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ken about 14 hours thus from 7 pm to 9am. Mrs.

Nkhata has no history of ante-partum or intra-partum haemorrhage as well as Pre-eclampsia or eclampsia.

PS !"#$#%&!'$ "&S(#) Mrs. Nkhata sai* that the pregnancy that she has now was a planne* one an* also that the *ecision to ha+e the pregnancy was ma*e by both her an* her husban* such that they both were +ery happy for the pregnancy. She also sai* that she *i* not ha+e any psychological problems *ue to both pre+ious pregnancy as well as the current one e,cept for the fear of labour pains. &MM-N&S'(&#NS Mrs. N.hata e,plaine* that she ha* recei+e* two *oss of (etanus (o,oi* /accine with the first pregnancy an* two *oses with the current pregnancy. "owe+er0 she e,presse* lack of knowle*ge on the fre1uency an* number of *oses of tetanus (o,oi* /accine she is e,pecte* to recei+e *espite knowing the importance of the immuni2ations. 3N/&)#NM3N('$ "&S(#) #n en+ironmental history0 Mrs. N.hata sai* that she has a two be*room house with a seat room which is occupie* by three members of thee family0 the husban*0 the first born chil* an* herself. (he house is iron sheet roofe*0 cement floore* an* electrifie*. She sai* that she gets water from a !ommunal 4ater Point which is about 56 metres from her house but she makes sure she has enough water all the time by keeping some in buckets knowing that there is a problem of water scarcity in her area at times. #n waste *isposal0 she sai* that there is a rubbish pit behin* the house which is use* for waste *isposal an* she keeps burning the waste in the pit to pre+ent it from being blown back to the house by win* when it7s full. S#!&#-3!#N#M&! "&S(#)

Mrs. Nkhata is a 8orm four $ea+er currently working with .-.- Matches !ompany as a Packer. "er husban* is an electrician who is self employe*. She sai* that her family is able to get their nee*s an* necessities from the combine* income that they get from their *uties an* they li+e happily. Mrs. Nkhata reporte* no e,posure to increase* workloa* for she is currently gi+en light work by her bosses ha+ing un*erstoo* her con*ition. Mrs. Nkhata *oes not smoke any kin* of cigar nor *rinks any kin* of alcohol although the husban* takes alcohol but in a reasonable manner. P)3S3N( #9S(3()&! "&S(#) Mrs. Nkhata is gra+i*a : Para 1 mother $ast normal menstrual perio* ; 3,pecte* *ate of *eli+ery ; %estation by *ates "&/ Status />)$ ; ; ; 15th <uly0 :616 ::n* 'pril0 :611 =6 weeks0 *ays Non-reacti+e Non-reacti+e

She is currently not on any me*ications e,cept for the 8errous Sulphate she is gi+en when se +isits antenatal clinic meant to help in the formulation of haemoglobin. 3$&M&N'(&#N Mrs. Nkhata has no any problem with either bowel mo+ement or urination. "owe+er0 she sai* that she ha* in the early *ays of pregnancy a problem of fre1uency micturation.

#9<3!(&/3 >'(' Vital Signs

(emperature 9loo* Pressure Pulse )ate )espiration )ate

; ; ; ;

=?.7@! 1:6A76mm"g 76 beats peer minute :: breaths per minute

%3N3)'$ 'PP33')'N!3 Mrs Nkhata is a 1?: cm tall woman0 slim an* light brown in comple,ion. She was wearing a re* blouse an* a black skirt with a pair of black slip-ons BshoesC. #n this *ay she weighe* 5D kilograms0 gaining : kilograms from the weight *uring her booking +isit which was 5? kilograms. "3'> "er hea* is o+oi* in shape with long chemical ma*e hair an* there was neither *an*ruff nor presence of scars or masses on the scalp. 8'!3 (here were no signs of facial oe*ema on both inspection an* palpation. (he face also *i* not ha+e scars on inspection. 3 3S (he eyes are symmetrical an* o+oi* in shape with no signs of peri-orbital oe*ema an* ha* a pink conEuncti+a. 3')S (he ears are symmetrical with the upper ears in line with the outer bor*ers of the eyes. (here were no sore0 no ear *ischarge0 no lesions an* no signs of inflammation on palpating the pre an* post auricular lymph no*es. N#S3

