r during birth complication. 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 reeclampsia or eclampsia.

!"#$%L%&'#(L $'!)%*" Mrs. Nkhata said that the pregnancy that she has now was a planned one and also that the decision to ha+e the pregnancy was made by both her and her husband such that they both were +ery happy for the pregnancy. !he also said that she did not ha+e any psychological problems due to both pre+ious pregnancy as well as the current one e,cept for the fear of labour pains. 'MM-N'!()'%N! Mrs. N.hata e,plained that she had recei+ed two doss of )etanus )o,oid /accine with the first pregnancy and two doses with the current pregnancy. $owe+er0 she e,pressed lack of knowledge on the fre1uency and number of doses of tetanus )o,oid /accine she is e,pected to recei+e despite knowing the importance 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 which is occupied by three members of thee family0 the husband0 the first born child and herself. )he house is iron sheet roofed0 cement floored and electrified. !he said that she gets water from a #ommunal 4ater oint 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 disposal0 she said that there is a rubbish pit behind the house which is used for waste disposal and she keeps burning the waste in the pit to pre+ent it from being blown back to the house by wind when it7s full. !%#'%-3#%N%M'# $'!)%*"

Mrs. Nkhata is a 8orm four Lea+er currently working with .-.- Matches #ompany as a acker. $er husband is an electrician who is self employed. !he said that her family is able to get their needs and necessities from the combined income that they get from their duties and they li+e happily. Mrs. Nkhata reported no e,posure to increased workload for she is currently gi+en light work by her bosses ha+ing understood her condition. Mrs. Nkhata does not smoke any kind of cigar nor drinks any kind of alcohol although the husband takes alcohol but in a reasonable manner. *3!3N) %9!)3)*'# $'!)%*" Mrs. Nkhata is gra+ida : ara 1 mother Last normal menstrual period ; 3,pected date of deli+ery ; &estation by dates $'/ !tatus />*L ; ; ; 15th <uly0 :616 ::nd (pril0 :611 =6 weeks0 days Non-reacti+e Non-reacti+e

!he is currently not on any medications e,cept for the 8errous !ulphate she is gi+en when se +isits antenatal clinic 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 pregnancy a problem of fre1uency micturation.

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

)emperature 9lood ressure ulse *ate *espiration *ate &3N3*(L (

; ; ; ;

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

33(*(N#3

Mrs Nkhata is a 1?: cm tall woman0 slim and light brown in comple,ion. !he was wearing a red blouse and a black skirt with a pair of black slip-ons BshoesC. %n this day she weighed 5D kilograms0 gaining : kilograms from the weight during her booking +isit which was 5? kilograms. $3(> $er head is o+oid in shape with long chemical made hair and there was neither dandruff nor presence of scars or masses on the scalp. 8(#3 )here were no signs of facial oedema on both inspection and palpation. )he face also did not ha+e scars on inspection. 3"3! )he eyes are symmetrical and o+oid in shape with no signs of peri-orbital oedema and had a pink conEuncti+a. 3(*! )he ears are symmetrical with the upper ears in line with the outer borders of the eyes. )here were no sore0 no ear discharge0 no lesions and no signs of inflammation on palpating the pre and post auricular lymph nodes. N%!3

$er nostrils are symmetrical with no any discharge. !he has no history of epista,is and did not ha+e any polyps in the nostrils. M%-)$ $er lips were smooth with no sores or cracks. $er tongue and oral mucosa were pink with no sore0 no korpliks spots or signs of candidiasis. )here were neither decayed teeth nor gingi+itis. !he has neither cleft lip nor cleft palate. )he tonsilor0 submandibular and sub mental lymph nodes were not enlarged. N3#. !he has no problems with neck fle,ion as well as forward and backward neck bending. %n inspection0 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 cer+ical0 sub-cla+icle and infra -cla+icle lymph nodes. #$3!) %n inspection0 the chest did not ha+e scars0 lesions or signs of a pigeon chest with normal respiratory mo+ements. %n auscultation0 there were normal lung and heart sounds. 9*3(!)! )he breasts are symmetrical in both si2e and shape and they both are light brown in colour with dark alleorae. )he breasts ha+e no scars0 scales0 lesions0 no sores0 rashes0 redness and no dimpling. %n breast palpation0 no masses were felt e,cept for the normal mammary gland. )he nipples are dark in colour0 clean and not in+erted. 3* 3F)*3M')'3!

