fish. g ant food.

She explained that she has enough food in her house that is enough for her family all the times. She 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.

PAST OBST T!"#A$ %"STO!& 'rs. ()hata is Para * with first deli+ery in ,--, and she was ,, years by then. B! A).O/( The first pregnancy way term with 0- weeks gestation by fundal height. The baby was deli+ered at (dirande %ealth #entre and she deli+ered by Spontaneous 1ertex .eli+ery but sustained a tear which was sutured and healed without any complications. The baby was 20--g at birth and was born without any congenital nor during birth complication. $abour had taken about *0 hours thus from 3 pm to 4am. 'rs. (khata has no history of ante5partum or intra5partum haemorrhage as well as Pre5eclampsia or eclampsia.

PS&#%O$O6"#A$ %"STO!& '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. She 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. "''7("SAT"O(S 'rs. ()hata explained that she had recei+ed two doss of Tetanus Toxoid 1accine with the first pregnancy and two doses with the current pregnancy. %owe+er, she expressed

lack of knowledge on the fre8uency and number of doses of tetanus Toxoid 1accine she is expected to recei+e despite knowing the importance of the immuni9ations. (1"!O(' (TA$ %"STO!& On en+ironmental history, 'rs. ()hata 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. The house is iron sheet roofed, cement floored and electrified. She said that she gets water from a #ommunal /ater Point which is about :- 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. On 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 it;s full. SO#"O5 #O(O'"# %"STO!& 'rs. (khata is a <orm four $ea+er currently working with )7)7 'atches #ompany as a Packer. %er husband is an electrician who is self employed. She 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 exposure 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. P! S (T OBST T!"# %"STO!& 'rs. (khata is gra+ida , Para * mother $ast normal menstrual period = xpected date of deli+ery = *:th >uly, ,-*,,nd April, ,-**

6estation by dates %"1 Status 1.!$

= = =

2- weeks, days (on5reacti+e (on5reacti+e

She is currently not on any medications except for the <errous Sulphate she is gi+en when se +isits antenatal clinic meant to help in the formulation of haemoglobin. $"'"(AT"O( 'rs. (khata 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 fre8uency micturation.

OB> #T"1 .ATA Vital Signs Temperature Blood Pressure Pulse !ate !espiration !ate 6 ( !A$ APP = = = = A!A(# 2?.3@# *,-A3-mm%g 3- beats peer minute ,, breaths per minute

'rs (khata is a *?, cm tall woman, slim and light brown in complexion. She was wearing a red blouse and a black skirt with a pair of black slip5ons BshoesC. On this day she weighed :D kilograms, gaining , kilograms from the weight during her booking +isit which was :? kilograms. % A.

%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. <A# There were no signs of facial oedema on both inspection and palpation. The face also did not ha+e scars on inspection. & S The eyes are symmetrical and o+oid in shape with no signs of peri5orbital oedema and had a pink conEuncti+a. A!S The ears are symmetrical with the upper ears in line with the outer borders of the eyes. There were no sore, no ear discharge, no lesions and no signs of inflammation on palpating the pre and post auricular lymph nodes. (OS %er nostrils are symmetrical with no any discharge. She has no history of epistaxis and did not ha+e any polyps in the nostrils. 'O7T% %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. There were neither decayed teeth nor gingi+itis. She has neither cleft lip nor cleft palate. The tonsilor, sub5 mandibular and sub mental lymph nodes were not enlarged. ( #) She has no problems with neck flexion as well as forward and backward neck bending. On inspection, there were no ob+ious signs of distended Eugular +eins, no sores, no ob+ious lesions. On palpation, there were neither signs of enlarged thyroid gland nor enlarged deep cer+ical, sub5cla+icle and infra 5cla+icle lymph nodes.

