on. Labour had taken 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-e lampsia or e lampsia.

P!"#$%L%&'#(L $'!)%*" Mrs. Nkhata said that the pregnan y that she has now was a planned one and also that the de ision to ha+e the pregnan y was made by both her and her husband su h that they both were +ery happy for the pregnan y. !he also said that she did not ha+e any psy hologi al problems due to both pre+ious pregnan y as well as the urrent one e, ept for the fear of labour pains. 'MM-N'!()'%N! Mrs. N.hata e,plained that she had re ei+ed two doss of )etanus )o,oid /a ine with

the first pregnan y and two doses with the urrent pregnan y. $owe+er0 she e,pressed la k of knowledge on the fre1uen y and number of doses of tetanus )o,oid /a ine she is e,pe ted to re ei+e despite knowing the importan e of the immuni2ations. 3N/'*%NM3N)(L $'!)%*" %n en+ironmental history0 Mrs. N.hata said that she has a two bedroom house with a seat room whi h is o upied by three members of thee family0 the husband0 the first born hild and herself. )he house is iron sheet roofed0 ement floored and ele trified. !he said that she gets water from a #ommunal 4ater Point whi h is about 56 metres from her house but she makes sure she has enough water all the time by keeping some in bu kets knowing that there is a problem of water s ar ity in her area at times. %n waste disposal0 she said that there is a rubbish pit behind the house whi h is used for waste disposal and she keeps burning the waste in the pit to pre+ent it from being blown ba k to the house by wind when it7s full. !%#'%-3#%N%M'# $'!)%*"

Mrs. Nkhata is a 8orm four Lea+er urrently working with .-.- Mat hes #ompany as a Pa ker. $er husband is an ele tri ian who is self employed. !he said that her family is able to get their needs and ne essities from the ombined in ome that they get from their duties and they li+e happily. Mrs. Nkhata reported no e,posure to in reased workload for she is urrently gi+en light work by her bosses ha+ing understood her ondition. Mrs. Nkhata does not smoke any kind of igar nor drinks any kind of al ohol although the husband takes al ohol but in a reasonable manner. P*3!3N) %9!)3)*'# $'!)%*" Mrs. Nkhata is gra+ida : Para 1 mother Last normal menstrual period ; 3,pe ted date of deli+ery ; &estation by dates $'/ !tatus />*L ; ; ; 15th <uly0 :616 ::nd (pril0 :611 =6 weeks0 days Non-rea ti+e Non-rea ti+e

!he is urrently not on any medi ations e, ept for the 8errous !ulphate she is gi+en when se +isits antenatal lini meant to help in the formulation of haemoglobin. 3L'M'N()'%N Mrs. Nkhata has no any problem with either bowel mo+ement or urination. $owe+er0 she said that she had in the early days of pregnan y a problem of fre1uen y mi turation.

%9<3#)'/3 >()( Vital Signs

)emperature 9lood Pressure Pulse *ate *espiration *ate

; ; ; ;

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

&3N3*(L (PP33(*(N#3 Mrs Nkhata is a 1?: m tall woman0 slim and light brown in omple,ion. !he was wearing a red blouse and a bla k skirt with a pair of bla k slip-ons BshoesC. %n this day she weighed 5D kilograms0 gaining : kilograms from the weight during her booking +isit whi h was 5? kilograms. $3(> $er head is o+oid in shape with long hemi al made hair and there was neither dandruff nor presen e of s ars or masses on the s alp. 8(#3 )here were no signs of fa ial oedema on both inspe tion and palpation. )he fa e also did not ha+e s ars on inspe tion. 3"3! )he eyes are symmetri al and o+oid in shape with no signs of peri-orbital oedema and had a pink onEun ti+a. 3(*! )he ears are symmetri al with the upper ears in line with the outer borders of the eyes. )here were no sore0 no ear dis harge0 no lesions and no signs of inflammation on palpating the pre and post auri ular lymph nodes. N%!3

