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, 2011), it seems that the Nkhatas family manages a diet which is well mixed with all the required

six food groups on daily basis !he also pro"ed to be knowledgeable of the six food groups by mentioning all of them with examples #rs Nkhata also reported no history of pica towards non food items with both her pregnancies $owe"er, she said that the pregnancy has made her like some of the foods she ne"er liked like fresh fish #rs Nkhata said that she does not eat pork based on religious ground as she is a #uslim but said that her culture does not restrict her from eating ant food !he explained that she has enough food in her house that is enough for her family all the times !he has good preparation and storage methods of food with some good storage principles like no relish remains to be used the next day, they only prepare enough food for the day

%&!' ()!'*'+,-&. $,!'(+/ #rs N0hata is %ara 1 with first deli"ery in 2002 and she was 22 years by then )+*&01(2N 'he first pregnancy way term with 30 weeks gestation by fundal height 'he baby was deli"ered at Ndirande $ealth -entre and she deli"ered by !pontaneous 4ertex 1eli"ery but sustained a tear which was sutured and healed without any complications 'he baby was 5300g at birth and was born without any congenital nor during birth complication .abour had taken about 13 hours thus from 6 pm to 7am #rs Nkhata has no history of ante8partum or intra8partum haemorrhage as well as %re8eclampsia or eclampsia

%!/-$(.(9,-&. $,!'(+/ #rs 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 except for the fear of labour pains ,##:N,!&',(N! #rs N0hata explained that she had recei"ed two doss of 'etanus 'oxoid 4accine with the first pregnancy and two doses with the current pregnancy $owe"er, she expressed lack of knowledge on the frequency and number of doses of tetanus 'oxoid 4accine she is expected to recei"e despite knowing the importance of the immuni;ations *N4,+(N#*N'&. $,!'(+/ (n en"ironmental history, #rs N0hata said that she has a two bedroom house with a seat room which is occupied by three members of thee family, the husband, the first born child and herself 'he house is iron sheet roofed, cement floored and electrified !he said that she gets water from a -ommunal 2ater %oint which is about <0 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 disposal, 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 its full !(-,(8*-(N(#,- $,!'(+/ #rs Nkhata is a =orm four .ea"er currently working with 0:0: #atches -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 #rs Nkhata reported no exposure to increased workload for she is currently gi"en light work by her bosses ha"ing understood her condition #rs Nkhata does not smoke any kind of cigar nor drinks any kind of alcohol although the husband takes alcohol but in a reasonable manner

%+*!*N' ()!'*'+,- $,!'(+/ #rs Nkhata is gra"ida 2 %ara 1 mother .ast normal menstrual period > *xpected date of deli"ery > 9estation by dates $,4 !tatus 41+. > > > 1<th ?uly, 2010 22nd &pril, 2011 50 weeks, days Non8reacti"e Non8reacti"e

!he is currently not on any medications except for the =errous !ulphate she is gi"en when se "isits antenatal clinic meant to help in the formulation of haemoglobin *.,#,N&',(N #rs Nkhata has no any problem with either bowel mo"ement or urination $owe"er, she said that she had in the early days of pregnancy a problem of frequency micturation

()?*-',4* 1&'& Vital Signs 'emperature )lood %ressure %ulse +ate +espiration +ate > > > > 5@ 6A120B60mm$g 60 beats peer minute 22 breaths per minute

9*N*+&. &%%**&+&N-*

#rs Nkhata is a 1@2 cm tall woman, slim and light brown in complexion !he was wearing a red blouse and a black skirt with a pair of black slip8ons Cshoes) (n this day she weighed <D kilograms, gaining 2 kilograms from the weight during her booking "isit which was <@ kilograms $*&1 $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 =&-* 'here were no signs of facial oedema on both inspection and palpation 'he face also did not ha"e scars on inspection */*! 'he eyes are symmetrical and o"oid in shape with no signs of peri8orbital oedema and had a pink conEuncti"a *&+! 'he ears are symmetrical with the upper ears in line with the outer borders of the eyes 'here were no sore, no ear discharge, no lesions and no signs of inflammation on palpating the pre and post auricular lymph nodes N(!* $er nostrils are symmetrical with no any discharge !he has no history of epistaxis and did not ha"e any polyps in the nostrils #(:'$ $er lips were smooth with no sores or cracks $er tongue and oral mucosa were pink with no sore, no korpliks spots or signs of candidiasis 'here were neither decayed teeth nor gingi"itis !he has neither cleft lip nor cleft palate 'he tonsilor, sub8 mandibular and sub mental lymph nodes were not enlarged

