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Vertex Delivery but sustained a tear which was sutured and healed without any complications.

The baby was 3400g at birth and was born without any congenital nor during birth complication. Labour had taken about 4 hours thus !rom " pm to #am. $rs. %khata has no history o! ante&partum or intra&partum haemorrhage as well as 're& eclampsia or eclampsia.

'()*+,L,-.*/L +.(T,0) $rs. %khata 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. (he 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. .$$1%.(/T.,%( $rs. %2hata explained that she had received two doss o! Tetanus Toxoid Vaccine with the !irst pregnancy and two doses with the current pregnancy. +owever3 she expressed lack o! knowledge on the !re4uency and number o! doses o! tetanus Toxoid Vaccine she is expected to receive despite knowing the importance o! the immuni5ations. 6%V.0,%$6%T/L +.(T,0) ,n environmental history3 $rs. %2hata said that she has a two bedroom house with a seat room which is occupied by three members o! thee !amily3 the husband3 the !irst born child and hersel!. The house is iron sheet roo!ed3 cement !loored and electri!ied. (he said that she gets water !rom a *ommunal 7ater 'oint which is about 80 metres !rom her house but she makes sure she has enough water all the time by keeping some in buckets knowing that there is a problem o! water scarcity in her area at times. ,n waste disposal3 she said that there is a rubbish pit behind the house which is used !or waste disposal and she keeps burning the waste in the pit to prevent it !rom being blown back to the house by wind when it9s !ull.

(,*.,&6*,%,$.* +.(T,0) $rs. %khata is a :orm !our Leaver currently working with 2121 $atches *ompany as a 'acker. +er husband is an electrician who is sel! employed. (he 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. %khata reported no exposure to increased workload !or she is currently given light work by her bosses having understood her condition. $rs. %khata does not smoke any kind o! cigar nor drinks any kind o! alcohol although the husband takes alcohol but in a reasonable manner. '06(6%T ,;(T6T0.* +.(T,0) $rs. %khata is gravida < 'ara Last normal menstrual period = 6xpected date o! delivery = -estation by dates +.V (tatus VD0L = = = mother 8th >uly3 <0 0 <<nd /pril3 <0 30 weeks3 days %on&reactive %on&reactive

(he is currently not on any medications except !or the :errous (ulphate she is given when se visits antenatal clinic meant to help in the !ormulation o! haemoglobin. 6L.$.%/T.,% $rs. %khata has no any problem with either bowel movement or urination. +owever3 she said that she had in the early days o! pregnancy a problem o! !re4uency micturation.

,;>6*T.V6 D/T/

Vital Signs Temperature ;lood 'ressure 'ulse 0ate 0espiration 0ate = = = = 3?."@* <0A"0mm+g "0 beats peer minute << breaths per minute

-6%60/L /''66/0/%*6 $rs %khata is a ?< cm tall woman3 slim and light brown in complexion. (he was wearing a red blouse and a black skirt with a pair o! black slip&ons BshoesC. ,n this day she weighed 8D kilograms3 gaining < kilograms !rom the weight during her booking visit which was 8? kilograms. +6/D +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. :/*6 There were no signs o! !acial oedema on both inspection and palpation. The !ace also did not have scars on inspection. 6)6( The eyes are symmetrical and ovoid in shape with no signs o! peri&orbital oedema and had a pink conEunctiva. 6/0( The ears are symmetrical with the upper ears in line with the outer borders o! the eyes. There were no sore3 no ear discharge3 no lesions and no signs o! in!lammation on palpating the pre and post auricular lymph nodes. %,(6

+er nostrils are symmetrical with no any discharge. (he has no history o! epistaxis and did not have any polyps in the nostrils. $,1T+ +er lips were smooth with no sores or cracks. +er tongue and oral mucosa were pink with no sore3 no korpliks spots or signs o! candidiasis. There were neither decayed teeth nor gingivitis. (he has neither cle!t lip nor cle!t palate. The tonsilor3 sub& mandibular and sub mental lymph nodes were not enlarged. %6*2 (he has no problems with neck !lexion as well as !orward and backward neck bending. ,n inspection3 there were no obvious signs o! distended Eugular veins3 no sores3 no obvious lesions. ,n palpation3 there were neither signs o! enlarged thyroid gland nor enlarged deep cervical3 sub&clavicle and in!ra &clavicle lymph nodes. *+6(T ,n inspection3 the chest did not have scars3 lesions or signs o! a pigeon chest with normal respiratory movements. ,n auscultation3 there were normal lung and heart sounds. ;06/(T( The breasts are symmetrical in both si5e and shape and they both are light brown in colour with dark alleorae. The breasts have no scars3 scales3 lesions3 no sores3 rashes3 redness and no dimpling. ,n breast palpation3 no masses were !elt except !or the normal mammary gland. The nipples are dark in colour3 clean and not inverted. 1''60 6FT06$.T.6( The arms are symmetrical with no signs o! oedema on both inspection and palpation. (he has a capillary re!ill o! less than 3 seconds and has pink palms. +owever3 $rs. %khata reported having tingling sensation o! the upper extremities. /;D,$6%

