OBJECTIVES When you have completed this unit you should be able to: Describe mother friendly care in pregnancy. List the principles of mother friendly care during pregnancy. Understand the importance of individualised care. Help women to play a role in their own pregnancy care. Provide mother friendly antenatal care. Explain the importance of involving the partner, family and community in antenatal care. Encourage health care workers to be mother friendly.

COPYRIGHT

All rights reserved. No part of this Perinatal Education Programme may be altered in any way without the written permission of the editorial board of the Perinatal Education Trust. To facilitate the improvement of perinatal care, the Programme may be reproduced for teaching purposes provided due acknowledgement is given and the material is not sold for financial profit. While the advice and information in the Programme is believed to be accurate, the editorial board cannot accept responsibility or liability for any errors or omissions that may have been made.

ISBN 0 7992 2253 4

MOTHER FRIENDLY CARE FOR PREGNANT WOMEN

41-1 WHAT IS MOTHER FRIENDLY CARE DURING PREGNANCY?

This is the method of caring for women during pregnancy, where the best interests of the woman and her fetus are considered above those of the hospital or clinic staff. Mother friendly care is good care.

41-2 WHAT ARE THE PRINCIPLES OF MOTHER FRIENDLY CARE DURING PREGNANCY?

1. Each woman is welcomed and given individualistic care, paying special attention to her own wishes and needs. Always call a mother by her name.
2. Women are treated with kindness, compassion, patience and gentleness.
3. Care should be sensitive, responsive and supportive to the needs, values and customs of each woman’s culture and home background.
4. Women are encouraged and helped to play an important role in their own care and decision making.
5. The woman’s physical and emotional needs are considered.
6. Women are informed about their condition and that of the unborn infant in a way that they will understand.
7. Health workers give women opportunities to voice their feelings, needs and questions.
8. Wherever possible, care should be evidence based.

41-3 WHAT IS MEANT BY INDIVIDUALISED ANTENATAL CARE?

With individualised care, every effort is made to ensure that the same health worker sees the same patient at each visit. This may be easy to achieve in rural areas with few health workers and smaller numbers of pregnant women. However in peri-urban and urban areas with many health workers and large numbers of patients, good organisation is required to achieve this goal.

Individualised (personalised) care also means that the specific needs of each woman are considered when her antenatal care is planned. The needs of all pregnant women are not the same. The needs of different individuals often vary.

41-4 WHAT ARE THE BENEFITS OF INDIVIDUALISED CARE?

1. A relationship of trust and respect develops between the patient and health worker. Pregnant women are more likely to ask questions and speak openly with someone they get to know.
2. The health worker knows that observations at a visit are done in exactly the same way as during the previous visits (i.e. interobserver variation is ruled out).
3. Abnormal observations will be reacted upon and not thought to be the result of the previous person doing observations incorrectly.
4. Patients feel they are receiving better care.
5. Health care workers experience more job satisfaction as they get to know the women they are taking care of.

INDIVIDUALISED CARE RESULTS IN BETTER CARE

41-5 WHAT PERSONAL HISTORY SHOULD BE TAKEN DURING ANTENATAL CARE?

In addition to the medical history routinely taken during antenatal care, attending an antenatal clinic provides a woman with the opportunity to talk about her home, partner, fears and wishes. Assessing the woman’s emotional status is important as it may identify women at increased risk of postnatal depression and anxiety. Emotional or physical abuse, economic problems or drug abuse may also be identified.

Excessive fear and anxiety during a vaginal examination may suggest previous bad experiences. It is important to allow women to speak about any previous births. Taking a brief psychiatric history is important, especially to screen women for features of anxiety or depression. Most women with postpartum depression have symptoms during their pregnancy. Early diagnosis and treatment gives a better outcome. Women on antidepressants must not stop their treatment because they are pregnant.

Postnatal depression is discussed in Unit 42 of the Perinatal Education Programme.

41-6 HOW CAN PREGNANT WOMEN PLAY A GREATER ROLL IN THEIR OWN CARE?

1. By being allowed and encouraged to speak about their needs and fears.
2. By learning more about the physical and emotional changes that take place during pregnancy.
3. By understanding the care they are being given.
4. By helping to monitor their own pregnancy, e.g. becoming aware of fetal movements.
5. By understanding the importance of a good diet during pregnancy.
6. By understanding that care of themselves will improve the health of their infant.
7. By not smoking or drinking alcohol during pregnancy.

WOMEN SHOULD BE ENCOURAGED TO PLAY A MORE ACTIVE ROLL IN THE MANAGEMENT OF THEIR PREGNANCIES

41-7 CAN WOMEN BE HELPED TO MONITOR THEIR OWN PREGNANCY?

1. Women should be taught to be aware for danger signs during pregnancy, such as bleeding, severe headache or abdominal pain and visual disturbances (in severe pre-eclampsia).
2. Being aware of fetal movements can help mothers to also monitor the well being of their unborn infant.
3. Women should know the early signs of labour.

Women should contact or go to the delivery centre as soon as they recognize danger signs or go into labour.

41-8 WHAT IS EVIDENCED BASED CARE IN PREGNANCY?

Evidence based care is the clinical management of a patient where the treatment is decided by the results of carefully done clinical trials. This is far better than care based on prejudices, unconfirmed beliefs and traditions. It is important to question every aspect of patient care. Only in this way can unhelpful practices be rejected and effective care introduced.

WHENEVER POSSIBLE, CARE IN PREGNANCY SHOULD BE EVIDENCE BASED

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