N*-0 !he has no problems with neck flexion as well as forward and backward neck bending (n inspection, there were no ob"ious signs of distended Eugular "eins, no sores, no ob"ious lesions (n palpation, there were neither signs of enlarged thyroid gland nor enlarged deep cer"ical, sub8cla"icle and infra 8cla"icle lymph nodes -$*!' (n inspection, the chest did not ha"e scars, lesions or signs of a pigeon chest with normal respiratory mo"ements (n auscultation, there were normal lung and heart sounds )+*&!'! 'he breasts are symmetrical in both si;e and shape and they both are light brown in colour with dark alleorae 'he breasts ha"e no scars, scales, lesions, no sores, rashes, redness and no dimpling (n breast palpation, no masses were felt except for the normal mammary gland 'he nipples are dark in colour, clean and not in"erted :%%*+ *F'+*#,',*! 'he arms are symmetrical with no signs of oedema on both inspection and palpation !he has a capillary refill of less than 5 seconds and has pink palms $owe"er, #rs Nkhata reported ha"ing tingling sensation of the upper extremities &)1(#*N (n inspection of the abdomen, there was a dark linea nigra, some striae gra"idalum with no sores or scars 'he abdomen was o"oid in shape with a medium si;e =oetal mo"ements were also obser"ed medially on inspection .i"er and spleen were not palpable indicating absence of organomegally 'he calculated gestation by dates was 50 weeks and Fundal height Pelvic, Lateral and Fundal Palpation

=undal height =oetal %resentation > =oetal .ie =oetal %osition =oetal $eart +ate > > >

>

27 weeks

-ephalic .ongitudinal +ight (ccipital &nterior 132 beats per minute

.(2*+ *F'+*#,',*! 'he lower extremities are symmetrical with no scars, "aricose "eins as well as signs of oedema on inspection (n palpation, no tibial, ankle or pedal oedema was detected No signs of 4aricose 4eins or 1eep 4ein 'hrombosis were detected on palpation of the cuff muscles Howmans sign was not obser"ed on flexion on the feet 9*N,'&.,& :pon inspection of the genitalia, no oedema, sores, warts, genital ulcers, 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 mild, whitish and odourless

%+().*#! BN**1! ,1*N',=,*1 0nowledge deficit on sexuality during intra and post partum periods related to inability set times on when to stop and resume sex .ack of adequate information on immunisations related to limited information gi"en on immunisations as e"idenced by inability to outline the normal schedule for 'etanus 'oxoid 4accine 0nowledge deficit on =ocussed &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 1epo8 %ro"era is phasing out

-&+* %+(4,1*1 =ocus &ntenatal -are looks at comprehensi"e care gi"en to a pregnant woman with specified type of care per each "isit of the four expected "isits that the woman attends antenatal clinic ,t looks at quality of care and not quantity of the number of "isits =ocused &ntenatal -are emphasises on treating e"ery mother as an indi"idual or unique person with indi"idual problems and needs 'he care that was gi"en to #rs Nkhata was based on the problems and needs that she had as well as specific care according to hergestation age (n this day, #rs Nkhata was treated comprehensi"ely starting with history taking to fill in gaps followed by $,4 and !yphilis tests then full physical assessment which in"ol"ed using all the four modalities of inspection, palpation, auscultation and percussion , made sure that the clients care was pro"ided in a "ery conduci"e en"ironment, thus ensuring pri"acy as well as cleanliness , made sure that she felt well taken care of and welcome to the clinic by being respectful, accommodati"e and letting her ask questions and express fears than looking at the care as a burden throughout the procedures *N4,+(N#*N' 1uring the filling in of gaps, collection of important information that was missed out on the booking day, 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 required .ikewise, during the physical examination, a cubical was used to promote pri"acy considering that procedures in"ol"ed this time include exposure of sensiti"e areas like the chest, abdomen and genitalia

