A Medical View

Abstract

For more than 50 years obstetricians have given a lead in demonstrating their concern for prevention by stressing the importance of good antenatal care. A primary objective of these antenatal programmes has been to achieve an optimal level of maternal and infant health, by early identification of any complications such as toxaemia or fetal growth retardation, and to anticipate potential problems associated with the delivery itself. However, these clinical objectives were not originally seen as the only—or even the main—reason for developing universal antenatal care. The obstetrician Ballantyne, who did so much to develop the concept of antenatal surveillance at the turn of the century, always taught that ‘the first objective of those caring for pregnant and childbearing women is the removal of anxiety and dread’. The removal of such anxiety depends on providing knowledge and information to counter the fear of the unknown, and on building up a sense of shared commitment and trust between the provider and the receiver of care without which childbirth would remain a very lonely ordeal. How far we have progressed along the road to achieving this ideal is a question we would do well to consider. Pregnancy is undoubtedly safer than it was 50 years ago, but we should not lightly assume that the fear of pregnancy and childbirth has fallen to a comparable degree.