)he arms are symmetrical with no signs of oedema on both inspection and palpation. !he has a capillary refill of less than = seconds and has pink palms. $owe+er0 Mrs. Nkhata reported ha+ing tingling sensation of the upper e,tremities. (9>%M3N

%n inspection of the abdomen0 there was a dark linea nigra0 some striae gra+idalum with no sores or scars. )he abdomen was o+oid in shape with a medium si2e. 8oetal mo+ements were also obser+ed medially on inspection. Li+er and spleen were not palpable indicating absence of organomegally. )he calculated gestation by dates was =6 weeks and Fundal height Pelvic, Lateral and Fundal Palpation 8undal height 8oetal resentation ; 8oetal Lie 8oetal osition 8oetal $eart *ate ; ; ; ; :9 weeks

#ephalic Longitudinal *ight %ccipital (nterior 14: beats per minute

L%43* 3F)*3M')'3! )he lower e,tremities are symmetrical with no scars0 +aricose +eins as well as signs of oedema on inspection. %n palpation0 no tibial0 ankle or pedal oedema was detected. No signs of /aricose /eins or >eep /ein )hrombosis were detected on palpation of the cuff muscles. Howmans sign was not obser+ed on fle,ion on the feet. &3N')(L'( -pon inspection of the genitalia0 no oedema0 sores0 warts0 genital ulcers0 abnormal +aginal discharge or signs of hematoma were obser+ed. )here were no signs of +aricose +eins or genital mutilation or circumcision seen. )he +aginal discharge was mild0 whitish and odourless.

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

.nowledge deficit on se,uality during intra and post partum periods related to inability set times on when to stop and resume se,. Lack of ade1uate information on immunisations related to limited information gi+en on immunisations as e+idenced by inability to outline the normal schedule for )etanus )o,oid /accine. .nowledge deficit on 8ocussed (ntenatal #are and its importance related to limited information gi+en about focussed antenatal care as e+idenced by late coming for initial +isit. ossibily of not using family planning methods related to untrue speculations that >eporo+era is phasing out.

#(*3 *%/'>3> 8ocus (ntenatal #are looks at comprehensi+e care gi+en to a pregnant woman with specified type of care per each +isit of the four e,pected +isits that the woman attends antenatal clinic. 't looks at 1uality of care and not 1uantity of the number of +isits. 8ocused (ntenatal #are emphasises on treating e+ery mother as an indi+idual or uni1ue person with indi+idual problems and needs. )he care that was gi+en to Mrs. Nkhata was based on the problems and needs that she had as well as specific care according to hergestation age. %n this day0 Mrs. Nkhata was treated comprehensi+ely starting with history taking to fill in gaps followed by $'/ and !yphilis tests then full physical assessment which in+ol+ed using all the four modalities of inspection0 palpation0 auscultation and percussion. ' made sure that the client7s care was pro+ided in a +ery conduci+e en+ironment0 thus ensuring pri+acy as well as cleanliness. ' made sure that she felt well taken care of and welcome to the clinic by being respectful0 accommodati+e and letting her ask 1uestions and e,press fears than looking at the care as a burden throughout the procedures.

3N/'*%NM3N) >uring the filling in of gaps0 collection of important information that was missed out on the booking day0 an en+ironment that ensured pri+acy and comfort was ensured. )he 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 gi+e the information that was re1uired. Likewise0 during the physical e,amination0 a cubical was used to promote pri+acy considering that procedures in+ol+ed this time include e,posure of sensiti+e areas like the chest0 abdomen and genitalia. 8'LL'N& 'N %8 &( ! -pon re+iew of the (ntenatal cardApage 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 which also needed filling in. )he health did not ha+e information on her family medical history and her medical and surgical history which is supposed to be filled o the first and second pages of the health passport and this is also where some important personal data is documented. !ee (ppendi,...... showing the pages after filling in. Not only that but also blood group and rhesus factor were not tested but still more being an important information especially when it comes to emergencies 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 indicated during the first +isit but got documented on this +isit. TESTS 8ocused (ntenatal recommends mothers undergoing se+eral different tests at different +isits and different gestation ages. !uch tests are like $'/0 !yphilis0 haemoglobin le+el0 urine protein and #>4 count in case of those who are $'/ positi+e but not on antiretro+iral therapy.