$er nostrils are symmetri al with no any dis harge. !he has no history of epista,is and did not ha+e any polyps in the nostrils. M%-)$ $er lips were smooth with no sores or ra ks. $er tongue and oral mu osa were pink with no sore0 no korpliks spots or signs of andidiasis. )here were neither de ayed teeth nor gingi+itis. !he has neither left lip nor left palate. )he tonsilor0 submandibular and sub mental lymph nodes were not enlarged. N3#. !he has no problems with ne k fle,ion as well as forward and ba kward ne k bending. %n inspe tion0 there were no ob+ious signs of distended Eugular +eins0 no sores0 no ob+ious lesions. %n palpation0 there were neither signs of enlarged thyroid gland nor enlarged deep er+i al0 sub- la+i le and infra - la+i le lymph nodes. #$3!) %n inspe tion0 the hest did not ha+e s ars0 lesions or signs of a pigeon hest with normal respiratory mo+ements. %n aus ultation0 there were normal lung and heart sounds. 9*3(!)! )he breasts are symmetri al in both si2e and shape and they both are light brown in olour with dark alleorae. )he breasts ha+e no s ars0 s ales0 lesions0 no sores0 rashes0 redness and no dimpling. %n breast palpation0 no masses were felt e, ept for the normal mammary gland. )he nipples are dark in olour0 lean and not in+erted. -PP3* 3F)*3M')'3! )he arms are symmetri al with no signs of oedema on both inspe tion and palpation. !he has a apillary refill of less than = se onds and has pink palms. $owe+er0 Mrs. Nkhata reported ha+ing tingling sensation of the upper e,tremities. (9>%M3N

%n inspe tion of the abdomen0 there was a dark linea nigra0 some striae gra+idalum with no sores or s ars. )he abdomen was o+oid in shape with a medium si2e. 8oetal mo+ements were also obser+ed medially on inspe tion. Li+er and spleen were not palpable indi ating absen e of organomegally. )he al ulated gestation by dates was =6 weeks and Fundal height Pelvic, Lateral and Fundal Palpation 8undal height 8oetal Presentation ; 8oetal Lie 8oetal Position 8oetal $eart *ate ; ; ; ; :9 weeks

#ephali Longitudinal *ight % ipital (nterior 14: beats per minute

L%43* 3F)*3M')'3! )he lower e,tremities are symmetri al with no s ars0 +ari ose +eins as well as signs of oedema on inspe tion. %n palpation0 no tibial0 ankle or pedal oedema was dete ted. No signs of /ari ose /eins or >eep /ein )hrombosis were dete ted on palpation of the uff mus les. Howmans sign was not obser+ed on fle,ion on the feet. &3N')(L'( -pon inspe tion of the genitalia0 no oedema0 sores0 warts0 genital ul ers0 abnormal +aginal dis harge or signs of hematoma were obser+ed. )here were no signs of +ari ose +eins or genital mutilation or ir um ision seen. )he +aginal dis harge was mild0 whitish and odourless.

P*%9L3M! AN33>! '>3N)'8'3>.

.nowledge defi it on se,uality during intra and post partum periods related to inability set times on when to stop and resume se,. La k of ade1uate information on immunisations related to limited information gi+en on immunisations as e+iden ed by inability to outline the normal s hedule for )etanus )o,oid /a ine. .nowledge defi it on 8o ussed (ntenatal #are and its importan e related to limited information gi+en about fo ussed antenatal are as e+iden ed by late oming for initial +isit. Possibily of not using family planning methods related to untrue spe ulations that >epoPro+era is phasing out.

#(*3 P*%/'>3> 8o us (ntenatal #are looks at omprehensi+e are gi+en to a pregnant woman with spe ified type of are per ea h +isit of the four e,pe ted +isits that the woman attends antenatal lini . 't looks at 1uality of are and not 1uantity of the number of +isits. 8o used (ntenatal #are emphasises on treating e+ery mother as an indi+idual or uni1ue person with indi+idual problems and needs. )he are that was gi+en to Mrs. Nkhata was based on the problems and needs that she had as well as spe ifi are a ording to hergestation age.

