healed without any complications.

The baby was 3400g at birth and was born without any congenital nor during birth complication. Labour had taken about 14 hours thus from 7 pm to 9am. rs. !khata has no history of ante"partum or intra"partum haemorrhage as well as #re"eclampsia or eclampsia.

#$%&'(L()*&+L '*$T(,% rs. !khata 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. $he also said that she did not ha-e any psychological problems due to both pre-ious pregnancy as well as the current one e.cept for the fear of labour pains. * /!*$+T*(!$ rs. !0hata e.plained that she had recei-ed two doss of Tetanus To.oid 1accine with the first pregnancy and two doses with the current pregnancy. 'owe-er2 she e.pressed lack of knowledge on the fre3uency and number of doses of tetanus To.oid 1accine she is e.pected to recei-e despite knowing the importance of the immuni4ations. 5!1*,(! 5!T+L '*$T(,% (n en-ironmental history2 rs. !0hata said that she has a two bedroom house with a

seat room which is occupied by three members of thee family2 the husband2 the first born child and herself. The house is iron sheet roofed2 cement floored and electrified. $he said that she gets water from a &ommunal 6ater #oint which is about 70 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 disposal2 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 it8s full.

$(&*("5&(!( *& '*$T(,% rs. !khata is a 9orm four Lea-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. !khata reported no e.posure to increased workload for she is currently gi-en light work by her bosses ha-ing understood her condition. rs. !khata does not smoke any kind of cigar nor drinks any kind of alcohol although the husband takes alcohol but in a reasonable manner. #,5$5!T (:$T5T,*& '*$T(,% rs. !khata is gra-ida ; #ara 1 mother Last normal menstrual period < 5.pected date of deli-ery < )estation by dates '*1 $tatus 1>,L < < < 17th =uly2 ;010 ;;nd +pril2 ;011 30 weeks2 days !on"reacti-e !on"reacti-e

$he is currently not on any medications e.cept for the 9errous $ulphate she is gi-en when se -isits antenatal clinic meant to help in the formulation of haemoglobin. 5L* *!+T*(! rs. !khata has no any problem with either bowel mo-ement or urination. 'owe-er2 she said that she had in the early days of pregnancy a problem of fre3uency micturation.

(:=5&T*15 >+T+

Vital Signs Temperature :lood #ressure #ulse ,ate ,espiration ,ate < < < < 3?.7@& 1;0A70mm'g 70 beats peer minute ;; breaths per minute

)5!5,+L +##55+,+!&5 rs !khata is a 1?; cm tall woman2 slim and light brown in comple.ion. $he was wearing a red blouse and a black skirt with a pair of black slip"ons BshoesC. (n this day she weighed 7D kilograms2 gaining ; kilograms from the weight during her booking -isit which was 7? kilograms. '5+> 'er head is o-oid in shape with long chemical made hair and there was neither dandruff nor presence of scars or masses on the scalp. 9+&5 There were no signs of facial oedema on both inspection and palpation. The face also did not ha-e scars on inspection. 5%5$ The eyes are symmetrical and o-oid in shape with no signs of peri"orbital oedema and had a pink conEuncti-a. 5+,$ The ears are symmetrical with the upper ears in line with the outer borders of the eyes. There were no sore2 no ear discharge2 no lesions and no signs of inflammation on palpating the pre and post auricular lymph nodes. !($5