$'/0 />*L and $aemoglobin le+el are the tests that are e,pected 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,pected 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 came out negati+e as indicated on the antenatal card B(ppendi,.....C after filling in the gaps. $owe+er0 ' referred the client to Gueen 3li2abeth #entral $ospital for the tests which could not be done at Ndirande (ntenatal #linic due to lack of materials like the haemacue kits and protein dipsticks. )he referral was done after Ndirande $ealth #entre also reported not ha+ing the materials $"!'#(L 3F(M'N()'%N (s indicated in thee obEecti+e data0 during physical assessment0 no specific problems were presented or detected from Mrs. Nkhata and all the findings were documented on the antenatal card and were also communicated to the client. !ee (ppendi,...... showing the antenatal card with findings of the abdominal assessment. M3>'#()'%N! Most of medications at the (ntenatal #linic are gi+en according to gestation ages of the mothers and most of them are gi+en for prophylactic purposes i.e. ! 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 combat worms infestation. ! is gi+en e+ery four weeks between the gestations of 1? to =? weeksH 8errous !ulphate is gi+en at e+ery +isit throughout pregnancy whilst (benda2ole is gi+en Eust once and at first +isit. ! 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 ! tablets B=C as well as 8errous !ulphate B=6 tabletsC. ! was gi+en after confirming that 4 weeks had passed since the last dose was taken.

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

(N(L"!'! %8 #(*3 ( lot of things and care were done during Mrs. Nkhata7s booking antenatal +isit. ' should sincerely gi+e credit to the care pro+ider who handled Mrs. Nkhata on the first +isit for the good Eob for most things e,pected to be done on booking especially data needed to be filled on the antenatal card was filled. $owe+er0 not e+ery bit of information was collected and documentedH for e,ample0 no information was documented indicating gra+idity and parity on the antenatal card. )his information is +ery important to e+ery midwife who would come into contact with the client for it gi+es a picture of the kind of client one is dealing with i.e. prim-gra+ida0 multigra+ida or grand multipara. )hese also determine the kind of care that a client will get. !econdly0 the data documented on the antenatal card for abdominal assessment seem to ha+e been taken for granted by the care 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 could not calculate the gestation by dates for this day knowing its importance. )he calculated gestation by dates is +ery important to a midwife for it gi+es a base comparison with the fundal height done by tape measure or finger breadths. 't also seems that the midwife who cared for Mrs. Nkhata during the first +isit does not know what it means when we say presentation by abdominal assessment for sheAhe indicated that it was a +erte, presentation of which +erte, can not be determined by pel+ic palpation but +aginally. !heAhe would rather indicate cephalic for presentation and a position i.e. *ight %ccipital (nterior0 Left %ccipital (nterior or other positions. 9lood ressure is on of the important +ital signs in pregnant women and unfortunately0 it was not done on the booking day. "es its true there could be no a sphygmomanometer but still more a referral to Ndirande only for a blood pressure check would be helpful. regnant women are at a risk of de+eloping pre-eclampsia which is high blood pressure in pregnancy and can only be diagnosed if blood pressure if checked at e+ery +isit.

-rine protein test is also +ital in the way that presence of protein in urine is indicati+e of pre-eclampsia Mrs. Nkhata had come for booking at a gestation age of :? weeks by fundal height and this clearly shows lack of knowledge on focused antenatal care as well as its importance. Mrs. Nkhata being a ara one with birth of first born in :667 when focused antenatal was already under implementation0 it was e,pected she must ha+e already been e,posed to such type of care. -nfortunately0 the mother came at :? weeks gestation following the old routine antenatal system. 4hen i asked her0 she said coming at :6 weeks and abo+e was what she knew. )his mother lacked information on focused antenatal and its importance which reflects that she was not gi+en enough information about it during her first pregnancy. 3F 3#)3> 8'N>'N&! 8%* )$3 N3F) /'!') Mrs. Nkhata had come for her second antenatal +isit at a gestation age of :9 weeks0 howe+er0 according to focused antenatal0 by this time she was supposed to becoming for her third +isit which is supposed to bee between :D weeks and =: weeks. 'n this case Mrs. Nkhata will ha+e her third and final normal +isit at =? weeks though at this time a mother is normally e,pected to be coming for a fourth +isit. 4hen Mrs. Nkhata comes at =? weeks which would be on .............0 she will undergo se+eral assessments some that are routine like +itals signs whilst some will base on her condition as being in third trimester or ha+ing a =? weeks gestation. !ome of thee care 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 check on the care gi+en on the pre+ious +isit0 e+aluate and then ha+e a basing for planning hisAher care and this will also depend on the current problems and the unmet needs of the client. )he midwife will collect some information from the client to fill in the gaps that are not filled during this +isit. !he will also check on the progress of pregnancy by asking Mrs. Nkhata on how she fairing with her pregnancy. !ome of the 1uestions she may ask are the presence of foetal mo+ements and minor disorders of pregnancy for this will help the midwife to isolate the problems that the client has at present.

