antenatal care visits in

TYLER S. ROGERS, MD, MBA, FAAFP, AND BRENDAN LUSHBOUGH, DO, Martin Army Community Hospital, Fort Benning, Georgia

Am Fam Physician. 2023;107(2):187-190

Author disclosure: No relevant financial relationships.

Key Clinical Issue

What are the risks and benefits of less frequent antenatal in-person visits vs. traditional visit schedules and televisits replacing some in-person antenatal appointments?

Evidence-Based Answer

Compared with traditional schedules of antenatal appointments, reducing the number of appointments showed no difference in gestational age at birth (mean difference = 0 days), likelihood of being small for gestational age (odds ratio [OR] = 1.08; 95% CI, 0.70 to 1.66), likelihood of a low Apgar score (mean difference = 0 at one and five minutes), likelihood of neonatal intensive care unit (NICU) admission (OR = 1.05; 95% CI, 0.74 to 1.50), maternal anxiety, likelihood of preterm birth (nonsignificant OR), and likelihood of low birth weight (OR = 1.02; 95% CI, 0.82 to 1.25). (Strength of Recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.) Studies comparing hybrid visits (i.e., televisits and in-person) with in-person visits only did not find differences in rates of preterm births (OR = 0.93; 95% CI, 0.84 to 1.03; P = .18) or rates of NICU admissions (OR = 1.02; 95% CI, 0.82 to 1.28). (SOR: B, inconsistent or limited-quality patient-oriented evidence.) There was insufficient evidence to assess other outcomes. 1

Practice Pointers

Antenatal care is a cornerstone of obstetric practice in the United States, and millions of patients receive counseling, screening, and medical care in these visits. 2 , 3 There is clear evidence supporting the benefits of antenatal care; however, the number of appointments needed and setting of visits is less understood.

The American College of Obstetricians and Gynecologists recommends antenatal visits every four weeks until 28 weeks' gestation, every two weeks until 36 weeks' gestation, and weekly thereafter, which typically involves 10 to 12 visits. 4

Expert consensus and past meta-analyses have favored fewer antenatal care visits given similar maternal and neonatal outcomes. In 1989, the U.S. Public Health Service suggested a reduction in the antenatal visit schedule based on a multidisciplinary panel and expert opinion in conjunction with a literature review; however, the American College of Obstetricians and Gynecologists has not updated its guidelines, and practices have not changed. 5 A 2010 Cochrane review found no differences in perinatal mortality between patients randomized to higher vs. reduced antenatal care groups in high-income countries, and a 2015 Cochrane review showed no difference in neonatal outcomes for women in high-income countries. 6 , 7

The Agency for Healthcare Research and Quality (AHRQ) review showed moderate- and low-strength evidence and did not find significant differences between traditional and abbreviated schedules when looking at many outcomes, such as gestational age at birth, low birth weight, Apgar scores, NICU admission, preterm birth, and maternal anxiety. The review was limited by a small evidence base with studies that are difficult to compare. The randomized controlled trials that were eligible were adjusted for confounding, whereas the nonrandomized controlled studies were not adjusted and were at high risk for confounding.

Telemedicine, defined as the use of electronic information and telecommunication to support health care among patients, clinicians, and administrators, is a new option for antenatal care delivery. 8 Televisits, the real-time communication between patients and clinicians via phone or the internet, are the specific interactions that encompass telemedicine. Recent literature suggests that supplementing in-person visits with televisits in low-risk pregnancies resulted in similar clinical outcomes and higher patient satisfaction scores. 9 The AHRQ review found no significant differences between rates of preterm births or NICU admissions for a hybrid model of televisits and in-person visits compared with in-person visits only. The review was limited due to the lack of adjustments for potential confounders in the study. For example, some of the studies were conducted during the COVID-19 pandemic, which adds multiple confounders and potential for bias.

The AHRQ review offers limited opportunity for conclusions to suggest changes in current practice. The current evidence supports past evidence, suggesting that fewer visits are not associated with neonatal or maternal harm, and televisits may have a role in antenatal care. Many of the other outcomes of interest had insufficient evidence to generate conclusions.

Editor's Note: American Family Physician SOR ratings are different from the AHRQ Strength of Evidence ratings.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army, the U.S. Department of Defense, or the U.S. government.

For the full review, go to https://effectivehealthcare.ahrq.gov/sites/default/files/product/pdf/cer-257-antenatal-care.pdf .

Balk EM, Konnyu KJ, Cao W, et al. Schedule of visits and televisits for routine antenatal care: a systematic review. Comparative effectiveness review no. 257. (Prepared by the Brown Evidence-Based Practice Center under contract no. 75Q80120D00001.) AHRQ publication no. 22-EHC031. Agency for Healthcare Research and Quality; June 2022. Accessed October 1, 2022. https://effectivehealthcare.ahrq.gov/sites/default/files/related_files/cer-257-antenatal-care-evidence-summary.pdf

Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: part I. General prenatal care and counseling issues. Am Fam Physician. 2005;71(7):1307-1316.

Zolotor AJ, Carlough MC. Update on prenatal care. Am Fam Physician. 2014;89(3):199-208.

Kriebs JM. Guidelines for perinatal care, sixth edition: by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. J Midwifery Womens Health. 2010;55(2):e37.

Rosen MG, Merkatz IR, Hill JG. Caring for our future: a report by the expert panel on the content of prenatal care. Obstet Gynecol. 1991;77(5):782-787.

Dowswell T, Carroli G, Duley L, et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2010(10):CD000934.

Dowswell T, Carroli G, Duley L, et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2015(7):CD000934.

Fatehi F, Samadbeik M, Kazemi A. What is digital health? Review of definitions. Stud Health Technol Inform. 2020;275:67-71.

Cantor AG, Jungbauer RM, Totten AM, et al. Telehealth strategies for the delivery of maternal health care: a rapid review. Ann Intern Med. 2022;175(9):1285-1297.

The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based on the review. AHRQ’s summary is accompanied by an interpretation by an AFP author that will help guide clinicians in making treatment decisions.

This series is coordinated by Joanna Drowos, DO, MPH, MBA, contributing editor. A collection of Implementing AHRQ Effective Health Care Reviews published in AFP is available at https://www.aafp.org/afp/ahrq .

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The Impact of Antenatal Care in Maternal and Perinatal Health

Submitted: 20 October 2020 Reviewed: 01 June 2021 Published: 16 July 2021

DOI: 10.5772/intechopen.98668

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Every moment, somewhere in our planet especially in low in come country, women of reproductive age group die from problems linked to gestations. The major reason for this enormous magnitude of complication is failure to use antenatal care services particularly in developing countries. The World Health Organization recommends a minimum of four ANC visits. However, global estimates indicate that only about half of all pregnant women receive this recommended amount of care. Antenatal care is one of the evidence-based interventions to decrease the probability of bad health outcomes for mothers and their newborns. Effectiveness of antenatal care, however, relies on the quality of care provided during each antenatal care visits. Antenatal care is an umbrella term used to describe the medical procedures and care that carried out starting from preconception. lt is a care a woman receives throughout her pregnancy and is important in helping to ensure a healthy pregnancy state and safe childbirth. Therefore, antenatal care is to assure that every wanted pregnancy results in the delivery of a healthy baby without impairing the mother’s health. The aim of this chapter is to examine the impact of antenatal care in decreasing maternal and newborn death from preconception through postnatal period.

impact of ANC
preconception

Author Information

Teketel ermias geltore *.

Midwifery Department, School of Nursing and Midwifery, College of Health Sciences and Medicine, Wachemo University–Durame Campus, Ethiopia

Dereje Laloto Anore

KembataTembaro Zone Health Department, Ethiopia

*Address all correspondence to: [email protected]

1. Introduction

The World Health Organization launched a safe motherhood initiative in 1987, which aimed to reduce the number of complications and deaths related with pregnancy and childbirth [ 1 ]. In the provision of prenatal care, service care providers have often under emphasized women’s health and health interventions aimed at improving reproductive care [ 2 ].

Healthy lifestyles during pregnancy are known to be associated with improved pregnancy outcomes for both mothers and offspring. As such, much attention has been placed on designing effective prenatal care guidance, and considerable research has been done to identify appropriate interventions to improve maternal and child health during the prenatal period [ 3 , 4 ].

Among women who become pregnant, health risks experienced in the preconception period often continue during pregnancy, such as the use of alcohol, tobacco and other substances. Furthermore, the increasing prevalence of obesity and chronic conditions demand attention in the context of preconception care [ 5 ]. If these factors are not managed properly during this period, they may result in preterm delivery, low birth weight, stillbirth, birth defects, abortion and maternal complication [ 6 , 7 , 8 , 9 , 10 , 11 ].

Antenatal care is a comprehensive health supervision of a pregnant woman before delivery or it is planned examination, observation and guidance given to the pregnant women from preconception until postnatal period. The antenatal period presents an important chance for detecting threats to the mother and unborn baby’s health, as well as for counseling on nutrition, danger signs, and family planning options after the birth [ 12 , 13 ].

To reduce maternal and neonatal morbidity and mortality, the World Health Organization recommended that pregnant women should receive ANC services at least 4 times starting from the first trimester of pregnancy [ 14 , 15 , 16 ].

Good ANC for pregnant women has become a vital component in the safe motherhood program whose aim is to improve the outcome of pregnancy for mother and newborn [ 17 , 18 ].

According to the WHO report, 60 million deliveries take place globally each year in which the woman is cared for her by relatives only, or by no one at all. Being a long distance from health services, multiple demands for women’s time, low coverage and poor quality of ANC have been identified as key factors [ 19 , 20 ].

