UNIVERSITY OF BUEA

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF NURSING

MIDWIFERY PROGRAM

COURSE CODE: MWS304

COURSE TITLE: TEACHING/COUNSELLING

AND COMMUNICATION FOR MIDWIVES

COURSE INSTRUCTOR: Dr EBOB BESSEM

GROUP 7

TOPIC: COUNSELING FOR PRECONCEPTION

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Sn Names Matricules

1 TSAGUE KENFACK GRACE M* HS21A241

2 AHONE EBUNE SOLANGE HS21A187

3 FARHA ZAINAB SALISSOU HS21A204

4 NDOB NDOUNGO SOPHIE NAOMIE HS21A224

5 NDOME EYOUM CHARLOTTE E. M. HS21A225

6 NKECHI ONYEMA HS21A229

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Table of Contents

CASE STUDY.................................................................................................................................................4
IDENTIFICATION OF NEEDS FOR COUNSELING.............................................................................................4
DEFINITION OF KEY TERMS..........................................................................................................................4
GOALS/EXPECTED OUTCOMES OF COUNSELLING........................................................................................5
OBJECTIVES OF THE COUNSELING...............................................................................................................5
GUIDING PRINCIPLES FOR COUNSELING....................................................................................................10
COUNSELING SKILLS DURING PRECONCEPTION.........................................................................................12
COUNSELING MATERIALS..........................................................................................................................14
THE COUNSELLING PROCESS USING THE GATHER METHOD.....................................................................18
1. GREET............................................................................................................................................18
2. ASK.................................................................................................................................................18
3. TELL................................................................................................................................................18
4. HELP...............................................................................................................................................19
5. EXPLAIN.........................................................................................................................................19
6. RETURN..........................................................................................................................................20
REFERENCES..............................................................................................................................................20

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CASE STUDY
Miriam, a 24years old obese and unemployed woman comes in today for her appointment with
her midwife seeking advice. Inorder to relieve some of the stress and frustrations her social
situation she frequently goes out partying with friends where she admits drinking excessively.
She has been dating Joshua for 3 years now and has suffered 3 known miscarriages during their
relationship. In all 3 cases she did not know that she was pregnant and continued partying. She
had been adopted at 2months and has never looked for her biological family, she is unaware of
any health conditions she may be predisposed to.

IDENTIFICATION OF NEEDS FOR COUNSELING

The problems identified are
 she is stressed and frustrated by her obesity and unemployment,
 parties and drinks a lot,
 has had multiple miscarriages and
 Doesn’t know anything concerning her genetics.

DEFINITION OF KEY TERMS

1. Counseling
This is a form of “talk therapy “. It is a process where an individual, couple or family meet with a
trained professional counselor to talk about issues and problems that they are facing in their lives
encouraging them to face them with an eventual goal to overcome the problem.
2. Conception
This refers to the action of conceiving a child or of one being conceived.
This can also be defined as the beginning of pregnancy, marked by fertilization of an egg by a
sperm.
3. Preconception care
This is defined as the promotion of the health and well-being of a woman and her partner before
pregnancy.
4. Miscarriage
This refers to the spontaneous or unplanned expulsion of a fetus from the womb before it is able
to survive independently. It is also defined as the spontaneous loss of a fetus before the 20th
week of pregnancy. It can be threatened, inevitable, complete, incomplete or missed.
It can also be defined as the unsuccessful outcome of something.

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 5. Preconception counseling
Preconception counseling can be defined as an appointment with your healthcare provider that’s
used to plan for future pregnancy. Your family history, risk factors, medical conditions and
lifestyle are all discussed. This appointment is an important part of a planned and healthy
pregnancy.
This can also be defined as a set of prevention and management intervention that aim to identify
and modify biomedical, behavioral of social risk to a woman’s health or pregnancy outcome.

GOALS/EXPECTED OUTCOMES OF COUNSELLING

1) Improve the knowledge, attitudes and behaviors of Miriam and her partner related to
preconception.
2) Assure Miriam obtains preconception services (evidence-based, health promotion and
interventions) that will enable her to enter pregnancy with optimal health.
3) By advising her about her weight and lifestyles
4) Reduce her risks of miscarriages through interventions during the preconception period,
which can prevent or minimize her health problems for her and her future baby.
5) Reduce disparities in adverse pregnancy outcomes.
6) By reducing child and maternal mortality after counseling about alcohol consumption
7) Prevent stillbirths, preterm labour and preterm birth
8) Prevent low birth weight since alcohol is a teratogen which adversely affect pregnancy
9) Provide emotional support for Miriam during counseling to deal with her stress and
frustration

OBJECTIVES OF THE COUNSELING

We start by identifying the needs from which we will create the objectives
The objectives are divided into three parts
1. Risks assessment
 Describe how certain medical conditions affect pregnancy
 Assess a patient’s genetic risks as well as father’s genetic risks with regards to

pregnancy.