%n this day0 Mrs. Nkhata was treated omprehensi+ely starting with history taking to fill in gaps followed by $'/ and !yphilis tests then full physi al assessment whi h in+ol+ed using all the four modalities of inspe tion0 palpation0 aus ultation and per ussion. ' made sure that the lient7s are was pro+ided in a +ery ondu i+e en+ironment0 thus ensuring pri+a y as well as leanliness. ' made sure that she felt well taken are of and wel ome to the lini by being respe tful0 a ommodati+e and letting her ask 1uestions and e,press fears than looking at the are as a burden throughout the pro edures.

3N/'*%NM3N) >uring the filling in of gaps0 olle tion of important information that was missed out on the booking day0 an en+ironment that ensured pri+a y and omfort was ensured. )he data was olle ted at an en losed pla e where no one else ould listen to what was being dis ussed and this made the lient to be more open and to gi+e the information that was re1uired. Likewise0 during the physi al e,amination0 a ubi al was used to promote pri+a y onsidering that pro edures in+ol+ed this time in lude e,posure of sensiti+e areas like the hest0 abdomen and genitalia. 8'LL'N& 'N %8 &(P! -pon re+iew of the (ntenatal ardApage for Mrs. Nkhata se+eral areas that re1uired to be filled in were realised. 'n addition to that0 some more areas in the health passport were identified whi h also needed filling in. )he health did not ha+e information on her family medi al history and her medi al and surgi al history whi h is supposed to be filled o the first and se ond pages of the health passport and this is also where some important personal data is do umented. !ee (ppendi,...... showing the pages after filling in. Not only that but also blood group and rhesus fa tor were not tested but still more being an important information espe ially when it omes to emergen ies like anaemia0 ' still referred her go also go for the tests when she goes for the other tests. %n the antenatal page as well0 gra+idity and parity of the mother were not indi ated during the first +isit but got do umented on this +isit. TESTS 8o used (ntenatal re ommends mothers undergoing se+eral different tests at different +isits and different gestation ages. !u h tests are like $'/0 !yphilis0 haemoglobin le+el0 urine protein and #>4 ount in ase of those who are $'/ positi+e but not on antiretro+iral therapy.

$'/0 />*L and $aemoglobin le+el are the tests that are e,pe ted to be done on booking so as to ha+e a baseline data for some of them like $'/ and haemoglobin are tested again after sometime i.e. $'/ is tested again after = months while haemoglobin le+el is retested at =? weeks. -rine protein is e,pe ted to be tested e+ery +isit from first to fourth +isit but unfortunately none of these were done on the first +isit %n this +isit ' played a role of helping Mrs. Nkhata get tested for $'/ and !yphilis whose results ame out negati+e as indi ated on the antenatal ard B(ppendi,.....C after filling in the gaps. $owe+er0 ' referred the lient to Gueen 3li2abeth #entral $ospital for the tests whi h ould not be done at Ndirande (ntenatal #lini due to la k of materials like the haema ue kits and protein dipsti ks. )he referral was done after Ndirande $ealth #entre also reported not ha+ing the materials P$"!'#(L 3F(M'N()'%N (s indi ated in thee obEe ti+e data0 during physi al assessment0 no spe ifi problems were presented or dete ted from Mrs. Nkhata and all the findings were do umented on the antenatal ard and were also ommuni ated to the lient. !ee (ppendi,...... showing the antenatal ard with findings of the abdominal assessment. M3>'#()'%N! Most of medi ations at the (ntenatal #lini are gi+en a ording to gestation ages of the mothers and most of them are gi+en for prophyla ti purposes i.e. !P is gi+en to pre+ent a mother from malaria0 8errous !ulphate is gi+en to pre+ent anaemia whilst (benda2ole is gi+en to ombat worms infestation. !P is gi+en e+ery four weeks between the gestations of 1? to =? weeksH 8errous !ulphate is gi+en at e+ery +isit throughout pregnan y whilst (benda2ole is gi+en Eust on e and at first +isit. !P is gi+en in su h a way to pre+ent the tetratonegi effe ts 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 !P tablets B=C as well as 8errous !ulphate B=6 tabletsC. !P was gi+en after onfirming that 4 weeks had passed sin e the last dose was taken.

