Al Neelain University Faculty of Medicine
Semester (7)Primary Health Care Course
Antenatal careThe Focused Antenatal Care
Approach (FANC).
Dr.Abeer Abuzeid Atta Elmannan
Session outlines
• The maternity Cycle.• Objectives of Antenatal care.• Traditional approach versus FANC approach.• Concepts and principles of FANC.• The schedule, objectives and procedures covered in FANC
visits .• The Safe Motherhood Initiative.• The Mother-Baby Package.
The stages in maternity cycle
• Fertilization : Takes place in outer part of fallopian tube.• Antenatal or prenatal period : Care during pregnancy- ovum: 0-14 days- Embryo: 14 days-9 weeks - Fetus: 9the week to birth • Intranatal period : Care during or at the time of birth.• Post-natal period :Care of the mother (and the newborn)
immediately after birth and extending for about 6 weeks (Puerperium ).
• Interconceptional period :care of a woman during her reproductive years, between pregnancies.
Antenatal care
• The primary aim is to achieve at the end of a pregnancy a healthy mother and a healthy baby.
• Ideally it should begin soon after conception, and continue throughout pregnancy. Visits should be;
- Once a month during the first 7 months - Twice a month during the next month.- Once a week thereafter if everything is normal.
Objectives of antenatal care
• To promote, protect, and maintain the health of the mother during pregnancy.
• To detect high risk • To foresee complications and prevent them .• To remove anxiety associated with delivery.• To reduce maternal and infant mortality.• To teach the mother. • To sensitize the mother to the need for family planning. • To pay attention to the under fives accompanying the
mother.
The Traditional antenatal care services
• Developed in the early 1900s. • This model assumes that frequent visits and classifying
pregnant women into low and high risk is the best way to care for the mother and the fetus.
• The traditional approach was replaced by focused antenatal care (FANC).
Focused antenatal care FANC : concepts and principles
• It is a goal-oriented antenatal care approach, which was recommended by researchers in 2001 and adopted by the World Health Organization (WHO) in 2002
Focused antenatal care: FANC
• FANC aims to promote the health of mothers and their babies through targeted assessments of pregnant women.
• FANC split pregnant women into those eligible to receive routine ANC (the basic component) and those who need specialised care .
• FANC emphasises targeted and individualised care planning and birth planning.
• FANC makes the pregnant woman, with her husband and the family, participatory.
• A pregnant woman has four antenatal visits.
FANC aims to facilitate:
• Identification and treatment of already established disease• Early detection of complications• Prophylaxis and treatment for diorders.
FANC also aims to give holistic individualised care to each woman through timely guidance and advice on:
• Birth preparedness .• Nutrition, immunization, personal hygiene and family
planning• Counselling on danger symptoms .
Basic principles of focused antenatal care
• Antenatal care service providers make a thorough evaluation of the pregnant woman.
• They administer prophylaxis as indicated.• With the mother, they decide on where to have the follow-
up antenatal visits.• Provided that quality of care is given much emphasis the
majority of pregnancies progress without complication.• No pregnancy is labelled as ‘risk-free’ till proved otherwise. • Pregnant women and their husbands are seen as ‘risk
identifiers’ and they are also ‘collaborators’ with the health service.
Advantages of FANC
• effective in terms of reducing maternal and perinatal mortality (deaths) and morbidity (disease, disorder or disability).
• FANC is the best approach for resource-limited countries
Failings of the traditional approach to antenatal care
• The traditional approach to antenatal care is unable to identify accurately women who are ‘at risk’ of developing any of life-threatening conditions.
• It identifies some women as being ‘low risk’ who subsequently develop danger symptoms that need urgent professional intervention.
Basic differences between traditional and focused antenatal care
Characteristics Traditional antenatal care Focused antenatal care
Number of visits 16–18 regardless of risk status 4 for women categorised in the basic component .
Approach Vertical: only pregnancy issues are addressed by health providers
Integrated with other services; e.g counselling on danger symptoms, HIV testing, malaria prevention, nutrition, vaccination, etc.
Assumption Assumes that the more the number of visits, the better the outcomes
Assumes all pregnancies are potentially ‘at risk’. Targeted and individualised visits help to detect problems
Use of risk indicatorsRelies on routine risk indicators, such as maternal height <150 cm, weight <50 kg, leg oedema, malpresentations before 36 weeks, etc.
