id that there are no any problems with this current pregnancy as per issues to do with sex.

She reported they still were having sex with the husband at this gestation age and were planning to stop when the pregnancy reaches 8 months. NUTRITION ! "ISTOR# ccording to $rs. N%hata&s dietary call o' the day be'ore coming to the clinic () th *ebruary+ ,-../+ it seems that the N%hata&s 'amily manages a diet which is well mixed with all the re0uired six 'ood groups on daily basis. She also proved to be %nowledgeable o' the six 'ood groups by mentioning all o' them with examples. $rs. N%hata also reported no history o' pica towards non 'ood items with both her pregnancies. "owever+ she said that the pregnancy has made her li%e some o' the 'oods she never li%ed li%e 'resh 'ish. $rs. N%hata said that she does not eat por% based on religious ground as she is a $uslim but said that her culture does not restrict her 'rom eating ant 'ood. She explained that she has enough 'ood in her house that is enough 'or her 'amily all the times. She has good preparation and storage methods o' 'ood with some good storage principles li%e no relish remains to be used the next day+ they only prepare enough 'ood 'or the day.

1 ST O2ST3TRI4 ! "ISTOR# $rs. N5hata is 1ara . with 'irst delivery in ,--, and she was ,, years by then. 2R3 56O7N The 'irst pregnancy way term with 8- wee%s gestation by 'undal height. The baby was delivered at Ndirande "ealth 4entre and she delivered by Spontaneous 9ertex 6elivery but sustained a tear which was sutured and healed without any complications. The baby was :8--g at birth and was born without any congenital nor during birth complication. !abour had ta%en about .8 hours thus 'rom ; pm to <am. $rs. N%hata has no history o' ante=partum or intra=partum haemorrhage as well as 1re=eclampsia or eclampsia.

1S#4"O!O>I4 ! "ISTOR# $rs. N%hata said that the pregnancy that she has now was a planned one and also that the decision to have the pregnancy was made by both her and her husband such that they both were very happy 'or the pregnancy. She also said that she did not have any psychological problems due to both previous pregnancy as well as the current one except 'or the 'ear o' labour pains. I$$UNIS TIONS $rs. N5hata explained that she had received two doss o' Tetanus Toxoid 9accine with the 'irst pregnancy and two doses with the current pregnancy. "owever+ she expressed lac% o' %nowledge on the 're0uency and number o' doses o' tetanus Toxoid 9accine she is expected to receive despite %nowing the importance o' the immuni?ations. 3N9IRON$3NT ! "ISTOR# On environmental history+ $rs. N5hata said that she has a two bedroom house with a seat room which is occupied by three members o' thee 'amily+ the husband+ the 'irst born child and hersel'. The house is iron sheet roo'ed+ cement 'loored and electri'ied. She said that she gets water 'rom a 4ommunal 7ater 1oint which is about @- metres 'rom her house but she ma%es sure she has enough water all the time by %eeping some in buc%ets %nowing that there is a problem o' water scarcity in her area at times. On waste disposal+ she said that there is a rubbish pit behind the house which is used 'or waste disposal and she %eeps burning the waste in the pit to prevent it 'rom being blown bac% to the house by wind when it&s 'ull. SO4IO=34ONO$I4 "ISTOR# $rs. N%hata is a *orm 'our !eaver currently wor%ing with 5U5U $atches 4ompany as a 1ac%er. "er husband is an electrician who is sel' employed. She said that her 'amily is

able to get their needs and necessities 'rom the combined income that they get 'rom their duties and they live happily. $rs. N%hata reported no exposure to increased wor%load 'or she is currently given light wor% by her bosses having understood her condition. $rs. N%hata does not smo%e any %ind o' cigar nor drin%s any %ind o' alcohol although the husband ta%es alcohol but in a reasonable manner. 1R3S3NT O2ST3TRI4 "ISTOR# $rs. N%hata is gravida , 1ara . mother !ast normal menstrual period A 3xpected date o' delivery A >estation by dates "I9 Status 96R! A A A .@th Buly+ ,-.,,nd pril+ ,-.. :- wee%s+ days Non=reactive Non=reactive

She is currently not on any medications except 'or the *errous Sulphate she is given when se visits antenatal clinic meant to help in the 'ormulation o' haemoglobin. 3!I$IN TION $rs. N%hata has no any problem with either bowel movement or urination. "owever+ she said that she had in the early days o' pregnancy a problem o' 're0uency micturation.