=,..,N9 ,N (= 9&%! :pon re"iew of the &ntenatal cardBpage for #rs Nkhata se"eral areas that required to be filled in were realised ,n addition to that, 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 &ppendix 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 anaemia, , still referred her go also go for the tests when she goes for the other tests (n the antenatal page as well, gra"idity and parity of the mother were not indicated during the first "isit but got documented on this "isit TESTS =ocused &ntenatal recommends mothers undergoing se"eral different tests at different "isits and different gestation ages !uch tests are like $,4, !yphilis, haemoglobin le"el, urine protein and -13 count in case of those who are $,4 positi"e but not on antiretro"iral therapy $,4, 41+. and $aemoglobin le"el are the tests that are expected to be done on booking so as to ha"e a baseline data for some of them like $,4 and haemoglobin are tested again after sometime i e $,4 is tested again after 5 months while haemoglobin le"el is retested at 5@ weeks :rine protein is expected 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 #rs Nkhata get tested for $,4 and !yphilis whose results came out negati"e as indicated on the antenatal card C&ppendix ) after filling in the gaps $owe"er, , referred the client to Gueen *li;abeth -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 $ealth -entre also reported not ha"ing the materials %$/!,-&. *F&#,N&',(N &s indicated in thee obEecti"e data, during physical assessment, no specific problems were presented or detected from #rs Nkhata and all the findings were documented on the antenatal card and were also communicated to the client !ee &ppendix showing the antenatal card with findings of the abdominal assessment #*1,-&',(N! #ost 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 malaria, =errous !ulphate is gi"en to pre"ent anaemia whilst &benda;ole is gi"en to combat worms infestation !% is gi"en e"ery four weeks between the gestations of 1@ to 5@ weeksH =errous !ulphate is gi"en at e"ery "isit throughout pregnancy whilst &benda;ole 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 "isit, #rs Nkhata, ha"ing the gestation age of 50 weeks, she was gi"en both !% tablets C5) as well as =errous !ulphate C50 tablets) !% was gi"en after confirming that 3 weeks had passed since the last dose was taken #,12,=*+/ -&+*

&N&./!,! (= -&+* & lot of things and care were done during #rs Nkhatas booking antenatal "isit , should sincerely gi"e credit to the care pro"ider who handled #rs Nkhata on the first "isit for the good Eob for most things expected to be done on booking especially data needed to be filled on the antenatal card was filled $owe"er, not e"ery bit of information was collected and documentedH for example, 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 prim8gra"ida, multigra"ida or grand multipara 'hese also determine the kind of care that a client will get !econdly, 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 period, there was no reason heBshe 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 #rs Nkhata during the first "isit does not know what it means when we say presentation by abdominal assessment for sheBhe indicated that it was a "ertex presentation of which "ertex can not be determined by pel"ic palpation but "aginally !heBhe would rather indicate cephalic for presentation and a position i e +ight (ccipital &nterior, .eft (ccipital &nterior or other positions )lood %ressure is on of the important "ital signs in pregnant women and unfortunately, 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 pre8eclampsia 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 pre8eclampsia #rs Nkhata had come for booking at a gestation age of 2@ weeks by fundal height and this clearly shows lack of knowledge on focused antenatal care as well as its importance #rs Nkhata being a %ara one with birth of first born in 2006 when focused antenatal was already under implementation, it was expected she must ha"e already been exposed to such type of care :nfortunately, the mother came at 2@ weeks gestation following the old routine antenatal system 2hen i asked her, she said coming at 20 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 *F%*-'*1 =,N1,N9! =(+ '$* N*F' 4,!,' #rs Nkhata had come for her second antenatal "isit at a gestation age of 27 weeks, howe"er, according to focused antenatal, by this time she was supposed to becoming for her third "isit which is supposed to bee between 2D weeks and 52 weeks ,n this case #rs Nkhata will ha"e her third and final normal "isit at 5@ weeks though at this time a mother is normally expected to be coming for a fourth "isit 2hen #rs Nkhata comes at 5@ weeks which would be on , 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 5@ 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 next "isit the midwife will ha"e to check on the care gi"en on the pre"ious "isit, e"aluate and then ha"e a basing for planning hisBher 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 #rs Nkhata on how she fairing with her pregnancy !ome of the questions 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 #rs 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 trimester, at 5@ weeks to be specific whilst for urine protein is checked at e"ery "isit to the antenatal clinic 4ital 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 =or exampleH high blood pressure could be indicati"e