 Describe genetic screening options in pregnancy

 Recognize a patient’s risk of substance abuse an intimate partner violence and explain
how it could be addressed with the patient
 Appraise a patient’s nutritional status and make recommendations to the patient on
exercise and nutrition
 Assess a patient’s medications, immunization and environmental hazards in pregnancy
 Identify appropriate folic acid intake

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  Identify ethical issues associated with the need for screening and diagnostic tests
Answer commonly asked questions concerning pregnancy, labor and delivery
2. Health promotion
Counseling covers topics such as healthy diet, physical activity, folic acid supplementation,
substance use, and intimate partner violence, protection from sexually transmitted infections
(STIs), contraception use, genetic screening and vaccination.
Nutrition pre-pregnancy
Weight
Pre-pregnancy weight directly influences the baby. Miriam is an overweight woman which
increases the risks of problems during pregnancy such as gestational diabetes, high blood
pressure and large babies with potential risks of difficulties during delivery. We need to note that
the ideal BMI ranges from 19-25.
The weight to be gained the few weeks before pregnancy and during pregnancy ranges from 5-
18.5 kg.
For an underweight: 12.5 – 18kg
Healthy weight: 11.5 – 16kg
Overweight. : 7kg – 11.5kg
Exercise
Whether pregnant or not exercise should be done 30minutes per day and 5 days in a week.
Diet
Protein intake
Preconception Protein should account for 12 percent to 20 percent of your daily calories. Make
sure to eat 0.8 grams of protein per kilogram of your body weight (to convert pounds to
kilograms, divide the pounds by 2.2), with a minimum of 40 grams of protein a day.
Iron
Miriam has low iron stores as a result of monthly menstruation, diets low in iron and her multiple
miscarriages. Women over age 18 need 18 milligrams (mg) of iron daily (since she is 24 years
old) Iron needs increase during pregnancy. Building iron stores helps prepare a mother’s body
for the needs of the developing baby during pregnancy. Good sources of iron include the
following:
Meats, poultry, fish
Leafy greens of the cabbage family such as broccoli, kale, turnip greens, and collards, legumes

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Calcium
Preparing for pregnancy includes building healthy bones. If there is not enough calcium in the
pregnancy diet, the developing baby may draw calcium from the mother’s bones. This can put
women at risk for osteoporosis later in life. The recommended calcium intake for women over
the age of 18 is 1,000 mg daily. For women 18 years of age and younger, the recommended daily
calcium intake is 1,300 mg.
Other nutrients
Vitamin A and vitamin B12 are to be consumed with minerals salt. A balance diet containing
every class of food should be done. Miriam may be advised to use apps such as myplate which
will help her partition her meals into the right proportions of all the classes of food.
Special diets (vegans and vegetarian)
Vegetarians should increase their protein intake. Vegans are at higher risks because they don’t
consume dairy products but are later on advised to do so. Those who are lactose intolerant should
take calcium supplements.
Folic acid supplements
It is important to take folic acid tablets 2-3 months before conceiving. This allows to build up
a protective system for the future baby and prevent neural tube defect such as spina bifida.
The dosage during preconception advised is 400mcg supplement everyday through the first
12 weeks of pregnancy as it reduces the risk for NTD by 72%. Folic acid can also be gotten
from multivitamins tablets, eating food that contains it such as; broccoli, spinach, breakfast
cereals.
Unfortunately, Miriam is a heavy drinker so higher dose of 5mg folic acid will be required as
drinking increases the risk for NTD.
Substance abuse
Alcohol consumption
Alcohol is a known teratogen. It affects the fetus adversely by leading to mental retardation,
developmental delay, birth defects and fetal alcohol syndrome. During counseling Miriam
will be advised to stop alcohol consumption.
Smoking
Miriam mustn’t necessarily smoke for it to affect the baby. She has a hyperactive social life
and always in the club so most likely to be around smokers. Smoking leads to infertility,
miscarriages, low birth weight, sudden infant death.
Caffeine
Limit caffeine because women who take large amounts have slightly higher risks of low birth
weight and miscarriages.

