Proper care during pregnancy is important for both the expectant mother and the unborn baby, but the awareness of antenatal care in some communities may be less than ideal.

The reasons for not getting pregnancy care vary from hesitancy to lack of access, and it can impact the physical and mental health of pregnant women and their babies.

In the sixth episode of Selalu SIGAP, our host Andrea Lee chats with dr. Ardiansjah Dara Sjahruddin, Sp.OG., M.Kes, or dr. Dara, an obstetrician-gynecologist, about the importance of antenatal care and the things you need to know about it.

This episode covers:
   a. What is antenatal care
   b. Why it is important for expectant mothers and their babies
   c. What you need to remember

Pregnancy Care

Antenatal care is a pregnancy examination to ensure the optimal health of an expectant mother and her unborn baby. It should be initiated at the onset of pregnancy to identify any potential risk so that it can be prevented or reduced.

According to dr. Dara, the first examination always includes a check-up with ultrasonography (USG) to ensure that the expectant mother’s uterus contains a gestational sac. A large cavity of fluid surrounding the embryo, it is evident by around day 30 of pregnancy.

A normal pregnancy occurs when an embryo is seen within the gestational sac. But when a fertilized egg grows outside a woman’s uterus, called ectopic pregnancy, it can cause life-threatening loss of blood. This is an example of how antenatal care plays a critical role in preventing any risks to an expectant mother and the baby.

Ideally, an expectant mother should have her pregnancy checked by a doctor once every month to make sure that she and the baby receive the best care possible. But Dr Dara acknowledged that doing so might be a privilege for some people who lack access to such services. For them, he suggested that at least check-ups are done twice in the first trimester, once in the second trimester and once or twice in the third trimester.

Along with a USG examination, antenatal care would also include monitoring the pregnancy progress, identifying any pregnancy complication, providing mothers with vitamin supplementation and discussions about the mother’s medical history and general health.

Doctors will also consult with expectant mothers about the delivery process, ensure their mental wellness and prepare them for taking the baby home.

The Essential Matters

With antenatal check-ups, abnormalities in pregnancy and preventable illnesses can be detected. These include early complications such as hypertension and diabetes in pregnancy that can seriously affect an expectant mother and the baby. Gestational diabetes may increase the risk of high blood pressure for the mother, while the baby may be at risk of excessive birth weight and breathing difficulties.

“Hypertension and diabetes are illnesses that can occur during a pregnancy, even though an expectant mother has no medical history of such illnesses,” said dr. Dara.

“During pregnancy, one might have cravings for sweet foods such as chocolate and ice cream, because those foods provide a feeling of comfort and happiness,” he added. “Pregnant women can go through so many mixed and confusing feelings, and sweet foods can be there as a friend. But too much consumption of sweet foods can lead to diabetes when it is not controlled. And that is one thing that can be prevented with antenatal care.”

For monitoring the fetus’ development in the womb, doctors rely on the use of USG. “With USG, we can minimize any risk of death for the mother and the baby through careful observation,” said dr. Dara.

For example, late in pregnancy a baby might be in a breech position. It is when the baby’s buttocks or feet lie bottom first in the uterus instead of the usual head-first position. With a pregnancy examination, a doctor can provide advice and techniques to move the baby in the uterus. That way, an expectant mother can give birth through a vaginal delivery instead of a cesarean delivery that might pose more risks.

Research showed that having antenatal care visits reduced the probability of neonatal mortality and infant mortality. Antenatal care is critical in improving care of pregnant women, reduce the risk of pregnancy complications and defects, providing accurate nutritional advice and keep track of the fetus’ development.

The Reminders

According to dr. Dara, pregnancy care or examination is crucial to achieve an optimal pregnancy, both for the mother and the baby in the womb.

“The desired output is a healthy baby who is perfectly developed,” he said.

When asked about how some people fear the effect of USG in antenatal care, dr. Dara said that the technique is perfectly safe. By using a high-frequency sound wave, it captures live images from inside the body. There is no radiation involved and it does not pose any danger to the mother or fetus. Moreover, with recent developments USG results can present very detailed images which will immensely help doctors to detect any abnormalities.

dr. Dara also said that in recent years he saw how pregnant women have become more educated due to social media. “We appreciate the YouTubers or Instagram stars and influencers that inform their audience. When expectant mothers come for consultations now, they have a bit of knowledge and they can cross-check the information they received on social media with us,” he said.