O2B34TI93 6 T Vital Signs Temperature A :).;C4

2lood 1ressure 1ulse Rate Respiration Rate

A A A

.,-D;-mm"g ;- beats peer minute ,, breaths per minute

>3N3R ! 1133 R N43 $rs N%hata is a .), cm tall woman+ slim and light brown in complexion. She was wearing a red blouse and a blac% s%irt with a pair o' blac% slip=ons (shoes/. On this day she weighed @8 %ilograms+ gaining , %ilograms 'rom the weight during her boo%ing visit which was @) %ilograms. "3 6 "er head is ovoid in shape with long chemical made hair and there was neither dandru'' nor presence o' scars or masses on the scalp. * 43 There were no signs o' 'acial oedema on both inspection and palpation. The 'ace also did not have scars on inspection. 3#3S The eyes are symmetrical and ovoid in shape with no signs o' peri=orbital oedema and had a pin% conEunctiva. 3 RS The ears are symmetrical with the upper ears in line with the outer borders o' the eyes. There were no sore+ no ear discharge+ no lesions and no signs o' in'lammation on palpating the pre and post auricular lymph nodes. NOS3 "er nostrils are symmetrical with no any discharge. She has no history o' epistaxis and did not have any polyps in the nostrils.

$OUT" "er lips were smooth with no sores or crac%s. "er tongue and oral mucosa were pin% with no sore+ no %orpli%s spots or signs o' candidiasis. There were neither decayed teeth nor gingivitis. She has neither cle't lip nor cle't palate. The tonsilor+ sub= mandibular and sub mental lymph nodes were not enlarged. N345 She has no problems with nec% 'lexion as well as 'orward and bac%ward nec% bending. On inspection+ there were no obvious signs o' distended Eugular veins+ no sores+ no obvious lesions. On palpation+ there were neither signs o' enlarged thyroid gland nor enlarged deep cervical+ sub=clavicle and in'ra =clavicle lymph nodes. 4"3ST On inspection+ the chest did not have scars+ lesions or signs o' a pigeon chest with normal respiratory movements. On auscultation+ there were normal lung and heart sounds. 2R3 STS The breasts are symmetrical in both si?e and shape and they both are light brown in colour with dar% alleorae. The breasts have no scars+ scales+ lesions+ no sores+ rashes+ redness and no dimpling. On breast palpation+ no masses were 'elt except 'or the normal mammary gland. The nipples are dar% in colour+ clean and not inverted. U113R 3FTR3$ITI3S The arms are symmetrical with no signs o' oedema on both inspection and palpation. She has a capillary re'ill o' less than : seconds and has pin% palms. "owever+ $rs. N%hata reported having tingling sensation o' the upper extremities. 26O$3N On inspection o' the abdomen+ there was a dar% linea nigra+ some striae gravidalum with no sores or scars. The abdomen was ovoid in shape with a medium si?e. *oetal

movements were also observed medially on inspection. !iver and spleen were not palpable indicating absence o' organomegally. The calculated gestation by dates was :- wee%s and Fundal height Pelvic, Lateral and Fundal Palpation *undal height *oetal 1resentation A *oetal !ie *oetal 1osition *oetal "eart Rate A A A A ,< wee%s

4ephalic !ongitudinal Right Occipital nterior .8, beats per minute

!O73R 3FTR3$ITI3S The lower extremities are symmetrical with no scars+ varicose veins as well as signs o' oedema on inspection. On palpation+ no tibial+ an%le or pedal oedema was detected. No signs o' 9aricose 9eins or 6eep 9ein Thrombosis were detected on palpation o' the cu'' muscles. Howmans sign was not observed on 'lexion on the 'eet. >3NIT !I Upon inspection o' the genitalia+ no oedema+ sores+ warts+ genital ulcers+ abnormal vaginal discharge or signs o' hematoma were observed. There were no signs o' varicose veins or genital mutilation or circumcision seen. The vaginal discharge was mild+ whitish and odourless.