In addition to the risk of dying during pregnancy and childbirth, many more women suffer from short and long-term maternal disabilities and illness. According to WHO for every maternal death, an estimated 30 to 50 women suffer pregnancy related health problems such as vesico vaginal fistulae, infertility, and depression that can be permanently debilitating [ 21 ].

ANC provides possibility to provide pregnant women with information, treat existing social and medical conditions, as well as screen for risk factors. However, it is not enough to receive ANC, because majority of the fatal complications occur during or shortly after delivery. Therefore, availability of skilled obstetric attendance during delivery is mandatory. However, use of these services in most developing countries is inhibited due to various cultural and demographic factors. As the result, disproportions between high income and low-income countries regarding use ANC, labor and delivery as well as postpartum services showed many difference. In developed countries about 97% of the pregnant women receive ANC and 99% use trained personnel during delivery, whereas in developing countries, only 65% and 53% of women use ANC and skilled obstetric care services, respectively [ 22 , 23 ]. The aim of this chapter is to provide information on the importance of antenatal care in decreasing maternal and newborn death from preconception through postnatal period. This chapter identified the risk factors are associated with negative health outcomes for the woman, her fetus.

2. The benefits of ANC in decreasing maternal and neonatal death

According to the studies conducted in different countries, the finding revealed that provision of 0.4 mg of folic acid three months prior to pregnancy, during pregnancy, and six weeks postpartum has been associated with more than 80% reduction in different types of specific congenital anomalies [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. On the other hand, the finding of different studies showed that preconception folic acid administration is associated with increased fetal growth, and decreased risks of low birth weight [ 32 , 33 , 34 ]. Moreover, other study result depicted that the consumption of folic acid prior to conception can decrease the risk of developing anemia [ 35 ].

The provision of ANC services brings with it a positive impact and it can be achieved through screening for pregnancy problems, assessing risk factors, treating problems that may arise during the antenatal period, providing information to the pregnant woman, preparing physically and psychologically for parturition and parenthood [ 36 , 37 , 38 ].

Moreover, it also focuses on educating the pregnant woman on a range of topics, including well-being, birth preparedness, complication readiness, and breastfeeding [ 39 , 40 ]. ANC also provides effective interventions for preventing and treating certain conditions, such as anemia, hypertensive disorders of pregnancy, sexually transmitted diseases including HIV/AIDS external cephalic version to detect a breeched position [ 39 , 41 , 42 ]. The overall aim of ANC is to produce a healthy mother and baby at the end of pregnancy by allocating necessary budgetary resource [ 43 , 44 , 45 ]. The recommended time for patients to receive ANCIS; first visit better before or at 16 weeks, with the next visit at 24 and 28 weeks, third visit at 30–32 weeks and fourth visit better from 36 to 40 weeks. During these visits, the healthcare professional measures uterine height, checks fetal heartbeat, tests urine, and measures the mother’s blood pressure [ 40 ].

ANC indirectly saves the lives of mothers and babies by promoting and establishing good health before childbirth and the early postnatal period — the periods of highest risk. ANC often presents the first contact opportunity for a woman to connect with health services, thus offering an entry point for integrated care, promoting healthy home practices, influencing care seeking behaviors, and linking women with pregnancy complications to a referral system. Women are more likely to give with a skilled attendant if they have had at least one ANC visit [ 46 ].

ANC offers pregnant women chance to access protectiv’e care. In dev’eloping countries where access to emergency obstetric services is limited, ANC presents a viable option for pregnant women to be screened for potential risks during pregnancy or delivery. lt also provides an opportunity for treatment and health education including nutritional advice. On one hand practice of ANC, including the number of visits, to be associated with reduced risk of neonatal mortality, On the other hand, others study findings showed that found adverse or no relations between ANC utilization and birth outcomes and insufficient evidence that ANC interventions reduced neonatal or infant mortality in vulnerable populations [ 47 , 48 , 49 , 50 , 51 ].

ANC is very important in detection of high-risk pregnancies through the analysis of socioeconomic, medical and obstetrical factors. Beside to this, it is used as a platform for additional interventions that have been shown to positively influence the maternal and child health status, such as immunization, nutrition programs, breastfeeding and family planning and birth spacing counseling. Furthermore, ANC programs are used to provide care and information that is not directly related to pregnancy but can reduce the possible maternal risk factors, such as promoting healthy lifestyles, tackle malnutrition or inform about gender-based violence [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ].

Some studies finding showed that ANC from a skilled provider was associated with decreased risk of neonatal mortality by the provision of the most effective ANC interventions included TT injection, and weight and blood pressure measurements [ 71 ].

TT vaccination that provide during ANC, protects the mother and the baby against tetanus, a deadly infection caused by Clostridium tetani bacteria, which enter the body through skin cuts and wounds such as those during delivery or cutting of the umbilical cord [ 72 , 73 ].

In high-income settings, provision of ANC, skillful midwife-led has been associated with positive outcomes, including fewer preterm births, fewer fetal losses at any gestation, and high rates of positive experiences reported by women [ 74 ].

To improve maternal, newborn, and child health, the World Health Organization and other organizations, over the past years, have been encouraging for continuum of care. lt can provide as a key package of programs for MNCH, and can show a corridor to help reduce maternal and neonatal deaths [ 75 , 76 , 77 , 78 ].

Effective and timely maternal health care before conception, as well as during pregnancy and childbirth, could save nearly 3 million newborns in high burden countries. Most neonatal deaths could be prevented by direct interventions. Evidence suggests that two thirds of neonatal deaths could be prevented if all pregnant mothers and newborns had access to cost-effective and direct interventions as well as receiving care from skilled health care providers during pregnancy and childbirth [ 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ].

High quality ANC can also influence women’s health seeking behavior towards choosing skilled care at birth and helping them prepare to be able to access it. A positive experience during both pregnancy and childbirth are vital to person-centered care and the right of every childbearing woman, as highlighted in recent World Health Organization recommendations [ 89 , 90 , 91 , 92 , 93 , 94 ].

3. Risk factors are associated with negative health outcomes for the woman, her fetus

A literature review reported usage of ginger during pregnancy is not a safe. Higher doses of ginger can cause thinning of blood, stomach discomfort and heartburn [ 95 , 96 , 97 , 98 , 99 ].

In developing countries, child marriage is widespread, with almost one-third of girls being married before age 18. A practice that is driven by poverty, social norms, and discrimination against girls, child marriage has emerged as an important social issue in recent years, due in part to increased concerns among reproductive health advocates about the harmful consequences for young women marrying too early. As a result: dropping out of school; health risks that result from early sexual activity and pregnancy, including sexually transmitted diseases and maternal mortality; being prevented from taking advantage of economic opportunities; and if they have children, child malnutrition and mortality. Moreover, at child marriage deprives girls of their basic human rights and puts them at risk for harmful practices including exploitation, intimate partner violence, and abuse [ 100 , 101 , 102 , 103 ].

A study conducted in Italy, and the result exposures of women to chemical agents, pesticides, physical agents, ergonomic factors and stress, it appears that at present the evidence is sufficient to warrant the maximum protection of pregnant women to several well-documented occupational risk factors. These include exposures to anaesthetic gases, antineoplastic drugs, heavy metals, solvents, heavy physical work and irregular work schedules. For other work risks, such as exposure to nonionizing radiation and psychosocial work stress, the evidence is often suggestive but not conclusive [ 104 ].

Substance use during pregnancy can be risky to the woman’s health and that of her children in both the short and long term. Most drugs, including opioids and stimulants, could potentially harm an unborn baby. Use of some substances can increase the risk of miscarriage and can cause migraines, seizures, or high blood pressure in the mother, which may affect her fetus. In addition, the risk of stillbirth is 2 to 3 times greater in women who smoke tobacco or marijuana, take prescription pain relievers, or use illegal drugs during pregnancy [ 105 ]. Smoking tobacco during pregnancy is estimated to have caused 1,015 infant deaths per year from 2005 through 2009 [ 106 ].

Anemia during pregnancy is an important factor for negative health outcome for mother and her new born. The causes of anemia during pregnancy in developing countries are multifactorial; these include micronutrient deficiencies of iron, folate, and vitamins A and B12 and anemia due to parasitic infections such as malaria and hookworm or chronic infections like TB and HIV [ 107 , 108 , 109 , 110 , 111 ].

4. Conclusion

Antenatal care is an important determinant of high maternal mortality rate and one of the basic components of maternal care on which the life of mothers and babies depend. Thus, Antenatal care is a key strategy to improve maternal and infant health.

Early initiation of antenatal care facilitates the timely management and treatment of pregnancy complications to reduce maternal and newborns deaths.

Studies examining the effectiveness of antenatal care on maternal and newborn health outcomes have provided conflicting results.

Good ANC links the woman and her family with the formal health system, increases the chance of using a skilled attendant at birth and contributes to good health through the life cycle. Inadequate care during this time breaks a critical link in the continuum of care, and affects both women and babies.

Indirect causes of maternal morbidity and mortality, such as HIV and malaria infections, contribute to approximately 25% of maternal deaths and near misses, so that by utilization of appropriate ANC services STIs and other diseases can be prevented and managed concurrently through integrated service delivery.

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© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Pregnancy and COVID-19: What are the risks?

Y ou may wonder how coronavirus disease 2019 (COVID-19) could affect your risk of illness, birth plan or time bonding with your baby. You also might have questions about the safety of the COVID-19 vaccines. Here's what you need to know.

