Preface

Midwifery across the globe faces different issues. In some countries the autonomy of the profession is a tradition, while in some societies midwives struggle to practice autonomous‐ ly the basic competencies. In one part of the world the medicalisation of childbirth is the main issue, preventing the natural processes of pregnancy and childbirth to flow at their own pace, while in other parts of the world midwives struggle with lack of resources to pro‐ vide safe midwifery care.

The authors of this book practice midwifery in different cultures and within different social contexts. They have to deal with different obstacles and seek solutions to diverse problems. With their contributions, they offer an insight into their thinking, their dilemmas, and the problems of midwifery practices in their countries. However, despite different backgrounds, they all have in common a uniform goal—a wish to offer women optimal midwifery care and to improve midwifery services.

> **Assist. Prof. Ana Polona Mivšek, PhD** Faculty of Health Sciences University of Ljubljana, Slovenia

**Chapter 1**

**Provisional chapter**

**Basic Antenatal Care Approach to Antenatal Care**

**Basic Antenatal Care Approach to Antenatal Care** 

DOI: 10.5772/intechopen.79361

Globally, antenatal care is advocated as the cornerstone for reducing children's deaths and improving maternal health. The basic antenatal care approach is used in the public health institutions in South Africa to provide healthcare services to the pregnant women. The basic antenatal care approach is a modified version of the focused antenatal care approach that was recommended by researchers during 2001 and adopted by the World Health Organisation in 2002 following realisation that traditional antenatal care programmes that were meant for developed countries were poorly implemented and largely ineffective when used in developing countries. The basic antenatal care approach is listed as one of the priority interventions for reducing maternal and child mortality in the country and is recommended as the minimum level of antenatal care that every pregnant woman should receive. Every site where pregnant women make contact with healthcare services should provide antenatal care services daily using this approach so that the first antenatal care visit consultation takes place as soon as the pregnancy has been confirmed or the very first time that a pregnant woman visits a health facility. The introductions of the basic antenatal care approach have been a positive milestone for South Africa. **Keywords:** antenatal care, approach to health care, basic antenatal care, pregnancy,

Antenatal care (ANC) is an umbrella term used to describe medical care and procedures that are carried out to and for the pregnant women [1]. It is the health care that is rendered to the pregnant women throughout pregnancy until the child's birth and is aimed at detecting the already existing problems and/or problems that can develop during pregnancy, affecting

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

**Service Provision**

**Abstract**

**1. Introduction**

**Service Provision**

Thembelihle Sylvia Patience Ngxongo

Thembelihle Sylvia Patience Ngxongo

http://dx.doi.org/10.5772/intechopen.79361

pregnancy outcome, South Africa

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

#### **Basic Antenatal Care Approach to Antenatal Care Service Provision Basic Antenatal Care Approach to Antenatal Care Service Provision**

DOI: 10.5772/intechopen.79361

Thembelihle Sylvia Patience Ngxongo Thembelihle Sylvia Patience Ngxongo

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79361

#### **Abstract**

Globally, antenatal care is advocated as the cornerstone for reducing children's deaths and improving maternal health. The basic antenatal care approach is used in the public health institutions in South Africa to provide healthcare services to the pregnant women. The basic antenatal care approach is a modified version of the focused antenatal care approach that was recommended by researchers during 2001 and adopted by the World Health Organisation in 2002 following realisation that traditional antenatal care programmes that were meant for developed countries were poorly implemented and largely ineffective when used in developing countries. The basic antenatal care approach is listed as one of the priority interventions for reducing maternal and child mortality in the country and is recommended as the minimum level of antenatal care that every pregnant woman should receive. Every site where pregnant women make contact with healthcare services should provide antenatal care services daily using this approach so that the first antenatal care visit consultation takes place as soon as the pregnancy has been confirmed or the very first time that a pregnant woman visits a health facility. The introductions of the basic antenatal care approach have been a positive milestone for South Africa.

**Keywords:** antenatal care, approach to health care, basic antenatal care, pregnancy, pregnancy outcome, South Africa

## **1. Introduction**

Antenatal care (ANC) is an umbrella term used to describe medical care and procedures that are carried out to and for the pregnant women [1]. It is the health care that is rendered to the pregnant women throughout pregnancy until the child's birth and is aimed at detecting the already existing problems and/or problems that can develop during pregnancy, affecting

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

the pregnant woman and/or her unborn child [2]. The care includes various screening tests, diagnostic procedures, prophylactic treatments, some of which are done routinely, and others are provided to the women based on identified problems and risk factors.

avoidable causes of the deaths of mothers, babies and children and make recommendations to improve the quality of care provided to mothers, babies and children at the time when they need it most. All three committees highlight, in their triennial reports, the importance of ANC for reducing maternal, perinatal and children's deaths. Bradshaw et al. [10] further emphasise that addressing the health challenges should involve strengthening the provision of healthcare packages within the continuum of care and recognise that the effectiveness of each package depends on whether it provides high-impact, evidence-based interventions and also on the coverage and quality of the service rendered. ANC can screen for, detect and thus prevent many maternal complications that might occur before childbirth and could signifi-

Basic Antenatal Care Approach to Antenatal Care Service Provision

http://dx.doi.org/10.5772/intechopen.79361

3

The one document by the NCCEMD, which might appear old but which conveys a very important message for South Africa, is the Saving Mothers Policy and Management Guidelines for Common Causes of Maternal Deaths [11]. This policy document highlights that one of the major areas of substandard care identified in South Africa is the poor initial assessment of patients during ANC visits. The authors attribute this to the fact that the midwives are trained in the traditional method of history taking, clinical examination and special investigations when assessing patients. This might make it difficult to assimilate the multiple abnormalities found and to formulate a management plan for a patient with multiple organ disease, the very

South Africa has a burden of high maternal and perinatal mortality rates and therefore needs to work very hard to address this problem. The number of reported maternal mortalities had increased by 20% during the 2005–2007 triennium compared to the 2002–2004 trienniums [3]. The constant rise in maternal and perinatal mortality rates resulted in South Africa's inclusion of the MNCWH programme as one of the priority programmes in the 10-year strategic plan for the country [12]. The majority of the provider-related preventable deaths in South Africa

South Africa can address the problem of the constantly rising maternal and perinatal mortality rates because the majority of avoidable provider-related maternal deaths can be avoided through providing proper and good-quality ANC services [13]. The Saving Mothers Report 2008–2010 indicates that a total of (16.6%, n = 713) of women who died during this triennium did not attend ANC clinics and (7.0%, n = 300) attended ANC clinics infrequently [14]. The Saving Mothers' Report indicates that the avoidable causes of maternal deaths included a number of health provider-related issues such as poor initial assessments, problems with recognising problems, delays in referring the pregnant women to different healthcare facilities causing pregnant women to be managed at inappropriate healthcare levels, incorrect management, substandard management/care and failure to take actions when abnormalities were found [14].

Several approaches to ANC are used in different countries including the traditional approach, goal-directed ANC, focussed ANC (FANC) and the basic ANC (BANC) approach. While some

cantly improve the outcomes for unborn infants [2].

type of cases described in the maternity mortality reports [12].

have been attributed to poor ANC.

**3. Approaches to antenatal care**