'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. (/T' 'er lips were smooth with no sores or cracks. 'er tongue and oral mucosa were pink with no sore2 no korpliks spots or signs of candidiasis. There were neither decayed teeth nor gingi-itis. $he has neither cleft lip nor cleft palate. The tonsilor2 sub" mandibular and sub mental lymph nodes were not enlarged. !5&0 $he has no problems with neck fle.ion as well as forward and backward neck bending. (n inspection2 there were no ob-ious signs of distended Eugular -eins2 no sores2 no ob-ious lesions. (n palpation2 there were neither signs of enlarged thyroid gland nor enlarged deep cer-ical2 sub"cla-icle and infra "cla-icle lymph nodes. &'5$T (n inspection2 the chest did not ha-e scars2 lesions or signs of a pigeon chest with normal respiratory mo-ements. (n auscultation2 there were normal lung and heart sounds. :,5+$T$ The breasts are symmetrical in both si4e and shape and they both are light brown in colour with dark alleorae. The breasts ha-e no scars2 scales2 lesions2 no sores2 rashes2 redness and no dimpling. (n breast palpation2 no masses were felt e.cept for the normal mammary gland. The nipples are dark in colour2 clean and not in-erted. /##5, 5FT,5 *T*5$ The arms are symmetrical with no signs of oedema on both inspection and palpation. $he has a capillary refill of less than 3 seconds and has pink palms. 'owe-er2 !khata reported ha-ing tingling sensation of the upper e.tremities. +:>( 5! rs.

(n inspection of the abdomen2 there was a dark linea nigra2 some striae gra-idalum with no sores or scars. The abdomen was o-oid in shape with a medium si4e. 9oetal mo-ements were also obser-ed medially on inspection. Li-er and spleen were not palpable indicating absence of organomegally. The calculated gestation by dates was 30 weeks and Fundal height Pelvic, Lateral and Fundal Palpation 9undal height 9oetal #resentation < 9oetal Lie 9oetal #osition 9oetal 'eart ,ate < < < < ;9 weeks

&ephalic Longitudinal ,ight (ccipital +nterior 14; beats per minute

L(65, 5FT,5 *T*5$ The lower e.tremities are symmetrical with no scars2 -aricose -eins as well as signs of oedema on inspection. (n palpation2 no tibial2 ankle or pedal oedema was detected. !o signs of 1aricose 1eins or >eep 1ein Thrombosis were detected on palpation of the cuff muscles. Howmans sign was not obser-ed on fle.ion on the feet. )5!*T+L*+ /pon inspection of the genitalia2 no oedema2 sores2 warts2 genital ulcers2 abnormal -aginal discharge or signs of hematoma were obser-ed. There were no signs of -aricose -eins or genital mutilation or circumcision seen. The -aginal discharge was mild2 whitish and odourless.

#,(:L5 $ A!55>$ *>5!T*9*5>.

0nowledge deficit on se.uality during intra and post partum periods related to inability set times on when to stop and resume se.. Lack of ade3uate information on immunisations related to limited information gi-en on immunisations as e-idenced by inability to outline the normal schedule for Tetanus To.oid 1accine. 0nowledge deficit on 9ocussed +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 >epo" #ro-era is phasing out.

&+,5 #,(1*>5> 9ocus +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 3uality of care and not 3uantity of the number of -isits. 9ocused +ntenatal &are emphasises on treating e-ery mother as an indi-idual or uni3ue person with indi-idual problems and needs. The care that was gi-en to rs. !khata was based on the problems and needs that she

had as well as specific care according to hergestation age. (n this day2 rs. !khata was treated comprehensi-ely starting with history taking to fill

in gaps followed by '*1 and $yphilis tests then full physical assessment which in-ol-ed using all the four modalities of inspection2 palpation2 auscultation and percussion. * made sure that the client8s care was pro-ided in a -ery conduci-e en-ironment2 thus ensuring pri-acy as well as cleanliness. * made sure that she felt well taken care of and welcome to the clinic by being respectful2 accommodati-e and letting her ask 3uestions and e.press fears than looking at the care as a burden throughout the procedures.

