What is quality antenatal care?

Tandi* had prayed for a baby for so long, she literally felt that her prayer line to God may have long been disconnected without her knowledge.

Six years into her marriage and all she could think of was her incapacity to have a little Tandi running around. Her husband was extremely supportive but Tandi didn’t feel he understood, considering he already had a daughter with his late wife. Her step-daughter adored her but despite their great relationship, Tandi felt that she had failed her too by not giving her a sibling.

Numerous tests done to ascertain their fertility were all normal and no amount of reassuring Tandi and asking her to take it easy was working. We were at our rope’s end and considering in-vitro fertilisation as an option. Tandi’s beliefs did not support IVF as an option. Together with the husband, we opted for a different tact.

Tandi had always wanted to do her Masters degree but she somehow did not get around to doing it. With her husband’s support, Tandi was enrolled into a two-year programme in the Netherlands. He encouraged her to look at it as the baby she could get at her own pace while she waited for God’s time with regard to her biological baby. Tandi went off to school, dejected at the thought of not being a mother, but also with the excitement of starting something new.

Her husband, who travelled to Europe often enough, would visit her at least once every two months and was happy to report that Tandi had settled in well and was indeed blossoming away from the pressures of being at home and worrying about the pregnancy. Living in a city where the primary mode of transport was bicycles, Tandi had acquired a feisty little bike she rode everywhere and took hundreds of photos, plastering them all over her social media.

Somewhere along her second year of school, Tandi texted me. She had the flu but no amount of resting was helping. She was also unable to stomach anything, what with her saliva tasting all salty. She was wishing it away but wanted to know if it was safe to take the anti-vomiting medicine she had carried from home for a rainy day, before she resolved to visiting the doctor.

I was absolutely afraid of hoping but I did encourage her to book an appointment with the doctor even as she took the medication. Two days later, I came out of surgery to find 15 missed calls from Tandi. I reached out wondering what the emergency was! Tandi had sent me pictures of all 12 home pregnancy test strips she had taken! She was pregnant at last. Her husband was busy trying to book the next available flight over!

Let’s just say the new mother-to-be managed to complete her coursework and projects a record seven weeks early so she could board a flight home to deliver her baby on Kenyan soil!

She was 30 weeks when she got back home. She scheduled an appointment to see me as soon as she arrived and I asked her to bring all her medical reports with her.

Imagine my surprise when she really had nothing to provide. Tandi was so focused on finishing school early she neglected her antenatal clinics. She only ever attended the first two clinics. Once she got to the second trimester and the nausea settled, she ignored her visits, putting all her spare time into her project.

We literally had to start from scratch. While doing her antenatal profiles and her obstetric ultrasounds, the reports highlighted Tandi’s complications. She had developed gestational diabetes. Her baby was a little too big for age and her blood sugar levels were unacceptable.

It was a scramble to get her into care by the endocrinologist, doing further tests, starting her on treatment, teaching her how to self-inject, use the blood sugar monitor at home and to balance her plate to ensure adequate caloric intake for herself and the little one, while balancing her blood sugars to ensure she remains stable.

It was a rollercoaster for her and just as she thought she was finally catching on, I introduced the conversation on her birth plan. She buried her head in her palms and groaned. She was tired of all the decisions she needed to make. It was hectic, but thankfully, Tandi gracefully completed the journey successfully and was able to finally hold her little one in her arms safely!

Let’s just say it was an intense eight weeks. This is the reason antenatal clinic attendance is encouraged from as early on as possible. It is not just a visit to see the doctor but a journey towards safe delivery. Every clinic visit has its specific objectives to be achieved. Screening for pregnancy complications in both mother and baby happens at various stages. The idea is to be able to do it at the correct time, to permit interventions that are timely and most effective when done right.

It is also a period to evaluate a mother’s risk with regard to planning their individual birth plan. This isn’t always a medical risk; it can be a social risk. What if you live very far from the hospital you have chosen to deliver in? How will you arrive on time? What is your means of transport?

Medically, education about the risk factor is crucial, to empower you as the mother and her support system, to feel like they are part and parcel of the decision-making process, not just sitting by the side waiting for instructions. This also helps to heighten both the mother’s and her birth partner’s sense of alertness to possible complications. The mother is able to appreciate the danger signs better and be more in tune with their body as it carries out the precious talks of carrying the little one.

This is the cornerstone of reducing the first delay that results in bad obstetric outcomes; the delay in identifying danger signs and responding quickly. Together, we must walk the journey to eliminating maternal and perinatal mortality!

Dr Bosire is an obstetrician/ gynaecologist