"er nostrils are symmetrical with no any *ischarge. She has no history of epista,is an* *i* not ha+e any polyps in the nostrils. M#-(" "er lips were smooth with no sores or cracks. "er tongue an* oral mucosa were pink with no sore0 no korpliks spots or signs of can*i*iasis. (here were neither *ecaye* teeth nor gingi+itis. She has neither cleft lip nor cleft palate. (he tonsilor0 subman*ibular an* sub mental lymph no*es were not enlarge*. N3!. She has no problems with neck fle,ion as well as forwar* an* backwar* neck ben*ing. #n inspection0 there were no ob+ious signs of *isten*e* Eugular +eins0 no sores0 no ob+ious lesions. #n palpation0 there were neither signs of enlarge* thyroi* glan* nor enlarge* *eep cer+ical0 sub-cla+icle an* infra -cla+icle lymph no*es. !"3S( #n inspection0 the chest *i* not ha+e scars0 lesions or signs of a pigeon chest with normal respiratory mo+ements. #n auscultation0 there were normal lung an* heart soun*s. 9)3'S(S (he breasts are symmetrical in both si2e an* shape an* they both are light brown in colour with *ark alleorae. (he breasts ha+e no scars0 scales0 lesions0 no sores0 rashes0 re*ness an* no *impling. #n breast palpation0 no masses were felt e,cept for the normal mammary glan*. (he nipples are *ark in colour0 clean an* not in+erte*. -PP3) 3F()3M&(&3S (he arms are symmetrical with no signs of oe*ema on both inspection an* palpation. She has a capillary refill of less than = secon*s an* has pink palms. "owe+er0 Mrs. Nkhata reporte* ha+ing tingling sensation of the upper e,tremities. '9>#M3N

#n inspection of the ab*omen0 there was a *ark linea nigra0 some striae gra+i*alum with no sores or scars. (he ab*omen was o+oi* in shape with a me*ium si2e. 8oetal mo+ements were also obser+e* me*ially on inspection. $i+er an* spleen were not palpable in*icating absence of organomegally. (he calculate* gestation by *ates was =6 weeks an* Fundal height Pelvic, Lateral and Fundal Palpation 8un*al height 8oetal Presentation ; 8oetal $ie 8oetal Position 8oetal "eart )ate ; ; ; ; :9 weeks

!ephalic $ongitu*inal )ight #ccipital 'nterior 14: beats per minute

$#43) 3F()3M&(&3S (he lower e,tremities are symmetrical with no scars0 +aricose +eins as well as signs of oe*ema on inspection. #n palpation0 no tibial0 ankle or pe*al oe*ema was *etecte*. No signs of /aricose /eins or >eep /ein (hrombosis were *etecte* on palpation of the cuff muscles. Howmans sign was not obser+e* on fle,ion on the feet. %3N&('$&' -pon inspection of the genitalia0 no oe*ema0 sores0 warts0 genital ulcers0 abnormal +aginal *ischarge or signs of hematoma were obser+e*. (here were no signs of +aricose +eins or genital mutilation or circumcision seen. (he +aginal *ischarge was mil*0 whitish an* o*ourless.

P)#9$3MS AN33>S &>3N(&8&3>.

.nowle*ge *eficit on se,uality *uring intra an* post partum perio*s relate* to inability set times on when to stop an* resume se,. $ack of a*e1uate information on immunisations relate* to limite* information gi+en on immunisations as e+i*ence* by inability to outline the normal sche*ule for (etanus (o,oi* /accine. .nowle*ge *eficit on 8ocusse* 'ntenatal !are an* its importance relate* to limite* information gi+en about focusse* antenatal care as e+i*ence* by late coming for initial +isit. Possibily of not using family planning metho*s relate* to untrue speculations that >epoPro+era is phasing out.