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 3. Medical problems
Review conditions such as: diabetes, hypertension, thrombophilias, thyroid diseases,
seizures. All medical problems should be addressed in terms of effects both ON and OF
the pregnancy should be optimized. Referrals should include medical specialists, physicians and
neonatologists.
Diabetes
Fetal malformations rate have a relation with hemoglobin A1C. Hemoglobin A1C > 11 increases
the chances for malformations by 25% and miscarriages by 44%. The blood sugar level should
be controlled with the use of a proper diet, insulin injections and oral glycemic drugs.
Hypertension
Hypertension increases the risk for superimposed preeclampsia, placental abruption and fetal
growth restriction. Hypertensive patients on drugs such as angiotensin II, direct renin blockers
should discontinue the use. Methyldopa and labetalol are safe during pregnancy.
Infectious diseases
Test for HIV and screen for other STIs (syphilis, Chlamydia, herpes, hepatitis etc)
Vaccines
Live vaccines such as rubella, varicella, hepatitis B and pertussis can not be offered during
pregnancy so a preconception visit is an ideal time to offer these vaccines.
Animals and pets
Women trying to conceive should reduce the exposure to cats as their excrements contain
toxoplasmosis.
Vi Genetic screening
Preconception carrier screening is a genetic test that can tell if you carry a gene for a certain
genetic disorder.If you are at risk of having a child with a genetic disorder, this screening is part
of decision making process in having a baby. Disorders which are commonly tests for;
Cystic fibrosis
Fragile x syndrome
Sickle cell disease
Tay-Sachs doseas

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 Spinal muscular atrophy
We should note that here screening should also be done for both partners.
In this case study, family’s genetic history is not known as she is adopted.

Psychological intervention and follow up

Here we tackle the problem of employment, frustration and stress
Frustration and stress
Frustration is a reaction to stress. In Miriam’s case this may be due to her finances,
unemployment and her numerous miscarriages.

How to handle her miscarriages as a counsellor

Acknowledge her loss
She feels isolated after miscarriages. Some may feel like they aren’t allowed to grief but you
should encourage her to grieve. Encourage her to talk about the events as it uplifts the weight
they feel.
Choose your words carefully
Avoid saying stuffs like “everything happens for a reason “as it will upset her” or you are still
young.
Sit and listen
Allow her to grief the way she wants.
Note: Having a miscarriage affects a woman’s physical health as well as causing emotional pain.
For example, they may have been to hospital for an operation. They may be feeling
overwhelmed by irregular hormones or exhausted after losing blood or the trauma of
miscarrying.Offering practical support can help. For example, you could offer to do the
shopping, cook dinner or simply offer to keep them company.
Unemployment
Counsel her into getting a job and tone down her social life (clubbing and smoking). A job brings
financial aid to her and will help her manage her future pregnancy better.
Note: At the end of counselling the counselor should not that, he advises and the patient makes
the choices. The information provided should be need-based, information based and not
persuasive.

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GUIDING PRINCIPLES FOR COUNSELING
 Accountability:
The counselor needs to be held accountable in disrespecting the rights of the client in terms of
providing education, information and counseling. In this case give detailed and all information
concerning preconception care, weight management, risks of overweight to her attempt of having
a baby, genetic counseling.
 Participation:
Good communication builds good rapports, trust and participation from the client. During this
counseling session we will see that the counselor will as much as possible to provide privacy,
help client identify solutions and implement then. The client will be free and able to ask
questions if she has a worry or have understood anything during the counseling session.

 Privacy and Confidentiality:

Despite the fact she had been dating for 3 years all her worries, concerns, any test to be done
will not be disclosed to her partner without authorization or full consent of the client.
 Informed decision making:
All advantages, disadvantages, side effects, complications, use and effectiveness of the possible
options available will be discussed without the counselor imposing her own beliefs to
influencing the choice the client will make. If there is any misunderstanding the counselor will
give in the possible best to make the client comprehend, respect the client’s culture and beliefs.
All this will add up to help out client make an informed decision concerning her health.
 Quality:
In order to provide evidence based information the counselor must be updated with new findings
and each role stated should have a rational. All this information should be recorded on data
collection files.
 Acceptable information and services:
This counseling session will be based on her worries and needs to avoid overcharging the brain.
The counselor will be warm and friendly towards the client, and also use posters to enable easy
transmission of information.
 Non-discrimination;
This counseling session will portray respect, and dignity to the client without making fun of her
weight, the miscarriages she went through, her sex live or the fact she is an orphan.
 Accessible information and Services;

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 The use of posters and drawings to ease understanding, at the end of the session the counselor
will make sure to give another appointment to check on the improvement and the level of
implementation of the decisions the client took into consideration for better follow up care.