Mrs. Nkhata will also ha+e to undergo se+eral tests which will be due by this time i.e. haemoglobin le+el and urine protein. $aemoglobin le+el is checked on booking and in third trimester0 at =? weeks to be specific whilst for urine protein is checked at e+ery +isit to the antenatal clinic. /ital signs are another aspect that will ha+e to be checked by the midwife as part of monitoring progress of pregnancy. (ny abnormality in the +ital signs is indicati+e of a problem in the pregnant woman. 8or e,ampleH high blood pressure could be indicati+e of pre-eclampsia0 fe+er could indicate a systemic infection and increased respiratory rate could mean difficulty breathing0 though0 it is thought to be normal at =? weeks. hysical assessment will also be done including general assessment as well as abdominal assessment. &eneral assessment will in+ol+e a head to assessment and no abnormality is e,pected from it. )he abdominal assessment will in+ol+e inspection0 palpation and auscultation of the abdomen to check si2e and shape of abdomen0 fundal height0 lie0 presentation and position of foetus as well as foetal heart rate. )he abdomen is inspected for scars0 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 pregnancy. )hen the pel+is will be palpated for presentation which 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 located in the pel+ic. 8oetal heart rate will also ha+e to bee auscultated using a fetalscope to confirm wellbeing of the foetus.

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

#ephalic

8oetal Lie 8oetal osition 8oetal $eart *ate

; ; ;

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

)he abo+e e,pected findings are thee normal e,pected finding in the absence 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. ! will not be gi+en because it is belie+ed to ha+e a teratonic effect on the fetus when gi+en at the gestation of =? weeks and abo+e. 3F 3#)3> >'!%*>3*! 9y this time the e,pected disorders that Mrs. Nkhata may ha+e are difficulty breathing0 fre1uent micturation0 headache0 constipation0 backache0 oedema +aricosities0 haemorrhoids and cramps for 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 )his is a burning0 irritating sensation in the oesophagus also known as gastric reflu, B8raser0 #ooper and Nolte0 :66?C. &astric reflu, commonly occurs as a result of delayed gastric emptying0 decreased intestinal motility0 and decreased lower oesophageal sphincter tone. 'f it happens that Mrs. Nkhata de+elops heartburn0 education and counseling on li'est(le
)odi'ication will be pro+ided and will include awareness of posture i.e. Maintaining upright positions Bespecially after mealsC0 sleeping in a propped up position and dietar( )odi'ications Be.g. small fre1uent meals0 eating slowly0 reduction of high-fat foods and caffeineC.

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 become an issue. (t the same time0 swelling in legs0 arms or hands may place pressure on ner+es0 causing tingling or numbness. 8luid retention and dilated blood +essels may lea+e the face and eyelids puffy0 especially in the morning. )o reduce swelling0 the client will be ad+ised to use cold compresses on the affected 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 which will also minimise the swelling by gra+ity. ",SPNEA )his is a common 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 educated 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 increasing the area for lung e,pansion hence impro+ed respiratory condition. !he will also be encouraged to ha+e periods and resting to reduce the body need for o,ygen. !ONST#PAT#ON #onstipation in pregnancy especially third trimester is usually caused by reduced motility of large intestine which comes due to the muscle la,ati+e effect of the hormone progesterone which is produced in large amounts this period0 'ncreased water reabsorption from large intestine due to hormone aldosterone effect0 ressure on the pel+ic colon by the pregnant uterus and sedentary life during pregnancy . if the client will come with the problem of constipation0 she will ad+ised on drinking plenty of fluids0 high fibre foods and get plenty of e,ercise. )hese help in softening the bowels hence reduced risk of constipation. %A!-A!HE

>uring pregnancy0 ligaments become softer and stretch to prepare for labour. )his can put a strain on the Eoints of the lower back and pel+is0 which can result in backache. )o o+ercome this problem Mrs. Nkhata will be ad+ised to a+oid hea+y lifting0 bend her knees and keep her back straight when lifting or picking up things from the ground0 mo+e her feet when turning and a+oid sudden twisting mo+ements0 4ork at a surface high enough to pre+ent her from stooping and to sit with her back straight and wellsupported. (nother ad+ice will be that she should make sure she gets enough rest0 particularly later in pregnancy.