Should an expectant mother worry about the cost of antenatal care, he said that there are options ranging from numerous hospitals to community health centers. The latter, for instance, are to be found across Indonesia and provide health care for population on sub-district level.

SDG Academy Indonesia celebrated the graduation of its 33 students through a virtual commencement on July 23, 2021. The graduates were the first batch of students of the SDG Leadership Program, a five-month course which aims to empower local leaders in various sectors in the achievement of Sustainable Development Goals (SDGs).

“Indonesia needs more agents of change for SDGs with creative and innovative solutions to solve the pressing issues that will contribute to the achievement of the SDGs,” SDG Academy Indonesia’s Director J. Ansye Sopacua said. “In addition, the involvement of all SDG stakeholders plays a crucial role.”

A collaborative platform between the United Nations Development Programme (UNDP), the National Development Planning Agency (Bappenas), and the Tanoto Foundation, SDG Academy Indonesia targets all SDG stakeholders that include the government, academia, the private sector, philanthropy, civil society organizations and the media. It features three main programs: the SDG Leadership Certification Program, SDG Mobile Learning and SDG Study Abroad.

The 33 students enrolling in the SDG Leadership Program came from various backgrounds, including civil servants, professionals and academics. With blended learning online courses that featured topics such as governance, leadership and SDG specific issues, the program was completed with a colloquium where students presented projects on Poverty Alleviation and Improving the Quality of Education.

The students then received the title of “SDG Certified Leader”, equipped with complex problem-solving skills and the knowledge of development within the SDG framework.

UNDP Indonesia Resident Representative Norimasa Shimomura stated his appreciation for the graduates. “If the SDGs are about leaving no one behind, through better targeting with stronger synergies and power of innovation, we need to redouble our effort to achieve the SDGs. We have nine years to work on it. This is where the leadership skills you have acquired at SDG Academy Indonesia becomes essential. It is important to continue to demonstrate such a leadership and commitment, and embrace responsibility in the years to come,” he said.

Meanwhile, Deputy Minister for Maritime and Natural Resources Affairs at Ministry of National Development Planning (Bappenas) Arifin Rudiyanto expressed hope that SDG Academy Indonesia can involve more stakeholders in the program, allowing them to learn from each other, to contribute and produce innovations on SDGs.

The second batch of the SDG Leadership Program will begin in August 2021 with topics on Natural Resources Management and Violence Against Women and Children. Thirty-five participants will enroll in the program, selected out of 200 applicants.

Ansye Sopacua emphasized that SDG Academy Indonesia is committed to producing leaders who can accelerate the achievement of the SDGs.

Indonesia is grappling with surging and record high COVID-19 cases amidst a strained healthcare system and oxygen shortage. Will it get better?

Despite having rolled out a nation-wide vaccination campaign, we currently hold the unenviable honor of being one of five countries – others being Brazil, Argentina, India and Columbia – with the highest daily new cases and death toll, and being the epicentre of the pandemic in Southeast Asia. We have to learn quickly and act decisively.

Singapore’s COVID-19 multi-ministry task force outlined what we believe are non-negotiable areas for a nation to confidently exit the pandemic – vaccines, testing, treatment and social responsibility. We believe adding a fifth in the form of collaboration and partnerships will be helpful in accelerating Indonesia’s recovery.

If this multi-prong approach is not already challenging enough for a country of 17,508 islands with an East-West span of 5,100km and which also happens to be the world’s fourth most populous nation, we also have to simultaneously address the immediate challenges while laying new foundations to strengthen our systemic resilience. These five areas are mutually dependent and interconnected, as a deficiency in one can affect the others.

First, vaccines play a life-saving role. We have seen for ourselves how countries with higher vaccination rates have lower hospitalization and mortality rates. With vaccines, the mortal threat of the virus will be significantly blunted.

In addition to having sufficient supply and overcoming logistic barriers, the success of the national-scale vaccination drive largely depends on broader public-private collaboration and an increased awareness and scientific literacy among the population.

In this war on COVID-19, vaccine hesitancy and resistance are unfortunate and unhelpful non-considerations in the urgent process of saving lives and alleviating the strain on our embattled healthcare system. As of early July 2021, only 5.1 percent of Indonesia’s population is fully vaccinated with two doses. Considering the surge of new cases in recent weeks, it is even more urgent for Indonesia now than ever to bolster its vaccination drive.

