Self-Assessment Questions (SAQs) for Study Session 11
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the questions below. 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.
First read Case Study 11.1 and then answer the questions that follow it.
Case Study 11.1 Tsega’s pregnancy
Tsega is a newly married 18-year-old girl who has found that she is pregnant. She had wanted to continue her education so was unhappy about her pregnancy. However, the families are very happy for the young couple and Tsega has been in good health. You have made the four FANC visits and Tsega has a plan to deliver at your health post. A week after your fourth visit she developed labour pains and was brought to your health post, which is just a half-hour walk from Tsega’s home. Some people from her village brought her but her mother, who was her supporter, was not able to come with them. Tsega is now alone and is weeping.
SAQ 11.1 (tests Learning Outcomes 11.1 and 11.2)
Does Tsega have a high risk of obstructed labour? What evidence is there for your answer?
Answer
Tsega is not under 16 so her risk of obstructed labour is not especially high, although it is higher than it would be for an older woman. However, at 18 her pelvis might be immature so the birth canal could be restricted in size. On a positive note she has been in good health and both families are pleased she is pregnant so she may be well nourished.
SAQ 11.2 (tests Learning Outcomes 11.2 and 11.3)
What particular emotional needs might Tsega have during pregnancy and childbirth?
Answer
Tsega was not happy to be pregnant so she will have needed caring support during her pregnancy. At the health post she is weeping so she is probably missing her family and will need support through the labour from a skilled assistant. She should not be left alone to weep.
SAQ 11.3 (tests Learning Outcomes 11.2 and 11.3)
- a.You were not at the health post when Tsega was brought in but you arrived just before she gave birth to a healthy boy. After birth, for how long will you observe her at your facility and what will you advise her on before you send her home?
- b.When will you make home visits to see how she is doing and what will you do during each visit?
Answer
- a.You should observe her for six hours, explain the signs of postpartum complications to her and tell her when to return to the health care facility.
- b.You should schedule a home visit for follow-up on the 7th and 42nd days after birth. During the first week postpartum visit, congratulate her on her labour and if possible tell family members how well she managed. Then pay attention to her ability to cope with change and new responsibilities. Observe the mother–baby interaction and breastfeeding (attachment, removal, positioning and style of feeding). Take a brief history focusing on progress in healing and involution; inspect breasts, abdomen and perineum.
During the sixth week visit take a complete history and physical examination and discuss her contraceptive needs. Explore with her how she is coping with mothering and find out whether she has any physical, emotional and/or baby problems.
Notes for Activity 11.1
You should have used the principles of FANC to help you complete this table.
| First visit (when pregnancy is confirmed) | Second visit (4–6 months) | Third visit (8 months) | Fourth visit (9 months) |
|---|---|---|---|
| 1 Take a proper history | 1 Ask for and note any changes since last visit | 1 Ask for and note any changes since last visit | 1 Ask for and note any changes since last visit |
| 2 Counsel on danger signs and on: PMTCT breastfeeding hygiene nutrition sleeping under ITN HTP | 2 Counsel on danger signs and other issues as before and also on family planning | 2 Counsel as before | 2 Counsel as before |
| 3 Explain the need for 3 additional ANC visits | 3 Explain the need for 2 additional ANC visits | 3 Explain the need for 1 additional ANC visit | 3 Review birth plan |
| 4 Assist woman and family to develop a birth plan | 4 Review the birth plan | 4 Review the birth plan | 4 Check BP and examine woman to confirm fetal lie and presentation |
| 5 Check BP, weight and give physical examination | 5 Check BP and give a general and abdominal physical examination | 5 Check BP and give physical examination as before | 5 Treat malaria(if necessary) |
| 6 Give first dose of tetanus toxoid (TT) vaccine unless the mother’s TT is up to date | 6 Give second dose of TT vaccine | 6 Treat malaria (if necessary) | 6 Refer for further evaluation if BP is high, fetal movement is not felt or there is abnormal lie and presentation, there is suspicion of multiple pregnancy or if any sign of emergency is detected |
| 7 Provide iron supplement for 3 months | 7 Provide iron supplement for 3 months | 7 Refer for further evaluation if BP is high, fetal movement is not felt, there is suspicion of multiple pregnancy or any sign of emergency is detected | 7 Refer for any other services and management as appropriate |
| 8 Treat malaria (if necessary) | 8 Treat malaria (if necessary) | 8 Refer for any other services and management as appropriate | 8 Register the mother on ANC registry |
| 9 Refer for lab tests | 9 Refer for further evaluation if fetal movement is not felt or if any sign of emergency is detected | 9 Give schedule for fourth visit | |
| 10 Refer for any other services and management as appropriate | 10 Refer for any other services and management as appropriate | 10 Register the mother on ANC registry | |
| 11 Give schedule for second visit | 11 Give schedule for third visit | ||
| 12 Register the mother on ANC registry | 12 Register the mother on ANC registry |
Summary of Study Session 11