M'>4'83*" #(*3

(N(L"!'! %8 #(*3 ( lot of things and are were done during Mrs. Nkhata7s booking antenatal +isit. ' should sin erely gi+e redit to the are pro+ider who handled Mrs. Nkhata on the first +isit for the good Eob for most things e,pe ted to be done on booking espe ially data needed to be filled on the antenatal ard was filled. $owe+er0 not e+ery bit of information was olle ted and do umentedH for e,ample0 no information was do umented indi ating gra+idity and parity on the antenatal ard. )his information is +ery important to e+ery midwife who would ome into onta t with the lient for it gi+es a pi ture of the kind of lient one is dealing with i.e. prim-gra+ida0 multigra+ida or grand multipara. )hese also determine the kind of are that a lient will get. !e ondly0 the data do umented on the antenatal ard for abdominal assessment seem to ha+e been taken for granted by the are pro+ider during the pre+ious +isit. $a+ing been gi+en the date for the last normal menstrual period0 there was no reason heAshe ould not al ulate the gestation by dates for this day knowing its importan e. )he al ulated gestation by dates is +ery important to a midwife for it gi+es a base omparison with the fundal height done by tape measure or finger breadths. 't also seems that the midwife who ared for Mrs. Nkhata during the first +isit does not know what it means when we say presentation by abdominal assessment for sheAhe indi ated that it was a +erte, presentation of whi h +erte, an not be determined by pel+i palpation but +aginally. !heAhe would rather indi ate ephali for presentation and a position i.e. *ight % ipital (nterior0 Left % ipital (nterior or other positions. 9lood Pressure is on of the important +ital signs in pregnant women and unfortunately0 it was not done on the booking day. "es its true there ould be no a sphygmomanometer but still more a referral to Ndirande only for a blood pressure he k would be helpful. Pregnant women are at a risk of de+eloping pre-e lampsia whi h is high blood pressure in pregnan y and an only be diagnosed if blood pressure if he ked at e+ery +isit.

-rine protein test is also +ital in the way that presen e of protein in urine is indi ati+e of pre-e lampsia Mrs. Nkhata had ome for booking at a gestation age of :? weeks by fundal height and this learly shows la k of knowledge on fo used antenatal are as well as its importan e. Mrs. Nkhata being a Para one with birth of first born in :667 when fo used antenatal was already under implementation0 it was e,pe ted she must ha+e already been e,posed to su h type of are. -nfortunately0 the mother ame at :? weeks gestation following the old routine antenatal system. 4hen i asked her0 she said oming at :6 weeks and abo+e was what she knew. )his mother la ked information on fo used antenatal and its importan e whi h refle ts that she was not gi+en enough information about it during her first pregnan y. 3FP3#)3> 8'N>'N&! 8%* )$3 N3F) /'!') Mrs. Nkhata had ome for her se ond antenatal +isit at a gestation age of :9 weeks0 howe+er0 a ording to fo used antenatal0 by this time she was supposed to be oming for her third +isit whi h is supposed to bee between :D weeks and =: weeks. 'n this ase Mrs. Nkhata will ha+e her third and final normal +isit at =? weeks though at this time a mother is normally e,pe ted to be oming for a fourth +isit. 4hen Mrs. Nkhata omes at =? weeks whi h would be on .............0 she will undergo se+eral assessments some that are routine like +itals signs whilst some will base on her ondition as being in third trimester or ha+ing a =? weeks gestation. !ome of thee are will also base of the gaps that the midwife will identify as being left out during the pre+ious +isit. %n the ne,t +isit the midwife will ha+e to he k on the are gi+en on the pre+ious +isit0 e+aluate and then ha+e a basing for planning hisAher are and this will also depend on the urrent problems and the unmet needs of the lient. )he midwife will olle t some information from the lient to fill in the gaps that are not filled during this +isit. !he will also he k on the progress of pregnan y by asking Mrs. Nkhata on how she fairing with her pregnan y. !ome of the 1uestions she may ask are the presen e of foetal mo+ements and minor disorders of pregnan y for this will help the midwife to isolate the problems that the lient has at present.

