Antenatal appointments are important in monitoring the health of a pregnant woman and her unborn child. This article discusses what to expect during antenatal appointments, with a focus on the 28 week appointment.
An assessment of maternal physical and emotional wellbeing is a key activity undertaken at the 28 week appointment. This includes a physical examination and accompanying discussion assessing the normality of the woman’s physiological changes – including blood pressure alterations, weight increases, possible variscosities/ oedema/skin pigmentation, rising fatigue levels, vaginal loss, bowel and bladder function, nausea/vomiting, etc. – with comparison to the baseline data recorded at her previous appointments (Grigg, 2009; Viccars, 2009). The midwife should also assess the woman’s current socioemotional state – including her antenatal coping mechanisms and her self-perception, etc. – focusing on the psychosocial priorities identified at her previous appointments (Austin, Priest & Sullivan, 2008; Grigg, 2009). The midwife must also begin assessing the woman’s preparedness for labour and motherhood, providing education where appropriate and encouraging active decision making (Grigg, 2009).
Grigg (2008) recommends that maternal blood pressure is taken seated or lying with a wedge under the left hip – the supine position may result in hypotension and reduced placental perfusion due to the pressure exerted on the maternal aorta by the fetus. To obtain the most accurate measure, wherever possible the mother must be rested and relaxed (Viccars, 2009). Due to the dilatory actions of placental hormones such as progesterone, the majority of women are naturally diastolically hypotensive during the first and second trimesters of pregnancy (Steer et. al, 2004). However, obesity is a significant risk factor in the development of gestational hypertension – consistent systolic readings of above 160mmHg and/or consistent diastolic readings of above 110mmHg (National Institute for Clinical Excellence, 2008).
An assessment of fetal wellbeing should also be undertaken at the 28 week appointment. This includes a physical examination and accompanying discussion assessing the normality of fetal movements, fetal size and position, fetal heart rate, maternal pelvic capacity and amniotic fluid volume (Viccars, 2009). Throughout this process, the midwife should respect the woman’s own expertise in monitoring the wellbeing of her child (Grigg, 2009).
A glucose tolerance test to screen for gestational diabetes mellitus (GDM) should also be conducted at the 28 week appointment (Joanna Briggs Institute, 2010/3). A high BMI and poor diet indicates a woman may be at increased risk for the development of gestational diabetes and associated macrosomia and labour/birth complications (Tieu, Crowther & Middleton, 2011). Glucose challenges should be undertaken at each antenatal visit from 16 weeks onwards to assess a woman’s glucose tolerability and permit the implementation of GDM management strategies as appropriate (Joanna Briggs Institute, 2010/3).
As discussed by Viccars (2009), antenatal appointments are important for the midwife to develop her fundamental role of partnering with a woman as she prepares for her labour and birth – as such, education, discussion and reflection are critical.
Austin, M.P., Priest, S.R. & Sullivan, E.A. (2008). Antenatal psychosocial assessment for reducing perinatal mental health morbidity. Cochrane Database of Systemic Reviews (Online). doi: 10.1002/14651858.CD005124.pub2; Grigg, C. (2009). Working with women in pregnancy. In Pairman, S., Pincombe, J., Thorogood, C. & Tracy, S. (Eds.). Midwifery: preparation for practice. UK: Churchill Livingstone Elsevier; Joanna Briggs Institute (2010/3). Gestational diabetes: screening, diagnosis and management [Evidence based recommended practice]. Retrieved from http://www.joannabriggs.edu.au; National Institute for Clinical Excellence. (2008). Routine antenatal care for healthy pregnant women [Evidence based recommended practice]. Retrieved from http://www.nice.org.uk/nicemedia/pdf/CG062PublicInfo.pdf; Steer, P.J., Little, M.P., Kold-Jensen, T., Chapelle, J. & Elliot, P. (2004). Maternal blood pressure in pregnancy, birth weight and perinatal mortality in the first births: a prospective study. British Medical Journal, 329(7478), 1312-1314. doi: 10.1136/bmj.38258.566262.7C; Tieu, J., Crowther, C.A. & Middleton, P. (2011). Dietary advice in pregnancy for preventing gestational diabetes mellitus. Cochrane Database of Systemic Reviews (Online). doi: 10.1002/14651858.CD006674.pub2; Viccars, A. (2009). Antenatal Care. In Fraser, D.M. & Cooper, M.A. (Eds.). Myles Textbook for Midwives (pp. 263-287). UK: Churchill Livingstone Elsevier.