of pre8eclampsia, fe"er could indicate a systemic infection and increased respiratory rate could mean difficulty breathing, though, it is thought to be normal at 5@ weeks %hysical assessment will also be done including general assessment as well as abdominal assessment 9eneral assessment will in"ol"e a head to assessment and no abnormality is expected from it 'he abdominal assessment will in"ol"e inspection, palpation and auscultation of the abdomen to check si;e and shape of abdomen, fundal height, lie, presentation and position of foetus as well as foetal heart rate 'he abdomen is inspected for scars, linea nigra, striae gra"idalum, si;e and shape, foetal mo"ements, 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 normally, lateral palpation will be done to note the lie and position of the foetus =undal 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 =oetal heart rate will also ha"e to bee auscultated using a fetalscope to confirm wellbeing of the foetus

*F%*-'**1 =,N1,N9! =undal height =oetal %resentation > =oetal .ie =oetal %osition =oetal $eart +ate > > > > 5@ weeks

-ephalic .ongitudinal +ight (ccipital &nteriorB.eft (ccipital &nterior 130 I 1@0 beats per minute

'he abo"e expected findings are thee normal expected finding in the absence of possibility of ha"ing abnormal findings

1+:9! (n this "isit #rs Nkhata will only be pro"ided with =errous !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 5@ weeks and abo"e *F%*-'*1 1,!(+1*+! )y this time the expected disorders that #rs Nkhata may ha"e are difficulty breathing, frequent micturation, headache, constipation, backache, oedema "aricosities, 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 burning, irritating sensation in the oesophagus also known as gastric reflux C=raser, -ooper and Nolte, 200@) 9astric reflux commonly occurs as a result of delayed gastric emptying, decreased intestinal motility, and decreased lower oesophageal sphincter tone ,f it happens that #rs Nkhata de"elops heartburn, education and counseling on li'est(le
)odi'ication will be pro"ided and will include awareness of posture i e #aintaining upright positions Cespecially after meals), sleeping in a propped up position and dietar( )odi'ications Ce g small frequent meals, eating slowly, reduction of high8fat foods and caffeine)

S*ELL#NG+E"EMA &s the growing uterus puts pressure on the "eins that return blood from feet and legs, swollen feet and ankles may become an issue &t the same time, swelling in legs, arms or hands may place pressure on ner"es, causing tingling or numbness =luid retention and dilated blood "essels may lea"e the face and eyelids puffy, especially in the morning

'o reduce swelling, the client will be ad"ised to use cold compresses on the affected areas .ying 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 53 and 5@ weeks ,t is as a result of the pressure by the growing uterus on the diaphragm C=raser, -ooper and Nolte, 200@) ,f #rs Nkhata happens to de"elop dyspnoea, she will be educated of the physiology of the problem for her to understand whats happening !he will also be ad"ised on sleeping in semi8fowlers position so as to be increasing the area for lung expansion hence impro"ed respiratory condition !he will also be encouraged to ha"e periods and resting to reduce the body need for oxygen !ONST#PAT#ON -onstipation in pregnancy especially third trimester is usually caused by reduced motility of large intestine which comes due to the muscle laxati"e effect of the hormone progesterone which is produced in large amounts this period, ,ncreased water re8 absorption from large intestine due to hormone aldosterone effect, %ressure on the pel"ic colon by the pregnant uterus and sedentary life during pregnancy if the client will come with the problem of constipation, she will ad"ised on drinking plenty of fluids, high fibre foods and get plenty of exercise 'hese help in softening the bowels hence reduced risk of constipation %A!-A!HE 1uring pregnancy, ligaments become softer and stretch to prepare for labour 'his can put a strain on the Eoints of the lower back and pel"is, which can result in backache 'o o"ercome this problem #rs Nkhata will be ad"ised to a"oid hea"y lifting, bend her knees and keep her back straight when lifting or picking up things from the ground, mo"e her feet when turning and a"oid sudden twisting mo"ements, 2ork at a surface high enough to pre"ent her from stooping and to sit with her back straight and well8

supported &nother ad"ice will be that she should make sure she gets enough rest, particularly later in pregnancy