#% ST On inspection, the chest did not ha+e scars, lesions or signs of a pigeon chest with normal respiratory mo+ements. On auscultation, there were normal lung and heart sounds. B! ASTS The breasts are symmetrical in both si9e and shape and they both are light brown in colour with dark alleorae. The breasts ha+e no scars, scales, lesions, no sores, rashes, redness and no dimpling. On breast palpation, no masses were felt except for the normal mammary gland. The nipples are dark in colour, clean and not in+erted. 7PP ! FT! '"T" S The arms are symmetrical with no signs of oedema on both inspection and palpation. She has a capillary refill of less than 2 seconds and has pink palms. %owe+er, 'rs. (khata reported ha+ing tingling sensation of the upper extremities. AB.O' ( On inspection of the abdomen, there was a dark linea nigra, some striae gra+idalum with no sores or scars. The abdomen was o+oid in shape with a medium si9e. <oetal mo+ements were also obser+ed medially on inspection. $i+er and spleen were not palpable indicating absence of organomegally. The calculated gestation by dates was 2- weeks and Fundal height Pelvic, Lateral and Fundal Palpation <undal height <oetal Presentation = <oetal $ie <oetal Position = = = ,4 weeks

#ephalic $ongitudinal !ight Occipital Anterior

<oetal %eart !ate

*0, beats per minute

$O/ ! FT! '"T" S The lower extremities are symmetrical with no scars, +aricose +eins as well as signs of oedema on inspection. On palpation, no tibial, ankle or pedal oedema was detected. (o signs of 1aricose 1eins or .eep 1ein Thrombosis were detected on palpation of the cuff muscles. Howmans sign was not obser+ed on flexion on the feet. 6 ("TA$"A 7pon inspection of the genitalia, no oedema, sores, warts, genital ulcers, 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 mild, whitish and odourless.

P!OB$ 'S A(

.S ". (T"<" ..

)nowledge deficit on sexuality during intra and post partum periods related to inability set times on when to stop and resume sex. $ack of ade8uate information on immunisations related to limited information gi+en on immunisations as e+idenced by inability to outline the normal schedule for Tetanus Toxoid 1accine. )nowledge deficit on <ocussed Antenatal #are and its importance related to limited information gi+en about focussed antenatal care as e+idenced by late coming for initial +isit. Possibily of not using family planning methods related to untrue speculations that .epo5 Pro+era is phasing out.

#A! P!O1". .

<ocus Antenatal #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 8uality of care and not 8uantity of the number of +isits. <ocused Antenatal #are emphasises on treating e+ery mother as an indi+idual or uni8ue 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. On this day, 'rs. (khata was treated comprehensi+ely starting with history taking to fill in gaps followed by %"1 and Syphilis tests then full physical assessment which in+ol+ed using all the four modalities of inspection, palpation, auscultation and percussion. " made sure that the client;s 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 8uestions and express fears than looking at the care as a burden throughout the procedures. (1"!O(' (T .uring 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. 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 re8uired. $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. <"$$"(6 "( O< 6APS 7pon re+iew of the Antenatal cardApage for 'rs. (khata se+eral areas that re8uired to be filled in were realised. "n addition to that, some more areas in the health passport 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. See Appendix...... 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 anaemia, " still referred her go also go for the tests when she goes for the other tests. On 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 Antenatal recommends mothers undergoing se+eral different tests at different +isits and different gestation ages. Such tests are like %"1, Syphilis, haemoglobin le+el, urine protein and #.0 count in case of those who are %"1 positi+e but not on antiretro+iral therapy. %"1, 1.!$ 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 %"1 and haemoglobin are tested again after sometime i.e. %"1 is tested again after 2 months while haemoglobin le+el is retested at 2? weeks. 7rine 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 On this +isit " played a role of helping 'rs. (khata get tested for %"1 and Syphilis whose results came out negati+e as indicated on the antenatal card BAppendix.....C after filling in the gaps. %owe+er, " referred the client to Gueen li9abeth #entral %ospital for the tests which could not be done at (dirande Antenatal #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 P%&S"#A$ FA'"(AT"O(

As indicated in thee obEecti+e data, during physical assessment, 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. See Appendix...... showing the antenatal card with findings of the abdominal assessment. ' ."#AT"O(S 'ost of medications at the Antenatal #linic are gi+en according to gestation ages of the mothers and most of them are gi+en for prophylactic purposes i.e. SP is gi+en to pre+ent a mother from malaria, <errous Sulphate is gi+en to pre+ent anaemia whilst Abenda9ole is gi+en to combat worms infestation. SP is gi+en e+ery four weeks between the gestations of *? to 2? weeksH <errous Sulphate is gi+en at e+ery +isit throughout pregnancy whilst Abenda9ole is gi+en Eust once and at first +isit. SP is gi+en in such a way to pre+ent the tetratonegic effects that the sulphur may ha+e on the foetus. On this +isit, 'rs. (khata, ha+ing the gestation age of 2- weeks, she was gi+en both SP tablets B2C as well as <errous Sulphate B2- tabletsC. SP was gi+en after confirming that 0 weeks had passed since the last dose was taken. '"./"< !& #A!