1RO2!3$S DN336S I63NTI*I36. 5nowledge de'icit on sexuality during intra and post partum periods related to inability set times on when to stop and resume sex.

!ac% o' ade0uate in'ormation on immunisations related to limited in'ormation given on immunisations as evidenced by inability to outline the normal schedule 'or Tetanus Toxoid 9accine. 5nowledge de'icit on *ocussed ntenatal 4are and its importance related to limited in'ormation given about 'ocussed antenatal care as evidenced by late coming 'or initial visit. 1ossibily o' not using 'amily planning methods related to untrue speculations that 6epo= 1rovera is phasing out.

4 R3 1RO9I636 *ocus ntenatal 4are loo%s at comprehensive care given to a pregnant woman with speci'ied type o' care per each visit o' the 'our expected visits that the woman attends antenatal clinic. It loo%s at 0uality o' care and not 0uantity o' the number o' visits. *ocused ntenatal 4are emphasises on treating every mother as an individual or uni0ue person with individual problems and needs. The care that was given to $rs. N%hata was based on the problems and needs that she had as well as speci'ic care according to hergestation age. On this day+ $rs. N%hata was treated comprehensively starting with history ta%ing to 'ill in gaps 'ollowed by "I9 and Syphilis tests then 'ull physical assessment which involved using all the 'our modalities o' inspection+ palpation+ auscultation and percussion. I made sure that the client&s care was provided in a very conducive environment+ thus ensuring privacy as well as cleanliness. I made sure that she 'elt well ta%en care o' and welcome to the clinic by being respect'ul+ accommodative and letting her as% 0uestions and express 'ears than loo%ing at the care as a burden throughout the procedures. 3N9IRON$3NT

6uring the 'illing in o' gaps+ collection o' important in'ormation that was missed out on the boo%ing day+ an environment that ensured privacy and com'ort was ensured. The data was collected at an enclosed place where no one else could listen to what was being discussed and this made the client to be more open and to give the in'ormation that was re0uired. !i%ewise+ during the physical examination+ a cubical was used to promote privacy considering that procedures involved this time include exposure o' sensitive areas li%e the chest+ abdomen and genitalia. *I!!IN> IN O* > 1S Upon review o' the ntenatal cardDpage 'or $rs. N%hata several areas that re0uired to be 'illed in were realised. In addition to that+ some more areas in the health passport were identi'ied which also needed 'illing in. The health did not have in'ormation on her 'amily medical history and her medical and surgical history which is supposed to be 'illed o the 'irst and second pages o' the health passport and this is also where some important personal data is documented. See ppendix...... showing the pages a'ter 'illing in. Not only that but also blood group and rhesus 'actor were not tested but still more being an important in'ormation especially when it comes to emergencies li%e anaemia+ I still re'erred her go also go 'or the tests when she goes 'or the other tests. On the antenatal page as well+ gravidity and parity o' the mother were not indicated during the 'irst visit but got documented on this visit. TESTS *ocused ntenatal recommends mothers undergoing several di''erent tests at di''erent visits and di''erent gestation ages. Such tests are li%e "I9+ Syphilis+ haemoglobin level+ urine protein and 468 count in case o' those who are "I9 positive but not on antiretroviral therapy.