F$E.&ENT M#!T&$AT#ON &s the baby mo"es deeper into your pel"is towards term of pregnancy, a woman feel more pressure on your bladder and may find herself urinating more often, e"en during the night 'his extra pressure may also cause her to leak urine J especially when she laughs, coughs or snee;es ,n this case the client will Eust ha"e to be assured that this is normal with a good explanation of the cause !he will also ha"e to be ad"ised on perineal care to pre"ent ascending infections !$AMPS -ramp is a sudden, sharp pain, usually in calf muscles or feet ,t is most common at night, but nobody really knows what causes it 'he woman will be oriented to skills she will ha"e practice to combat the problem for exampleH pulling up of toes hard up towards the ankle, or rub the muscle hard 9entle exercise in pregnancy, particularly ankle and leg mo"ements, which can impro"e blood circulation and may help to pre"ent cramp occurring and plenty of calcium rich foods Cleafy green "egetables, dairy products, sunflower seeds, salmon and dried beans) and magnesium rich foods Cnuts, dates and figs, yellow corn, green "egetables and apples) in her diet FEA$ &s the pregnancy draws near term most women become afraid of the labour pains, fears about childbirth may become more persistent $ow much will it hurtK $ow long will it lastK $ow will they copeK ,f #rs Nkhata happens to come with such a problem, 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 experience of labour and this will help in relie"ing her fears

*1:-&',(N &N1 -(:N!*..,N9

1uring the assessment, se"eral areas were identified that needed education and counselling to #rs Nkhata =&#,./ %.&NN,N9 #rs Nkhata indeed knows what family planning is as well as the a"ailable family planning methods in #alawi but has problems with choice of family planning method according to her reproducti"e goals #rs Nkhata expressed that she wants to use inEectable contracepti"es C1epo8%ro"era) as her family planning methods of choice $owe"er, she also expressed fears that she had heard that the method is phasing out soon .ooking at her reproducti"e goals, , felt that #rs Nkhata could also benefit from other family methods that are long term like ,ntrauterine -ontracepti"e 1e"ice and ?adelle than the methods she had chosen , discussed with her of all the methods on the positi"es, 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 < years , also commented on the speculation that inEectable contracepti"es are phasing out by telling her that it is not true , also explained to her that the best time to start family planning is six weeks after deli"ery for it is belie"ed that by this time a womans fertility has returned and also her body has returned to her pre8pregnant state and can resume sex C=amily %lanning $andbook, 2007) ,##:N,!&',(N! )ased on the information that she had recei"ed only two doses of 'etanus 'oxoid 4accine with the first pregnancy and two with the current one, , felt she needed more information on the right expected schedule the mothers are need to follow to complete all the fi"e doses for ''4 (n this day, an explanation on the normal "accination schedule was gi"en to #rs Nkhata so that as she has already started with the two doses, should finish the remaining three doses =inishing the doses will help in reducing

the risk of the baby from getting tetanus 2e together planned on how she was going to get the other doses 'he third dose will be gi"en on 6BDB11, the fourth dose will be gi"en on 6BDB12 and the last dose will de gi"en on 6BDB15 !*F:&.,'/ #rs Nkhata did not ha"e knowledge on when to stop sex before deli"ery and when resume after deli"ery (n this day, 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 ha"e sex until term of pregnancy as far as they are comfortable , also explained to her that they can resume sex as early as @ weeks as far as she feels that her body is ready for sex ),+'$$ %.&N &N1 -(#%.,-&',(N %+*%&+*1N*!! +ealising that #rs Nkhata was afraid of labour pains, , took sometime counselling her on normal processes of pregnancy until labour and deli"ery so as to alley her anxiety ,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 experience se"eral times who can help her prepare for her labour and deli"ery =(-:!*1 &N'*N&'&. -&+* )asing on the time that she had started antenatal "isits, 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 is, and its importance #rs Nkhata was told what is done at the clinic where focused antenatal system is followed and also what if expected of women undergoing focused antenatal care especially when to start attending antenatal and how frequent 2e also discussed on the importance of attending all the expected normal four "isits of antenatal care #,N(+ 1,!(1*+! (= %+*9N&N-/

,n addition to these education and counselling sessions, #rs Nkhata was also prepared for the expected minor disorders that may de"elop as the pregnancy progresses especially in the third trimester #inor disorders like dyspnoea, heartburn, 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 anxious but accept them as things that happen normally

1ate for the next "isit

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