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COUNSELING SKILLS DURING PRECONCEPTION
Preconception counseling is an appointment with your healthcare provider that is used to plan for
a future pregnancy. Family history, risk factors, medical conditions, and lifestyle are all
discussed. This appointment is an important part of a planned and healthy pregnancy.
Preconception education intervention covers a variety of topics related to those behaviors, such
as nutrition, exercise and weight management, birth control methods, STI prevention, controlling
chronic disease, reducing alcohol consumption, quitting smoking and other tobacco use, or
improving health.
Counseling skills now come in to guide the counselor give appropriate and need-based support to
the client. Counseling skills are soft (interpersonal) and hard (technical) attributes that a
counselor puts to use in order to best help their clients work through personal issues and
overcome obstacles that are currently preventing them from living a full and happy life.
The following are counseling skills used by a counselor;
1. Active listening:
As a good counselor, you need to be a good listener to grab all the client’s problems and issues
during each session. That is when Miriam expresses herself and her worries, be at attention to be
able to troubleshoot the problems she is facing. As a counselor the key point of your work is to
help the client feel heard, respected, and validated. By this the counselor’s (Solange) attention is
focused on the client (Miriam) in order to see each of her reactions and get every little word she
says.
2. Responsiveness :
This makes the client actually feel listened to, that is through eye contact, nodding, facial
expressions and body language the client will feel you are actually following up and giving
response to her feelings, thus creating a sense of trust. It’s important to make sure your response
do not show judgement, boredom or frustration. The way you respond and interact with your
client both verbally and non-verbally will determine if he/she is comfortable and wishes to
continue with the counselor-client relationship.

3. Questioning ability:
When talking to Miriam, try to ask open-ended questions instead of closed-ended questions. This
will give her the floor or possibility to answer. Also avoid asking questions like “why” which
may give rise to a sense of guilt or shame. The counselor should be as skilled in asking questions
as in listening. Good question techniques will help the counselor better interpret the client’s
response and gain insights into their experiences.

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 4. Information interpretation :
The counselor should have the ability to easily descript what the client is trying to express. That
is, the client will not always be straight forward or say what exactly they are feeling or
experiencing. You will need to be able to interpret vague and non-verbal information like body
language and facial expressions. This ability to read between the lines is essential to be a good
counselor as what a client does not say or avoids to say is as important (if not more than) as what
he/she decides to share.
5. Attending behavior:
The counselor should be friendly and put in place a conducive environment to make the client
feel at ease and attended to. This will facilitate the flow of information and thus communication.
6. Empathy:
As a good counselor, you need to show empathy or the ability to put yourself into the client’s
situation to understand their experience. You should also be genuine and authentic, also the
client must feel safe and nurtured. The counselor can try to share experiences with the client and
maintain professional boundaries, and prevent their own feelings or experiences from affecting
their counselor-client relationship.
7. Trustworthiness :
The client must feel as she can trust the counselor and confide in her. The client will need to
know that the counselor will maintain confidentiality, respect her experiences and not be
judgmental. By you building a sense of trust, it makes the client feel comfortable to share with
you personal and difficult feelings and information. You must take into consideration the client’s
culture, religion and morals and not impose your judgement or opinion to the client. Also some
clients might rely on humor as a coping mechanism, therefore try to be smiley, and be able to
relate with to the client on a more personal level, this can also create trust.

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COUNSELING MATERIALS
These are materials used before or during the counseling session to create and enhance
awareness in the counseled by the counselor.
The information found on this counseling material should be up to date, acceptable and
understandable. It’s should be also given in a form that will be easily understood by the client.
It can be in the form of posters, in the office, flyers, books, videos etc.
Examples of counseling materials used during this sessions include

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THE COUNSELLING PROCESS USING THE GATHER METHOD
G.A.T.H.E.R is simply an acronym representing the steps a counselor follows during a
counseling session.
In the lines that follow, each of the steps will be explained in details and related to our case
study.
1. GREET
Represented by the letter "G" stands for greeting. Greeting the patient in a warm and welcoming
way .In this step of the counselling process the health care provider has to be friendly, respectful
and make client feel comfortable. This is essential because it helps to create a trustworthy
relationship between the patient and the care provider and the client will feel more confident of
sharing the most intimate and secret parts of themselves.
For our case, greeting the patient in a welcoming and friendly way can help her to feel more
comfortable and be able to talk about the parts of her life she has been keeping secret for
example the fact that she has been adopted and feels rejected by her biological family or the
multiple miscarriages she had in the past months.
2. ASK
In the acronym GATHER, “A” stands for Ask. Here, the care provider questions effectively and
listens actively to the client’s answer. By asking open ended questions the care provider will
achieve the following
 Learn why the client came to the health facility.
 Help the client to express his needs and wants.
 Help the client to express feelings
 Help the client think clearly about choices.
While asking those questions the provider should use a tone that shows interest, concern and
friendliness, use words that the client will understand easily and ask only one question at the
time and show interest for the answer.
For Miriam’s appointment, the midwife will ask questions that will allow Miriam to air out her
mind and channel her worries while giving her a listening ear. As an example here we can see
that Miriam goes further by saying she is not comfortable with her body image, that she feels
guilty and thinks the miscarriages occurred due to her unhealthy lifestyles. Here the midwife is
requested to communicate nonverbally to let Miriam know she is at the right place and with the
right person and most importantly making Miriam understand nobody judges her.
3. TELL
The letter “T” in GATHER stands for Tell. The care provider responds to the client’s situation,
needs and concerns. This is done by giving the client information that will help him or her reach