"I9+ 96R! and "aemoglobin level are the tests that are expected to be done on boo%ing so as to have a baseline data 'or some o' them li%e "I9 and haemoglobin are tested again a'ter sometime i.e. "I9 is tested again a'ter : months while haemoglobin level is retested at :) wee%s. Urine protein is expected to be tested every visit 'rom 'irst to 'ourth visit but un'ortunately none o' these were done on the 'irst visit On this visit I played a role o' helping $rs. N%hata get tested 'or "I9 and Syphilis whose results came out negative as indicated on the antenatal card ( ppendix...../ a'ter 'illing in the gaps. "owever+ I re'erred the client to Gueen 3li?abeth 4entral "ospital 'or the tests which could not be done at Ndirande ntenatal 4linic due to lac% o' materials li%e the haemacue %its and protein dipstic%s. The re'erral was done a'ter Ndirande "ealth 4entre also reported not having the materials 1"#SI4 ! 3F $IN TION s indicated in thee obEective data+ during physical assessment+ no speci'ic problems were presented or detected 'rom $rs. N%hata and all the 'indings were documented on the antenatal card and were also communicated to the client. See ppendix...... showing the antenatal card with 'indings o' the abdominal assessment. $36I4 TIONS $ost o' medications at the ntenatal 4linic are given according to gestation ages o' the mothers and most o' them are given 'or prophylactic purposes i.e. S1 is given to prevent a mother 'rom malaria+ *errous Sulphate is given to prevent anaemia whilst benda?ole is given to combat worms in'estation. S1 is given every 'our wee%s between the gestations o' .) to :) wee%sH *errous Sulphate is given at every visit throughout pregnancy whilst benda?ole is given Eust once and at 'irst visit. S1 is given in such a way to prevent the tetratonegic e''ects that the sulphur may have on the 'oetus. On this visit+ $rs. N%hata+ having the gestation age o' :- wee%s+ she was given both S1 tablets (:/ as well as *errous Sulphate (:- tablets/. S1 was given a'ter con'irming that 8 wee%s had passed since the last dose was ta%en.

$I67I*3R# 4 R3

N !#SIS O* 4 R3 lot o' things and care were done during $rs. N%hata&s boo%ing antenatal visit. I should sincerely give credit to the care provider who handled $rs. N%hata on the 'irst visit 'or the good Eob 'or most things expected to be done on boo%ing especially data needed to be 'illed on the antenatal card was 'illed. "owever+ not every bit o' in'ormation was collected and documentedH 'or example+ no in'ormation was documented indicating gravidity and parity on the antenatal card. This in'ormation is very important to every midwi'e who would come into contact with the client 'or it gives a picture o' the %ind o' client one is dealing with i.e. prim=gravida+ multigravida or grand multipara. These also determine the %ind o' care that a client will get. Secondly+ the data documented on the antenatal card 'or abdominal assessment seem to have been ta%en 'or granted by the care provider during the previous visit. "aving been given the date 'or the last normal menstrual period+ there was no reason heDshe could not calculate the gestation by dates 'or this day %nowing its importance. The calculated gestation by dates is very important to a midwi'e 'or it gives a base comparison with the 'undal height done by tape measure or 'inger breadths. It also seems that the midwi'e who cared 'or $rs. N%hata during the 'irst visit does not %now what it means when we say presentation by abdominal assessment 'or sheDhe indicated that it was a vertex presentation o' which vertex can not be determined by pelvic palpation but vaginally. SheDhe would rather indicate cephalic 'or presentation and a position i.e. Right Occipital nterior+ !e't Occipital nterior or other positions. 2lood 1ressure is on o' the important vital signs in pregnant women and un'ortunately+ it was not done on the boo%ing day. #es its true there could be no a sphygmomanometer but still more a re'erral to Ndirande only 'or a blood pressure chec% would be help'ul. 1regnant women are at a ris% o' developing pre=eclampsia which is high blood pressure in pregnancy and can only be diagnosed i' blood pressure i' chec%ed at every visit.

