Antenatal care in Nigeria

Announcement of conception is often a thing of joy in many households. It is then followed by preparations and planning, as though awaiting the arrival of the president of a nation.

Booking for antenatal care (ANC) is one of the most important preparatory processes for an expectant mother.

After you’ve confirmed that you’re pregnant, you then have to decide on where you want to receive antenatal care and when you will go for the booking.  Most women will ask their friends or coworkers for recommendations.

Where to register for antenatal care in Nigeria

 You have many options, ranging from primary healthcare centres, general hospitals, private hospitals to teaching hospitals. Your choice of a health centre may be based on proximity to your home or work place, recommendation from friends, family, or from other experienced mothers, cost (affordability), aesthetics of the hospital environment, and relationship with a healthcare worker in the hospital or health centre.

Some people prefer to go and check out the health centres close to their homes or place of work before they decide on the best. Whatever route you decide to take in arriving at the decision, there are important things you should consider to ensure your safety and that of your unborn baby(ies).

antenatal care in nigeria

Here are 5 important things you should look out for in choosing a hospital or health centre for antenatal care in Nigeria

1. There is a medical doctor preferably resident in the hospital.

An obstetrician is a medical doctor who has had further training in care of pregnant women. He/she is a specialist in pregnancy care.

In some health centres, you only get to see the midwife from booking to delivery if the pregnancy goes smoothly without any concurrent illness or complications. However, it is safer to be in a health centre that has an obstetrician for specialised care, just in case of unexpected events in pregnancy or during delivery.

2. The hospital has facilities and the expertise to carry out blood tests and ultrasound scans, as and when needed. In addition, it has a functioning blood bank in the event that you lose a lot of blood and need an urgent transfusion to save your life or that of your baby.

3. The hospital is equipped to handle obstetric emergencies. This is in terms of equipment such as a standby power generating set (because of our peculiar power situation in Nigeria) and manpower; healthcare practitioners that are available on ground.

4. Has facilities to resuscitate a newborn in the labour room or operating theatre.

5. There is a Paediatrician to check on a baby immediately after it’s born with a functional neonatal ICU or at least an affiliation with a nearby hospital that accepts babies in need of intensive care.

When you should register for ante-natal care

The World Health Organisation (WHO) recommends that women have their first  contact with a healthcare facility within the 1st trimester and to book their pregnancies before the 17th week of gestation. This is approximately when you are 4 months gone. ANC registration in most government owned hospitals in Nigeria commence from about 4 months of pregnancy, although you will still be booked if you present as late as the 8th month of pregnancy. There are conditions in which a pregnancy is considered “as high-risk”. In these special cases, you should see your doctor and register as soon as you find out that you’re pregnant. Special cases include

  1. A woman who has had recurrent miscarriages within the 1st 3 months of pregnancy
  2. A woman that has been trying to conceive for years
  3. A woman who has a chronic medical condition such as diabetes mellitus, sickle cell disease, hypertension.
  4. A woman that has lost a newborn baby at term or suffered intrauterine foetal death in the past.
  5. A woman that had pre-eclampsia, eclampsia or gestational diabetes mellitus in a previous pregnancy .
  6. An in-vitro fertilisation (IVF) conceived pregnancy particularly twin, triplet, quadruplet e.t.c. gestation
  7. A woman who has had a child born with a malformed body system(s) in the past.

These cases need close monitoring and early booking to avoid pregnancy loss, worsening of the health condition and or complications that may result in disability or death of the expectant mother. In addition, early booking helps to detect problems which were hitherto unknown, early enough for appropriate management to preserve the lives of both the mother and baby.

Cost of booking antenatal care in Nigeria

Antenatal care in Nigeria costs money in most cases. Even though some states offer free antenatal care to expectant mothers, the state bears the cost.

The cost of antenatal care depends on the hospital and health insurance coverage. The cost is subsidised by the government, hence it is more affordable in government-owned healthcare centres and maternity homes. Prices for antenatal care booking range from a few thousands of naira to hundreds of thousands in private hospitals.

If your workplace (or that of your husband) offers health insurance coverage, this may cover 50 to 100 percent of the cost of antenatal care. You may also get personal health insurance coverage if your workplace does not offer one. Ensure you get a package that covers antenatal care, delivery and postnatal care,if you plan to get pregnant.