!')3 P)#/&>3> 8ocus 'ntenatal !are looks at comprehensi+e care gi+en to a pregnant woman with specifie* type of care per each +isit of the four e,pecte* +isits that the woman atten*s antenatal clinic. &t looks at 1uality of care an* not 1uantity of the number of +isits. 8ocuse* 'ntenatal !are emphasises on treating e+ery mother as an in*i+i*ual or uni1ue person with in*i+i*ual problems an* nee*s. (he care that was gi+en to Mrs. Nkhata was base* on the problems an* nee*s that she ha* as well as specific care accor*ing to hergestation age. #n this *ay0 Mrs. Nkhata was treate* comprehensi+ely starting with history taking to fill in gaps followe* by "&/ an* Syphilis tests then full physical assessment which in+ol+e* using all the four mo*alities of inspection0 palpation0 auscultation an* percussion. & ma*e sure that the client7s care was pro+i*e* in a +ery con*uci+e en+ironment0 thus ensuring pri+acy as well as cleanliness. & ma*e sure that she felt well taken care of an* welcome to the clinic by being respectful0 accommo*ati+e an* letting her ask 1uestions an* e,press fears than looking at the care as a bur*en throughout the proce*ures.

3N/&)#NM3N( >uring the filling in of gaps0 collection of important information that was misse* out on the booking *ay0 an en+ironment that ensure* pri+acy an* comfort was ensure*. (he *ata was collecte* at an enclose* place where no one else coul* listen to what was being *iscusse* an* this ma*e the client to be more open an* to gi+e the information that was re1uire*. $ikewise0 *uring the physical e,amination0 a cubical was use* to promote pri+acy consi*ering that proce*ures in+ol+e* this time inclu*e e,posure of sensiti+e areas like the chest0 ab*omen an* genitalia. 8&$$&N% &N #8 %'PS -pon re+iew of the 'ntenatal car*Apage for Mrs. Nkhata se+eral areas that re1uire* to be fille* in were realise*. &n a**ition to that0 some more areas in the health passport were i*entifie* which also nee*e* filling in. (he health *i* not ha+e information on her family me*ical history an* her me*ical an* surgical history which is suppose* to be fille* o the first an* secon* pages of the health passport an* this is also where some important personal *ata is *ocumente*. See 'ppen*i,...... showing the pages after filling in. Not only that but also bloo* group an* rhesus factor were not teste* but still more being an important information especially when it comes to emergencies like anaemia0 & still referre* her go also go for the tests when she goes for the other tests. #n the antenatal page as well0 gra+i*ity an* parity of the mother were not in*icate* *uring the first +isit but got *ocumente* on this +isit. TESTS 8ocuse* 'ntenatal recommen*s mothers un*ergoing se+eral *ifferent tests at *ifferent +isits an* *ifferent gestation ages. Such tests are like "&/0 Syphilis0 haemoglobin le+el0 urine protein an* !>4 count in case of those who are "&/ positi+e but not on antiretro+iral therapy.

"&/0 />)$ an* "aemoglobin le+el are the tests that are e,pecte* to be *one on booking so as to ha+e a baseline *ata for some of them like "&/ an* haemoglobin are teste* again after sometime i.e. "&/ is teste* again after = months while haemoglobin le+el is reteste* at =? weeks. -rine protein is e,pecte* to be teste* e+ery +isit from first to fourth +isit but unfortunately none of these were *one on the first +isit #n this +isit & playe* a role of helping Mrs. Nkhata get teste* for "&/ an* Syphilis whose results came out negati+e as in*icate* on the antenatal car* B'ppen*i,.....C after filling in the gaps. "owe+er0 & referre* the client to Gueen 3li2abeth !entral "ospital for the tests which coul* not be *one at N*iran*e 'ntenatal !linic *ue to lack of materials like the haemacue kits an* protein *ipsticks. (he referral was *one after N*iran*e "ealth !entre also reporte* not ha+ing the materials P" S&!'$ 3F'M&N'(&#N 's in*icate* in thee obEecti+e *ata0 *uring physical assessment0 no specific problems were presente* or *etecte* from Mrs. Nkhata an* all the fin*ings were *ocumente* on the antenatal car* an* were also communicate* to the client. See 'ppen*i,...... showing the antenatal car* with fin*ings of the ab*ominal assessment. M3>&!'(&#NS Most of me*ications at the 'ntenatal !linic are gi+en accor*ing to gestation ages of the mothers an* most of them are gi+en for prophylactic purposes i.e. SP is gi+en to pre+ent a mother from malaria0 8errous Sulphate is gi+en to pre+ent anaemia whilst 'ben*a2ole is gi+en to combat worms infestation. SP is gi+en e+ery four weeks between the gestations of 1? to =? weeksH 8errous Sulphate is gi+en at e+ery +isit throughout pregnancy whilst 'ben*a2ole is gi+en Eust once an* at first +isit. SP is gi+en in such a way to pre+ent the tetratonegic effects that the sulphur may ha+e on the foetus. #n this +isit0 Mrs. Nkhata0 ha+ing the gestation age of =6 weeks0 she was gi+en both SP tablets B=C as well as 8errous Sulphate B=6 tabletsC. SP was gi+en after confirming that 4 weeks ha* passe* since the last *ose was taken.