COVID-19 risks during pregnancy

Pregnant people seem to catch the virus that causes COVID-19 at about the same rate as people who aren't pregnant. Also, pregnant people usually get better without needing care in the hospital. But pregnancy is a factor that raises the risk of severe COVID-19. That risk stays higher for at least a month after giving birth.

And the risk continues to go up if a pregnant person has other health issues linked to severe COVID-19. Examples of these health issues are obesity, diabetes, high blood pressure or lung disease.

Being very sick with COVID-19 means that a person's lungs don't work as well as they should. Severe or critical COVID-19 is treated in the hospital with oxygen and other medical help to treat damage throughout the body. Severe COVID-19 can lead to death.

Pregnant people with severe COVID-19 also may be more likely to develop other health problems as a result of COVID-19. They include heart damage, blood clots and kidney damage. Moderate to severe symptoms from COVID-19 have also been linked to higher rates of preterm birth, high blood pressure or preeclampsia.

These risks may shift as the virus that causes COVID-19 changes. Risks also may change as disease prevention and treatment evolve. But risks are lowered significantly when a pregnant person gets the COVID-19 vaccine.

Preventing COVID-19 during pregnancy and breastfeeding

The Centers for Disease Control and Prevention recommends getting a 2023-2024 COVID-19 vaccine if:

You are planning or trying to get pregnant.
You are pregnant now.
You are breastfeeding.

Staying up to date on your COVID-19 vaccine helps prevent severe COVID-19 illness. It also may help a newborn avoid getting COVID-19 if you are vaccinated during pregnancy.

People at higher risk of serious illness can talk to a healthcare professional about additional COVID-19 vaccines or other precautions. It also can help to ask about what to do if you get sick so you can quickly start treatment.

While you’re pregnant, it’s important for you and those in your household to:

Test for COVID-19. If you have COVID-19 symptoms, test for the infection. If you are exposed, test five days after you came in contact with the virus. In the United States, the Food and Drug Administration, also known as the FDA, approves or authorizes the tests. On the FDA website, you can find a list of the tests that are validated and their expiration dates. You also can check with your healthcare professional before buying a test if you have any concerns.
Keep some distance. Avoid close contact with anyone who is sick or has symptoms, if possible.
Wash your hands. Wash your hands well and often with soap and water for at least 20 seconds. Or use an alcohol-based hand sanitizer with at least 60% alcohol.
Cover your coughs and sneezes. Cough or sneeze into a tissue or your elbow. Then wash your hands.
Clean and disinfect high-touch surfaces. For example, clean doorknobs, light switches, electronics and counters regularly.

Try to spread out in crowded public areas, especially in places with poor airflow. This is important if you have a higher risk of serious illness.

The CDC recommends that people wear a mask in indoor public spaces if you're in an area with a high number of people with COVID-19 in the hospital. They suggest wearing the most protective mask possible that you'll wear regularly, that fits well and is comfortable.

COVID-19 and prenatal care

Unlike earlier in the pandemic, in-person prenatal visits typically are not disrupted by COVID-19.

If you test positive for COVID-19, your healthcare professional will want to discuss your options with you. That might mean a virtual or in-person appointment to figure out how to best keep track of your health. It may help to know that in most cases, the COVID-19 infection doesn't spread to the unborn baby.

If you test positive for COVID-19 and have symptoms, your healthcare team will monitor you closely. A healthcare professional may ask about your symptoms, review your other medical conditions and determine your risk of serious illness. You may be offered medicine to block the infection from getting worse. Treatment with these medicines may be a pill that you swallow, or a liquid given through a needle into a vein.

You also may be asked to use a device to monitor your oxygen level, called a pulse oximeter.

After the infection, your healthcare professional may plan on extra imaging tests to make sure the unborn baby is growing as expected.

COVID-19 and giving birth

If you test positive for COVID-19 close to when you give birth, you may not need to change your birth plan.

But it's also possible that your healthcare professional will suggest a change in timing or delivery options for your safety. People who also are managing high blood pressure linked to pregnancy or preeclampsia are more likely to be monitored in the hospital if they get COVID-19.

After the baby is born, research suggests it's safe for your baby to stay with you even if you have COVID-19. If you are too ill to care for your baby, your healthcare professional may suggest the baby stay in another hospital area.

To limit your baby's exposure to the virus, wear a well-fitting face mask and have clean hands when caring for your newborn. Stay a reasonable distance from your baby when not feeding, if possible.

Breastfeeding and COVID-19

If you have COVID-19 but feel well enough, there is no need to stop breastfeeding or stay separate from your baby. To avoid spreading the infection, wash your hands before breastfeeding. Also, wear a well-fitting face mask whenever you are in close contact with your baby.

If you're pumping breast milk, wash your hands before touching any pump or bottle parts and follow instructions for pump cleaning. If you need care in the hospital, you may be able to keep pumping.

COVID-19 concerns after giving birth

Staying healthy can be a big concern for new parents. Worry about COVID-19 illness for yourself or your newborn may be an added burden. But it is typical for newborns to get their first illness during their first year of life. In fact, your baby may have mild illness regularly during this first year as the baby comes in contact with the world.

If you find that worry over COVID-19 or other illness is affecting your or your baby's health, talk to your healthcare professional.

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WHO antenatal care recommendations for a positive pregnancy experience: Nutritional interventions update: Multiple micronutrient supplements during pregnancy [Internet]. Geneva: World Health Organization; 2020.

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WHO antenatal care recommendations for a positive pregnancy experience: Nutritional interventions update: Multiple micronutrient supplements during pregnancy [Internet].

Introduction.

The comprehensive antenatal care (ANC) guideline, WHO recommendations on antenatal care for a positive pregnancy experience , was published by the World Health Organization (WHO) in 2016 with the objective of improving the quality of routine health care that all women and adolescent girls receive during pregnancy ( 1 ). The overarching principle – to provide pregnant service users with a positive pregnancy experience – aims to encourage countries to expand their health-care agendas beyond survival, with a view to maximizing health, human rights and the potential of their populations. Recognizing that ANC provides a useful platform for important health-care functions, including health promotion and disease prevention, 14 out of the 49 recommendations in the WHO ANC guideline relate to nutrition in pregnancy ( 1 ).

In April 2019, following pre-established prioritization criteria, the Executive Guideline Steering Group (GSG) prioritized updating of the recommendation on multiple micronutrient supplements (MMS). This resulting recommendation updates and supersedes the previous recommendation on antenatal MMS issued in the 2016 WHO ANC guideline.

Pregnancy and micronutrients

Pregnancy requires a healthy diet that includes an adequate intake of energy, protein, vitamins and minerals to meet increased maternal and fetal needs. However, for many pregnant women, dietary intake of fruit, vegetables, meat and dairy products is often insufficient to meet these needs, and may lead to micronutrient deficiencies. In resource-poor countries in sub-Saharan Africa, south-central Asia and south-east Asia, maternal undernutrition is highly prevalent and is recognized as a key determinant of poor perinatal outcomes ( 5 ). However, understanding of the individual requirements and contributions of all essential vitamins and minerals to optimize maternal and fetal health during the antenatal period is limited ( 6 ).

Maternal iron deficiency is the most common known micronutrient deficiency that causes anaemia. Anaemia is estimated to affect 40% of pregnant women globally, with the highest prevalence in the WHO regions of South-East Asia (49%), Africa (46%) and the Eastern Mediterranean (41%). A lower prevalence is estimated in the WHO regions of the Western Pacific (33%), the Americas (26%) and Europe (27%) ( 7 ). Supplementation with iron during pregnancy is therefore considered essential ( 1 , 6 ). Daily folic acid is also recommended as a routine antenatal supplement to prevent fetal neural tube defects ( 1 ). Iron and folic acid (IFA) are often combined in a single tablet, such as the daily IFA supplement of the United Nations Children’s Fund (UNICEF), which may include 30 mg or 60 mg elemental iron and 0.4 mg folic acid ( 8 , 9 ). They are also included in the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP), an established multiple micronutrient formulation that is widely available and contains 15 micronutrients, including IFA in doses of 30 mg and 0.4 mg, respectively ( 10 ).

For populations with low dietary intake of calcium, antenatal calcium supplementation is also recommended by WHO to prevent pre-eclampsia ( 1 , 11 ). In addition, in certain populations at risk of night blindness, vitamin A supplementation during pregnancy is recommended ( 1 ).

The updated recommendation in the context of the WHO ANC guideline

What are the effects of MMS containing at least 13 to 15 micronutrients (including IFA) compared with IFA supplements?
What are the effects of UNIMMAP compared with IFA supplements?

The GDG also requested additional subgroup analyses according to the dose of iron in the control group because most trials in the review evaluated MMS containing 30 mg of elemental iron, and this was compared with IFA controls that employed either 30 mg or 60 mg of iron. Similarly, as the existing WHO recommendation on IFA supplements recommends a folic acid dose of 0.4 mg, the GDG requested additional analyses restricting trials to those comparing MMS to these IFA doses. The rationale for these additional analyses was that, if countries are to consider transitioning to MMS, they would most likely be switching from one of these two IFA formulations (i.e. 30 mg iron/0.4 mg folic acid or 60 mg iron/0.4 mg folic acid).

In 2016, the resulting evidence suggested that MMS (containing 13 to 15 micronutrients, including IFA) were associated with an average 11% reduction in low birthweight compared with IFA supplements. However, lack of other beneficial effects, the added cost of MMS, equivocal evidence on neonatal mortality related to the dose of iron in IFA supplements, possibility of unknown harms, lack of evidence on cost-effectiveness, and concerns about feasibility led the GDG to decide not to recommend a change from existing IFA supplements strategies at the time ( 1 ).