5!1*,(! 5!T >uring the filling in of gaps2 collection of important information that was missed out on the booking day2 an en-ironment that ensured pri-acy and comfort was ensured. The data was collected at an enclosed place where no one else could listen to what was being discussed and this made the client to be more open and to gi-e the information that was re3uired. Likewise2 during the physical e.amination2 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 chest2 abdomen and genitalia. 9*LL*!) *! (9 )+#$ /pon re-iew of the +ntenatal cardApage for were identified which also needed filling in. The 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. !ot 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 anaemia2 * still referred her go also go for the tests when she goes for the other tests. (n the antenatal page as well2 gra-idity and parity of the mother were not indicated during the first -isit but got documented on this -isit. TESTS 9ocused +ntenatal recommends mothers undergoing se-eral different tests at different -isits and different gestation ages. $uch tests are like '*12 $yphilis2 haemoglobin le-el2 urine protein and &>4 count in case of those who are '*1 positi-e but not on antiretro-iral therapy. rs. !khata se-eral areas that re3uired to

be filled in were realised. *n addition to that2 some more areas in the health passport

'*12 1>,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 '*1 and haemoglobin are tested again after sometime i.e. '*1 is tested again after 3 months while haemoglobin le-el is retested at 3? 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 rs. !khata get tested for '*1 and $yphilis whose

results came out negati-e as indicated on the antenatal card B+ppendi......C after filling in the gaps. 'owe-er2 * referred the client to Gueen 5li4abeth &entral 'ospital for the tests which could not be done at !dirande +ntenatal &linic due to lack of materials like the haemacue kits and protein dipsticks. The referral was done after !dirande 'ealth &entre also reported not ha-ing the materials #'%$*&+L 5F+ *!+T*(! +s indicated in thee obEecti-e data2 during physical assessment2 no specific problems were presented or detected from rs. !khata and all the findings were documented on the antenatal card and were also communicated to the client. $ee +ppendi....... showing the antenatal card with findings of the abdominal assessment. 5>*&+T*(!$ 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 malaria2 9errous $ulphate is gi-en to pre-ent anaemia whilst +benda4ole is gi-en to combat worms infestation. $# is gi-en e-ery four weeks between the gestations of 1? to 3? weeksH 9errous $ulphate is gi-en at e-ery -isit throughout pregnancy whilst +benda4ole 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 -isit2 rs. !khata2 ha-ing the gestation age of 30 weeks2 she was gi-en both $#

tablets B3C as well as 9errous $ulphate B30 tabletsC. $# was gi-en after confirming that 4 weeks had passed since the last dose was taken.

*>6*95,% &+,5

+!+L%$*$ (9 &+,5 + lot of things and care were done during rs. !khata8s booking antenatal -isit. * rs. !khata on the first

should sincerely gi-e credit to the care pro-ider who handled

-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-er2 not e-ery bit of information was collected and documentedH for e.ample2 no information was documented indicating gra-idity and parity on the antenatal card. This 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-ida2 multigra-ida or grand multipara. These also determine the kind of care that a client will get. $econdly2 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 period2 there was no reason heAshe could not calculate the gestation by dates for this day knowing its importance. The 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. !khata 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 +nterior2 Left (ccipital +nterior or other positions. :lood #ressure is on of the important -ital signs in pregnant women and unfortunately2 it was not done on the booking day. %es its true there could be no a sphygmomanometer but still more a referral to !dirande 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 rs. !khata 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. rs. !khata being a #ara one with birth of first born in ;007 when focused antenatal was already under implementation2 it was e.pected she must ha-e already been e.posed to such type of care. /nfortunately2 the mother came at ;? weeks gestation following the old routine antenatal system. 6hen i asked her2 she said coming at ;0 weeks and abo-e was what she knew. This 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. 5F#5&T5> 9*!>*!)$ 9(, T'5 !5FT 1*$*T rs. !khata had come for her second antenatal -isit at a gestation age of ;9 weeks2 howe-er2 according to focused antenatal2 by this time she was supposed to becoming for her third -isit which is supposed to bee between ;D weeks and 3; weeks. *n this case rs. !khata will ha-e her third and final normal -isit at 3? weeks though at this time a mother is normally e.pected to be coming for a fourth -isit. 6hen rs. !khata comes at 3? weeks which would be on .............2 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 3? 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 -isit2 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. The 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. !khata on how she fairing with her pregnancy. $ome of the 3uestions 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. !khata 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 trimester2 at 3? weeks to be specific whilst for urine protein is checked at e-ery -isit to the antenatal clinic. 1ital 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. 9or e.ampleH high blood pressure could be indicati-e of pre"eclampsia2 fe-er could indicate a systemic infection and increased respiratory rate could mean difficulty breathing2 though2 it is thought to be normal at 3? weeks. #hysical assessment will also be done including general assessment as well as abdominal assessment. )eneral assessment will in-ol-e a head to assessment and no abnormality is e.pected from it. The abdominal assessment will in-ol-e inspection2 palpation and auscultation of the abdomen to check si4e and shape of abdomen2 fundal height2 lie2 presentation and position of foetus as well as foetal heart rate. The abdomen is inspected for scars2 linea nigra2 striae gra-idalum2 si4e and shape2 foetal mo-ements2 bladder fullness and -isible organomegally. Thee fundal height will be measured using a tape measure of finger breadths so as to determine the age of pregnancy. Then the pel-is will be palpated for presentation which is normally2 lateral palpation will be done to note the lie and position of the foetus. 9undal 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. 9oetal heart rate will also ha-e to bee auscultated using a fetalscope to confirm wellbeing of the foetus.