Does not rely on routine risk indicators. Assumes that risks to the mother and fetus will be identified in due course
Prepares the family To be solely dependent on health service providers
Shared responsibility for complication readiness and birth preparedness
Communication One-way communication (health education) with pregnant women only
Two-way communication (counselling) with pregnant women and their husbands
Cost and time Incurs much cost and because this approach is not selective
Less costly and more time efficient. Since very few need frequent visits and referral
Implication Opens room for ignorance in those not labelled ‘at risk’.
Alerts health service providers and family in all pregnancies for potential complications which may occur at any time
Important elements of FANC
FANC has the following three stages: • Thorough evaluation (history taking, physical examination
and basic investigations)• Intervention (prevention/prophylaxis and treatment)• Promotion (health education/counselling and health
service dissemination).
Basic steps in the FANC service
• Gather information (take history) .• Interpret the gathered information (make a diagnosis) and
evaluate any risk factors.• Make an individualised care plan.• Follow the care plan .
In provision of the FANC service, important elements to be considered are:
• Keeping privacy and confidentiality.
• Continuous care is provided by the same provider for pregnant women in the community.
• Promotion of involvement of the woman’s husband or support person .
• Provision of routine antenatal care services according to the national protocols.
• Linking of antenatal and postnatal care with prevention of mother to child transmission of HIV (PMTCT) and provision of family planning services.
The basic and specialised components of FANC
• The FANC model divides pregnant women into two groups: • those eligible to receive routine antenatal care (called the
basic component),
• and those who need special care based on their specific health conditions or risk factors (the specialised component).
• Pre-set criteria are used to determine the eligibility of women to join the basic component.
Eligibility Criteria
Women are questioned and examined at the first antenatal visit to see if they have any of the following risk factors:
Previous pregnancy:• Ended in stillbirth or neonatal loss• History of three or more consecutive spontaneous abortions• A low birth weight baby (<2500 g) or a large baby (>400 g)• Hospital admission for hypertension, pre-eclampsia or eclampsia.
Current pregnancy:• Diagnosed or suspected twins, or a higher number of multiple pregnancies• Maternal age less than 16 years or more than 40 years• Mother has blood type Rhesus-negative.• Mother has vaginal bleeding, or a growth in her pelvis• Mother’s diastolic blood pressure is 90 mmHg or more• Mother currently has diabetes, heart disease, kidney disease, cancer, hypertension
or any severe communicable disease such as TB, malaria, HIV/AIDS or another sexually transmitted infection (STI).
The Antenatal Care Card
• is a guide to the information that you should gather at each of the four antenatal visits.
• It contains ; a registration number, identifying data, previous health history, and main health events.
• At the beginning of each visit, ask the mother if she has developed any danger symptoms since her last check up.
• Remind her to come to see you quickly if she develops vaginal bleeding, blurred vision, abdominal pain, fever or any other danger symptoms.
The FANC visits
The first FANC visit
• should ideally occur before 16 weeks of pregnancy.
Objectives of first FANC visit :
1. Determine the woman’s medical and obstetric history . 2. Perform basic examinations.3. If the pregnancy is beyond the first trimester, try to
determine the gestational age of the fetus. 4. Provide nutritional advice and routine iron and folate
supplementation. 5. Provide HIV counselling and PMTCT services.6. Give advice on malaria prevention and if necessary provide
insecticide-treated bed nets (ITNs). 7. Check her urine for sugar.8. Advise her and her husband to save money in case you
need to refer her.9. Provide specific answers to the woman’s and her husband`s
questions or concerns.
The second FANC visit at
• Scheduled at 24-28 weeks of pregnancy.
Objectives of Second FANC visit:
Follow the procedures already described for the first visit. In addition:
• Address any complaints and concerns .
• For first-time mothers and anyone with a history of hypertension or pre-eclampsia/eclampsia), perform the dipstick test for protein in the urine.
• Review and if necessary modify her individualised care plan.
• Give advice on any sources of social or financial support that may be available in her community.
The third FANC visit
• Should take place around 30–32 weeks of gestation.
