Routine checkups vital during pregnancy

Tantri Yuliandini, The Jakarta Post, Jakarta

Pregnancy is always an exciting period of a woman's life as it is a time to bring a new life into the world, someone who will continue her family line.

It is also a time when a woman, and indeed her whole family, becomes anxious -- with good cause, as 21 percent of all deaths of women between the age of 15 and 25 in Indonesia are caused by complications during pregnancy, while giving birth or after birth.

A routine check up at least once a month, or more, during pregnancy helps to cut down the risks.

According to Anne Hyre, a midwifery advisor to JHPIEGO, an organization for international education and training in reproductive health, a routine check up performed by a doctor or midwife only needs to be done about four times during a pregnancy.

At the same time, she also suggested that the practice of classifying women into high and low risk birth groups should be abandoned, as there were always risks associated with giving birth.

Making predictions before the actual labor would only alarm the woman or, even worse, lull her into thinking falsely that everything was all right, she said.

Hyre said that many practices and approaches to antenatal care were unnecessary, such as weighing and measuring the height of the mother during pregnancy.

"We used to think that a mother's weight could indicate signs of eclampsia, especially a sudden gain of weight. But now we have found there are other indications that are more reliable in determining eclampsia," she said, referring to a condition of internal poisoning and convulsions that may occur late in a pregnancy.

There is also a myth that shorter women are more liable to birth complications due to the shapes of their bodies.

"Complications at birth can happen to anyone of any shape or size, that's why it is important for the midwife or doctor to monitor a birth closely at all times," Pancho Hekagery Amilo Kaslam, a clinical training advisor of Maternal & Neonatal Health (MNH), said.

He explained that a woman with narrow hips, often thought incapable of a normal delivery, could give birth normally provided she had no history of polio or accidents that had altered her bones. "There's no need for a caesarean birth just because someone has narrow hips," Pancho said.

Hyre said the most important component of a consultation with a midwife or doctor was the establishment of rapport.

"A woman should be comfortable with whoever will deliver her baby. She should be able to trust that person," she said. She added that the first consultation, between the 12th and 14th weeks of pregnancy, was an opportunity to establish such a relationship.

During the first visit, the doctor or midwife should discuss the woman's preparations for birth, talk about contingency plans in the event of complications, tell her how to detect the early signs of problems, and encourage a healthy lifestyle.

"At this time there are very few other risks the woman might face besides bleeding," Hyre said, adding that a professional should ask the patient about her history of miscarriages.

The second visit should be done sometime before the pregnancy reaches seven months, and the most important thing to watch out for here is hypertension caused by pregnancy.

"Hypertension could indicate signs of pre-eclampsia and the midwife or doctor should be aware of its symptoms," Hyre said.

Pancho said that 45.2 percent of deaths during pregnancy were caused by bleeding, 12.9 percent by eclampsia, 11.1 percent by complications during a miscarriage, 9.6 percent by infection, 6.5 percent by delayed labor, and 1.6 percent by anemia.

"The rest, or 13.1 percent, are the result of indirect causes such as accidents," he added.

When the pregnancy reaches its seven month, the expectant mother should again consult with her doctor or midwife to determine the number of babies she is carrying.

"Before seven months this procedure is not necessary, and at this time it is also important to watch out for complications," Hyre said.

The last consultation should take place when the pregnancy reaches eight or nine months to determine whether the baby is in the right position.

Of course, Hyre said, should there be any complications during one of the check-ups, special attention should be paid. But for 85 percent of all pregnancies, four consultations will do.

"It is not necessary to go to a gynecologist at all during a normal pregnancy -- a midwife is more than capable of handling it."

Things to watch out for during a pregnancy: * Bleeding * Abnormal headaches * Nausea and stomach ache * Baby's movements are unusually infrequent * Fever * Color of ruptured membranes is murky

When these symptoms occur, it is best to quickly consult your doctor or midwife.