5F#5&T55> 9*!>*!)$ 9undal height 9oetal #resentation < < 3? weeks

&ephalic

9oetal Lie 9oetal #osition 9oetal 'eart ,ate

< < <

Longitudinal ,ight (ccipital +nteriorALeft (ccipital +nterior 140 I 1?0 beats per minute

The abo-e e.pected findings are thee normal e.pected finding in the absence of possibility of ha-ing abnormal findings >,/)$ (n this -isit rs. !khata will only be pro-ided with 9errous $ulphate as a drug to

supplement iron for haemoglobin formation. $# will not be gi-en because it is belie-ed to ha-e a teratonic effect on the fetus when gi-en at the gestation of 3? weeks and abo-e. 5F#5&T5> >*$(,>5,$ :y this time the e.pected disorders that rs. !khata may ha-e are difficulty breathing2

fre3uent micturation2 headache2 constipation2 backache2 oedema -aricosities2 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 This is a burning2 irritating sensation in the oesophagus also known as gastric reflu. B9raser2 &ooper and !olte2 ;00?C. )astric reflu. commonly occurs as a result of delayed gastric emptying2 decreased intestinal motility2 and decreased lower oesophageal sphincter tone. *f it happens that rs. !khata de-elops heartburn2 education and counseling on li'est(le
aintaining upright

)odi'ication will be pro-ided and will include awareness of posture i.e.

positions Bespecially after mealsC2 sleeping in a propped up position and dietar( )odi'ications Be.g. small fre3uent meals2 eating slowly2 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 legs2 swollen feet and ankles may become an issue. +t the same time2 swelling in legs2 arms or hands may place pressure on ner-es2 causing tingling or numbness. 9luid retention and dilated blood -essels may lea-e the face and eyelids puffy2 especially in the morning. To reduce swelling2 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 This is a common symptom between the gestation of 34 and 3? weeks. *t is as a result of the pressure by the growing uterus on the diaphragm B9raser2 &ooper and !olte2 ;00?C. *f rs. !khata happens to de-elop dyspnoea2 she will be educated of the physiology of the problem for her to understand what8s 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 period2 *ncreased water re" absorption from large intestine due to hormone aldosterone effect2 #ressure on the pel-ic colon by the pregnant uterus and sedentary life during pregnancy . if the client will come with the problem of constipation2 she will ad-ised on drinking plenty of fluids2 high fibre foods and get plenty of e.ercise. These help in softening the bowels hence reduced risk of constipation. %A!-A!HE

>uring pregnancy2 ligaments become softer and stretch to prepare for labour. This can put a strain on the Eoints of the lower back and pel-is2 which can result in backache. To o-ercome this problem rs. !khata will be ad-ised to a-oid hea-y lifting2 bend her knees and keep her back straight when lifting or picking up things from the ground2 mo-e her feet when turning and a-oid sudden twisting mo-ements2 6ork at a surface high enough to pre-ent her from stooping and to sit with her back straight and well" supported. +nother ad-ice will be that she should make sure she gets enough rest2 particularly later in pregnancy.