M&>4&83) !')3

'N'$ S&S #8 !')3 ' lot of things an* care were *one *uring Mrs. Nkhata7s booking antenatal +isit. & shoul* sincerely gi+e cre*it to the care pro+i*er who han*le* Mrs. Nkhata on the first +isit for the goo* Eob for most things e,pecte* to be *one on booking especially *ata nee*e* to be fille* on the antenatal car* was fille*. "owe+er0 not e+ery bit of information was collecte* an* *ocumente*H for e,ample0 no information was *ocumente* in*icating gra+i*ity an* parity on the antenatal car*. (his information is +ery important to e+ery mi*wife who woul* come into contact with the client for it gi+es a picture of the kin* of client one is *ealing with i.e. prim-gra+i*a0 multigra+i*a or gran* multipara. (hese also *etermine the kin* of care that a client will get. Secon*ly0 the *ata *ocumente* on the antenatal car* for ab*ominal assessment seem to ha+e been taken for grante* by the care pro+i*er *uring the pre+ious +isit. "a+ing been gi+en the *ate for the last normal menstrual perio*0 there was no reason heAshe coul* not calculate the gestation by *ates for this *ay knowing its importance. (he calculate* gestation by *ates is +ery important to a mi*wife for it gi+es a base comparison with the fun*al height *one by tape measure or finger brea*ths. &t also seems that the mi*wife who care* for Mrs. Nkhata *uring the first +isit *oes not know what it means when we say presentation by ab*ominal assessment for sheAhe in*icate* that it was a +erte, presentation of which +erte, can not be *etermine* by pel+ic palpation but +aginally. SheAhe woul* rather in*icate cephalic for presentation an* a position i.e. )ight #ccipital 'nterior0 $eft #ccipital 'nterior or other positions. 9loo* Pressure is on of the important +ital signs in pregnant women an* unfortunately0 it was not *one on the booking *ay. es its true there coul* be no a sphygmomanometer but still more a referral to N*iran*e only for a bloo* pressure check woul* be helpful. Pregnant women are at a risk of *e+eloping pre-eclampsia which is high bloo* pressure in pregnancy an* can only be *iagnose* if bloo* pressure if checke* at e+ery +isit.

-rine protein test is also +ital in the way that presence of protein in urine is in*icati+e of pre-eclampsia Mrs. Nkhata ha* come for booking at a gestation age of :? weeks by fun*al height an* this clearly shows lack of knowle*ge on focuse* antenatal care as well as its importance. Mrs. Nkhata being a Para one with birth of first born in :667 when focuse* antenatal was alrea*y un*er implementation0 it was e,pecte* she must ha+e alrea*y been e,pose* to such type of care. -nfortunately0 the mother came at :? weeks gestation following the ol* routine antenatal system. 4hen i aske* her0 she sai* coming at :6 weeks an* abo+e was what she knew. (his mother lacke* information on focuse* antenatal an* its importance which reflects that she was not gi+en enough information about it *uring her first pregnancy. 3FP3!(3> 8&N>&N%S 8#) ("3 N3F( /&S&( Mrs. Nkhata ha* come for her secon* antenatal +isit at a gestation age of :9 weeks0 howe+er0 accor*ing to focuse* antenatal0 by this time she was suppose* to becoming for her thir* +isit which is suppose* to bee between :D weeks an* =: weeks. &n this case Mrs. Nkhata will ha+e her thir* an* final normal +isit at =? weeks though at this time a mother is normally e,pecte* to be coming for a fourth +isit. 4hen Mrs. Nkhata comes at =? weeks which woul* be on .............0 she will un*ergo se+eral assessments some that are routine like +itals signs whilst some will base on her con*ition as being in thir* trimester or ha+ing a =? weeks gestation. Some of thee care will also base of the gaps that the mi*wife will i*entify as being left out *uring the pre+ious +isit. #n the ne,t +isit the mi*wife will ha+e to check on the care gi+en on the pre+ious +isit0 e+aluate an* then ha+e a basing for planning hisAher care an* this will also *epen* on the current problems an* the unmet nee*s of the client. (he mi*wife will collect some information from the client to fill in the gaps that are not fille* *uring this +isit. She will also check on the progress of pregnancy by asking Mrs. Nkhata on how she fairing with her pregnancy. Some of the 1uestions she may ask are the presence of foetal mo+ements an* minor *isor*ers of pregnancy for this will help the mi*wife to isolate the problems that the client has at present.

