Case 4.

A woman who booked late

34 year old Mrs A, who is Para 2 Gravida 3 presented to the antenatal clinic to register her pregnancy at
8 months 2 weeks. This was not a planned pregnancy. She has a history of post-partum haemorrhage in
her last pregnancy but both were via normal vertex deliveries. The nurse who attended her, examined
her quickly as she claimed that doing things thoroughly will only slow her done and her findings were,
fundal height of 36cm, cephalic presentation with a longitudinal lie and adequate liquor volume they
were no complains as of the day of presentation. The nurse in passing asked why she had booked late, it
turns out that Mrs A was facing relationship problems at time of conception and up till the time she
found out she was pregnant. During this period she lost her job and she did not have any money to
come to register early as women are required to bring $30 upon booking their pregnancy. She also
claims that she did not feel the need to actually come early for booking because besides the post-
partum haemorrhage she has never had any complications during her previous pregnancies. In a few
minutes the nurse was done left Mrs A to change on her own and she had examined her without
covering her. She referred her to Chitungwiza Hospital for further management. The nurse did not
educate the patient on the need to book early.

Reflection
This made me sad. I feel antenatal services should be free for everyone, the majority of women who
present at Zengeza cannot afford to pay the $30 required for booking, health workers seem to blame
these women when they come late for booking yet it’s important to understand the situation behind the
late booking as most of the time its beyond themselves.it was disheartening that with the shortage of
staff the procedures are now being done quickly and inappropriately just to finish up the line of women
who would be present at the ANC, the nurse did not do a thorough examination and she did not even
take her time to explain to the patient the importance of early booking and why she had referred her to
Chitungwiza Hospital. I suggest that its important us a s health workers to interact with people of
different backgrounds as it helps us to be understanding and show empathy to different women who
will present to the health facilities. I also felt let down by the nurse I expected respectful maternal care
from someone senior like her but the way she just quickly talked down the patient let me note that
sometimes the way we handle patients might also let them book late as they are afraid because of the
last time the way they were treated.

Learning points
This was a patient who should have benefited from family planning education and also education on the
importance of booking early. There is still room for improvement as the health sector in terms of
educating the community on the importance of booking early despite circumstances surrounding the
pregnancy be it issues at home. Also as the government should play a role in making sure that the fee
being paid by pregnant women at booking should be low as this is affecting a lot who would have been
educated but do not have the money to book their pregnancy. Women should be taught to empower
themselves as the right to use contraception should be equal to the male partner as sometimes males
might not condone the use of contraception yet it’s the woman who will fall pregnant. Education will
play a role in controlling the high rates of unplanned pregnancies and women should be educated on
dual contraception

A local study done in Zambia showed that high proportion of late ANC booking were associated with
presence of unplanned or unwanted pregnancies in the population. The concentration of this problem
was in lower or no education groups and may be an illustration of existing inequalities which might
further explain limitations in health promotion messages meant to mitigate this challenge. There is thus
urgent need to re-pack health promotion messages to specifically target this and related poor groups.
(Nyambe Sinyange& Lungowe Sitali, Choolwe Jacobs, Patrick Musonda, and Charles Michelo, et al)