Since the publication of the WHO ANC guideline, the Cochrane review has been updated to include four additional trials ( 13 ). This framework presents the updated research evidence on antenatal MMS compared with IFA supplements, which supports the updated recommendation on MMS.

Rationale and objectives

As part of the WHO’s normative work on supporting evidence-informed policies and practices and its living guidelines approach ( 14 ), the Department of Sexual and Reproductive Health and Research (SHR), the Department of Maternal, Newborn, Child, Adolescent Health and Ageing (MCA) and the Department of Nutrition and Food Safety (NFS) prioritized the updating of this recommendation on MMS following the advice of the Executive GSG 2017–2019, particularly the identification of new evidence on this intervention.

Target audience

The recommendation in this global guideline is intended to inform the development of relevant national- and local-level health policies and clinical protocols. Therefore, the target audience of this guideline includes national and local public health policy-makers, implementers and managers of national and local maternal and child health programmes, concerned nongovernmental and other organizations, professional societies involved in the planning and management of maternal and child health services, health professionals (including obstetricians, midwives, nurses and general medical practitioners) and academic staff involved in training health professionals.

Scope of the recommendations

This updated recommendation is relevant to all pregnant women and adolescent girls receiving ANC in any health-care facility or community-based setting, and to their unborn fetuses and newborns. The question was prioritized during the ANC guideline development process. In 2019, it was prioritized for updating in the context of WHO’s living guideline commitment ( 14 ). The authors of the Cochrane review on which the 2016 ANC guideline panel’s recommendation was based updated their review to include new studies. The outcomes of interest are therefore the same as those prioritized for the ANC guideline relevant to nutritional interventions (see Box 1 ).

Box 1 ANC nutritional interventions outcomes of interest

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How to find the right balance between telemedicine and in-person care

FILE - A patient sits in the living room of her apartment in the Brooklyn borough of New York during a telemedicine video conference with a physician on Jan. 14, 2019. Patients can now see an array of doctors without leaving their recliner thanks to telemedicine. But that doesn’t mean trips to the office should end. Finding the right balance between virtual and in-person visits can be a key to getting good care. (AP Photo/Mark Lennihan, File)

FILE - A doctor examines a patient at a clinic in Stanford, Calif., on April 9, 2019. Patients can now see an array of doctors without leaving their recliner thanks to telemedicine. But that doesn’t mean trips to the office should end. Finding the right balance between virtual and in-person visits can be a key to getting good care. (AP Photo/Jeff Chiu, file)

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Patients can now see an array of doctors without leaving their recliner thanks to telemedicine. But that doesn’t mean trips to the office should end.

Finding the right balance between virtual and in-person visits can be a key to getting good care.

Here’s what you need to know about which form of care may be right for you and when.

WHAT IS TELEMEDICINE?

This generally refers to diagnosing and treating patients remotely. It’s often done over a secure video connection provided by the doctor’s office. You can use your smartphone, tablet or computer.

But telemedicine also can involve telephone calls or trading secure messages with someone from your doctor’s office to discuss test results or follow-up steps after an appointment.

It can be used to diagnose new health problems and monitor existing, long-term issues like diabetes.

WHAT’S THE BUZZ?

These virtual visits can save time and give patients more doctor choices. That’s especially important for those who live where in-person care options are slim or for patients who can’t take time off work to get to the doctor or lack transportation.

Telemedicine use exploded after COVID-19 hit in 2020. It has cooled since, but it remains more popular than it was before the pandemic, particularly in specialties like dermatology or mental health care.

FILE - A dish with roast turkey breast is photographed in Concord, N.H., on Sept. 28, 2015. (AP Photo/Matthew Mead, File)

Amazon now offers a telemedicine option in every state. And many companies sell subscription-based plans centered on virtual care. For those, patients pay a regular fee for doctor visits and mail-order prescriptions to treat high blood pressure, anxiety or hair loss, among other issues.

WHAT ARE THE KEYS TO A VALUABLE VISIT?

Test your phone or tablet before the visit starts. You will want to make sure both audio and video work properly. You may need time to adjust your device settings.

Make sure you’re in a room or location that offers privacy, especially for therapy sessions. That’s usually not a work cubicle, library or restaurant with public Wi-Fi.

Don’t drive, walk or eat while talking to the doctor. Aside from being unsafe, those habits also can be distracting for both the patient and physician, noted Dr. Jay Lee, a family physician who does both in-person and virtual visits.

WHAT ARE THE LIMITS?

Telemedicine needs a secure, fast internet connection, and some patients or doctors may lack the technology to do a virtual visit.

Sometimes physical exams are necessary.

Someone seeking help for a urinary tract infection — which can be treated by telemedicine — might actually have gallbladder problems. That could require an ultrasound during an in-person visit, noted Lee, a board member with the American Academy of Family Physicians.

There also may be limits to receiving telemedicine from doctors outside your state. Pandemic emergency declarations that made this easier have ended .

That can make follow-up care challenging if a patient travels to see a specialist.

“There aren’t that many pediatric specialists in all of the different conditions that can affect kids,” said Krista Drobac, founder of the Alliance for Connected Care, which advocates for telemedicine use.

WHAT’S THE RIGHT BALANCE?

That can depend on the patient’s comfort with telemedicine and the treatment they need.

In some cases, there is no balance if a patient lacks an in-person option or that visit is tough to schedule.

If possible, Lee recommends an initial visit in person and then telemedicine follow-ups. He says that first visit is important for any doctor or specialist you expect to see again.

Both the physician and patient need to determine whether they “have a vibe, that they can get along and that they can work together,” he said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Time to initiation of antenatal care and its predictors among pregnant women who delivered in Arba Minch town public health facilities, Gamo Zone, southern Ethiopia, 2023: a retrospective follow-up study

Affiliations.

1 School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia. [email protected].
2 School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
3 School of Nursing and Public Health, Public Health Medicine Discipline, University of KwaZulu-Natal, Durban, South Africa.
4 Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.
PMID: 38822390
PMCID: PMC11143563
DOI: 10.1186/s12978-024-01818-w

Background: Early antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities.

Methods: An institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance.

Results: The median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors.

Conclusion: Half of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed.

Keywords: Antenatal care; Public health facilities; Southern Ethiopia; Time to initiation.

Follow-Up Studies
Health Facilities / statistics & numerical data
Patient Acceptance of Health Care / statistics & numerical data
Pregnant Women / psychology
Prenatal Care* / statistics & numerical data
Retrospective Studies
Time Factors
Young Adult

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Open access
Published: 24 May 2024

Impact evaluation of invisible intimate partner violence on maternal healthcare utilization in Pakistan

Xinfang Xu 1 na1 ,
Di Liang 1 na1 ,
Saeed Anwar 2 ,
Yanan Zhao 3 &
Jiayan Huang 1

BMC Pregnancy and Childbirth volume 24 , Article number: 386 ( 2024 ) Cite this article

134 Accesses

Metrics details

Introduction

Existing research has shown that intimate partner violence (IPV) may hinder maternal access to healthcare services, thereby affecting maternal and child health. However, current studies have ignored whether emotional intimate partner violence (EV) could negatively affect maternal healthcare use. This study aims to evaluate the impact of invisible IPV on maternal healthcare utilization in Pakistan.

We analyzed nationally representative data from the Pakistan Demographic and Health Survey database from 2012–2013 and 2017–2018. Exposure to physical intimate partner violence (PV) and EV was the primary predictor. Based on women’s last birth records, outcomes included three binary variables indicating whether women had inadequate antenatal care (ANC) visits, non-institutional delivery, and lack of postnatal health check-ups. A logistic regression model was established on weighted samples.

Exposure to EV during pregnancy was significantly associated with having inadequate ANC visits (aOR = 2.16, 95% CI: 1.06 to 4.38, p = 0.033) and non-institutional delivery (aOR = 2.24, 95% CI: 1.41 to 3.57, p = 0.001). Lifetime exposure to EV was associated with increased risks of inadequate ANC visits (aOR = 1.48, 95% CI: 1.00 to 2.19, p = 0.049). Lifetime exposure to low-scale physical intimate partner violence (LSPV) (adjusted OR (aOR) = 1.73, 95% CI: 1.29 to 2.31, p < 0.001) was associated with increased risks of having no postnatal health check-ups.

Conclusions

Pregnant women who experienced EV and LSPV are at greater risk of missing maternal healthcare, even if the violence occurred before pregnancy. Therefore, in countries with high levels of IPV, early screening for invisible violence needs to be integrated into policy development, and healthcare providers need to be trained to identify EV and LSPV.

Peer Review reports

Intimate partner violence (IPV) refers to behavior within an intimate partner that causes physical, sexual, or psychological harm [ 1 ]. While victims of violence include both men and women, the incidence of IPV is much higher in women than in men [ 2 ]. For a long time, IPV against women has been a serious global public health problem and human rights abuse [ 3 , 4 ]. A 2018 study of women aged 15–49 in 161 countries and territories found that globally, it is estimated that 27% of women aged 15–49 with a partner have experienced physical or sexual violence, or both, during their lifetime [ 5 ]. Intimate partner violence is not only physical violence in the traditional sense, but also includes many invisible violence types such as emotional violence and low-scale physical violence [ 6 ]. Compared with overt physical violence, this two violence are often harder to detect, and thus their impact on the body is often ignored [ 7 ].

