Antenatal assessment is the systematic evaluation of a pregnant woman and her developing foetus throughout gestation. The primary goal is to monitor maternal well-being, track foetal growth, and detect any deviation from normal physiological parameters early. In Nigerian midwifery practice, every booking visit establishes a baseline of health status, socioeconomic background, and medical history. Subsequent visits build on this baseline, turning routine check-ups into continuous monitoring opportunities. Midwives must approach each encounter with clinical intuition and cultural sensitivity, ensuring that the mother feels safe and heard.
Routine screening tests provide objective biological data that physical examination alone cannot reveal. Midwives coordinate these investigations early in pregnancy and repeat them as indicated by clinical guidelines.
A successful physical examination requires both a comfortable physical environment and psychological preparation. The examination room must guarantee privacy, good lighting, and adequate ventilation. Before beginning abdominal palpation, the midwife must explain every step clearly in a language the woman understands. Ask the woman to empty her bladder; a full bladder displaces the uterus, causes discomfort during palpation, and alters assessment accuracy. Position her comfortably on the couch in a dorsal position with a small pillow under her head, keeping her abdomen adequately exposed while draping her lower limbs to preserve dignity.
Abdominal palpation uses the standard four grips to assess foetal growth, lie, presentation, position, and engagement. Always warm your hands before touching the patient's abdomen to prevent sudden muscle guarding.
Auscultation of the foetal heart confirms foetal life and assesses well-being. This can be done using a Pinard stethoscope from about 24 to 28 weeks gestation or an electronic Doppler device earlier. Place the instrument over the point of maximum intensity, which corresponds to the foetal shoulder depending on the position determined during palpation. Count the beats for a full minute while simultaneously feeling the mother's pulse to ensure you are not accidentally counting maternal circulation. A normal baseline foetal heart rate ranges between 110 and 160 beats per minute.
Accurate record-keeping is a legal and clinical necessity in midwifery. Every finding from palpation and auscultation must be documented immediately in the antenatal card and case notes. Record the symphysis-fundal height in centimeters, which should roughly match the gestational age in weeks after 24 weeks. Document foetal lie (longitudinal, transverse, or oblique), presentation, position, and the exact foetal heart rate. Highlight any abnormal findings—such as reduced growth or abnormal heart rates—clearly and refer the woman promptly according to the facility protocol.
Effective communication builds trust between the pregnant woman and the midwife. Share examination findings in simple, reassuring language, avoiding heavy medical jargon that causes unnecessary anxiety. Use the antenatal visit as an educational platform to discuss danger signs like vaginal bleeding, severe headaches, and reduced foetal movements. Encourage birth preparedness, proper nutrition, and compliance with routine medications like iron and folate supplements. Address cultural beliefs respectfully while guiding mothers toward safe, evidence-based practices.