Urine protein test is also vital in the way that presence o' protein in urine is indicative o' pre=eclampsia $rs. N%hata had come 'or boo%ing at a gestation age o' ,) wee%s by 'undal height and this clearly shows lac% o' %nowledge on 'ocused antenatal care as well as its importance. $rs. N%hata being a 1ara one with birth o' 'irst born in ,--; when 'ocused antenatal was already under implementation+ it was expected she must have already been exposed to such type o' care. Un'ortunately+ the mother came at ,) wee%s gestation 'ollowing the old routine antenatal system. 7hen i as%ed her+ she said coming at ,- wee%s and above was what she %new. This mother lac%ed in'ormation on 'ocused antenatal and its importance which re'lects that she was not given enough in'ormation about it during her 'irst pregnancy. 3F134T36 *IN6IN>S *OR T"3 N3FT 9ISIT $rs. N%hata had come 'or her second antenatal visit at a gestation age o' ,< wee%s+ however+ according to 'ocused antenatal+ by this time she was supposed to becoming 'or her third visit which is supposed to bee between ,8 wee%s and :, wee%s. In this case $rs. N%hata will have her third and 'inal normal visit at :) wee%s though at this time a mother is normally expected to be coming 'or a 'ourth visit. 7hen $rs. N%hata comes at :) wee%s which would be on .............+ she will undergo several assessments some that are routine li%e vitals signs whilst some will base on her condition as being in third trimester or having a :) wee%s gestation. Some o' thee care will also base o' the gaps that the midwi'e will identi'y as being le't out during the previous visit. On the next visit the midwi'e will have to chec% on the care given on the previous visit+ evaluate and then have a basing 'or planning hisDher care and this will also depend on the current problems and the unmet needs o' the client. The midwi'e will collect some in'ormation 'rom the client to 'ill in the gaps that are not 'illed during this visit. She will also chec% on the progress o' pregnancy by as%ing $rs. N%hata on how she 'airing with her pregnancy. Some o' the 0uestions she may as% are the presence o' 'oetal movements and minor disorders o' pregnancy 'or this will help the midwi'e to isolate the problems that the client has at present.

$rs. N%hata will also have to undergo several tests which will be due by this time i.e. haemoglobin level and urine protein. "aemoglobin level is chec%ed on boo%ing and in third trimester+ at :) wee%s to be speci'ic whilst 'or urine protein is chec%ed at every visit to the antenatal clinic. 9ital signs are another aspect that will have to be chec%ed by the midwi'e as part o' monitoring progress o' pregnancy. ny abnormality in the vital signs is indicative o' a problem in the pregnant woman. *or exampleH high blood pressure could be indicative o' pre=eclampsia+ 'ever could indicate a systemic in'ection and increased respiratory rate could mean di''iculty breathing+ though+ it is thought to be normal at :) wee%s. 1hysical assessment will also be done including general assessment as well as abdominal assessment. >eneral assessment will involve a head to assessment and no abnormality is expected 'rom it. The abdominal assessment will involve inspection+ palpation and auscultation o' the abdomen to chec% si?e and shape o' abdomen+ 'undal height+ lie+ presentation and position o' 'oetus as well as 'oetal heart rate. The abdomen is inspected 'or scars+ linea nigra+ striae gravidalum+ si?e and shape+ 'oetal movements+ bladder 'ullness and visible organomegally. Thee 'undal height will be measured using a tape measure o' 'inger breadths so as to determine the age o' pregnancy. Then the pelvis will be palpated 'or presentation which is normally+ lateral palpation will be done to note the lie and position o' the 'oetus. *undal palpation will also be done to rule out multiple gestation or presentation in a situation where the head is not located in the pelvic. *oetal heart rate will also have to bee auscultated using a 'etalscope to con'irm wellbeing o' the 'oetus.

3F134T336 *IN6IN>S *undal height *oetal 1resentation A A :) wee%s

4ephalic

*oetal !ie *oetal 1osition *oetal "eart Rate

A A A

!ongitudinal Right Occipital nteriorD!e't Occipital nterior .8- I .)- beats per minute

The above expected 'indings are thee normal expected 'inding in the absence o' possibility o' having abnormal 'indings 6RU>S On this visit $rs. N%hata will only be provided with *errous Sulphate as a drug to supplement iron 'or haemoglobin 'ormation. S1 will not be given because it is believed to have a teratonic e''ect on the 'etus when given at the gestation o' :) wee%s and above. 3F134T36 6ISOR63RS 2y this time the expected disorders that $rs. N%hata may have are di''iculty breathing+ 're0uent micturation+ headache+ constipation+ bac%ache+ oedema varicosities+ haemorrhoids and cramps 'or these are the common disorders that usually come in third trimester. MANAGEMENT OF THE E PE!TE" M#N#$ "#SO$"E$S HEA$T%&$N This is a burning+ irritating sensation in the oesophagus also %nown as gastric re'lux (*raser+ 4ooper and Nolte+ ,--)/. >astric re'lux commonly occurs as a result o' delayed gastric emptying+ decreased intestinal motility+ and decreased lower oesophageal sphincter tone. I' it happens that $rs. N%hata develops heartburn+ education and counseling on li'est(le
)odi'ication will be provided and will include awareness o' posture i.e. $aintaining upright positions (especially a'ter meals/+ sleeping in a propped up position and dietar( )odi'ications (e.g. small 're0uent meals+ eating slowly+ reduction o' high='at 'oods and ca''eine/.