Women who experience IPV may suffer acute or non-acute health impairments [ 8 ] and adverse perinatal health outcomes, such as preterm birth and miscarriage [ 9 ]. Some studies suggested that the impact of IPV on maternal and child health is likely to occur through the impact on maternal healthcare utilization [ 10 , 11 , 12 ]. Maternal healthcare providers are also in a unique position to spot and help IPV victims. Therefore, maternal healthcare utilization could be a precursor to potential interventions to prevent the impact of IPV on maternal and child health. Although studies have hinted at the impact of IPV on maternal health use, most of them focused on analyzing the impact of aggregated violence on antenatal care [ 12 , 13 ]. Whether different types of violence have an impact remains open to debate, especially this invisible violence. Moreover, current research has been limited to a few countries in sub-Saharan Africa and South Asia [ 14 , 15 , 16 ]. Studies focusing on the impact of neglected intimate partner violence on the overall process of maternal healthcare utilization (including before, during, and after delivery) are still lacking.

As a South Asian country with a high burden of IPV, Pakistan also has a serious problem with maternal morbidity and mortality. According to a systematic review of IPV, the overall prevalence of physical and emotional violence in Pakistan is 10.0–98.5% and 31.3–83.6%, respectively [ 13 ]. In 2017, Pakistan had a maternal mortality rate of 140 deaths per 100,000 live births. Meanwhile, Pakistan also suffers from low utilization of maternal healthcare and low quality of maternal healthcare. The USAID study found that about half of pregnant women in Sindh still had fewer than four antenatal care visits in 2013, and about 40 percent of women did not receive postnatal care [ 17 ]. Most women also have difficulty finding the right doctor and do not receive any counseling on birth signs, family planning, and danger signs [ 18 ].

Current research in Pakistan has focused on the impact of IPV on adverse maternal pregnancy outcomes [ 19 ] (e.g., abortion, maternal death, etc.), antenatal care [ 20 ], and the location of delivery [ 21 ]. Some studies have also analyzed the impact of women’s attitudes toward IPV on maternal healthcare use [ 22 ]. However, most of these relevant studies of Pakistan in the past remained localized and didn’t use Pakistan’s nationally representative data.

This study aimed to comprehensively analyze the impact of different types of IPV on maternal health use. Specifically, it focuses on whether invisible intimate partner violence defined as emotional intimate partner violence (EV)and low-scale physical intimate partner violence (LSPV) influences the utilization of maternal healthcare services throughout the course of delivery.

Data source and study sample

To maximize the sample size, we chose two waves (2012–2013, 2017–2018) of the data from the Pakistan Demographic and Health Survey (PDHS). Five DHS studies have been conducted in Pakistan since 1990, and these two waves were the third and fourth survey waves, which were also the latest two surveys that include intimate partner violence data.

The PDHS database, with technical assistance from the National Institute of Population Research (NIPS) and the Pakistan Bureau of Statistics (PBS), focuses on the health of adolescents and women [ 23 ]. The survey was conducted using a two-stage stratified random sampling design. The first stage involved selecting sample points (clusters) consisting of enumeration blocks, which is the number of households residing in the enumeration blocks at the time of the census. In the second phase, a sample of households is drawn from a list of households in each selected cluster. Weighted factors have been calculated and added to the data file by PDHS researchers so that the results are representative at the country level (except for Azad Jammu and Kashmir, and Gilgit Baltistan).

In the PDHS 2012–2013 and 2017–2018 database, a total of 8,024 women aged between 15 and 49 participated in the questionnaire survey of the domestic violence module. Due to the lack of weighted data for Azad Jammu and Kashmir, and Gilgit Baltistan in the database, this study removed the data for these areas. Therefore, in this study, 6,886 women from Balochistan, Khyber Pakhtunkhwa (KPK), Punjab, Sindh, Islamabad Capital Territory (I.C.T), and Federally Administered Tribal Areas (F.A.T.A) were selected as the research participants. 6,656 women have completed the questions about physical or emotional violence. Of these women, the study sample was further limited to 3,688 women who had at least one live birth in the past 3/5 years before the start of the survey and 1,127 women who had given birth in the past year. Lifetime exposure and exposure in the past 12 months were divided into three sample groups based on outcome variables; the exact sample size varies from model to model due to the presence of missing values of each outcome variable and control variable. The specific sample size is shown in the flow chart in Fig. 1 .

Flowchart diagram of respondents’ records selection process. Note: ANC = antenatal care

Primary predictors

In this study, IPV was measured by two sets of predictors which varied in their nature and time frame. According to the domestic violence questionnaire, IPV was first classified as physical intimate partner violence (PV) and EV. Regarding PV, it was measured by a categorical variable indicating no physical violence, LSPV, and severe physical intimate partner violence (SPV). EV was measured by a binary variable indicating the presence of emotional violence. Detailed definitions of each type of IPV are shown in Supplementary Table 1. Our study looked at two-time frames for IPV: lifetime exposure and exposure during pregnancy. To measure IPV during pregnancy, we only included women who had given birth in the previous 12 months.

We examined three outcome variables to represent women’s entire process of maternal care utilization before, during, and after their last delivery in the past 3/5 years:

Having inadequate antenatal care (ANC) visits is evaluated based on whether a pregnant woman received healthcare less than eight times from a professional health institution [ 24 ]. The variable was assigned the value of 0 if the number of healthcare is 8 or more. Otherwise, it was assigned with 1 instead.

Non-institutional delivery is defined as the delivery of a pregnant woman, not in a professional delivery facility, where professional delivery facilities include government or private hospitals, clinics, basic health units, rural health centers, and community midwife set up. The results of the survey were converted into a binary output. A value of 0 was assigned if the woman’s last birth before the survey was institutional, and a value of 1 otherwise.

Having no postnatal check-ups for mothers after delivery is defined as the absence of any health examination for mothers after discharging from place of delivery. This variable included two questions in the questionnaire, namely whether women who gave birth in institutions had received a health check after discharge and whether women who gave birth outside institutions had received a health check after delivery. The variable was assigned a value of 0 if the woman received a health check after the last delivery before the survey and a value of 1 otherwise.

Control variables

The selection of control variables was based on previous research on the influencing factors of IPV and maternal healthcare [ 25 , 26 ]. The control variables include the age of the woman, the education level of the woman, the working status of the woman (yes or no), the wealth of the family, the year of the survey, women’s decision-making power over healthcare (yes or no), the current residence of the family and the working status of the spouse (yes or no). The ages of the women were divided into four subgroups: 15–23, 24–32, 33–40, and 41–49. The education level of the surveyed women was categorized into four grades according to their highest degree: no education, primary (1–5 grades), secondary (9–10 grades), and higher (year 11 or above). The year of the survey is divided into 2012–2013 and 2017–2018. According to the classification of the DHS, family wealth is assorted into five levels: the poorest, poorer, middle, richer, and richest. The current residence of the family is classified as urban or rural.

Statistical analysis

In the descriptive analysis, the sociodemographic characteristics of the respondents were presented as unweighted numbers (N) and proportions (%). In addition, the weighted prevalence of IPV in different regions will be presented in the form of a map based on 3303 samples of the PDHS 2017–2018 domestic violence module.

Logistic regression models were applied to examine the relationship between two types of IPV and three outcome variables of maternal healthcare utilization by calculating adjusted odds ratio (aOR) with a 95% confidence interval (95% CI) while controlling for confounding variables.

The logistic regression model for each outcome can be written as:

\({\text{X}}_{\text{ik},\text{PV}}\) and \({\text{X}}_{\text{ik},\text{EV}}\) are the PV and EV values of the \({\text{i}}^{\text{th}}\) woman in \({\text{k}}^{\text{th}}\) group, respectively, and \({\text{Z}}_{\text{ik}}\) is a vector containing all control variables of interest. Suppose there are \({\text{n}}_{\text{k}}\) women in the \({\text{k}}^{\text{th}}\) given group, \(\text{k}=1, 2\) represent group where women ever gave birth in the past past 5 years and group where women gave birth in the past 12 months, respectively. Let \({\text{Y}}_{\text{ijk}}\) be the \({\text{j}}^{\text{th}}\) outcome values of \({\text{i}}^{\text{th}}\) woman in \({\text{k}}^{\text{th}}\) group, \(\text{i}=1, 2, ..., {\text{n}}_{\text{k}},\text{ k}=1, 2\) , and \(\text{j}=1, 2, 3\) are the signals for three outcome variables, corresponding to inadequate ANC visits, non-institutional delivery, and the absence of postnatal health check-ups for mothers after delivery, respectively.

In this study, we focused on aOR, specifically \(\exp({\mathrm\alpha}_{1\mathrm{jk}})\) , and \(\exp({\mathrm\alpha}_{2\mathrm{jk}})\) , which quantify the impact of a one-unit change in PV and EV on the ratio of the \({\text{j}}^{\text{th}}\) outcome, allowing for a more accurate assessment of the relationship between event occurrence and EV and PV. Furthermore, a 95% CI and p -value for each aOR parameter were calculated using the two sided t-test method. In this study, the Stata survey (svy) commands in STATA were employed to adjust for sampling weight and clustering effects, considering a p -value < 0.05 as significant. T statistics were utilized to test the significance of coefficients rather than z statistics due to the application of the svy commands [ 27 ]. STATA 17.0 was used to conduct the data analysis.

Sample characteristics

As shown in Fig. 2 , the non-utilization rate of maternal healthcare among women in Pakistan was found to be high, particularly for antenatal care and postnatal health check-ups. Of the women who had given birth in the past 3/5 years in our study, 86.38% received less than 8 ANC visits, and 40.14% chose non-institutional delivery. For women who had given birth in the past 12 months, 85.18% had less than 8 ANC visits, and 68.54% did not participate in postnatal health check-ups. Overall, for all three indicators, women who gave birth in the past 3/5 years had a higher inadequate utilization rate of maternal healthcare than women who gave birth in the past 12 months.