Objectives of the third visit:
The objectives of the third visit are the same as those of the second visit. In addition you should:
• Direct special attention toward signs of multiple pregnancies .
• Review the birth preparedness and the complication readiness plan.
• Perform the dipstick test for protein in the urine for all pregnant women .
• Decide on the need for referral based on your updated risk assessment.
• Give advice on family planning .• Encourage the woman to consider exclusive breastfeeding
for her baby .
The fourth FANC visit
• should be the final one for women in the basic component and should occur between weeks 36-40 of gestation.
Objectives of Fourth visit
• You should cover all the activities already described for the third visit. In addition:
• The abdominal examination should confirm fetal lie and presentation,
• The individualised birth plan should be reviewed.• Provide the woman with advice on signs of normal labour
and pregnancy-related emergencies .
Birth preparedness, complication readiness and emergency planning
• Birth preparedness is the process of planning for a normal birth.
• Complication readiness is anticipating the actions needed in case of an emergency.
• Emergency planning is the process of identify and agreeing all the actions that need to take place quickly in the event of an emergency.
Causes of delay in getting emergency help
• There are three types of delay, all of which can be serious for the mother and her baby:
• Delay in healthcare-seeking behaviour .• Delay in reaching a health facility• Delay in getting the proper treatment.
These delays have many causes, including logistical and financial constraints,.
Causes of Delay
• Delays in deciding to seek care may be caused by :1. failure to recognise symptoms of complications, 2. cost considerations, 3. previous negative experiences with the healthcare system and 4. transportation difficulties. • Delays in reaching care may be created by :1. the distance from a woman’s home to a facility or healthcare
provider, 2. the condition of roads, or 3. a lack of emergency transportation. • Delays in receiving appropriate care may result from:1. shortages of supplies and basic equipment, 2. a lack of healthcare personnel, and 3. poor skills of healthcare providers.
Reproductive health care
includes, at the very minimum:• prevention and management of sexually transmitted
diseases (STDs); • family planning information and services • safe motherhood.
Safe motherhood initiative
What is Safe Motherhood?• Safe motherhood means ensuring that all women receive
the care they need to be safe and healthy throughout pregnancy and childbirth.
• The Safe Motherhood Initiative is a worldwide effort that aims to reduce the number of deaths and illnesses associated with pregnancy and childbirth. Ways to achieve safe motherhood include:– Skilled attendance at all births– Access to quality emergency obstetrical care– Access to quality reproductive health care, including
family planning and safe post-abortion care
Why Safe Motherhood?
•Maternal mortality is a major cause of death and disability among women of reproductive age.
• Maternal mortality and morbidity adversely affect the health and welfare of children, families, and communities.
Safe Motherhood Initiative
• In 1987 the World Bank, in collaboration with WHO and UNFPA, sponsored the Safe Motherhood Conference in Nairobi.
• The launch of the Safe Motherhood Initiative (SMI) was seen as a major milestone in the race to reduce the burden of maternal mortality throughout the world, particularly in developing countries
• In January 2004, an expanded Partnership for Safe Motherhood and Newborn Health was established with the aim of promoting the health of women and newborns, especially the most vulnerable.
The Pillars of Safe motherhood
strategies and specified interventions for the reduction of maternal morbidity and mortality, often referred to as the Pillars of Safe Motherhood.;1- Family Planning .2. Antenatal Care .3. Clean/Safe Delivery .4. Essential Obstetric Care . These four strategic interventions must be delivered through primary health care and rest on a foundation of greater equity for women.
The Mother-Baby Package
• Consists of a cluster of interventions designed to support countries in striving to attain the goals of the Safe Motherhood Initiative
• It is a practical tool to intensify promotive, preventive, treatment and rehabilitation interventions for mothers and infants
MOTHER-BABY PACKAGE
WHY? • Most maternal deaths have the same causes• Most pregnancy complications can be prevented or treated• Safe motherhood benefits babies too• Safe motherhood is attainable
WHAT? • Goals and objectives• Family planning• Basic maternity care• Prevention, early detection and management of complications
HOW? • Define national policy and guidelines• Assess needs• Prepare national plan of action• Estimate costs Identify sources of financial support• Develop detailed implementation plan• Implement planned activities• Monitor and evaluate
Thank you
