Rituals in antenatal care. Consider women's psychosocial needs

A qualitative study of women's perspectives of antenatal care in a rural area of Zimbabwe

OBJECTIVE

To describe the perspectives and experiences of women in their use of antenatal care and in their reasoning on specific antenatal care routines.

DESIGN

Two qualitative methods including focus group discussions and individual interviews were combined.

SETTING

: a rural district in Zimbabwe where a randomised control trial had been undertaken to introduce a new antenatal care package.

PARTICIPANTS

Forty-four women and twenty-four men participated in the study.

FINDINGS

Women were observed to take actions contrary to those assumed professionally acceptable in antenatal care generally and in some specific changed routines. Visits were to be reduced and weighing was to be omitted, but women, especially younger women, said they preferred more than the stipulated five goal oriented visits. One reason for this was the importance of being assured that the fetus was growing well. They considered that visits spaced too widely would make it difficult for service providers to help, should complications develop. On the other hand, older women (above 35 years old), a group professionally considered to be at high risk, were not so concerned with the visits. All the women said they wanted to be weighed at all the visits. The antenatal care visits are simply known as 'going for scale'. The health care providers complied by weighing the women without recording. Cultural beliefs had great influence, especially on the time a pregnancy is acknowledged and reported. It is believed that pregnant women and the pregnancy are vulnerable to witchcraft during the early period of pregnancy.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

We concluded that, whether in its traditional or new form, antenatal care ignores the experiences and views of women and the way they make sense of pregnancy and the care of pregnancy. The importance of understanding the perspectives of different stakeholders as the key to effective change is underlined.

A randomised controlled trial comparing two schedules of antenatal visits: the antenatal care project

OBJECTIVE

To compare the clinical and psychological effectiveness of the traditional British antenatal visit schedule (traditional care) with a reduced schedule of visits (new style care) for low risk women, together with maternal and professional satisfaction with care.

DESIGN

Randomised controlled trial.

SETTING

Places in south east London providing antenatal care for women receiving shared care and planning to deliver in one of three hospitals or at home.

SUBJECT

2794 women at low risk fulfilling the trial's inclusion criteria between June 1993 and July 1994.

MAIN OUTCOME MEASURES

Measures of fetal and maternal morbidity, health service use, psychosocial outcomes, and maternal and professional satisfaction.

RESULTS

Pregnant women allocated to new style care had fewer day admissions (0.8 v 1.0; P=0.002) and ultrasound scans (1.6 v 1.7; P=0.003) and were less often suspected of carrying fetuses that were small for gestational age (odds ratio 0.73; 95% confidence interval 0.54 to 0.99). They also had some poorer psychosocial outcomes; for example, they were more worried about fetal wellbeing antenatally and coping with the baby postnatally, and they had more negative attitudes to their babies, both in pregnancy and postnatally. These women were also more dissatisfied with the number of visits they received (odds ratio 2.50; 2.00 to 3.11).

CONCLUSIONS

Patterns of antenatal care involving fewer routine visits for women at low risk may lead to reduced psychosocial effectiveness and dissatisfaction with frequency of visits. The number of antenatal day admissions and ultrasound scans performed may also be reduced. For the variables reported, the visit schedules studied are similar in their clinical effectiveness. Uncertainty remains as to the clinical effectiveness of reduced visit schedules for rare pregnancy problems.