,n inspection o! the abdomen3 there was a dark linea nigra3 some striae gravidalum with no sores or scars. The abdomen was ovoid in shape with a medium si5e. :oetal movements were also observed medially on inspection. Liver and spleen were not palpable indicating absence o! organomegally. The calculated gestation by dates was 30 weeks and Fundal height Pelvic, Lateral and Fundal Palpation :undal height :oetal 'resentation = :oetal Lie :oetal 'osition :oetal +eart 0ate = = = = <# weeks

*ephalic Longitudinal 0ight ,ccipital /nterior 4< beats per minute

L,760 6FT06$.T.6( The lower extremities are symmetrical with no scars3 varicose veins as well as signs o! oedema on inspection. ,n palpation3 no tibial3 ankle or pedal oedema was detected. %o signs o! Varicose Veins or Deep Vein Thrombosis were detected on palpation o! the cu!! muscles. Howmans sign was not observed on !lexion on the !eet. -6%.T/L./ 1pon inspection o! the genitalia3 no oedema3 sores3 warts3 genital ulcers3 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 mild3 whitish and odourless.

'0,;L6$( A%66D( .D6%T.:.6D.

2nowledge de!icit on sexuality during intra and post partum periods related to inability set times on when to stop and resume sex. Lack o! ade4uate in!ormation on immunisations related to limited in!ormation given on immunisations as evidenced by inability to outline the normal schedule !or Tetanus Toxoid Vaccine. 2nowledge de!icit on :ocussed /ntenatal *are and its importance related to limited in!ormation given about !ocussed antenatal care as evidenced by late coming !or initial visit. 'ossibily o! not using !amily planning methods related to untrue speculations that Depo& 'rovera is phasing out.

*/06 '0,V.D6D :ocus /ntenatal *are looks 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. .t looks at 4uality o! care and not 4uantity o! the number o! visits. :ocused /ntenatal *are emphasises on treating every mother as an individual or uni4ue person with individual problems and needs. The care that was given to $rs. %khata was based on the problems and needs that she had as well as speci!ic care according to hergestation age. ,n this day3 $rs. %khata was treated comprehensively starting with history taking to !ill in gaps !ollowed by +.V and (yphilis tests then !ull physical assessment which involved using all the !our modalities o! inspection3 palpation3 auscultation and percussion. . made sure that the client9s care was provided in a very conducive environment3 thus ensuring privacy as well as cleanliness. . made sure that she !elt well taken care o! and welcome to the clinic by being respect!ul3 accommodative and letting her ask 4uestions and express !ears than looking at the care as a burden throughout the procedures.

6%V.0,%$6%T During the !illing in o! gaps3 collection o! important in!ormation that was missed out on the booking day3 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 re4uired. Likewise3 during the physical examination3 a cubical was used to promote privacy considering that procedures involved this time include exposure o! sensitive areas like the chest3 abdomen and genitalia. :.LL.%- .% ,: -/'( 1pon review o! the /ntenatal cardApage !or $rs. %khata several areas that re4uired to be !illed in were realised. .n addition to that3 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. (ee /ppendix...... showing the pages a!ter !illing in. %ot 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 like anaemia3 . still re!erred her go also go !or the tests when she goes !or the other tests. ,n the antenatal page as well3 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. (uch tests are like +.V3 (yphilis3 haemoglobin level3 urine protein and *D4 count in case o! those who are +.V positive but not on antiretroviral therapy.

