Are you anxious about your first pregnancy clinic?

As soon as you find out that you are pregnant, visit the antenatal clinic. This is irrespective of whether this is your first pregnancy or not. Remember that each pregnancy is unique, and will require unique attention.

Learn New Things And Meet New Friends

Visits to the antenatal clinic are going to be full of fun as you, your doctor and your midwife monitor your baby’s development in the womb to prepare for her arrival. These will be sessions when you discuss with your doctor or midwife, how your pregnancy is progressing. During antenatal visits, you can ask as many questions as you want. You are also going to meet other future mothers; this could be a chance for you to make new friends!

Your Very First Clinic

The World Health Organisation recommends a minimum of four antenatal visits for every pregnancy. Depending on how early you start attending clinic, you may have more than four visits which will benefit you and your child. Expect care from a competent provider at the antenatal clinic. You will be assisted in preparing for birth, and potential complications will be identified and addressed.

Promoting health and preventing disease are important functions of the antenatal clinic. Some of the medication given or procedures performed include the tetanus vaccination, nutritional supplements, advice on controlling tobacco and alcohol use, and preventing and treating malaria. Detecting existing diseases and managing complications is done for HIV, syphilis, tuberculosis and other co-existing medical diseases like hypertension and diabetes.

Your first visit should come before week 16 of pregnancy. This is because some mothers may have conditions like diabetes, which need early monitoring in pregnancy.

During this first visit, you will be required to describe your previous pregnancies and births (if there have been any) stating any problems you may have had. This information is necessary as it helps the doctor or midwife to determine whether you need any extra or special attention. Your expected date of delivery (EDD) is worked out during this visit. Your EDD can be determined from the first day of your last menstrual period (LMP).

It is therefore important that you keep a record of your LMP and have this information when you go for your first ante-natal visit. A series of screening tests will also be done on you. There will be physical examination, laboratory investigations and observations to be made.

Height

Your height will be taken once. This gives indirect information on how adequate your pelvis may be for delivery. Your height will also help to calculate your body mass index to determine whether you are underweight or overweight. Once this has been determined, you will be advised accordingly. Women whose height is below 150 cm may have a small pelvis and must deliver in hospital where they can get maximum attention.

Weight

This will be measured during every visit. Your weight helps to monitor your health throughout the pregnancy. Excessive weight gain in pregnancy may indicate pregnancy-induced hypertension or gestational diabetes. On the other hand if you are not gaining enough weight as required, then your child is also most likely not gaining weight!

Blood pressure

This is taken during every visit. In subsequent visits, the blood pressure value will be compared to that of previous visits. This monitoring helps rule out high or low blood pressure and to manage it if either is diagnosed. The risks of having high blood pressure in pregnancy are high. For example, you may develop eclampsia (see Sept-Oct 2006 issue of Pregnant), a disorder in pregnancy which can lead to the loss of your baby.

Haemoglobin estimation

This blood test, also known as Hb estimation, gives information on the haemoglobin level in blood. The test helps detect anaemia in pregnancy. Hb estimation will be done during the first visit, and repeated between week 28 and week 32.

Blood grouping 

A few millilitres of your blood will be drawn to establish your blood group. In case you require an urgent transfusion, your blood group will have already been determined and that could save your life and that of your baby!

Rhesus factor

Knowing early in pregnancy whether your blood group is positive or negative (Rhesus factor or Rh), is important to help save your baby from complications that can arise from blood incompatibility (haemolytic disease) of the newborn, in case you are rhesus negative and your partner is rhesus positive. Talk to your doctor in detail to understand the Rh factor.

Urine test

You will be required to give a urine sample. This sample will be tested for the presence of sugar, proteins, ketone bodies and bilirubin. This information is necessary to detect problems such as diabetes in pregnancy and pre-eclampsia.

Other investigations will also be done such as VDRL (venereal disease research laboratory) test for syphilis. If this screening test is positive you will be subjected to further confirmatory tests for syphilis. If you have syphilis, you will need to be treated to save your baby from complications or death in the uterus.

HIV test

You will be counselled before and after the HIV test. It is important for you to know your HIV status not only for your own good, but also for the good of your baby. If you are HIV positive, you will be guided on how to prevent transmitting the virus to your unborn child and how to improve your health.

Nutrition

You will be advised on appropriate nutrition during your pregnancy. You may be given folic acid supplements, to ensure that your baby does not get neural tube defects—a structural anomaly of the brain or spinal cord. It is expected that you will have already started boosting your folic acid levels before pregnancy (importance of folic acid was covered in the Sep-Oct 2006 issue of Pregnant). Remember that you also need a lot of energy, calcium (see The risk of Calcium Deficiency on page 16) and vitamin B.

Tetanus vaccine

The protection that you get from a tetanus vaccine will be passed on to your child and he/she will be safe from neonatal tetanus. This is one of the major killers of newborn babies. You will get two tetanus injections four weeks apart. Take the first jab as early as possible in your pregnancy and the second one,four weeks after the first.

You will get an antenatal clinic card which you must carry at every visit. Important information will be charted on this card that will help the doctor and midwife in monitoring your pregnancy. You will also carry this card with you when you go to deliver.

‘O MY GOD! WHY ALL THESE QUESTIONS?

Ajiambo Amolo, 25 years with an 8-month-old child states: I first attended antenatal clinic when l was six months pregnant. I was afraid of what awaited me. I was trembling as we arrived at the hospital, and my sister was the one who inquired about the charges and all the procedures. Then the nurse asked me whether I was married. I looked at my sister and then lied to the nurse. I said I was married. She asked for the name of my husband, my place of work, where I lived, if this was my first pregnancy, and if I had ever had an abortion. I was like, ‘Oh my God! Why all these questions?’

After answering the questions, I was ushered with my card to the doctor and here I got another shocking question:

‘Do you have a history of twins in your family?’

I almost collapsed. ‘Am I carrying twins?’ I asked the doctor. ‘No.’ said the doctor.

And why did you ask me whether we have twins in our family?’ I enquired. He explained to me that this was part of the procedure. ‘Doctors have to ask to find out the possibility of having twins,’ he said. ‘Soon you will have your baby. You may or may not have planned for this pregnancy, but all the same your health and that of your baby have to be taken care of during this period,’ the doctor clarified.
Ajiambo Amolo

END: PG 04/14-15