Mrs. Nkhata will also ha+e to un*ergo se+eral tests which will be *ue by this time i.e. haemoglobin le+el an* urine protein. "aemoglobin le+el is checke* on booking an* in thir* trimester0 at =? weeks to be specific whilst for urine protein is checke* at e+ery +isit to the antenatal clinic. /ital signs are another aspect that will ha+e to be checke* by the mi*wife as part of monitoring progress of pregnancy. 'ny abnormality in the +ital signs is in*icati+e of a problem in the pregnant woman. 8or e,ampleH high bloo* pressure coul* be in*icati+e of pre-eclampsia0 fe+er coul* in*icate a systemic infection an* increase* respiratory rate coul* mean *ifficulty breathing0 though0 it is thought to be normal at =? weeks. Physical assessment will also be *one inclu*ing general assessment as well as ab*ominal assessment. %eneral assessment will in+ol+e a hea* to assessment an* no abnormality is e,pecte* from it. (he ab*ominal assessment will in+ol+e inspection0 palpation an* auscultation of the ab*omen to check si2e an* shape of ab*omen0 fun*al height0 lie0 presentation an* position of foetus as well as foetal heart rate. (he ab*omen is inspecte* for scars0 linea nigra0 striae gra+i*alum0 si2e an* shape0 foetal mo+ements0 bla**er fullness an* +isible organomegally. (hee fun*al height will be measure* using a tape measure of finger brea*ths so as to *etermine the age of pregnancy. (hen the pel+is will be palpate* for presentation which is normally0 lateral palpation will be *one to note the lie an* position of the foetus. 8un*al palpation will also be *one to rule out multiple gestation or presentation in a situation where the hea* is not locate* in the pel+ic. 8oetal heart rate will also ha+e to bee auscultate* using a fetalscope to confirm wellbeing of the foetus.

3FP3!(33> 8&N>&N%S 8un*al height 8oetal Presentation ; ; =? weeks

!ephalic

8oetal $ie 8oetal Position 8oetal "eart )ate

; ; ;

$ongitu*inal )ight #ccipital 'nteriorA$eft #ccipital 'nterior 146 I 1?6 beats per minute

(he abo+e e,pecte* fin*ings are thee normal e,pecte* fin*ing in the absence of possibility of ha+ing abnormal fin*ings >)-%S #n this +isit Mrs. Nkhata will only be pro+i*e* with 8errous Sulphate as a *rug to supplement iron for haemoglobin formation. SP will not be gi+en because it is belie+e* to ha+e a teratonic effect on the fetus when gi+en at the gestation of =? weeks an* abo+e. 3FP3!(3> >&S#)>3)S 9y this time the e,pecte* *isor*ers that Mrs. Nkhata may ha+e are *ifficulty breathing0 fre1uent micturation0 hea*ache0 constipation0 backache0 oe*ema +aricosities0 haemorrhoi*s an* cramps for these are the common *isor*ers that usually come in thir* trimester. MANAGEMENT OF THE E PE!TE" M#N#$ "#SO$"E$S HEA$T%&$N (his is a burning0 irritating sensation in the oesophagus also known as gastric reflu, B8raser0 !ooper an* Nolte0 :66?C. %astric reflu, commonly occurs as a result of *elaye* gastric emptying0 *ecrease* intestinal motility0 an* *ecrease* lower oesophageal sphincter tone. &f it happens that Mrs. Nkhata *e+elops heartburn0 e*ucation an* counseling on li'est(le
)odi'ication will be pro+i*e* an* will inclu*e awareness of posture i.e. Maintaining upright positions Bespecially after mealsC0 sleeping in a proppe* up position an* dietar( )odi'ications Be.g. small fre1uent meals0 eating slowly0 re*uction of high-fat foo*s an* caffeineC.