Mrs. Nkhata will also ha+e to undergo se+eral tests whi h will be due by this time i.e. haemoglobin le+el and urine protein. $aemoglobin le+el is he ked on booking and in third trimester0 at =? weeks to be spe ifi whilst for urine protein is he ked at e+ery +isit to the antenatal lini . /ital signs are another aspe t that will ha+e to be he ked by the midwife as part of monitoring progress of pregnan y. (ny abnormality in the +ital signs is indi ati+e of a problem in the pregnant woman. 8or e,ampleH high blood pressure ould be indi ati+e of pre-e lampsia0 fe+er ould indi ate a systemi infe tion and in reased respiratory rate ould mean diffi ulty breathing0 though0 it is thought to be normal at =? weeks. Physi al assessment will also be done in luding general assessment as well as abdominal assessment. &eneral assessment will in+ol+e a head to assessment and no abnormality is e,pe ted from it. )he abdominal assessment will in+ol+e inspe tion0 palpation and aus ultation of the abdomen to he k si2e and shape of abdomen0 fundal height0 lie0 presentation and position of foetus as well as foetal heart rate. )he abdomen is inspe ted for s ars0 linea nigra0 striae gra+idalum0 si2e and shape0 foetal mo+ements0 bladder fullness and +isible organomegally. )hee fundal height will be measured using a tape measure of finger breadths so as to determine the age of pregnan y. )hen the pel+is will be palpated for presentation whi h is normally0 lateral palpation will be done to note the lie and position of the foetus. 8undal palpation will also be done to rule out multiple gestation or presentation in a situation where the head is not lo ated in the pel+i . 8oetal heart rate will also ha+e to bee aus ultated using a fetals ope to onfirm wellbeing of the foetus.

3FP3#)33> 8'N>'N&! 8undal height 8oetal Presentation ; ; =? weeks

#ephali

8oetal Lie 8oetal Position 8oetal $eart *ate

; ; ;

Longitudinal *ight % ipital (nteriorALeft % ipital (nterior 146 I 1?6 beats per minute

)he abo+e e,pe ted findings are thee normal e,pe ted finding in the absen e of possibility of ha+ing abnormal findings >*-&! %n this +isit Mrs. Nkhata will only be pro+ided with 8errous !ulphate as a drug to supplement iron for haemoglobin formation. !P will not be gi+en be ause it is belie+ed to ha+e a teratoni effe t on the fetus when gi+en at the gestation of =? weeks and abo+e. 3FP3#)3> >'!%*>3*! 9y this time the e,pe ted disorders that Mrs. Nkhata may ha+e are diffi ulty breathing0 fre1uent mi turation0 heada he0 onstipation0 ba ka he0 oedema +ari osities0 haemorrhoids and ramps for these are the ommon disorders that usually ome in third 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 gastri reflu, B8raser0 #ooper and Nolte0 :66?C. &astri reflu, ommonly o oesophageal sphin ter tone. 'f it happens that Mrs. Nkhata de+elops heartburn0 edu ation and ounseling on li'est(le
)odi'ication will be pro+ided and will in lude awareness of posture i.e. Maintaining upright positions Bespe ially after mealsC0 sleeping in a propped up position and dietar( )odi'ications Be.g. small fre1uent meals0 eating slowly0 redu tion of high-fat foods and affeineC.