F$E.&ENT M#!T&$AT#ON +s the baby mo-es deeper into your pel-is towards term of pregnancy2 a woman feel more pressure on your bladder and may find herself urinating more often2 e-en during the night. This e.tra pressure may also cause her to leak urine J especially when she laughs2 coughs or snee4es. *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 sudden2 sharp pain2 usually in calf muscles or feet. *t is most common at night2 but nobody really knows what causes it. The 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 ankle2 or rub the muscle hard. )entle e.ercise in pregnancy2 particularly ankle and leg mo-ements2 which can impro-e blood circulation and may help to pre-ent cramp occurring and plenty of calcium rich foods Bleafy green -egetables2 dairy products2 sunflower seeds2 salmon and dried beansC and magnesium rich foods Bnuts2 dates and figs2 yellow corn2 green -egetables and applesC in her diet. FEA$ +s the pregnancy draws near term most women become afraid of the labour pains2 fears about childbirth may become more persistent. 'ow much will it hurtK 'ow long will

it lastK 'ow will they copeK *f

rs. !khata happens to come with such a problem2 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.

5>/&+T*(! +!> &(/!$5LL*!) >uring the assessment2 se-eral areas were identified that needed education and counselling to rs. !khata.

9+ *L% #L+!!*!) rs. !khata 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 rs. !khata e.pressed that she wants to use according to her reproducti-e goals.

inEectable contracepti-es B>epo"#ro-eraC as her family planning methods of choice. 'owe-er2 she also e.pressed fears that she had heard that the method is phasing out soon. Looking at her reproducti-e goals2 * felt that than the methods she had chosen * discussed with her of all the methods on the positi-es2 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 7 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 woman8s fertility has returned and also her body has returned to her pre"pregnant state and can resume se. B9amily #lanning 'andbook2 ;009C * /!*$+T*(!$ rs. !khata could also benefit from other

family methods that are long term like *ntrauterine &ontracepti-e >e-ice and =adelle

:ased on the information that she had recei-ed only two doses of Tetanus To.oid 1accine with the first pregnancy and two with the current one2 * 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 TT1. (n this day2 an e.planation on the normal -accination schedule was gi-en to rs. !khata so that as she has already started with the two doses2 should finish the remaining three doses. 9inishing the doses will help in reducing the risk of the baby from getting tetanus. 6e together planned on how she was going to get the other doses. The third dose will be gi-en on 7ADA112 the fourth dose will be gi-en on 7ADA1; and the last dose will de gi-en on 7ADA13. $5F/+L*T% rs. !khata did not ha-e knowledge on when to stop se. before deli-ery and when resume after deli-ery. (n this day2 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.. :*,T'' #L+! +!> &( #L*&+T*(! #,5#+,5>!5$$ ,ealising that rs. !khata was afraid of labour pains2 * 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. 9(&/$5> +!T5!+T+L &+,5 :asing on the time that she had started antenatal -isits2 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 is2 and its importance. rs. !khata 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 fre3uent. 6e also discussed on the importance of attending all the e.pected normal four -isits of antenatal care. *!(, >*$(>5,$ (9 #,5)!+!&% *n addition to these education and counselling sessions2 especially in the third trimester. rs. !khata was also prepared

for the e.pected minor disorders that may de-elop as the pregnancy progresses inor disorders like dyspnoea2 heartburn2 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.