Antenatal care in Nigeria: what to expect

Pregnancy in Nigeria comes with a lot of advice from a lot of people, and not all of it is helpful. The one source of advice that actually changes outcomes is antenatal care: the regular visits where your blood pressure, your baby's growth, and a handful of tests are checked so that small problems are caught before they become dangerous ones.

This article explains what antenatal care involves, how many visits you should ideally have and when, what tests and treatments are offered, and how to make the system work for you, whether you are paying out of pocket or covered by an HMO.

What antenatal care is for

Antenatal care is not just counting your pregnancy. It is screening. It looks for the conditions that cause the most harm in pregnancy and childbirth, and it is designed to catch them early enough that something can be done. The main ones are high blood pressure and pre-eclampsia, anaemia, infections such as malaria and HIV, diabetes in pregnancy, and problems with the baby's growth or position.

It is also where you get information you can actually use: what to eat, what danger signs mean, how to plan for delivery, and where to go when labour starts.

How many visits you should have

The World Health Organization recommends a minimum of eight antenatal contacts during pregnancy, rather than the four visits that were standard for many years. The first contact should ideally happen before you are 12 weeks pregnant. After that, the recommended schedule is around 20, 26, 30, 34, 36, 38 and 40 weeks.

The reason for the increase is simple. More contacts mean more chances to pick up problems like raised blood pressure or a baby that is not growing well. Studies behind the recommendation found that this schedule is linked to fewer stillbirths and a better experience of care.

In practice, many women in Nigeria do not reach eight visits. Work, distance, transport costs, and clinic waiting times all get in the way. Do not let perfect be the enemy of good: if you can only manage fewer visits, attend the ones you can, and try not to miss the first one, which is the most important. Booking early gives you time to sort out everything else.

Your first visit

The first visit usually takes the longest, because it includes a full history and a set of baseline tests. You can expect to be asked about your previous pregnancies, your periods, any medical conditions, and any medicines you take. Your weight, height, and blood pressure will be recorded.

Common tests at or around the first visit include:

• Blood tests for your blood group and rhesus status, haemoglobin (to check for anaemia), HIV, hepatitis B and C, and syphilis
• A urine test for protein and glucose
• A test for malaria, or malaria prevention started, since malaria in pregnancy is a major cause of anaemia and low birth weight
• Screening for sickle cell and, where relevant, genetic counselling
• An ultrasound scan to confirm dates and check the pregnancy

Depending on the clinic, you may also be offered screening for diabetes in pregnancy, usually with a sugar drink and blood tests, and a repeat test later in pregnancy if you are at higher risk.

Regular checks at each visit

At each contact, the essentials are blood pressure, weight, urine testing, and a check on the baby's growth and heartbeat in the later months. In the second half of pregnancy, your doctor or midwife will feel your tummy to assess the baby's size, position, and the amount of fluid around it.

If your blood pressure is rising, or if protein appears in your urine, that is a signal that needs attention, because it can be the start of pre-eclampsia. Do not be surprised if a raised reading is repeated after you rest, and do not be offended if you are asked to come back sooner or referred on. This is the system working as it should.

Treatments offered routinely

Two treatments are offered widely in Nigerian antenatal care because they prevent serious problems. One is intermittent preventive treatment for malaria, given as tablets at scheduled visits in areas where malaria is common. The other is tetanus vaccination, to protect both you and your newborn from tetanus. Iron and folic acid supplements are also standard, and are given to reduce anaemia and protect against certain birth defects.

If you are offered these, take them as advised. They are among the most useful things antenatal care provides. If a treatment is recommended for a specific condition you have, your doctor will explain it and monitor you.

Making the most of your visits

Write your questions down before you go, because it is easy to forget them in a busy clinic. Ask about anything you do not understand, including the results of your tests. You are entitled to know your own results.

If you are covered by an HMO through your workplace or a family plan, check early which hospitals and which services are covered, and what you need to do to register. If you are paying out of pocket, ask at the first visit for an estimate of the costs of the visits, tests, and delivery, so you can plan rather than be caught out. Some clinics offer a package price for antenatal care and delivery; ask whether that exists.

Ask about the clinic's delivery plan as your pregnancy advances: which hospital to go to, whether they have blood available, whether a caesarean is possible if needed, and how to reach them at night.

Danger signs between visits

Antenatal visits are spaced apart, so most of the responsibility for noticing something wrong between visits rests on you. Any of the following mean you should seek care straight away and not wait for your next appointment:

• Bleeding from the vagina at any stage of pregnancy
• Severe headache, blurred vision, or flashing lights
• Swelling of your face or hands, or sudden swelling of the feet
• Severe pain in your tummy
• Fever, or chills and shivering
• Baby moving less than usual, or not moving, after you have felt regular movements
• Fluid leaking from the vagina
• Convulsions or fitting

These can indicate pre-eclampsia, infection, or another complication, and they are the reason antenatal care exists. Go to a hospital; do not wait for morning or for your next visit.

Next steps

Book your first antenatal visit as soon as you know you are pregnant, ideally before 12 weeks. If you have not registered anywhere yet, a general doctor or a hospital antenatal clinic can start you off. Keep your appointment card safe and bring it to every visit. If you are worried about a symptom between visits, call the clinic or go in rather than waiting. Regular care, booked early, is the single most reliable thing you can do for a safer pregnancy.

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