urs as a result of

delayed gastri emptying0 de reased intestinal motility0 and de reased lower

S*ELL#NG+E"EMA

(s the growing uterus puts pressure on the +eins that return blood from feet and legs0 swollen feet and ankles may be ome an issue. (t the same time0 swelling in legs0 arms or hands may pla e pressure on ner+es0 ausing tingling or numbness. 8luid retention and dilated blood +essels may lea+e the fa e and eyelids puffy0 espe ially in the morning. )o redu e swelling0 the lient will be ad+ised to use old ompresses on the affe ted areas. Lying down or using a footrest may relie+e ankle swelling. !he might e+en ele+ate her feet and legs while she sleeps whi h will also minimise the swelling by gra+ity. ",SPNEA )his is a ommon symptom between the gestation of =4 and =? weeks. 't is as a result of the pressure by the growing uterus on the diaphragm B8raser0 #ooper and Nolte0 :66?C. 'f Mrs. Nkhata happens to de+elop dyspnoea0 she will be edu ated of the physiology of the problem for her to understand what7s happening. !he will also be ad+ised on sleeping in semi-fowlers position so as to be in reasing the area for lung e,pansion hen e impro+ed respiratory ondition. !he will also be en ouraged to ha+e periods and resting to redu e the body need for o,ygen. !ONST#PAT#ON #onstipation in pregnan y espe ially third trimester is usually aused by redu ed motility of large intestine whi h omes due to the mus le la,ati+e effe t of the hormone progesterone whi h is produ ed in large amounts this period0 'n reased water reabsorption from large intestine due to hormone aldosterone effe t0 Pressure on the pel+i olon by the pregnant uterus and sedentary life during pregnan y . if the lient will ome with the problem of onstipation0 she will ad+ised on drinking plenty of fluids0 high fibre foods and get plenty of e,er ise. )hese help in softening the bowels hen e redu ed risk of onstipation. %A!-A!HE

>uring pregnan y0 ligaments be ome softer and stret h to prepare for labour. )his an put a strain on the Eoints of the lower ba k and pel+is0 whi h an result in ba ka he. )o o+er ome this problem Mrs. Nkhata will be ad+ised to a+oid hea+y lifting0 bend her knees and keep her ba k straight when lifting or pi king up things from the ground0 mo+e her feet when turning and a+oid sudden twisting mo+ements0 4ork at a surfa e high enough to pre+ent her from stooping and to sit with her ba k straight and wellsupported. (nother ad+i e will be that she should make sure she gets enough rest0 parti ularly later in pregnan y.

F$E.&ENT M#!T&$AT#ON (s the baby mo+es deeper into your pel+is towards term of pregnan y0 a woman feel more pressure on your bladder and may find herself urinating more often0 e+en during the night. )his e,tra pressure may also ause her to leak urine J espe ially when she laughs0 oughs or snee2es. 'n this ase the lient will Eust ha+e to be assured that this is normal with a good e,planation of the ause. !he will also ha+e to be ad+ised on perineal are to pre+ent as ending infe tions. !$AMPS #ramp is a sudden0 sharp pain0 usually in alf mus les or feet. 't is most ommon at night0 but nobody really knows what auses it. )he woman will be oriented to skills she will ha+e pra ti e to ombat the problem for e,ampleH pulling up of toes hard up towards the ankle0 or rub the mus le hard. &entle e,er ise in pregnan y0 parti ularly ankle and leg mo+ements0 whi h an impro+e blood ir ulation and may help to pre+ent ramp o urring and plenty of al ium ri h foods Bleafy green +egetables0 dairy produ ts0 sunflower seeds0 salmon and dried beansC and magnesium ri h foods Bnuts0 dates and figs0 yellow orn0 green +egetables and applesC in her diet. FEA$ (s the pregnan y draws near term most women be ome afraid of the labour pains0 fears about hildbirth may be ome more persistent. $ow mu h will it hurtK $ow long will

it lastK $ow will they opeK 'f Mrs. Nkhata happens to ome with su h a problem0 she will be ad+ised on the importan e of hospital deli+ery where pain relief me hanisms are a+ailable. !he will also be asked to ha+e time with other women who ha+e had positi+e e,perien e of labour and this will help in relie+ing her fears.