S*ELL#NG+E"EMA

's the growing uterus puts pressure on the +eins that return bloo* from feet an* legs0 swollen feet an* ankles may become an issue. 't the same time0 swelling in legs0 arms or han*s may place pressure on ner+es0 causing tingling or numbness. 8lui* retention an* *ilate* bloo* +essels may lea+e the face an* eyeli*s puffy0 especially in the morning. (o re*uce swelling0 the client will be a*+ise* to use col* compresses on the affecte* areas. $ying *own or using a footrest may relie+e ankle swelling. She might e+en ele+ate her feet an* legs while she sleeps which will also minimise the swelling by gra+ity. ",SPNEA (his is a common symptom between the gestation of =4 an* =? weeks. &t is as a result of the pressure by the growing uterus on the *iaphragm B8raser0 !ooper an* Nolte0 :66?C. &f Mrs. Nkhata happens to *e+elop *yspnoea0 she will be e*ucate* of the physiology of the problem for her to un*erstan* what7s happening. She will also be a*+ise* on sleeping in semi-fowlers position so as to be increasing the area for lung e,pansion hence impro+e* respiratory con*ition. She will also be encourage* to ha+e perio*s an* resting to re*uce the bo*y nee* for o,ygen. !ONST#PAT#ON !onstipation in pregnancy especially thir* trimester is usually cause* by re*uce* motility of large intestine which comes *ue to the muscle la,ati+e effect of the hormone progesterone which is pro*uce* in large amounts this perio*0 &ncrease* water reabsorption from large intestine *ue to hormone al*osterone effect0 Pressure on the pel+ic colon by the pregnant uterus an* se*entary life *uring pregnancy . if the client will come with the problem of constipation0 she will a*+ise* on *rinking plenty of flui*s0 high fibre foo*s an* get plenty of e,ercise. (hese help in softening the bowels hence re*uce* risk of constipation. %A!-A!HE

>uring pregnancy0 ligaments become softer an* stretch to prepare for labour. (his can put a strain on the Eoints of the lower back an* pel+is0 which can result in backache. (o o+ercome this problem Mrs. Nkhata will be a*+ise* to a+oi* hea+y lifting0 ben* her knees an* keep her back straight when lifting or picking up things from the groun*0 mo+e her feet when turning an* a+oi* su**en twisting mo+ements0 4ork at a surface high enough to pre+ent her from stooping an* to sit with her back straight an* wellsupporte*. 'nother a*+ice will be that she shoul* make sure she gets enough rest0 particularly later in pregnancy.

F$E.&ENT M#!T&$AT#ON 's the baby mo+es *eeper into your pel+is towar*s term of pregnancy0 a woman feel more pressure on your bla**er an* may fin* herself urinating more often0 e+en *uring the night. (his e,tra pressure may also cause her to leak urine J especially when she laughs0 coughs or snee2es. &n this case the client will Eust ha+e to be assure* that this is normal with a goo* e,planation of the cause. She will also ha+e to be a*+ise* on perineal care to pre+ent ascen*ing infections. !$AMPS !ramp is a su**en0 sharp pain0 usually in calf muscles or feet. &t is most common at night0 but nobo*y really knows what causes it. (he woman will be oriente* to skills she will ha+e practice to combat the problem for e,ampleH pulling up of toes har* up towar*s the ankle0 or rub the muscle har*. %entle e,ercise in pregnancy0 particularly ankle an* leg mo+ements0 which can impro+e bloo* circulation an* may help to pre+ent cramp occurring an* plenty of calcium rich foo*s Bleafy green +egetables0 *airy pro*ucts0 sunflower see*s0 salmon an* *rie* beansC an* magnesium rich foo*s Bnuts0 *ates an* figs0 yellow corn0 green +egetables an* applesC in her *iet. FEA$ 's the pregnancy *raws near term most women become afrai* of the labour pains0 fears about chil*birth may become more persistent. "ow much will it hurtK "ow long will

it lastK "ow will they copeK &f Mrs. Nkhata happens to come with such a problem0 she will be a*+ise* on the importance of hospital *eli+ery where pain relief mechanisms are a+ailable. She will also be aske* to ha+e time with other women who ha+e ha* positi+e e,perience of labour an* this will help in relie+ing her fears.

