An examiner, no lover of females, thrust a femur into her hand.
‘How many of these have you got?’ he demanded.
‘How do you come to that conclusion?’ he asked contemptuously.
‘I have two of my own, the one in my hand, and the two of my unborn child.’ Anonymous anecdote
Pregnancy and childbirth are very important and emotional events in the lives of women and their families. Their care during and after pregnancy is one of the most satisfying aspects of the work of the family doctor, who generally chooses breadth of knowledge rather than depth of knowledge. The changing trend towards specialisation has meant a change of role for the city practitioner and now shared obstetric care is a commonly practised routine. The quality of care that can be given in family practice is often superior to that offered in the hospital antenatal clinic, partly because of the continuing personal care offered by the family doctor.1
Antenatal care presents preventive medicine opportunities par excellence and is the ideal time to develop an optimal therapeutic relationship with the expectant mother. The opportunities for anticipatory guidance should be seized and education about the multitude of possible sensations during pregnancy (such as heartburn, backache, leg cramps, various fears and anxieties) should be addressed. In other words, an optimal communication system should be established between the expectant couple and the health care system.
Early diagnosis of high-risk pregnancy is important but of little value unless followed by normal attendance for antenatal care.
The information presented here is a basis for the shared care strategy where family doctors share basic antenatal care with consultants and have a ready referral strategy for high-risk pregnancies.
The basic aim of antenatal care is to assess the risk of harm to mother and baby and apply the appropriate level of surveillance to minimise or eradicate harmful effects.
Preconception care is to be commended to the woman contemplating pregnancy and her family doctor is well placed to provide general health care and screening as well as genetic counselling.
General advice should include optimal nutrition and diet, weight control, regular exercise and discouragement of smoking, alcohol and drugs. Listeria infection is a problem if contracted, with fetal mortality being 30–50%. Protection is afforded by good personal and food hygiene. For those who ask, advise avoidance of unpasteurised dairy products, soft cheeses, cold meats, raw seafoods, chilled ready-to-eat foods and takeaway foods.
Folic acid (0.5 mg tablets) is now generally recommended to commence about 3 months prior to conception, continuing to 12 weeks postconception. For women at increased risk, such as those on drugs known to increase fetal abnormalities or those with a past or family history of congenital abnormalities and also pre-pregnancy diabetes, the dose is 5 mg/day ...