F$E.&ENT M#!T&$AT#ON (s the baby mo+es deeper into your pel+is towards term of pregnancy0 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 cause her to leak urine J especially when she laughs0 coughs or snee2es. 'n this case the client will Eust ha+e to be assured that this is normal with a good e,planation of the cause. !he will also ha+e to be ad+ised on perineal care to pre+ent ascending infections. !$AMPS #ramp is a sudden0 sharp pain0 usually in calf muscles or feet. 't is most common at night0 but nobody really knows what causes it. )he woman will be oriented to skills she will ha+e practice to combat the problem for e,ampleH pulling up of toes hard up towards the ankle0 or rub the muscle hard. &entle e,ercise in pregnancy0 particularly ankle and leg mo+ements0 which can impro+e blood circulation and may help to pre+ent cramp occurring and plenty of calcium rich foods Bleafy green +egetables0 dairy products0 sunflower seeds0 salmon and dried beansC and magnesium rich foods Bnuts0 dates and figs0 yellow corn0 green +egetables and applesC in her diet. FEA$ (s the pregnancy draws near term most women become afraid of the labour pains0 fears about childbirth 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 ad+ised on the importance of hospital deli+ery where pain relief mechanisms are a+ailable. !he will also be asked to ha+e time with other women who ha+e had positi+e e,perience 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 education and counselling to Mrs. Nkhata. 8(M'L" L(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 choice of family planning method according to her reproducti+e goals. Mrs. Nkhata e,pressed that she wants to use inEectable contracepti+es B>epo- ro+eraC as her family planning methods of choice. $owe+er0 she also e,pressed fears that she had heard that the method is phasing out soon. Looking at her reproducti+e goals0 ' felt that Mrs. Nkhata could also benefit from other family methods that are long term like 'ntrauterine #ontracepti+e >e+ice and <adelle than the methods she had chosen ' discussed with her of all the methods on the positi+es0 negati+es and a+ailability of the methods with much emphasis on <adelle which is the best method 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 method as it is made to last for 5 years. ' also commented on the speculation that inEectable contracepti+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 can resume se, B8amily lanning $andbook0 :669C 'MM-N'!()'%N!

9ased on the information that she had recei+ed only two doses of )etanus )o,oid /accine with the first pregnancy and two with the current one0 ' felt she needed more information on the right e,pected schedule the mothers are need to follow to complete all the fi+e doses for ))/. %n this day0 an e,planation on the normal +accination schedule 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 reducing 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 can stop se, as well as when to resume. ' told 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,plained to her that they can resume se, as early as ? weeks as far as she feels that her body is ready for se,. 9'*)$$ L(N (N> #%M L'#()'%N *3 (*3>N3!! *ealising that Mrs. Nkhata was afraid of labour pains0 ' took sometime counselling her on normal processes of pregnancy until labour and deli+ery so as to alley her an,iety. 'i put emphasis on the need and importance of deli+ering at the hospital where measures of managing labour pains are used. ' also ad+ised her on the need to associate and learn from mothers who had undergone the same e,perience se+eral times who can 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 focused antenatal care and its importance. ' therefore planned to educate her on what focused antenatal is0 and its importance. Mrs. Nkhata was told what is done at the clinic where focused antenatal system is followed and also

what if e,pected of women undergoing focused antenatal care especially when to start attending antenatal and how fre1uent. 4e also discussed on the importance of attending all the e,pected normal four +isits of antenatal care. M'N%* >'!%>3*! %8 *3&N(N#" 'n addition to these education and counselling sessions0 Mrs. Nkhata was also prepared for the e,pected minor disorders that may de+elop as the pregnancy progresses especially in the third trimester. Minor disorders like dyspnoea0 heartburn0 constipation and backache are some of the common disorders that occur to mother in their third trimesters. !o she was told of the disorders so as when they happen she should not be an,ious but accept them as things that happen normally.

>ate for the ne,t +isit.