Self-Assessment Questions for Study Session 15

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 15.1 (tests Learning Outcomes 15.1 and 15.2)

For each of the following statements, say whether it is true or false. Explain what is incorrect about any statement that you judge to be false.

A  Saying welcome, showing a smiling face, letting her express her concerns and doubts, helps the mother feel comfortable and develop confidence in you.

B  You have to tell her that unless she comes on the day of her scheduled appointment, you will not see her at any other time.

C  You should not allow her to ask questions till you finish telling her what she needs to know.

D  You can counsel one woman who is sitting with you while you are conducting a physical exam of another one.

E  If she tells you that her two daughters were circumcised on the day she gave birth at home, tell her harshly that she shouldn’t do it again, and if she plans to do the same thing if this baby is a girl, she should not come back for any other visits.

F  Counselling a pregnant woman on danger symptoms is essential in every visit.


A is true. Welcoming the mother, smiling and letting her express her concerns and doubts, helps her to feel comfortable and develops confidence in you.

B is false. It is not an easy task always to come on the day of appointment for the majority of rural Ethiopian pregnant women, who typically have many personal and social responsibilities at home. It is their right to come earlier or later than the appointed date, or even not to come at all. It is the duty and responsibility of any health professional to say welcome with open hands at whatever time and date women come for their antenatal check-up.

C is false. The health service is primarily the client’s/patient’s business. The duty of the health professionals is to deliver a service which makes the client comfortable and satisfied. With that understanding, you have to be prepared to receive questions and do the best to encourage women to raise any questions which are not clear for them.

D is false. By its principle, counselling is discussing personal issues which the client may not like to be shared with other persons outside the family. Therefore, even when you are in a hurry, it is not advisable to counsel one woman while you are examining another. In such an environment, the one to be counselled may not freely share her feelings and concerns with you.

E is false. You cannot encourage behavioural change in adults by criticising, frustrating, demoralising and openly discouraging them. This woman will not feel respected by you and she may not return for further antenatal care. To make a positive change in unhealthy behaviour, the best method with adults is open discussion, letting them know the risks/disadvantages and giving them a chance to evaluate the options for themselves and make their own decision.

F is true. During every antenatal care visit, pregnant women should be counselled on the danger symptoms of pregnancy, so they can take swift action if an emergency arises.

SAQ 15.2 (tests Learning Outcome 15.3)

Based on what you have learned from Table 15.1, match each of the danger symptoms with the appropriate medical condition.

Using the following two lists, match each numbered item with the correct letter.

  1. Leakage of fluid from the vagina

  2. Vaginal bleeding

  3. Fever

  4. Abdominal size decreasing

  5. Flank pain

  6. Persistent headache

  • a.Antepartum haemorrhage

  • b.Hypertension

  • c.Malaria

  • d.PROM

  • e.Acute pyelonephritis

  • f.Missed abortion

The correct answers are:
  • 1 = d
  • 2 = a
  • 3 = c
  • 4 = f
  • 5 = e
  • 6 = b

SAQ 15.3 (tests Learning Outcome 15.4)

For each of the following statements, say whether it is true or false. Explain what is incorrect about any statement that you judge to be false.

A. The counsellor should tell the pregnant woman about all the danger symptoms of pregnancy during her first focused antenatal visit before 16 weeks of gestation.

B. Encouraging the pregnant woman to repeat what has been discussed during counselling will increase her memory (retention capacity) of the key points.


A is false. The area of counselling that pregnant women need should be appropriate to their stage of pregnancy, because:

  • Different pregnancy-related complications occur at different stages of pregnancy.
  • It is not easy for clients to understand and retain a lot of information, particularly if it is not relevant to them at that time.
  • Addressing all the danger symptoms during a single visit will take a lot of your time.
  • So much potentially worrying information about dangers may overwhelm the clients, and prevent them from raising their own questions and asking for clarification.

B is true. Repeating what has been discussed/said will help:

  • The pregnant woman to remember what she has heard.
  • The health service provider to check the woman’s level of understanding.

SAQ 15.4 (tests Learning Outcome 15.5)

List some of the advantages of involving the husband/partner in antenatal counselling on danger symptoms.


  • Counselling the husband/partner on the danger symptoms during antenatal visits means that he can also look out for them and get help more quickly in an emergency.
  • Involving husbands/partners is one way of informing the public more widely about the potential risks to women and babies during a pregnancy.
  • If the husband/partner knows the possible health risks of pregnancy, he may be more caring and more concerned about looking after his wife.
  • He is more likely to agree to take his pregnant wife to a health service provider if danger symptoms arise.
  • Counselling the husband/partner enables him to get prepared both psychologically and financially for dealing with a possible pregnancy-related emergency.

First read Case Study 15.1 carefully and then answer the questions that follow it.

Case study 15.1 Mrs H’s story

Mrs H is a 25-year-old woman in her second pregnancy, who came to see her Health Extension Practitioner (HEP) for the first time when she was 34 weeks pregnant. The HEP asked where she gave birth previously. Her blood pressure and weight was measured and her general health seemed good; her abdomen was examined, and the pregnancy seemed to be progressing normally. Lastly, she was told to come back after 3 weeks.

Two weeks later, she developed excess leakage of watery fluid from her vagina. She informed her neighbours and they told her not worry about it. Since it continued flowing, on the third day after the leakage began, she went back to the HEP and got the same advice she got at home. On the fifth day, she developed a high fever (temperature 39oC) and an offensive smelling vaginal discharge.

SAQ 15.5 (tests Learning Outcomes 15.1 to 15.5)

  • a.What is wrong with the antenatal visit at 34 weeks’ gestation from the perspective of counselling the pregnant woman effectively?
  • b.Why did Mrs H leak watery fluid from her vagina?
  • c.Why did she wait three days to report to the HEP after the leakage began?
  • d.What should have been done by the HEP when Mrs H came with leakage of fluid from her vagina?
  • e.Why did Mrs H develop a high fever and offensive smelling vaginal discharge?


  • a.Mrs H was not counselled on the danger symptoms of pregnancy at 34 weeks’ gestation. When she was worried about her symptoms, she requested advice from her neighbours. They thought (incorrectly) that the leakage of watery fluid from her vagina at 36 weeks was normal, instead of a serious pregnancy-related problem.
  • b.The watery fluid leaked because of the premature rupture of fetal membranes that function as a sac to hold the fetus and the amniotic fluid inside. So, it was the amniotic fluid which was coming out through the broken membranes.
  • c.She waited days before seeking help because she did not know fluid leakage is a danger sign of PROM (premature rupture of membranes) and her neighbours assured her that it was not a problem.
  • d.The HEP should have referred her to the nearest health centre or hospital for evaluation and treatment.
  • e.Mrs H developed a high fever and offensive smelling vaginal discharge because infection was able to rise up through the vagina into the uterus after the fetal membranes ruptured.

Summary of Study Session 15