More efforts should be exertedMaternal Health: Multi-angled issue [Archives:2007/1068/Health]

July 16 2007

Dr. Mohammed Al-Alie
For Yemen Times

In light of World Population Day, which concentrates this year on maternal health and the necessity of men's partnership in matters related to women's health, further attention should be paid to a number of measures, which if followed will ensure maternal health, particularly during pregnancy and delivery. The high rate of maternal mortality (death of women while pregnant or within 42 days after termination of pregnancy), particularly in developing countries, has made this phenomenon of global concern. In Yemen, over 360 out of 100,000 women die as a result of pregnancy and delivery complications, according to recent studies.

This high number of death among pregnant women in our country indicates the extent of poor health services and lack of antenatal and primary healthcare among pregnant women. In addition, lack of health education, exceeding rates of low income amongst Yemeni citizens, absence of free health care within public hospitals and the high cost of health services in private hospitals has exacerbated the problem.

With this revelation, it should be confirmed that antenatal care is the only way to reduce and prevent maternal mortality. It is also considered an important issue towards which men can play a major role, as they have the required privileges educationally, socially and politically and, hence, can contribute real progress to one of the most serious issues that concern women.

Antenatal Care (ANC) means “care before birth” and includes education, screening, counseling and treatment to monitor and promote the wellbeing of the mother and fetus. Adequate antenatal care is vital for the delivery of a healthy baby from a healthy mother. The aims of ANC include assessment and treatment of potential maternal risks as well as detecting dangerous symptoms like vaginal bleeding, headache, leakage of fluid from vagina, urinary tract infection and other infections. The increase of blood pressure during pregnancy is also dangerous and requires consultation and monitoring by doctors.

In addition, assessment and management of the fetus is of vital importance to ensure the well-being of both the fetus and the mother. This helps avoid any life-threatening complications that may occur before and after delivery.

To achieve these objectives, medical history and clinical examination using a combination of methods including biological and hematological tests as well as ultrasound diagnosis are needed to maintain maternal physical and mental wellbeing, prevent preterm delivery, anticipate difficulties and complications upon delivery, ensure the birth of a healthy infant and assist the couple in preparation for parenting.

Regular doctors visits are a significant factor in detecting, controlling and preventing many diseases, such as preeclampsia (increased blood pressure and collection of fluid due to excretion of protein in urine). If not treated, this disease may lead to death.

Malnutrition and anemia of pregnant women, two conditions prevalent in Yemen, lead to low birth weight, preterm labor, and increased risk of complications even after delivery. Malpresentation and position of a fetus may also lead to the obstruction of labor. In addition, some infections during pregnancy lead to congenital abnormalities, such as German measles, and may cause abortion.

Schedule of routine antenatal visits

Women should schedule at least four visits to antenatal clinics during every pregnancy, but may need to schedule more according to the condition of the mother. The first visit should occur as soon as the pregnancy is diagnosed, the second visit in the 6th month of pregnancy, the third visit in the 8th month of pregnancy and the last visit during the 9th month of pregnancy. However, if a woman experiences hypertension (increase in blood pressure) or anemia, she should visit the doctor more regularly, especially during the 8th month of pregnancy.

General advice to pregnant women

1. Advice on danger signs: Pregnant women are advised to go to their local hospital or health centre immediately, day or night, WITHOUT waiting if signs such as vaginal bleeding, convulsions, severe headaches with blurred vision, fever, weakness and inability to get out of bed, rapid or difficult breathing occur. In addition, pregnant women should go to the health centre as soon as possible if any signs of fever, abdominal pain, feeling of illness, or swelling of fingers, face or legs occur.

2. Diet during pregnancy: Pregnant women differ in required amount of nutrients. However, expectant mothers need more than 2500 calories in general per day. In fact, pregnant women need 15% around (300-500 cal) more per day than non-pregnant women. Keep in mind that the most important thing is the quality – not the quantity – of diet. For example, more proteins are needed with 2g of protein per every kg of body weight daily. So, if the mother's bodyweight is 70kg, then she needs 140g of protein daily.

Fat should be restricted

Also, pregnant women need about 5000 international units of vitamin A daily.

Vitamin B is essential because its deficiency may cause vomiting of the pregnant woman. Folic acid deficiency may lead to anemia and is therefore essential for pregnant women and fetal growth, with about 0.5 g recommended daily. In addition, lack of Vitamin C may lead to post delivery bleeding. Vitamin C is found in a lot of fruits and should be consumed daily.

All vitamins can be consumed through vegetables and fruits and there is no need for medication, except in the case of iron and folic acid, which should be taken in the form of tablets. Iron also should be supplemented by medication because the daily requirement of iron cannot be supplied by normal diet. It is very important for the fetus and mother.

Calcium is also necessary because pregnant women need more calcium than normal. One liter of milk daily is necessary for pregnant women (equal to 1.2 g of calcium daily). Deficiency of calcium leads to bone fragility in the mother, manifested as pelvic and back pain, which is a common complaint of pregnant women.

Pregnant women must avoid bad habits such as smoking, which increases the risk of abortion, preterm labor, and growth restriction of fetus in addition to affecting other aspects of a child's physical and mental development. Consumption of coffee, tea and chocolate should be minimized during pregnancy and sleep should be 8 hours at night and 2 hours rest during the afternoon.

Sexual intercourse should be avoided only if there is risk of abortion or preterm labor and clothing should be loose.

To conclude, the only way to decrease the high maternal mortality rate in our country is through effective antenatal care and proper health services for pregnant women. Antenatal care and education should be integrated and not separated in order to raise awareness among all people, men and women, about the importance of following proper medical procedures and precautions. Increasing focus on prenatal diagnosis and seeking the “perfect child” should not detract from the joys of pregnancy. There is a need to continually update and improve our current method of antenatal care. The move towards a more educational approach to antenatal care should be based on sound scientific evidence.