problems at the clinic. With good leadership training and encouragement the team spirit can be rebuilt. This will result in better patient care. Group activities such as audit meetings and self-help learning in groups would be very helpful. The staff need to be educated in the principles of mother friendly care.
They should form a ‘Friends of the Clinic’ committee to help raise funds to improve the appearance and facilities of the clinic. Community support, encouragement and pride in the clinic and staff will help to maintain a high standard of care.