Absence of maternal healthcare utilization among women in the two sampling groups. Note: ANC = antenatal care. Inadequate ANC visits is defined as a pregnant woman received healthcare less than eight times from a professional health institution. Non-institutional delivery is defined as the delivery of a pregnant woman not in a professional delivery facility, where professional delivery facilities include government or private hospitals, clinics, basic health units, rural health center, and community midwife set up

In our research, approximately 80% of the participants are in mature years, namely 24 to 40 years old, and half lived in rural religions. More than 50% of whom were shown to have no education and over four out of five respondents were not involved in any work at the time of the survey. Significantly, less than half of women had decision-making power over healthcare (Tables 1 and 2 ).

Prevalence of IPV in Pakistan

Figure 3 presents the prevalence of any type of IPV (both PV and EV) in the different administrative divisions of Pakistan in 2012–2013 and 2017–2018. The overall lifetime prevalence of IPV in Pakistan decreased from 38.63% in 2012–2013 to 33.47% in 2017–2018, with a downward trend across all regions (Fig. 3 ). Specific figures on the prevalence of PV and EV in different regions during these two periods are shown in Supplement Fig. 1 and Fig. 2.

Prevalence of any types of intimate partner violence in Pakistan in year 2012–2013 and 2017–2018. Note: F.A.T. A = Federally Administered Tribal Areas, KPK = Khyber Pakhtunkhwa, I.C.T = Islamabad Capital Territory. F.A.T.A data were not included in the PDHS2012-2013 data, so prevalence rates were listed for only five administrative divisions in year 2012–2013

Overall, the distribution of each type of violence follows a similar pattern, where the northwest region of Pakistan has a higher prevalence of IPV against women. This indicates a consistent pattern between 2012–2013 and 2017–2018. In the following description, we use 2017–2018 as an example to precisely describe the prevalence of IPV in different regions of Pakistan. Specifically, F.A.T.A has the highest victim proportions among all the administrative divisions, with 65.59% of women having experienced IPV during their lifetime (Fig. 3 ); among them, 42.25% and 64.51% have ever experienced LSPV, and EV respectively in the year 2017–2018 (supplement Fig. 1).

The prevalence of IPV in the past 12 months was slightly lower than the lifetime prevalence, but it also shows a pattern of higher prevalence in the northwest than in the southeast. Overall, the KPK had the highest prevalence of intimate partner violence in the past 12 months (45.83% in year 2012–2013 and 43.23% in year 2017–2018). The prevalence of IPV in other areas is shown in Fig. 3 .

Impact of IPV on maternal healthcare

Estimates of the logistic analysis of IPV and maternal healthcare utilization among women after adjusting for confounders are presented in Tables 3 and 4 . Results show that pregnant women’s experience of EV and LSPV is a strong predictor of their absence in maternal healthcare before and after delivery.

According to the findings, pregnant women who experienced EV were at greater risk of missing antenatal care and institutional delivery, even if the violence occurred before pregnancy. Exposure to EV during pregnancy significantly impacted adequate ANC visits and institutional delivery. The odds of inadequate ANC visits and non-institutional delivery were 2.16 times (95% CI: 1.06 to 4.38, p = 0.033) and 2.24 times (95% CI: 1.41 to 3.57, p = 0.001), respectively higher for those women who experienced EV than women who had not experienced it (Table 4 ). At the same time, lifetime EV continued to affect ANC. The odds of inadequate ANC visits were 1.48 times higher (95% CI: 1.00 to 2.19, p = 0.049) for women who experienced EV during their lifetime than women who had not experienced it (Table 3 ).

Another variable that affects maternal health use is low-scale PV. However, the impact of lifetime exposure to low-scale PV on maternal healthcare slightly differs from that experienced in the past 12 months. According to the results, lifetime exposure to low-scale PV significantly reduces the likelihood of a mother having a postnatal health check-up. The odds of no postnatal health check-ups were 1.73 times higher (95% CI: 1.29 to 2.31, p < 0.001) for women who experienced low-scale PV during their lifetime than women who had not experienced it (Table 3 ). The odds ratio for women who experienced PV (both low-scale and severe) during pregnancy was statistically not significant, indicating no difference between participation or non-participation in maternal healthcare (Table 4 ).

Discussions

Using data from PDHS 2012–2013 and 2017–2018, we found that Pakistan has a high rate of IPV, with EV and LSPV being the dominant types. Our study found that low-scale PV and EV can hurt maternal health use. Two of the most significant results were that lifetime exposure to LSPV reduced women’s likelihood of using postnatal health check-ups, while exposure to EV within the last 12 months had a strong negative impact on having adequate ANC visits and institutional delivery. According to our findings, invisible IPV could harm all aspects of maternal healthcare, while SPV does not affect access to maternal healthcare. The results are consistent with studies that have found that LSPV and EV may affect antenatal care utilization and institutional delivery negatively [ 28 , 29 ]. However, SPV, which has been shown to significantly decrease the likelihood of adequate ANC visits and institutional delivery in some previous studies [ 21 ], did not show significant results in our study. Our study did not find an effect of SPV on the inadequate utilization of maternal healthcare, which may be due to the relatively small sample sizes of the subgroup in our study with exposure to SPV.

Our research found that EV during pregnancy, while often overlooked, has a significant impact on maternal healthcare utilization and therefore on maternal and infant health. EV is one of the most common types of IPV but is often overlooked because of its insidious nature [ 30 ]. In previous studies, lifelong exposure to EV has been found to correlate with whether an institutional birth was chosen, which is consistent with the results of this study. However, the slight difference is that previous studies have considered less than 4 times as inadequate ANC visits; In this study, according to the latest standards of WHO, less than 8 times were considered as insufficient ANC visits. Our research further focused on EV during pregnancy and found that exposure to EV during pregnancy not only affected the location of delivery but also the amount of antenatal care a woman received. Compared with PV, we found that EV has a significant impact on maternal healthcare utilization, which affects both antenatal and childbirth. Although EV is often accompanied by PV, the impact of EV on pregnant women’s access to antenatal care and institutional delivery remains significant even after we exclude the influence of PV. In contrast, PV only affects the postnatal period. A possible reason is that EV often has a profound impact on women’s self-esteem and mental health, especially pregnant women. This emotional damage can also represent an unsupportive, neglected attitude of a spouse towards pregnant women, making it difficult for women to take the initiative to seek maternal healthcare in Pakistan, where women are generally poorly educated.

The study also found that exposure to LSPV was associated with a decrease in postnatal healthcare. This negative effect may be due to the avoidance of health checks by women who have experienced LSPV [ 31 ]. Controlling behavior from partners may also limit healthcare providers’ access to home [ 32 ]. Some studies outside Pakistan have also found that PV can have a negative effect on postnatal healthcare [ 29 , 31 ]. However, these studies did not break down the severity of PV, so it is difficult to explain whether different levels of PV have different effects. Compared with SPV, LSPV often does not cause visible harm to the body itself but can undermine maternal initiative in accessing health services and ultimately affect postnatal health [ 33 ]. This kind of violence usually occurs at home or in other private places, and because the impact is small, women often choose to lie to cover it up. This is also a possible reason why LSPV can interfere with postnatal check-ups since husbands tend to be reluctant to be found out about their violent behavior.

The above results and discussions suggest the impact of EV and LSPV on maternal healthcare use and provide new ideas for improving maternal healthcare use. Religious beliefs in Pakistan exert significant influence on women’s health-related decisions [ 34 ]. The gender inequality stemming from a patriarchal society, coupled with low education levels, contributes to high rates of IPV [ 35 ] and limits women’s access to maternal healthcare. Similar patterns of IPV exist in other South Asian countries. Therefore, our findings can not only provide a solid policy basis for Pakistan, but also provide valuable insights for other countries in South Asia, especially countries with cultural backgrounds similar to Pakistan.

Governments and other stakeholders need to work to change social barriers to gender inequality and reduce the incidence of IPV. Given that EV during pregnancy often goes undetected, health authorities should attach importance to the psychological abuse of women in their interventions, incorporating women’s self-reports and clinical findings. At the same time, the prevention of IPV should also be included in maternal and child health planning to reduce the impact of IPV on maternal health. There should be more screening for EV during pregnancy, and more attention should be paid to invisible intimate partner violence. For mothers, the number of home visits should be increased to reduce the probability of giving up postnatal health check-ups due to LSPV.

Study strength and limitations

Our study analyzed the impact of IPV on three components of maternal health use in Pakistan, considering both lifetime exposure and exposure during pregnancy. Nationally representative weighted data are used in this study, so the results represent women of childbearing age in Pakistan as a whole. They can provide a reference for other countries in South Asia.

However, our analysis for IPV and maternal healthcare service utilization is based on retrospective cross-sectional survey data, so recall bias is possible. Because the DHS database does not have data on EV during pregnancy, we measured the incidence of intimate partner violence during pregnancy by limiting the approximate time period. This measurement has no exact time limit and is an approximate estimate. At the same time, many women may be reluctant to disclose IPV during the survey process, leading to a lower estimated prevalence of IPV than the actual prevalence.

Pregnant women who experienced EV and LSPV are at greater risk of missing maternal healthcare, even if the violence occurred before pregnancy. Therefore, in countries with high levels of intimate partner violence, early screening for invisible violence needs to be integrated into policy development, and healthcare providers need to be built up to screen for EV and LSPV.