Antenatal booking price does not cover delivery costs. Delivery cost varies based on the mode of delivery: vaginal delivery or Caesarean section. It’s imperative that you bear this in mind when booking for antenatal care. Access antenatal care at a health centre where you can afford the delivery fee. Also set funds aside, just in case you need to make additional payment for an emergency C-section.

What to expect during Antenatal booking

When you go for the booking visit, you will see your midwife first, who will check your weight, height, blood pressure and pulse.Then your doctor will see you, ask some questions which will help to determine how often you should be seen and if there is a need for additional tests and drugs. On the average, you should have about 8 antenatal visits from time of booking.In addition to your booking or registration visit, your subsequent contacts should be at your 20th, 26th, 30th, 34th, 36th, 38th and 40th week of pregnancy. Your doctor or nurse will give you an appointment for the next antenatal visit.

You will then go for blood and urine tests as well as ultrasound scan. Blood tests that would be done are packed cell volume (PCV), haemoglobin genotype, blood group, hepatitis B and C,VDRL (syphilis) and HIV. You will be required to pass urine in a small bottle for tests. You need some urine in your bladder before your ultrasound, so you should wait to pass urine after the ultrasound scan.

In most secondary and tertiary health centres, you would be required to get someone to donate two pints of blood for you,to be kept in the blood bank before your due date. You might end up not needing this ,but it’s a contingency plan.

The main reason you have to book for antenatal care is that this is a period in which problems are detected early if present. For instance, hepatitis B infection and HIV may be detected for the first time during antenatal care. When these are detected before delivery, the expectant mother can start medications that will reduce the chances of her transmitting the infection to her unborn baby. Early detection of HIV for instance , would give the expectant mother enough time to decide on the mode of delivery and the most convenient feeding method for the baby. In addition, you are guided on how to prepare for childbirth and motherhood.

Antenatal drugs

During your antenatal visits, you will get 1 to 3 doses of tetanus toxoid injection (The 1st 2 doses are given 4 weeks apart, while the 3rd dose is given after 6 months. Therefore, the number of doses you get will depend on time of booking).

You will also get one or two doses of malaria medicine (intermittent preventive therapy) even if you don’t have malaria. This is to avoid malaria in pregnancy, for it may be fatal for you and your baby.

Ideally, you should start taking folic acid once you start planning to get pregnant. However, you can start when you book for antenatal. Folic acid helps prevent malformation of the brain and spinal cord, it also helps to increase your red blood cell levels (PCV). Iron tablets or syrup aid in building your blood levels as well as prevent preterm delivery, low birth weight and anaemia.

Preparing for labour and postnatal period

Antenatal care period is a time of preparation for labour and post-natal care. The midwives and nurses will teach you the signs of labour, how to monitor your contractions, when you should come to the hospital, and what you should have in your delivery bag. This is the time you get to know the location of the labour ward in the hospital, particularly if it’s a big one, so that you’ll know where to go when you’re in labour.

This is also when you get your permission letter or maternity leave letter to take to your work place before delivery. This is planned based on your estimated date of delivery (EDD). You need to know your last menstrual period in order to accurately calculate your EDD. However, an ultrasound scan in the 1st 3-4 months of pregnancy (before the 24th week) will give a fairly accurate EDD. 

Civil servants in Nigeria are entitled to paid maternity leave for 4 months :1 month before delivery and 3 months after. The maternity leave in private establishments varies between 1 and 4 months. Ask your company human resource manager and plan towards it so you can have time with the newborn and to recuperate before resumption.

In summary, ANC is imperative, even if you’ve had other pregnancies that ended in vaginal delivery without any complications. Every pregnancy is different, even in the same woman. Complications can arise at any time in the pregnancy, and up to the 6th week after delivery. You can’t be too careful. If you’re ever in doubt, see your midwife or doctor.

About the author

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Doctor

Grace is an internist currently practising in Nigeria. She has gained experience practising both in the private and public health sectors over the last ten years. She is passionate about giving patients adequate information about their health conditions. She believes that a large part of the management of chronic diseases lies with patients' understanding of their illnesses and the need for lifestyle modifications and medications.