S*ELL#NG+E"EMA

s the growing uterus puts pressure on the veins that return blood 'rom 'eet and legs+ swollen 'eet and an%les may become an issue. t the same time+ swelling in legs+ arms or hands may place pressure on nerves+ causing tingling or numbness. *luid retention and dilated blood vessels may leave the 'ace and eyelids pu''y+ especially in the morning. To reduce swelling+ the client will be advised to use cold compresses on the a''ected areas. !ying down or using a 'ootrest may relieve an%le swelling. She might even elevate her 'eet and legs while she sleeps which will also minimise the swelling by gravity. ",SPNEA This is a common symptom between the gestation o' :8 and :) wee%s. It is as a result o' the pressure by the growing uterus on the diaphragm (*raser+ 4ooper and Nolte+ ,--)/. I' $rs. N%hata happens to develop dyspnoea+ she will be educated o' the physiology o' the problem 'or her to understand what&s happening. She will also be advised on sleeping in semi='owlers position so as to be increasing the area 'or lung expansion hence improved respiratory condition. She will also be encouraged to have periods and resting to reduce the body need 'or oxygen. !ONST#PAT#ON 4onstipation in pregnancy especially third trimester is usually caused by reduced motility o' large intestine which comes due to the muscle laxative e''ect o' the hormone progesterone which is produced in large amounts this period+ Increased water re= absorption 'rom large intestine due to hormone aldosterone e''ect+ 1ressure on the pelvic colon by the pregnant uterus and sedentary li'e during pregnancy . i' the client will come with the problem o' constipation+ she will advised on drin%ing plenty o' 'luids+ high 'ibre 'oods and get plenty o' exercise. These help in so'tening the bowels hence reduced ris% o' constipation. %A!-A!HE

6uring pregnancy+ ligaments become so'ter and stretch to prepare 'or labour. This can put a strain on the Eoints o' the lower bac% and pelvis+ which can result in bac%ache. To overcome this problem $rs. N%hata will be advised to avoid heavy li'ting+ bend her %nees and %eep her bac% straight when li'ting or pic%ing up things 'rom the ground+ move her 'eet when turning and avoid sudden twisting movements+ 7or% at a sur'ace high enough to prevent her 'rom stooping and to sit with her bac% straight and well= supported. nother advice will be that she should ma%e sure she gets enough rest+ particularly later in pregnancy.

F$E.&ENT M#!T&$AT#ON s the baby moves deeper into your pelvis towards term o' pregnancy+ a woman 'eel more pressure on your bladder and may 'ind hersel' urinating more o'ten+ even during the night. This extra pressure may also cause her to lea% urine J especially when she laughs+ coughs or snee?es. In this case the client will Eust have to be assured that this is normal with a good explanation o' the cause. She will also have to be advised on perineal care to prevent ascending in'ections. !$AMPS 4ramp is a sudden+ sharp pain+ usually in cal' muscles or 'eet. It is most common at night+ but nobody really %nows what causes it. The woman will be oriented to s%ills she will have practice to combat the problem 'or exampleH pulling up o' toes hard up towards the an%le+ or rub the muscle hard. >entle exercise in pregnancy+ particularly an%le and leg movements+ which can improve blood circulation and may help to prevent cramp occurring and plenty o' calcium rich 'oods (lea'y green vegetables+ dairy products+ sun'lower seeds+ salmon and dried beans/ and magnesium rich 'oods (nuts+ dates and 'igs+ yellow corn+ green vegetables and apples/ in her diet. FEA$ s the pregnancy draws near term most women become a'raid o' the labour pains+ 'ears about childbirth may become more persistent. "ow much will it hurtK "ow long will

it lastK "ow will they copeK I' $rs. N%hata happens to come with such a problem+ she will be advised on the importance o' hospital delivery where pain relie' mechanisms are available. She will also be as%ed to have time with other women who have had positive experience o' labour and this will help in relieving her 'ears.