Availability of data and materials

The survey used data from the Pakistan Demographic and Health Survey (PDHS). Data is available at https://www.dhsprogram.com/data/available-datasets.cfm .

Abbreviations

Intimate partner violence

Emotional intimate partner violence

Physical intimate partner violence

Low-scale physical intimate partner violence

Severe physical intimate partner violence

Pakistan Demographic and Health Survey

National Institute of Population Research

Pakistan Bureau of Statistics

Federally Administered Tribal Areas

Antenatal care

World Health Organization. Violence info: intimate partner violence. https://apps.who.int/violence-info/intimate-partner-violence/ . Accessed 2022.

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Acknowledgements

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This article is supported by Pujiang Talent Program (2020PJC015). This research is funded by the Major Project of the National Social Science Fund of China (Grant ID: 20VMG027 & 20&ZD147). This funding source has no role during study design, data analysis, finding interpretation, and manuscript writing.

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Xinfang Xu and Di Liang contribute equally to this work.

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Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, 200032, China

Xinfang Xu, Di Liang & Jiayan Huang

Prime Institute of Public Health, Peshawar Medical College, Peshawar, 25000, Pakistan

Saeed Anwar

Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA

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Xinfang Xu and Di Liang are the first two authors contribute equally to the manuscript. Saeed and Jiayan Huang are responsible for the formulation of the article framework and the modification of the details. Yanan was responsible for writing the statistical analysis method part of the study.

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Xu, X., Liang, D., Anwar, S. et al. Impact evaluation of invisible intimate partner violence on maternal healthcare utilization in Pakistan. BMC Pregnancy Childbirth 24 , 386 (2024). https://doi.org/10.1186/s12884-024-06584-y

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How to find the right balance between telemedicine and in-person care

Patients can now see a growing array of doctors without leaving their living room recliner thanks to telemedicine

Patients can now see an array of doctors without leaving their recliner thanks to telemedicine. But that doesn’t mean trips to the office should end.

Finding the right balance between virtual and in-person visits can be a key to getting good care.

Here’s what you need to know about which form of care may be right for you and when.

WHAT IS TELEMEDICINE?

But telemedicine also can involve telephone calls or trading secure messages with someone from your doctor’s office to discuss test results or follow-up steps after an appointment.

It can be used to diagnose new health problems and monitor existing, long-term issues like diabetes.

WHAT'S THE BUZZ?

WHAT ARE THE KEYS TO A VALUABLE VISIT?

Test your phone or tablet before the visit starts. You will want to make sure both audio and video work properly. You may need time to adjust your device settings.

Make sure you’re in a room or location that offers privacy, especially for therapy sessions. That’s usually not a work cubicle, library or restaurant with public Wi-Fi.

WHAT ARE THE LIMITS?

Telemedicine needs a secure, fast internet connection, and some patients or doctors may lack the technology to do a virtual visit.

Sometimes physical exams are necessary.

There also may be limits to receiving telemedicine from doctors outside your state. Pandemic emergency declarations that made this easier have ended .

That can make follow-up care challenging if a patient travels to see a specialist.

WHAT'S THE RIGHT BALANCE?

That can depend on the patient’s comfort with telemedicine and the treatment they need.

In some cases, there is no balance if a patient lacks an in-person option or that visit is tough to schedule.

If possible, Lee recommends an initial visit in person and then telemedicine follow-ups. He says that first visit is important for any doctor or specialist you expect to see again.

Both the physician and patient need to determine whether they “have a vibe, that they can get along and that they can work together,” he said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Research Reports

Equity and inclusion in pregnancy care: report on the pregnancy outcomes and health care experiences of people with disabilities in Ontario

Funded by the US National Institutes of Health, the Disability and Pregnancy Study was a landmark study that used parallel evidence from health administrative data on nearly 150,000 births to people with disabilities and qualitative interview data from key informants to examine the preconception, pregnancy, labour and birth, and postpartum and newborn health outcomes and health care experiences of people with physical, sensory, developmental and multiple disabilities in Ontario, Canada.

This initiative was led by a multidisciplinary team with expertise in epidemiology, qualitative methods, maternal-fetal medicine, pediatrics, psychology, psychiatry and disability, including lived experience of disability, and was further informed by an Advisory Committee of people with disabilities, service-providers and decision-makers. The Disability and Pregnancy Study gathered evidence supporting the need for a more equitable and inclusive approach to pregnancy care that addresses the needs of disabled people.

To read the report, scroll to the bottom of this page and download the easy read summary, executive summary, or full report.

Webinar: Equity and Inclusion in Pregnancy Care

On June 18th from 3 – 4:30 p.m. , join us for a webinar! The research team will describe the findings of the Disability and Pregnancy Study, which showed avoidable pregnancy-related health disparities and barriers to care for people with disabilities. With an expert panel that includes researchers, people with lived experience of disability, and health and social service providers, the team will discuss next steps in creating an accessible pregnancy care system that considers the needs of people with disabilities.

We hope you will join us! Visit the registration page: Sign up now .

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Equity and inclusion in pregnancy care: executive summary, equity and inclusion in pregnancy care: full report, news releases, 1 in 8 pregnant people have a disability, but significant gaps exist in the provision of accessible care , discover more, association between anaesthesia–surgery team sex diversity and major morbidity.

Hallet J, Sutradhar R, Flexman A, McIsaac DI, Carrier FM, Turgeon AF, McCartney C, Chan WC, Coburn N, Eskander A, Jerath A, Perez d’Empaire P, Lorello G. Br J Surg. 2024; 11(5): znae097. Epub 2024 May 15.

COVID-19 hospitalization, mortality and pre-mature mortality by a history of immigration in Ontario, Canada: a population-based cohort study

Wanigaratne S, Shah B, Stukel TA, Lu H, Den Otter-Moore S, Shetty J, Saunders N, Gandhi S, Guttmann A. Lancet Reg Health Am . 2024; 34:100762. Epub 2024 May 13.

Postpartum emergency department use following midwifery-model vs obstetrics-model care

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Phone Numbers

Routine and emergency care.

Companion Animal Hospital in Ithaca, NY for cats, dogs, exotics, and wildlife

Equine and Nemo Farm Animal Hospitals in Ithaca, NY for horses and farm animals

Cornell Ruffian Equine Specialists, on Long Island for every horse

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Canine Health Information

The normal whelping process.

If your dog is pregnant or you plan to breed, it is best to prepare by becoming familiar with the normal canine birthing (whelping) process. A pregnant dog will experience several physiological changes. These changes include an increased heart rate, respiratory rate, and increases in several hormones to aid in maintaining the pregnancy and preparing the body for giving birth and nursing. Ideally, consulting with your veterinarian early and regularly if your dog is pregnant can help ensure a smooth pregnancy and labor. By understanding the normal process, you can detect when there might be a problem during labor and when to seek help from a veterinarian. If you know your dog is having difficulty giving birth (dystocia) or are unsure if things are progressing normally, seek veterinary care immediately.

How long is pregnancy in dogs?

A dog's pregnancy lasts about two months, or an average of 63 days from ovulation.

Predicting the exact expected day of birth can be difficult because the day of breeding might not be the date the dog becomes pregnant. For this reason, breeding dates are often inaccurate (63 +/-7 days from the date of the first breeding). This disparity can occur because of several reasons. The male dog's sperm can survive many days in the female reproductive tract. Additionally, when the female dog ovulates, the egg must mature for 2-3 days before it can be fertilized. Female dogs may accept mating for several days before and/or several days after ovulation, making for a wide possible window of fertilization.

If your dog’s date of ovulation is known, her due date can be predicted with much more precision. A dog’s heat cycle is usually monitored by measuring a blood hormone called progesterone, which increases before ovulation. Once the progesterone reaches a certain level, ovulation has occurred. The due date is expected to be 63 +/- 1-2 days from this date.

Can my veterinarian help predict when my dog will give birth?

Besides ovulation timing (mentioned above), which is considered the most reliable and preferred method for predicting parturition date, your veterinarian can measure the hormone progesterone with a blood sample at the end of pregnancy. In most dogs, this number will drop suddenly within 24 hours of giving birth. Your veterinarian may also be able to perform ultrasound measurements of the puppies when they are about midway through gestation to estimate your dog’s due date.

What are the expected stages of labor?

The initiation of birth occurs through a complex cascade of events involving the secretion of specific hormones, ultimately leading to a sharp decrease in progesterone levels, which induces labor.

There are three stages of labor:

Uterine contractions and dilation of the cervix
Expulsion of the fetus (puppy)
Expulsion of the placenta

The second and third stages happen simultaneously in dogs.

How will I know when my dog is going into labor?

You may notice behavior changes in your dog, such as extreme nesting behavior (fervently shredding bedding material, frantic nesting, etc.), discomfort and increased panting. These signs usually occur 6-12 hours before parturition and signify the start of stage I labor, but may last up to 24-36 hours.

While it is not always detected, rectal temperature transiently decreases within 24 hours of parturition (< 99ºF). The normal temperature for a dog is between 100-102.5ºF. This decrease in temperature typically lasts around eight hours.

Dogs may also have vaginal discharge before birth that is clear to white. If a clear or white sac is noted protruding from the vulva (external genitalia), whelping should be imminent. If green discharge is noted, it should be followed immediately by a fetus, as this indicates placental separation.

How long should it take between birthing puppies?

It typically takes 0-30 minutes for each puppy to be born. Up to two hours between puppies is considered normal. Contact your veterinarian if more than two hours have passed between the delivery of puppies.