+.V3 VD0L and +aemoglobin level are the tests that are expected to be done on booking so as to have a baseline data !or some o! them like +.V and haemoglobin are tested again a!ter sometime i.e. +.V is tested again a!ter 3 months while haemoglobin level is retested at 3? weeks. 1rine 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 ,n this visit . played a role o! helping $rs. %khata get tested !or +.V and (yphilis whose results came out negative as indicated on the antenatal card B/ppendix.....C a!ter !illing in the gaps. +owever3 . re!erred the client to Gueen 6li5abeth *entral +ospital !or the tests which could not be done at %dirande /ntenatal *linic due to lack o! materials like the haemacue kits and protein dipsticks. The re!erral was done a!ter %dirande +ealth *entre also reported not having the materials '+)(.*/L 6F/$.%/T.,% /s indicated in thee obEective data3 during physical assessment3 no speci!ic problems were presented or detected !rom $rs. %khata and all the !indings were documented on the antenatal card and were also communicated to the client. (ee /ppendix...... showing the antenatal card with !indings o! the abdominal assessment. $6D.*/T.,%( $ost o! medications at the /ntenatal *linic are given according to gestation ages o! the mothers and most o! them are given !or prophylactic purposes i.e. (' is given to prevent a mother !rom malaria3 :errous (ulphate is given to prevent anaemia whilst /benda5ole is given to combat worms in!estation. (' is given every !our weeks between the gestations o! ? to 3? weeksH :errous (ulphate is given at every visit throughout pregnancy whilst /benda5ole is given Eust once and at !irst visit. (' is given in such a way to prevent the tetratonegic e!!ects that the sulphur may have on the !oetus. ,n this visit3 $rs. %khata3 having the gestation age o! 30 weeks3 she was given both (' tablets B3C as well as :errous (ulphate B30 tabletsC. (' was given a!ter con!irming that 4 weeks had passed since the last dose was taken.

$.D7.:60) */06

/%/L)(.( ,: */06 / lot o! things and care were done during $rs. %khata9s booking antenatal visit. . should sincerely give credit to the care provider who handled $rs. %khata on the !irst visit !or the good Eob !or most things expected to be done on booking especially data needed to be !illed on the antenatal card was !illed. +owever3 not every bit o! in!ormation was collected and documentedH !or example3 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 kind o! client one is dealing with i.e. prim&gravida3 multigravida or grand multipara. These also determine the kind o! care that a client will get. (econdly3 the data documented on the antenatal card !or abdominal assessment seem to have been taken !or granted by the care provider during the previous visit. +aving been given the date !or the last normal menstrual period3 there was no reason heAshe could not calculate the gestation by dates !or this day knowing 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. .t also seems that the midwi!e who cared !or $rs. %khata during the !irst visit does not know what it means when we say presentation by abdominal assessment !or sheAhe indicated that it was a vertex presentation o! which vertex can not be determined by pelvic palpation but vaginally. (heAhe would rather indicate cephalic !or presentation and a position i.e. 0ight ,ccipital /nterior3 Le!t ,ccipital /nterior or other positions. ;lood 'ressure is on o! the important vital signs in pregnant women and un!ortunately3 it was not done on the booking day. )es its true there could be no a sphygmomanometer but still more a re!erral to %dirande only !or a blood pressure check would be help!ul. 'regnant women are at a risk o! developing pre&eclampsia which is high blood pressure in pregnancy and can only be diagnosed i! blood pressure i! checked at every visit.

1rine protein test is also vital in the way that presence o! protein in urine is indicative o! pre&eclampsia $rs. %khata had come !or booking at a gestation age o! <? weeks by !undal height and this clearly shows lack o! knowledge on !ocused antenatal care as well as its importance. $rs. %khata being a 'ara one with birth o! !irst born in <00" when !ocused antenatal was already under implementation3 it was expected she must have already been exposed to such type o! care. 1n!ortunately3 the mother came at <? weeks gestation !ollowing the old routine antenatal system. 7hen i asked her3 she said coming at <0 weeks and above was what she knew. This mother lacked 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. 6F'6*T6D :.%D.%-( :,0 T+6 %6FT V.(.T $rs. %khata had come !or her second antenatal visit at a gestation age o! <# weeks3 however3 according to !ocused antenatal3 by this time she was supposed to becoming !or her third visit which is supposed to bee between <D weeks and 3< weeks. .n this case $rs. %khata will have her third and !inal normal visit at 3? weeks though at this time a mother is normally expected to be coming !or a !ourth visit. 7hen $rs. %khata comes at 3? weeks which would be on .............3 she will undergo several assessments some that are routine like vitals signs whilst some will base on her condition as being in third trimester or having a 3? weeks gestation. (ome 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. ,n the next visit the midwi!e will have to check on the care given on the previous visit3 evaluate and then have a basing !or planning hisAher 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. (he will also check on the progress o! pregnancy by asking $rs. %khata on how she !airing with her pregnancy. (ome o! the 4uestions she may ask 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. %khata will also have to undergo several tests which will be due by this time i.e. haemoglobin level and urine protein. +aemoglobin level is checked on booking and in third trimester3 at 3? weeks to be speci!ic whilst !or urine protein is checked at every visit to the antenatal clinic. Vital signs are another aspect that will have to be checked 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&eclampsia3 !ever could indicate a systemic in!ection and increased respiratory rate could mean di!!iculty breathing3 though3 it is thought to be normal at 3? weeks. 'hysical 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 inspection3 palpation and auscultation o! the abdomen to check si5e and shape o! abdomen3 !undal height3 lie3 presentation and position o! !oetus as well as !oetal heart rate. The abdomen is inspected !or scars3 linea nigra3 striae gravidalum3 si5e and shape3 !oetal movements3 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 normally3 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.