36U4 TION N6 4OUNS3!!IN> 6uring the assessment+ several areas were identi'ied that needed education and counselling to $rs. N%hata. * $I!# 1! NNIN> $rs. N%hata indeed %nows what 'amily planning is as well as the available 'amily planning methods in $alawi but has problems with choice o' 'amily planning method according to her reproductive goals. $rs. N%hata expressed that she wants to use inEectable contraceptives (6epo=1rovera/ as her 'amily planning methods o' choice. "owever+ she also expressed 'ears that she had heard that the method is phasing out soon. !oo%ing at her reproductive goals+ I 'elt that $rs. N%hata could also bene'it 'rom other 'amily methods that are long term li%e Intrauterine 4ontraceptive 6evice and Badelle than the methods she had chosen I discussed with her o' all the methods on the positives+ negatives and availability o' the methods with much emphasis on Badelle which is the best method 'or her basing on her goals as she wants to have a space o' 'ive years be'ore gets pregnant again so the same with the method as it is made to last 'or @ years. I also commented on the speculation that inEectable contraceptives are phasing out by telling her that it is not true. I also explained to her that the best time to start 'amily planning is six wee%s a'ter delivery 'or it is believed that by this time a woman&s 'ertility has returned and also her body has returned to her pre=pregnant state and can resume sex (*amily 1lanning "andboo%+ ,--</ I$$UNIS TIONS

2ased on the in'ormation that she had received only two doses o' Tetanus Toxoid 9accine with the 'irst pregnancy and two with the current one+ I 'elt she needed more in'ormation on the right expected schedule the mothers are need to 'ollow to complete all the 'ive doses 'or TT9. On this day+ an explanation on the normal vaccination schedule was given to $rs. N%hata so that as she has already started with the two doses+ should 'inish the remaining three doses. *inishing the doses will help in reducing the ris% o' the baby 'rom getting tetanus. 7e together planned on how she was going to get the other doses. The third dose will be given on ;D8D..+ the 'ourth dose will be given on ;D8D., and the last dose will de given on ;D8D.:. S3FU !IT# $rs. N%hata did not have %nowledge on when to stop sex be'ore delivery and when resume a'ter delivery. On this day+ oriented her to the right time as to when she can stop sex as well as when to resume. I told her that there is no limitation as to when they can stop sex thus they can have sex until term o' pregnancy as 'ar as they are com'ortable. I also explained to her that they can resume sex as early as ) wee%s as 'ar as she 'eels that her body is ready 'or sex. 2IRT"" 1! N N6 4O$1!I4 TION 1R31 R36N3SS Realising that $rs. N%hata was a'raid o' labour pains+ I too% sometime counselling her on normal processes o' pregnancy until labour and delivery so as to alley her anxiety. Ii put emphasis on the need and importance o' delivering at the hospital where measures o' managing labour pains are used. I also advised her on the need to associate and learn 'rom mothers who had undergone the same experience several times who can help her prepare 'or her labour and delivery. *O4US36 NT3N T ! 4 R3 2asing on the time that she had started antenatal visits+ it showed that she did not have enough or no %nowledge on 'ocused antenatal care and its importance. I there'ore planned to educate her on what 'ocused antenatal is+ and its importance. $rs. N%hata was told what is done at the clinic where 'ocused antenatal system is 'ollowed and also

what i' expected o' women undergoing 'ocused antenatal care especially when to start attending antenatal and how 're0uent. 7e also discussed on the importance o' attending all the expected normal 'our visits o' antenatal care. $INOR 6ISO63RS O* 1R3>N N4# In addition to these education and counselling sessions+ $rs. N%hata was also prepared 'or the expected minor disorders that may develop as the pregnancy progresses especially in the third trimester. $inor disorders li%e dyspnoea+ heartburn+ constipation and bac%ache are some o' the common disorders that occur to mother in their third trimesters. So she was told o' the disorders so as when they happen she should not be anxious but accept them as things that happen normally.

6ate 'or the next visit.