It is common for two fetuses to be delivered, followed by two placentas, because of the tendency for each successive fetus to be delivered from alternate uterine horns. Head-first and tail-first presentations of birthing puppies are normal as long as all legs are extended straight.

What should I do if my dog has not passed the placenta after giving birth?

If you are concerned about a “retained placenta,” your dog has almost certainly consumed it without you noticing. Dogs will rapidly consume the placenta if permitted (possibly before you see its delivery).

It is neither beneficial nor detrimental for a bitch to consume the placenta, but consumption often results in diarrhea.

Is it normal that my dog has vaginal discharge after giving birth?

After giving birth, it is normal for dogs to have some vaginal discharge called lochia, which ranges in color from green to red or brown. Lochia usually persists for about three weeks but may last up to eight weeks. It should progressively darken in color and decrease over time.

Lochia should not have a foul odor. If a foul odor is noted or the amount of lochia increases at any time, seek veterinary care as this could be a sign of infection.

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Antenatal Care
9 months. 36-38 weeks. All pregnant women should have 4 routine antenatal visits. First antenatal contact should be as early in pregnancy as possible. During the last visit, inform the woman to return if she does not deliver within 2 weeks after the expected date of delivery.
Schedule of Visits and Televisits for Routine Antenatal Care
Antenatal care is a cornerstone of obstetric practice in the United States, and millions of patients receive counseling, screening, and medical care in these visits. 2, 3 There is clear evidence ...
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The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine plan a new evidence-based joint consensus statement to address the preferred visit schedule and the use of televisits for routine antenatal care. This systematic review will support the consensus statement. We searched PubMed ®, Cochrane ...
Schedule of Visits and Televisits for Routine Antenatal Care: A
Antenatal care (also termed prenatal care) is one of the most common preventive health services in the United States, accessed by about 4 million women annually.1 Antenatal care aims to improve the health and wellbeing of pregnant patients and their babies through (1) medical screening and treatment; (2) anticipatory guidance; and (3) psychosocial support.2, 3 The World Health Organization's ...
PDF GUIDELINES FOR ANTENATAL CARE
An important element in this continuum of care is effective antenatal care. The goal of the antenatal care package is to prepare for birth and parenthood as well as prevent, detect, alleviate, or manage the three types of health problems during pregnancy that affect mothers and babies: Antenatal care also provides women and their families with ...
PDF ANTENATAL CARE SERVICES
Antenatal care (ANC) is the care of the woman during pregnancy. The primary aim of ANC is to promote and protect the health of women and their unborn babies during ... Another visit around six weeks postpartum is also highly recommended The care providers Postpartum care starts right after the delivery. If the delivery occurs in a health ...
Early antenatal care visit: a systematic analysis of regional and
Progress in the coverage of early antenatal care visits has been achieved but coverage is still far from universal. Substantial inequity exists in coverage both within regions and between income groups. The absence of data in many countries is of concern and efforts should be made to collect and report coverage of early antenatal care visits to enable better monitoring and evaluation.
New guidelines on antenatal care for a positive pregnancy experience
Eight or more contacts for antenatal care can reduce perinatal deaths by up to 8 per 1000 births when compared to 4 visits. A woman's 'contact' with her antenatal care provider should be more than a simple 'visit' but rather the provision of care and support throughout pregnancy. The guideline uses the term 'contact' as it implies ...
Antenatal and Postnatal Care
Antenatal care visits offer an opportunity for risk identification, health education, health promotion, disease prevention, early identification and management of pregnancy-related or concurrent disorders,birth preparedness and complication readiness. Maternal mortality and complications during pregnancy, childbirth, and puerperium are ...
Antenatal care coverage
Antenatal care (ANC) coverage is an indicator of access and use of health care during pregnancy. The antenatal period presents opportunities for reaching pregnant women with interventions that may be vital to their health and wellbeing and that of their infants. ... Unlike antenatal care coverage (at least one visit), the indicator antenatal ...
PDF WHO recommendations on antenatal care
quality care throughout the pregnancy, childbirth and the postnatal period. Within the continuum of reproductive health care, antenatal care (ANC) provides a platform for important health-care functions, including health promotion, screening and diagnosis, and disease prevention. It has been established that by implementing timely
WHO Recommendations on Antenatal Care for a Positive Pregnancy
Background. Approximately 303,000 women and adolescent girls died from pregnancy and childbirth-related complications in 2015.1 That same year, 2.6 million babies were stillborn. Almost all of the maternal deaths (99%) and child deaths (98%) occurred in low- and middle-income countries.
Fact Sheet: Access to Antenatal and Delivery Care
Approximately 12.9 million of pregnant women accessed antenatal care consistently with four or more visits (ANC-4), representing 88% of pregnant women in the Americas. In Latin America and the Caribbean, this represented 86% of pregnant women. Within the continuum of reproductive health care, antenatal care (ANC) provides a platform for ...
The Impact of Antenatal Care in Maternal and Perinatal Health
Effectiveness of antenatal care, however, relies on the quality of care provided during each antenatal care visits. Antenatal care is an umbrella term used to describe the medical procedures and care that carried out starting from preconception. lt is a care a woman receives throughout her pregnancy and is important in helping to ensure a ...
Schedule of Visits and Televisits for Routine Antenatal Care
Reduced visit versus traditional visit schedules for routine antenatal care Studies comparing reduced routine antenatal visit schedules with traditional schedules did not find differences between schedules in gestational age at birth, likelihood of being small for gestational age, likelihood of a low Apgar score, likelihood of neonatal intensive care unit (NICU) admission, maternal anxiety ...
PDF Guidelines for Routine Prenatal Care
Prenatal care visits should occur with the following frequency: Prior to 20 weeks, ideally every 4 weeks but no less than every 6 weeks for lower-risk women. 20 to 28 weeks, every 4 weeks. 28 to 36 weeks, every 2-3 weeks, 3 weeks for lower-risk women. 36 weeks to delivery, at least every week. Urine dipstick for protein, glucose, and ketones ...
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ANTENATAL CARE (eight visits)/ANTENATAL CARE (8th visit) 2 I S A C E isits) CONCEPT AND DEFINITION Antenatal care (ANC) is a critical component for improving maternal and newborn health and provides a platform for important health-care functions, including: health promotion, screening and diagnosis,
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Also, pregnant people usually get better without needing care in the hospital. But pregnancy is a factor that raises the risk of severe COVID-19. That risk stays higher for at least a month after ...
The importance of the antenatal home visit by the health visitor
The article will look at the picture across the UK; and, in particular, how Scotland has the potential to implement an antenatal home visit within the core programme. References Allan G (2015) A journey of ... Matching parenting support needs to service provision in a universal child health surveillance visits. Child Care Health Dev 38(5): ...
Introduction
The comprehensive antenatal care (ANC) guideline, WHO recommendations on antenatal care for a positive pregnancy experience, was published by the World Health Organization (WHO) in 2016 with the objective of improving the quality of routine health care that all women and adolescent girls receive during pregnancy (1). The overarching principle - to provide pregnant service users with a ...
How to find the right balance between telemedicine and in-person care
Finding the right balance between virtual and in-person visits can be a key to getting good care. (AP Photo/Mark Lennihan, File) Read More. 1 of 2. FILE - A patient sits in the living room of her apartment in the Brooklyn borough of New York during a telemedicine video conference with a physician on Jan. 14, 2019. Patients can now see an array ...
Time to initiation of antenatal care and its predictors among ...
Background: Early antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities.
Disability Access Barriers In Pregnancy Care Highlighted In ...
On the medical side, emergency department visits due to obstetric reasons in pregnancy were more common in females with physical (20%), developmental (27%) and multiple disabilities (25%) than non ...
Impact evaluation of invisible intimate partner violence on maternal
Having inadequate antenatal care (ANC) visits is evaluated based on whether a pregnant woman received healthcare less than eight times from a professional health institution . The variable was assigned the value of 0 if the number of healthcare is 8 or more. Otherwise, it was assigned with 1 instead.
How to find the right balance between telemedicine and in-person care
Finding the right balance between virtual and in-person visits can be a key to getting good care. (AP Photo/Mark Lennihan, File) Patients can now see an array of doctors without leaving their ...
Maternal health
They are competent to: (i) provide and promote evidence-based, human-rights based, quality, socioculturally sensitive and dignified care to women and newborns; (ii) facilitate physiological processes during labour and delivery to ensure a clean and positive childbirth experience; and (iii) identify and manage or refer women and/or newborns with ...
Equity and inclusion in pregnancy care: report on the pregnancy
The Disability and Pregnancy Study gathered evidence supporting the need for a more equitable and inclusive approach to pregnancy care that addresses the needs of disabled people. To read the report, scroll to the bottom of this page and download the easy read summary, executive summary, or full report. Webinar: Equity and Inclusion in ...
Widespread disrespect, abuse in maternity care leave mothers with
Widespread disrespect, abuse in maternity care leave mothers with lasting trauma. by Annika Neklason - 05/28/24 6:00 AM ET. Kimberly Turbin thought she was going to be a happy mom. "But that was ...
The normal whelping process
If your dog is pregnant or you plan to breed, it is best to prepare by becoming familiar with the normal canine birthing (whelping) process. A pregnant dog will experience several physiological changes. These changes include an increased heart rate, respiratory rate, and increases in several hormones to aid in maintaining the pregnancy and preparing the body for giving birth and nursing.
Pregnant in a rural town of 400: How this mom is getting vital ...
Ashley Jacobson has a high risk pregnancy and lives nearly 2 hours from her OB/GYN. Some women in rural Minnesota choose to forgo their doctors appointments entirely because of the distance. CNN ...