The country with the highest vaccination rate in the world, Israel has been able to meet the provision of 10.9 million doses of COVID-19 vaccines (covering two doses) for approximately 60.3 percent of its total population. Its Healthy Ministry reported a rapid decline in average daily new cases, which fell to 149 per day by April and nearly zero average daily deaths in June. Even India, once Asia’s COVID-19 epicenter before Indonesia took over, has administered three to four million per day in attempts to dampen the impact of the devastating second wave.

Second, to curb the spread of infection, testing is vital and has to be made readily available and accessible to all. A Jakarta Department of Health serology survey of 5,000 samples suggests that almost half of Jakarta (around 4.7 million residents) has already been infected. A disproportionately inadequate testing capacity will not only slow down diagnosis and treatment but also unnecessarily prolong our battle with COVID-19. Early detection, especially in high-risk segments of the population, will allow for early intervention and containment.

Third, management and treatment. Thanks to the international community and local companies and organizations Indonesia is bringing in oxygen supply and oxygen concentrators to support the management of severe cases. Previously, companies and organizations brought in testing equipment, medical supplies and personal protective equipment to bolster the country’s fight against COVID-19. Moving forward, will we continue to have the means, capacity and infrastructure to treat and every patient effectively and save their lives? How will we plan and prepare for the next emergency?

Fourth, social responsibility is crucial to ensuring our journey out of this pandemic remains measured and steady. We have to recognise that everyone plays an equally important role in the safety and well-being of the wider community. It is therefore socially responsible to get vaccinated if you are not; to get tested if you are unwell; and to seek appropriate treatment to facilitate your recovery.

To a significant extent, scientific literacy underpins social responsibility. We need to be able to discern and better appreciate evidence-based facts and safeguard ourselves against misinformation and fake news. Building up our understanding of the wider benefits of vaccines and testing can help us make better informed decisions for ourselves, our loved ones and the community.

Fifth, an area of great opportunity on which we can further tap is collaboration and partnerships, at both international and national levels. At this point, this unprecedented public health emergency has surely reminded us that our respective differing agenda and pursuits of a healthy life, a productive workforce, a potential-realizing outcome, social mobility, among others, all remain entwined with and contingent on our combined efforts and resolve in effectively containing the virus. The cost of not doing so – lives. Unless we can morally afford to stray from our common purpose against a common enemy, collaboration and partnerships are necessary.

We observe how international community, private philanthropies and non-government organizations have worked closely with the government to broaden and accelerate the vaccination campaign, in addition to strengthening testing and treatment capacities. These are urgent near-term fixes and boosters that also provide a glimpse into how our longer term strategy can systemically normalize and accommodate partnerships to achieve impact at scale. Thanks to the growing number of public-private partnerships, we are witnessing the acceleration of the national vaccination campaign. Beyond Indonesia, global collaboration and partnerships must primarily address inequities in vaccine distribution, especially to developing countries, and should be based on the key values of solidarity, equity, social justice and human rights.

In an information and content saturated age, influencers, celebrities, community and religious leaders have been engaged to share government advisories and evidence-based advice with the broader public. Private organizations too already join in the public health messaging and vaccine advocacy, and in terms of supporting the nation’s rally to get people vaccinated, the mainstream media has and will continue to play an important role. Having the right information and message alone is ineffective; we need to ensure that its reach is far-reaching, calibrated, timely and sustained. With more on board, united under a common purpose of saving lives and keeping our communities safe, we can eventually overcome misinformation and vaccine hesitancy.

If we stayed the course on vaccination, testing, treatment, social responsibility and continuous collaboration and partnerships, we will together chart a more decisive path out of this pandemic and into a new normal. We deal with our complex contexts by sharing a common purpose, fostering our mutual understanding and support for one another, and developing the clarity as we build up and sustain our scientific literacy. There is a lot to learn from the international community and we will also need to have the resolve, commitment and leadership to realize the hopes we have of the brighter days ahead of us. Indonesia will prevail and emerge stronger.

Dr J. Satrijo Tanudjojo is Global CEO of Tanoto Foundation. Tanoto Foundation is an independent philanthropic organization founded by Sukanto Tanoto and Tinah Bingei Tanoto based on the belief that every person should have the opportunity to realize his or her full potential.

Professor Tikki Pangestu is visiting Professor at the Yong Loo Lin School of Medicine, National University of Singapore. Former Director of Research Policy and Cooperation at the World Health Organization.