6F'6*T66D :.%D.%-( :undal height :oetal 'resentation = = 3? weeks

*ephalic

:oetal Lie :oetal 'osition :oetal +eart 0ate

= = =

Longitudinal 0ight ,ccipital /nteriorALe!t ,ccipital /nterior 40 I ?0 beats per minute

The above expected !indings are thee normal expected !inding in the absence o! possibility o! having abnormal !indings D01-( ,n this visit $rs. %khata will only be provided with :errous (ulphate as a drug to supplement iron !or haemoglobin !ormation. (' will not be given because it is believed to have a teratonic e!!ect on the !etus when given at the gestation o! 3? weeks and above. 6F'6*T6D D.(,0D60( ;y this time the expected disorders that $rs. %khata may have are di!!iculty breathing3 !re4uent micturation3 headache3 constipation3 backache3 oedema varicosities3 haemorrhoids and cramps !or these are the common disorders that usually come in third trimester. MANAGEMENT OF THE E PE!TE" M#N#$ "#SO$"E$S HEA$T%&$N This is a burning3 irritating sensation in the oesophagus also known as gastric re!lux B:raser3 *ooper and %olte3 <00?C. -astric re!lux commonly occurs as a result o! delayed gastric emptying3 decreased intestinal motility3 and decreased lower oesophageal sphincter tone. .! it happens that $rs. %khata develops heartburn3 education and counseling on li'est(le
)odi'ication will be provided and will include awareness o! posture i.e. $aintaining upright positions Bespecially a!ter mealsC3 sleeping in a propped up position and dietar( )odi'ications Be.g. small !re4uent meals3 eating slowly3 reduction o! high&!at !oods and ca!!eineC.

S*ELL#NG+E"EMA

/s the growing uterus puts pressure on the veins that return blood !rom !eet and legs3 swollen !eet and ankles may become an issue. /t the same time3 swelling in legs3 arms or hands may place pressure on nerves3 causing tingling or numbness. :luid retention and dilated blood vessels may leave the !ace and eyelids pu!!y3 especially in the morning. To reduce swelling3 the client will be advised to use cold compresses on the a!!ected areas. Lying down or using a !ootrest may relieve ankle swelling. (he 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! 34 and 3? weeks. .t is as a result o! the pressure by the growing uterus on the diaphragm B:raser3 *ooper and %olte3 <00?C. .! $rs. %khata happens to develop dyspnoea3 she will be educated o! the physiology o! the problem !or her to understand what9s happening. (he will also be advised on sleeping in semi&!owlers position so as to be increasing the area !or lung expansion hence improved respiratory condition. (he will also be encouraged to have periods and resting to reduce the body need !or oxygen. !ONST#PAT#ON *onstipation 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 period3 .ncreased water re& absorption !rom large intestine due to hormone aldosterone e!!ect3 'ressure on the pelvic colon by the pregnant uterus and sedentary li!e during pregnancy . i! the client will come with the problem o! constipation3 she will advised on drinking plenty o! !luids3 high !ibre !oods and get plenty o! exercise. These help in so!tening the bowels hence reduced risk o! constipation. %A!-A!HE

During pregnancy3 ligaments become so!ter and stretch to prepare !or labour. This can put a strain on the Eoints o! the lower back and pelvis3 which can result in backache. To overcome this problem $rs. %khata will be advised to avoid heavy li!ting3 bend her knees and keep her back straight when li!ting or picking up things !rom the ground3 move her !eet when turning and avoid sudden twisting movements3 7ork at a sur!ace high enough to prevent her !rom stooping and to sit with her back straight and well& supported. /nother advice will be that she should make sure she gets enough rest3 particularly later in pregnancy.