3>-!'(&#N 'N> !#-NS3$$&N% >uring the assessment0 se+eral areas were i*entifie* that nee*e* e*ucation an* counselling to Mrs. Nkhata. 8'M&$ P$'NN&N% Mrs. Nkhata in*ee* knows what family planning is as well as the a+ailable family planning metho*s in Malawi but has problems with choice of family planning metho* accor*ing to her repro*ucti+e goals. Mrs. Nkhata e,presse* that she wants to use inEectable contracepti+es B>epo-Pro+eraC as her family planning metho*s of choice. "owe+er0 she also e,presse* fears that she ha* hear* that the metho* is phasing out soon. $ooking at her repro*ucti+e goals0 & felt that Mrs. Nkhata coul* also benefit from other family metho*s that are long term like &ntrauterine !ontracepti+e >e+ice an* <a*elle than the metho*s she ha* chosen & *iscusse* with her of all the metho*s on the positi+es0 negati+es an* a+ailability of the metho*s with much emphasis on <a*elle which is the best metho* for her basing on her goals as she wants to ha+e a space of fi+e years before gets pregnant again so the same with the metho* as it is ma*e to last for 5 years. & also commente* on the speculation that inEectable contracepti+es are phasing out by telling her that it is not true. & also e,plaine* to her that the best time to start family planning is si, weeks after *eli+ery for it is belie+e* that by this time a woman7s fertility has returne* an* also her bo*y has returne* to her pre-pregnant state an* can resume se, B8amily Planning "an*book0 :669C &MM-N&S'(&#NS

9ase* on the information that she ha* recei+e* only two *oses of (etanus (o,oi* /accine with the first pregnancy an* two with the current one0 & felt she nee*e* more information on the right e,pecte* sche*ule the mothers are nee* to follow to complete all the fi+e *oses for ((/. #n this *ay0 an e,planation on the normal +accination sche*ule was gi+en to Mrs. Nkhata so that as she has alrea*y starte* with the two *oses0 shoul* finish the remaining three *oses. 8inishing the *oses will help in re*ucing the risk of the baby from getting tetanus. 4e together planne* on how she was going to get the other *oses. (he thir* *ose will be gi+en on 7ADA110 the fourth *ose will be gi+en on 7ADA1: an* the last *ose will *e gi+en on 7ADA1=. S3F-'$&( Mrs. Nkhata *i* not ha+e knowle*ge on when to stop se, before *eli+ery an* when resume after *eli+ery. #n this *ay0 oriente* her to the right time as to when she can stop se, as well as when to resume. & tol* her that there is no limitation as to when they can stop se, thus they can ha+e se, until term of pregnancy as far as they are comfortable. & also e,plaine* to her that they can resume se, as early as ? weeks as far as she feels that her bo*y is rea*y for se,. 9&)("" P$'N 'N> !#MP$&!'(&#N P)3P')3>N3SS )ealising that Mrs. Nkhata was afrai* of labour pains0 & took sometime counselling her on normal processes of pregnancy until labour an* *eli+ery so as to alley her an,iety. &i put emphasis on the nee* an* importance of *eli+ering at the hospital where measures of managing labour pains are use*. & also a*+ise* her on the nee* to associate an* learn from mothers who ha* un*ergone the same e,perience se+eral times who can help her prepare for her labour an* *eli+ery. 8#!-S3> 'N(3N'('$ !')3 9asing on the time that she ha* starte* antenatal +isits0 it showe* that she *i* not ha+e enough or no knowle*ge on focuse* antenatal care an* its importance. & therefore planne* to e*ucate her on what focuse* antenatal is0 an* its importance. Mrs. Nkhata was tol* what is *one at the clinic where focuse* antenatal system is followe* an* also

what if e,pecte* of women un*ergoing focuse* antenatal care especially when to start atten*ing antenatal an* how fre1uent. 4e also *iscusse* on the importance of atten*ing all the e,pecte* normal four +isits of antenatal care. M&N#) >&S#>3)S #8 P)3%N'N! &n a**ition to these e*ucation an* counselling sessions0 Mrs. Nkhata was also prepare* for the e,pecte* minor *isor*ers that may *e+elop as the pregnancy progresses especially in the thir* trimester. Minor *isor*ers like *yspnoea0 heartburn0 constipation an* backache are some of the common *isor*ers that occur to mother in their thir* trimesters. So she was tol* of the *isor*ers so as when they happen she shoul* not be an,ious but accept them as things that happen normally.

>ate for the ne,t +isit.