A(A$&S"S O< #A! A lot of things and care were done during 'rs. (khata;s booking antenatal +isit. " should sincerely gi+e credit to the care pro+ider who handled 'rs. (khata 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. 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. prim5gra+ida, multigra+ida or grand multipara. These also determine the kind of care that a client will get.

Secondly, 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 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 +ertex presentation of which +ertex can not be determined by pel+ic palpation but +aginally. SheAhe would rather indicate cephalic for presentation and a position i.e. !ight Occipital Anterior, $eft Occipital Anterior or other positions. Blood Pressure 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 (dirande only for a blood pressure check would be helpful. Pregnant women are at a risk of de+eloping pre5eclampsia which is high blood pressure in pregnancy and can only be diagnosed if blood pressure if checked at e+ery +isit. 7rine protein test is also +ital in the way that presence of protein in urine is indicati+e of pre5eclampsia '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 Para one with birth of first born in ,--3 when focused antenatal was already under implementation, it was expected she must ha+e already been exposed to such type of care. 7nfortunately, the mother came at ,? weeks gestation following the old routine antenatal system. /hen i asked her, she said coming at ,- 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. FP #T . <"(."(6S <O! T% ( FT 1"S"T

'rs. (khata had come for her second antenatal +isit at a gestation age of ,4 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 ,D weeks and 2, weeks. "n this case 'rs. (khata will ha+e her third and final normal +isit at 2? weeks though at this time a mother is normally expected to be coming for a fourth +isit. /hen 'rs. (khata comes at 2? 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 2? weeks gestation. Some of thee care will also base of the gaps that the midwife will identify as being left out during the pre+ious +isit. On 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 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. She will also check on the progress of pregnancy by asking 'rs. (khata on how she fairing with her pregnancy. Some of the 8uestions 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 trimester, at 2? 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. Any 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 pre5eclampsia, fe+er could indicate a systemic infection and increased respiratory rate could mean difficulty breathing, though, it is thought to be normal at 2? weeks. Physical assessment will also be done including general assessment as well as abdominal assessment.

6eneral assessment will in+ol+e a head to assessment and no abnormality is expected from it. The abdominal assessment will in+ol+e inspection, palpation and auscultation of the abdomen to check si9e and shape of abdomen, fundal height, lie, presentation and position of foetus as well as foetal heart rate. The abdomen is inspected for scars, linea nigra, striae gra+idalum, si9e and shape, foetal mo+ements, 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 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.

FP #T

. <"(."(6S = 2? weeks

<undal height <oetal Presentation = <oetal $ie <oetal Position <oetal %eart !ate = = =

#ephalic $ongitudinal !ight Occipital AnteriorA$eft Occipital Anterior *0- I *?- beats per minute

The abo+e expected findings are thee normal expected finding in the absence of possibility of ha+ing abnormal findings .!76S On this +isit 'rs. (khata will only be pro+ided with <errous Sulphate as a drug to supplement iron for haemoglobin formation. SP 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 2? weeks and abo+e. FP #T . ."SO!. !S By this time the expected disorders that 'rs. (khata may ha+e are difficulty breathing, fre8uent 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 This is a burning, irritating sensation in the oesophagus also known as gastric reflux B<raser, #ooper and (olte, ,--?C. 6astric reflux commonly occurs as a result of delayed gastric emptying, decreased intestinal motility, and decreased lower oesophageal sphincter tone. "f it happens that 'rs. (khata 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 Bespecially after mealsC, sleeping in a propped up position and dietar( )odi'ications Be.g. small fre8uent meals, eating slowly, reduction of high5fat foods and caffeineC.

