Antenatal care services in Nigeria.
Being pregnant is a wonderful experience. It is not something you should go through alone, you need the doctors and nurses to take you through it hence, you need to register for antenatal care to ensure a favourable outcome for you and your baby.
Probably it is your first pregnancy and you need guidance, below is a list of antenatal care services you will be rendered in Nigeria in each of your clinic visit.
- Physical examination
- Health education
- Ultrasound services
- Counseling services
- Malaria prevention
- Anemia prevention
- Nutritional services
- Information on breastfeeding and
Antenatal care services in Nigeria may be individualised based on the history you give to your doctor but majority of Nigerian women undergo the listed above.
1. Screening is one of the most components of antenatal care services in Nigeria
On your first visit to the antenatal clinic, your blood sample will be in order to screen you for common diseases like HIV, hepatitis B, syphilis, and sometimes rubella. Your blood group, genotype and Rhesus group will also be tested or confirmed. Screening for HIV and hepatitis B during your booking visit will help reduce transmission of these diseases to your baby. Knowing your status early will enable your doctor to institute treatment and determine the best birth plan suitable for you and your baby.
2. Physical examination
A thorough physical examination will be performed on you. Your height, weight, and blood pressure will be measured. You will be examined and evaluated for pallor, jaundice, cyanosis and leg swelling. You neck will be checked for thyroid gland and lymph node enlargements. You tommy will be examined for liver, spleen and kidney enlargements.
The doctor will also check how well your baby is growing and listen to its heart beat. Your pelvis will examined to determine if it is adequate for the baby to pass through during delivery.
3. Health education
A key component of antenatal care services in Nigeria. During the health education session usually carried out by the nurses, important messages relating to your health and that of your baby will be conveyed to you and possibly other members of the community. These messages will be effectively conveyed to all pregnant women at the beginning of each antenatal visit, while waiting for weight and height to be taken. You could watch some of these messages recorded and played on videos. Your health care provider should be available to answer all questions that may arise from health talks. In Nigeria, songs on some of these messages are composed and pregnant women sing these songs while waiting to be attended to. Some of the health messages that you will be educated on include antenatal visits, essential services, clean and safe delivery, danger symptoms and signs of pregnancy, coping with emergency, nutrition and hygiene, newborn care, family planning, harmful traditional practices, routine antenatal drugs for anemia and malaria prevention, preparation for breastfeeding and delivery and feeding options for HIV positive mothers.
Antenatal care services in Nigeria will not be complete without immunization against tetanus. Tetanus is a deadly bacteria infection that can be passed to your baby. But it is preventable by vaccination. The modalities of administering tetanus vaccine varies from country to country. In all your reproductive years, you will require a total of 5 doses of tetanus vaccine. In Nigeria 3 doses of the vaccine is given in your first pregnancy. The first dose is given between 16- 20 weeks, the second dose will be 4 weeks after, the 3 dose will be 6 months after the second dose or few weeks before delivery. The first dose offers no protection, the second dose offers you protection for 1-3 years and the third dose is 5 years protection.
In your second and third pregnancies, your doctor may decide to give you single doses until it completes a total of 5. The fifth dose offers protection for life.
If the interval between your pregnancies is about 5 years apart, you will be given booster doses even though you have completed the total of 5 doses.
Please note that some doctors will give you only 2 doses in your first pregnancy. This is also acceptable.
Obstetric scan to confirm pregnancy and check the number of babies you are carrying is now part and parcel of the routine antenatal care services in in modern day Nigeria. It is usually done at 20-25 weeks or earlier for dating and multiple pregnancy. Ultrasound scan is also used for the diagnosis of structural and chromosomal abnormalities. In later pregnancy, ultrasound scan is done for specific indications such as bleeding per vagina during pregnancy, big babies, intrauterine growth restriction (baby not growing well), reduced fetal movements and rupture of membranes. The cost of obstetric scan for pregnancy is around #2,500- #4,000 naira.
6. Counselling services
You can discuss your worries, troubles, and fears with you doctor and she will counsel you as appropriate. Have any questions concerning your pregnancy? Talk to your doctor.
7. Malaria prevention
The dangers of malaria in pregnancy are too grave. Malaria in pregnancy can cause miscarriage, intrauterine growth restriction, stillbirths, fetal anomalies, anemia in pregnancy, false contractions (labour) and among others. Antenatal care services in Nigeria focuses on malaria prevention for the well being of mother and baby.
Chloroquine is no longer used for malaria prevention in Nigeria as it has been banned by the federal ministry of health.
Oral proguanil 200mg called “sunday sunday medicine” is taken every 7 days by pregnant women for malaria prevention.
Intermittent Preventive Treatment is now the recommended method of preventing malaria in pregnancy by the World Health Organization and it has been adopted by Nigeria. It is the treatment of malaria in pregnancy with a full therapeutic course of antimalarial medicine given to pregnant women in Nigeria at routine antenatal visits regardless of whether she is infected or not. The recommended IPT drug is sulphadoxine-pyrimethamine (fansidar). Each satchet contains 3 tablets and you will be required to take the 3 tablets once starting from the second trimester. Each dose taken should be at least one month apart. You are expected to 3 doses in one pregnancy.
8. Anemia prevention
Anemia, just like malaria has similar negative effect on the mother and baby. To prevent this, most antenatal clinics in Nigeria take their time in preventing anemia in pregnancy.
Most pregnant women are placed on the routine antenatal drugs in Nigeria which are mainly blood boosters. These drugs include: folic acid, vitamin C, fesolate (iron supplements), vitamin B complex and sometimes calcium. You are expected to be taking these drugs daily and when they are exhausted , you report back to the hospital for a refill. Taking folic acid before and during your pregnancy will protect your baby from a disabling anomaly called spinal bifida.
9. Nutritional services
Good food and a balanced diet will ensure a healthy mother and baby.
The need for a balanced diet during pregnancy forms part of the health education talk at every antenatal visit. Ideally, your diet should contain adequate amount of nutrients such as carbohydrates, protein, fats, mineral salts and water. In Nigeria, the opportunity of the health education talk is taken to demonstrate the local foodstuffs that contain the nutrients you require with emphasis on the quality rather than quantity of the foodstuffs.
Poverty, ignorance, taboos, and superstitions contribute to the poor nutritional state seen in some pregnant women and most women will benefit from nutritional counselling and education.
For every antenatal visit, you urine sample will be obtained and tested for protein, sugar and acetone. Protein in your urine may be a sign of renal disease and is an important sign in early detection of pre-eclampsia. Glucose in your urine is obtained in the fasting state and may be the first sign of diabetes mellitus. Acetone in urine may be a sign of dehydration following excessive vomiting in pregnancy but can also be a sign of diabetes milletus. Depending on the hospital, expectant mothers pay between #150- #500 naira each visit for urine analysis.
11. Breastfeeding education
A key component of antenatal care services in Nigeria. The importance of breastfeeding to the baby, mother and the society is a jingle in our antenatal clinics. You will be educated on exclusive breastfeeding and how to achieve it without stress even though you are a working mother. HIV positive mothers will be educated on the best feeding options for their babies.
12. Contraceptive services
Are you having your second, third, fourth, or fifth baby and you think you have reached the “bus stop” of childbirth or you simply want to practice effective birth spacing? Your doctor or nurse will counsel you on the available family planning methods like the use of pills, barrier methods ( condom, sponge, diaphragm, cervical cap), tubal ligation, subdermal implants and the natural or traditional method of contraception. The decision on the method to use will be made by you and not the doctor or nurse.
Comments, suggestions or contributions on services provided during antenatal care visits in Nigeria are welcomed.
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