3>-#()'%N (N> #%-N!3LL'N& >uring the assessment0 se+eral areas were identified that needed edu ation and ounselling to Mrs. Nkhata. 8(M'L" PL(NN'N& Mrs. Nkhata indeed knows what family planning is as well as the a+ailable family planning methods in Malawi but has problems with hoi e of family planning method a ording to her reprodu ti+e goals. Mrs. Nkhata e,pressed that she wants to use inEe table ontra epti+es B>epo-Pro+eraC as her family planning methods of hoi e. $owe+er0 she also e,pressed fears that she had heard that the method is phasing out soon. Looking at her reprodu ti+e goals0 ' felt that Mrs. Nkhata ould also benefit from other family methods that are long term like 'ntrauterine #ontra epti+e >e+i e and <adelle than the methods she had hosen ' dis ussed with her of all the methods on the positi+es0 negati+es and a+ailability of the methods with mu h emphasis on <adelle whi h is the best method for her basing on her goals as she wants to ha+e a spa e of fi+e years before gets pregnant again so the same with the method as it is made to last for 5 years. ' also ommented on the spe ulation that inEe table ontra epti+es are phasing out by telling her that it is not true. ' also e,plained to her that the best time to start family planning is si, weeks after deli+ery for it is belie+ed that by this time a woman7s fertility has returned and also her body has returned to her pre-pregnant state and an resume se, B8amily Planning $andbook0 :669C 'MM-N'!()'%N!

9ased on the information that she had re ei+ed only two doses of )etanus )o,oid /a ine with the first pregnan y and two with the urrent one0 ' felt she needed more ination information on the right e,pe ted s hedule the mothers are need to follow to omplete all the fi+e doses for ))/. %n this day0 an e,planation on the normal +a s hedule was gi+en to Mrs. Nkhata so that as she has already started with the two doses0 should finish the remaining three doses. 8inishing the doses will help in redu ing the risk of the baby from getting tetanus. 4e together planned on how she was going to get the other doses. )he third dose will be gi+en on 7ADA110 the fourth dose will be gi+en on 7ADA1: and the last dose will de gi+en on 7ADA1=. !3F-(L')" Mrs. Nkhata did not ha+e knowledge on when to stop se, before deli+ery and when resume after deli+ery. %n this day0 oriented her to the right time as to when she an stop se, as well as when to resume. ' told her that there is no limitation as to when they an stop se, thus they an ha+e se, until term of pregnan y as far as they are omfortable. ' also e,plained to her that they an resume se, as early as ? weeks as far as she feels that her body is ready for se,. 9'*)$$ PL(N (N> #%MPL'#()'%N P*3P(*3>N3!! *ealising that Mrs. Nkhata was afraid of labour pains0 ' took sometime ounselling her on normal pro esses of pregnan y until labour and deli+ery so as to alley her an,iety. 'i put emphasis on the need and importan e of deli+ering at the hospital where measures of managing labour pains are used. ' also ad+ised her on the need to asso iate and learn from mothers who had undergone the same e,perien e se+eral times who an help her prepare for her labour and deli+ery. 8%#-!3> (N)3N()(L #(*3 9asing on the time that she had started antenatal +isits0 it showed that she did not ha+e enough or no knowledge on fo used antenatal are and its importan e. ' therefore planned to edu ate her on what fo used antenatal is0 and its importan e. Mrs. Nkhata was told what is done at the lini where fo used antenatal system is followed and also

what if e,pe ted of women undergoing fo used antenatal are espe ially when to start attending antenatal and how fre1uent. 4e also dis ussed on the importan e of attending all the e,pe ted normal four +isits of antenatal are. M'N%* >'!%>3*! %8 P*3&N(N#" 'n addition to these edu ation and ounselling sessions0 Mrs. Nkhata was also prepared for the e,pe ted minor disorders that may de+elop as the pregnan y progresses espe ially in the third trimester. Minor disorders like dyspnoea0 heartburn0 onstipation and ba ka he are some of the ommon disorders that o an,ious but a ept them as things that happen normally. ur to mother in their third trimesters. !o she was told of the disorders so as when they happen she should not be

>ate for the ne,t +isit.