S*ELL#NG+E"EMA As the growing uterus puts pressure on the +eins that return blood from feet and legs, swollen feet and ankles may become an issue. At 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. To 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. She 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 20 and 2? weeks. "t is as a result of the pressure by the growing uterus on the diaphragm B<raser, #ooper and (olte, ,--?C. "f 'rs. (khata happens to de+elop dyspnoea, she will be educated of the physiology of the problem for her to understand what;s happening. She will also be ad+ised on sleeping in semi5fowlers position so as to be increasing the area for lung expansion hence impro+ed respiratory condition. She 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 re5 absorption from large intestine due to hormone aldosterone effect, Pressure 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. These help in softening the bowels hence reduced risk of constipation. %A!-A!HE .uring pregnancy, ligaments become softer and stretch to prepare for labour. This can put a strain on the Eoints of the lower back and pel+is, which can result in backache. To o+ercome this problem 'rs. (khata 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, /ork at a surface high enough to pre+ent her from stooping and to sit with her back straight and well5 supported. Another ad+ice will be that she should make sure she gets enough rest, particularly later in pregnancy.

F$E.&ENT M#!T&$AT#ON

As 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. This extra pressure may also cause her to leak urine J especially when she laughs, coughs or snee9es. "n this case the client will Eust ha+e to be assured that this is normal with a good explanation of the cause. She will also ha+e to be ad+ised on perineal care to pre+ent ascending infections. !$AMPS #ramp is a sudden, sharp pain, usually in calf muscles or feet. "t is most common at night, but nobody really knows what causes it. The woman will be oriented to skills she will ha+e practice to combat the problem for exampleH pulling up of toes hard up towards the ankle, or rub the muscle hard. 6entle exercise in pregnancy, particularly ankle and leg mo+ements, which can impro+e blood circulation and may help to pre+ent cramp occurring and plenty of calcium rich foods Bleafy green +egetables, dairy products, sunflower seeds, salmon and dried beansC and magnesium rich foods Bnuts, dates and figs, yellow corn, green +egetables and applesC in her diet. FEA$ As 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. (khata 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. She 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.

.7#AT"O( A(. #O7(S $$"(6 .uring the assessment, se+eral areas were identified that needed education and counselling to 'rs. (khata. <A'"$& P$A(("(6

'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 according to her reproducti+e goals. 'rs. (khata expressed that she wants to use inEectable contracepti+es B.epo5Pro+eraC as her family planning methods of choice. %owe+er, she also expressed fears that she had heard that the method is phasing out soon. $ooking at her reproducti+e goals, " felt that 'rs. (khata could also benefit from other family methods that are long term like "ntrauterine #ontracepti+e .e+ice and >adelle than the methods she had chosen " discussed with her of all the methods on the positi+es, negati+es and a+ailability of the methods with much emphasis on >adelle which is the best method for her basing on her goals as she wants to ha+e a space of fi+e years before gets pregnant again so the same with the method as it is made to last for : years. " also commented on the speculation that inEectable contracepti+es are phasing out by telling her that it is not true. " also explained to her that the best time to start family planning is six weeks after deli+ery for it is belie+ed that by this time a woman;s fertility has returned and also her body has returned to her pre5pregnant state and can resume sex B<amily Planning %andbook, ,--4C "''7("SAT"O(S Based on the information that she had recei+ed only two doses of Tetanus Toxoid 1accine with the first pregnancy and two with the current one, " felt she needed more information on the right expected schedule the mothers are need to follow to complete all the fi+e doses for TT1. On this day, an explanation on the normal +accination schedule was gi+en to 'rs. (khata so that as she has already started with the two doses, should finish the remaining three doses. <inishing the doses will help in reducing the risk of the baby from getting tetanus. /e together planned on how she was going to get the other doses. The third dose will be gi+en on 3ADA**, the fourth dose will be gi+en on 3ADA*, and the last dose will de gi+en on 3ADA*2. S F7A$"T&

'rs. (khata did not ha+e knowledge on when to stop sex before deli+ery and when resume after deli+ery. On 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. B"!T%% P$A( A(. #O'P$"#AT"O( P! PA! .( SS !ealising that 'rs. (khata 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. <O#7S . A(T (ATA$ #A! Basing 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. (khata 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 fre8uent. /e also discussed on the importance of attending all the expected normal four +isits of antenatal care. '"(O! ."SO. !S O< P! 6(A(#& "n addition to these education and counselling sessions, 'rs. (khata 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. So she was told of the disorders so as when they happen she should not be anxious but accept them as things that happen normally.

.ate for the next +isit.