F$E.&ENT M#!T&$AT#ON /s the baby moves deeper into your pelvis towards term o! pregnancy3 a woman !eel more pressure on your bladder and may !ind hersel! urinating more o!ten3 even during the night. This extra pressure may also cause her to leak urine J especially when she laughs3 coughs or snee5es. .n this case the client will Eust have to be assured that this is normal with a good explanation o! the cause. (he will also have to be advised on perineal care to prevent ascending in!ections. !$AMPS *ramp is a sudden3 sharp pain3 usually in cal! muscles or !eet. .t is most common at night3 but nobody really knows what causes it. The woman will be oriented to skills she will have practice to combat the problem !or exampleH pulling up o! toes hard up towards the ankle3 or rub the muscle hard. -entle exercise in pregnancy3 particularly ankle and leg movements3 which can improve blood circulation and may help to prevent cramp occurring and plenty o! calcium rich !oods Blea!y green vegetables3 dairy products3 sun!lower seeds3 salmon and dried beansC and magnesium rich !oods Bnuts3 dates and !igs3 yellow corn3 green vegetables and applesC in her diet. FEA$ /s the pregnancy draws near term most women become a!raid o! the labour pains3 !ears about childbirth may become more persistent. +ow much will it hurtK +ow long will

it lastK +ow will they copeK .! $rs. %khata happens to come with such a problem3 she will be advised on the importance o! hospital delivery where pain relie! mechanisms are available. (he will also be asked to have time with other women who have had positive experience o! labour and this will help in relieving her !ears.

6D1*/T.,% /%D *,1%(6LL.%During the assessment3 several areas were identi!ied that needed education and counselling to $rs. %khata. :/$.L) 'L/%%.%$rs. %khata indeed knows 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. %khata expressed that she wants to use inEectable contraceptives BDepo&'roveraC as her !amily planning methods o! choice. +owever3 she also expressed !ears that she had heard that the method is phasing out soon. Looking at her reproductive goals3 . !elt that $rs. %khata could also bene!it !rom other !amily methods that are long term like .ntrauterine *ontraceptive Device and >adelle than the methods she had chosen . discussed with her o! all the methods on the positives3 negatives and availability o! the methods with much emphasis on >adelle 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 8 years. . also commented on the speculation that inEectable contraceptives are phasing out by telling her that it is not true. . also explained to her that the best time to start !amily planning is six weeks a!ter delivery !or it is believed that by this time a woman9s !ertility has returned and also her body has returned to her pre&pregnant state and can resume sex B:amily 'lanning +andbook3 <00#C .$$1%.(/T.,%(

;ased on the in!ormation that she had received only two doses o! Tetanus Toxoid Vaccine with the !irst pregnancy and two with the current one3 . !elt she needed more in!ormation on the right expected schedule the mothers are need to !ollow to complete all the !ive doses !or TTV. ,n this day3 an explanation on the normal vaccination schedule was given to $rs. %khata so that as she has already started with the two doses3 should !inish the remaining three doses. :inishing the doses will help in reducing the risk 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 "ADA on "ADA < and the last dose will de given on "ADA 3. (6F1/L.T) $rs. %khata did not have knowledge on when to stop sex be!ore delivery and when resume a!ter delivery. ,n this day3 oriented her to the right time as to when she can stop sex as well as when to resume. . told her that there is no limitation as to when they can stop sex thus they can have sex until term o! pregnancy as !ar as they are com!ortable. . also explained to her that they can resume sex as early as ? weeks as !ar as she !eels that her body is ready !or sex. ;.0T++ 'L/% /%D *,$'L.*/T.,% '06'/06D%6(( 0ealising that $rs. %khata was a!raid o! labour pains3 . took sometime counselling her on normal processes o! pregnancy until labour and delivery so as to alley her anxiety. .i put emphasis on the need and importance o! delivering at the hospital where measures o! managing labour pains are used. . 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. :,*1(6D /%T6%/T/L */06 ;asing on the time that she had started antenatal visits3 it showed that she did not have enough or no knowledge on !ocused antenatal care and its importance. . there!ore planned to educate her on what !ocused antenatal is3 and its importance. $rs. %khata was told what is done at the clinic where !ocused antenatal system is !ollowed and also 3 the !ourth dose will be given

what i! expected o! women undergoing !ocused antenatal care especially when to start attending antenatal and how !re4uent. 7e also discussed on the importance o! attending all the expected normal !our visits o! antenatal care. $.%,0 D.(,D60( ,: '06-%/%*) .n addition to these education and counselling sessions3 $rs. %khata was also prepared !or the expected minor disorders that may develop as the pregnancy progresses especially in the third trimester. $inor disorders like dyspnoea3 heartburn3 constipation and backache are some o! the common disorders that occur to mother in their third trimesters. (o she was told o! the disorders so as when they happen she should not be anxious but accept them as things that happen normally.

Date !or the next visit.