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a decision and make an informed choice. To make informed choices, client’s needs useful and
understandable information. This information should describe client’s various options and
explain possible results. Here information dished out should be both tailored and personalized.
Tailored information, is information that helps the client make a specific decision. The care
provider should skip information that makes no difference to the client because this can overload
and confuse the client.
Personalized information is information put in terms of the client’s own situation.
Personalizing information helps the client to understand what the information means to her
personally.
In Miriam’s case, during the “Ask” step of GATHER, the care provider will learn what decision
she is facing like the fact she wants to quit alcohol and junk food consumption and in the “Tell”
step the care provider will give specific information that will help her make those decisions for
example scheduling an appointment with the dietician and encouraging her to engage into
physical activities and also the midwife will communicate to Miriam the reasons why she needs
preconception genetic counselling.
4. HELP
In GATHER, H stands for Help. During this phase of the counselling session the client and
provider discuss the choices, their different results for the client, and how the client would feel
about these results. In this way, the provider help the client to reach a decision. After the client
has consider the options it is very important to ask the question “what have you decided to do?”
and reflect back to the client’s decision by saying “so, you have decided to …” then the client
can agree or disagree.
In this counselling session during the “help phase” the makes sure that a decision is need and
that the decision belongs to the client only. For this case Miriam will have to decide whether or
not she will accept the appointment with the dietician, engage into the physical activities and go
through the steps for genetic counselling. And if Miriam is unsure about her decision the
midwife will have to ask more questions to further discuss the choice.
5. EXPLAIN
“E” in the acronym GATHER stands Explain, the provider explains to the client how to carry out
his decisions. Often, the provider gives instructions. When explaining the provider tries to tailor
and personalize instructions to suit the individual’s way of life. The provider can ask questions
like “do you think you can do this?” “What might stop you?” if the clients sees a problem the
provider and client can discuss ways to overcome them.
The provider should make sure information shared with the client is short, simple, separate,
organized, specific and understandable. This process can be eased by giving out pamphlets or
flyers to the client to take home.

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The midwife will explain to Miriam the importance of daily doses of Iron and other minerals
before getting pregnant. She will also give some recommendations of some laboratories that
offer genetic testing for some genetic diseases.

6. RETURN
“R” represents Return for follow up. All clients should be invited to return whenever they wish,
for any reason. At the same time clients should not be made to come back when not necessary.
For example the provider should give clients plenty of supply and not schedule unnecessary
follow-ups.
Counselling a returning client should be flexible that is he or she should not be made to through
full counselling again. There are 2 major rules to take into consideration when counselling
returning clients are
 Find out what the client wants: “how can we help you today what will you like to
discuss?” or “any new health problems since your last visit?”
 Respond to what the client wants: If the client has any problems resolve them, if the
clients has any questions resolve them, if the client needs more supplies, provide them
generously.
For Miriam’s case, the midwife will list the reasons in which she should return to the health
setting. For example after she has had the results of her tests or in case her supplies of Iron and
minerals gets finished.

REFERENCES
https://shopsplusproject.org/sites/default/files/resources/Gather%20approach_JHUCCP.pdf
https://www.medicalnewstoday.com/articles/conception
https://www.visioncounselling.com.au/what-is-counselling/
https://www.womenshealth.gov/pregnancy/you-get-pregnant/preconception-health
https://www.pregnancybirthbaby.org.au/amp/article/miscarriage
https://www.verywellmind.com/feel-less-frustrated-when-stressed-3145200
https://www.google.com/amp/s/familydoctor.org/preconception-carrier-screenings/amp/
https://youtu.be/vtlra127JQM

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THANKS FOR LISTENING!!!!

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