Welcome the woman and ask her to sit near you and facing you. Smile and make good eye contact with her. Reassure her that you will always maintain her privacy and confidentiality Without her permission, do not include a third person in the meeting. Use simple non-medical language and terminologies throughout that she can understand, and check frequently that she has really understood. Actively listen to her, using gestures and verbal communication to show her that you are paying attention to what she says. Encourage her to ask questions, express her needs and concerns, and seek clarification of any information that she does not understand.

1. General principles of counselling
the pregnant woman

3. • Welcome the woman and ask her to sit near you and facing you.
• Smile and make good eye contact with her.
• Reassure her that you will always maintain her privacy and
confidentiality
• Without her permission, do not include a third person in the
meeting.
• Use simple non-medical language and terminologies throughout
that she can understand, and check frequently that she has really
understood.
• Actively listen to her, using gestures and verbal communication to
show her that you are paying attention to what she says.
• Encourage her to ask questions, express her needs and concerns, and
seek clarification of any information that she does not understand.

4. • Ideally, she should talk for about
two-thirds of the time, and you
talk for only one-third.
• Research has shown that health
professionals often talk too
much, and don’t allow enough
time for the client to express
their own views and needs.

5. Counselling about danger symptoms
• Counselling has succeeded when
the pregnant woman:
• Feels she got the help she wanted
• Understands the common danger
symptoms
• Knows what to do and feels confident
that she can come soon if she
develops one of the danger
symptoms
• Feels respected, listened to and
appreciated
• Comes back when she needs your
help

6. Conception to 20 weeks of pregnancy
Persistent vomiting, weight loss Hyperemesis gravidarum
Characterized by persistent vomiting, weight loss of 5
kg and above, urine analysis shows ketones 2+ or more
(You learnt about this in Study Session 12; how to do
the urine analysis is in Study Session 19)
Vaginal bleeding (fresh), may include passage of clots
and fleshy material, with crampy lower abdominal
pain
Abortion (acute)
All types of spontaneous abortions except missed
abortion are acute ‘sudden’ events
Pregnancy symptoms disappear, abdomen is not
growing or is even decreasing in size, there may be
minimal dark vaginal bleeding
Missed abortion
When the fetus or fetal tissue is entirely in the uterus,
but it has no signs of life and the cervix is completely
closed
Vaginal bleeding (menstrual-like), lower abdominal
pain, missed or irregular period
Ectopic pregnancy
Vaginal bleeding (fresh), passage of tissues which look
like an ice spoiled with blood (grape-like tissues), fast
abdominal growth
Molar pregnancy

7. 20 weeks to full term pregnancy
Headache, burning epigastric pain, blurred
vision, generalised body swelling (involving
the back, abdominal wall, hands and face),
decreased urine output
Hypertensive disorders of pregnancy
Leakage of watery fluid Premature rupture of membranes (PROM)
Progressively increasing pushing down pain Preterm labour
No change in abdominal growth, fetal kick felt
less than 10 times in 12 hours.
Intrauterine fetal growth restriction (IUGR)
Absent fetal kick for more than 6 hours Intrauterine fetal death (IUFD)

8. At any time during pregnancy
Fever, headache, chills, rigor, sweating, feels
thirsty, generalised aching pain, lost appetite
Malaria, typhoid fever, typhus fever or
relapsing fever
Urination
becomes painful, frequent, urgent and may
be bloody or look like pus
Urinary tract infections
Pain in the sides (flanks), fever, vomiting,
bloody urine, urgency and frequency in
urination
Acute pyelonephritis
Yellowish discolouration of the eyes, loss of
appetite, hate spicy food smell, feels
exhausted, nausea and vomiting
Liver disease
Thirsty, drinks excessive amounts of
water, urinates a lot, feels hungry, weight
loss
Diabetes mellitus
Persistent cough Lung and heart disease

9. Following up on previous counselling
messages
• In subsequent antenatal visits, helping the woman to go over what was
discussed before will help you to:
• Discover how much she understood the issue already
• Discover how much she can recall correctly
• Identify her acceptance and readiness to act on the knowledge
• Identify areas she has wrongly understood.
• It will also help her to express her concerns and doubts, so that you can:
• Discuss any issues that were not clear or not accepted
• Plan together what to do next, involving her husband/partner.

10. Involving the husband/partner in antenatal
visits
• Helps the partner/husband to become aware of the danger symptoms the
woman may encounter during the pregnancy.
• Will make him more caring and more concerned.
• Helps him to take action (early reporting) when danger symptoms appear.
• Alerts him to save money for possible emergencies, e.g. transport to the
health facility.
• Alerts the family to decide on their preferred place of delivery.
• Helps the family get prepared for caring for the mother and her baby after
the birth.
• Is a further entry point to increase general public awareness of the
potential risks during pregnancy.

11. • 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.

12. Case study
• 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.