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Check the baby

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HealthWiki > A Book for Midwives > Chapter 8: Prenatal Checkups > Check the baby


Contents

Measure the mother's womb



  • The size of the womb matches the due date.
  • The womb grows about 2 finger widths every month.



  • The size of the womb does not match the due date the first time you check.
  • The womb grows more or less than 2 finger widths every month.


When you measure the womb, you check to see where the top of the womb is. This will show you 3 things:

  1. How many months the woman is pregnant now.
  2. The probable due date. If you were able to figure out the due date from the mother’s last monthly bleeding, measuring the womb can help you see if this due date is probably correct. If you were unable to figure out her due date from her monthly bleeding, measuring the womb can help you figure out a probable due date. This should be done during the first checkup.
  3. How fast the baby is growing. At each checkup, measure the womb to see if the baby is growing at a normal rate. If it is growing very fast or very slow, there may be a problem.

How to measure the womb

As the baby grows inside the womb, you can feel the womb grow bigger in the mother’s belly. The top of the womb moves about 2 finger widths higher each month. At 3 months, the top of the womb is usually just above the mother’s pubic bone (where her pubic hair begins). At about 5 months, the top of the womb is usually right at the mother’s bellybutton. At 8½ to 9 months, the top of the womb is almost up to the mother’s ribs. Babies may drop lower in the weeks just before birth.

To feel the womb, have the mother lie on her back with some support under her head and knees. Your touch should be firm but gentle.

Find the top of the womb.

womb
Walk your fingers up
the side of the belly
Find the top of the womb
(it feels like a hard ball
under the skin.)
You can feel the top by
curving into the belly
To measure using the finger method
marks every 2 finger-widths going down a woman's abdomen; the bellybutton is at about 5 months.
8½-9 months
9 MONTHS!
7½-8 months
6½-7 months
5½-6 months
4½-5 months
3½-4 months
2½-3 months
  1. If the top of the womb is below the bellybutton, measure how many fingers below the bellybutton it is. If the top of the womb is above the bellybutton, measure how many fingers above the bellybutton it is. Then see how many months pregnant the woman is now by comparing the number of fingers with this picture (each line is about the width of 2 fingers).

  2. Write down what you find, with a picture or with numbers.
    To draw a picture: Make a circle for the mother’s belly, a dot for her bellybutton, and a curved line for the top of the womb. Then draw the number of fingers the top of the womb is above or below the bellybutton. For example:
    This drawing means that the top of the womb is 2 fingers below the bellybutton.
    bellybutton
    top of the womb
    This drawing means that the top of the womb is 3 fingers above the bellybutton.
    This woman is about 4½ months pregnant. This woman is about 6½ months pregnant


    To use numbers: Write down the number of fingers you used to measure the womb. Put a “+” sign in front of the number if the top of the womb is above the bellybutton. Put a “–” sign in front of the number if the top of the womb is below the bellybutton. The example above on the left would be – 2. The one on the right would be +3.


  3. a health worker speaking to a woman while measuring her womb.
    The top of the womb is 4 fingers above your bellybutton — just where it should be at 7 months!
  4. Figure out (or double check) the due date. For example, if measuring the top of the womb tells you that the woman is 7 months pregnant, you can expect that the baby will be born in about 2 months. If you have already figured out her due date using her last monthly bleeding, check to see if the 2 dates are about the same. See information on if the 2 dates are not about the same.
To measure using a soft tape measure

You can use this method when the womb grows as
high as the woman’s bellybutton.

  1. Lay a cloth or paper measuring tape on the mother’s belly, holding the 0 on the tape at the top of the pubic bone. Follow the curve of her womb up and hold the tape at the top of her womb.

  2. Write down the number of centimeters from the top of
    the pubic bone to the top of the womb.

  3. Doctors, nurses, and many midwives are taught to count pregnancy by weeks instead of months. They start counting at the first day of the last monthly bleeding, even though the woman probably got pregnant 2 weeks later. Counting this way makes most pregnancies 40 weeks long.

    During the second half of pregnancy, the womb measures close in centimeters to the number of weeks that the woman has been pregnant. For example, if it has been 24 weeks since her last monthly bleeding, the womb will usually measure 22 to 26 centimeters. The womb should grow about 1 centimeter every week, or 4 centimeters every month.

If the size of the womb is not what you expected

If you are measuring correctly and you do not find the top of the womb where you expect it, it could mean 3 different things:

  • The due date you got by counting from the last monthly bleeding could be wrong.
  • The womb could be growing too fast.
  • The womb could be growing too slowly.
The due date you got by counting from the last monthly bleeding is wrong

There are several reasons why a due date figured from the last monthly bleeding could be wrong. Sometimes women do not remember the date of their last monthly bleeding correctly. Sometimes a woman misses her bleeding for another reason, and then gets pregnant later. This woman could really be less pregnant than you thought, so the womb is smaller than you expect. Or sometimes a woman has a little bleeding after she gets pregnant. If you assumed that was her regular monthly bleeding, this woman will be 1 or 2 months more pregnant than you thought. The womb will be bigger than you expect.

If the due date does not match the size of the womb at the first visit, make a note. Wait and measure the womb again in 2 to 4 weeks. If the womb grows about 1 to 2 finger widths a month or 1 centimeter a week, the due date that you got from feeling the top of the womb is probably correct. The due date you got by figuring from the last monthly bleeding was probably wrong.

Remember: Due dates are not exact. Women often give birth up to 2 or 3 weeks before or after their due date. This is perfectly safe.
The womb is growing too quickly

If the womb grows more than 2 finger widths a month or more than 1 centimeter a week, several different causes are possible:

  • The mother may have twins.Learn how to tell if there are twins.
  • The mother may have diabetes.
  • The mother may have too much water in the womb.
  • The mother may have a molar pregnancy (a tumor instead of a baby).


Too much water in the womb
Too much water is not always a problem, but it can cause the womb to stretch too much. Then the womb cannot contract enough to push the baby out or to stop the bleeding after the birth. In rare cases it can mean that the baby will have birth defects. To see if the mother has too much water, try the thump test:

Have a helper put a hand along the middle of the mother's belly.
Put one of your hands on one side of the mother's belly. Thump the other side of her belly with your other hand.

If there is too much water inside, you may feel a wave or ripple cross the belly from one side to the other. (The helper’s hand keeps the wave from traveling through the mother’s skin.) If there is too much water, get medical advice. It may be safer for the mother to have the birth in a medical center.

Molar pregnancy (tumor)
Sometimes a woman gets pregnant, but a tumor grows instead of a baby. This is called a molar pregnancy.

a tumor growing inside a womb, with blood and tissue passing through the vagina.
molar
pregnancy

Other signs of a molar pregnancy are: no heartbeat can be heard, no baby can be felt, the mother has bad nausea all through pregnancy, and the mother has spotting of blood and tissue (sometimes shaped like grapes).

If you see signs of a molar pregnancy, get medical help as soon as possible. The tumor can become cancer and kill the woman — sometimes very fast. A doctor can remove the tumor to save the woman.

The womb is growing too slowly

Slow growth can be a sign of one of these problems:

  • The mother may have high blood pressure. High blood pressure can keep the baby from getting the nutrition it needs to grow well. If you do not have equipment to check her blood pressure, get medical help.
  • The mother may have a poor diet. Find out what kind of food the mother has been eating. If she is too poor to get enough good food, try to find some way to help her and her baby. Healthy mothers and children make the whole community stronger.
  • The mother may have too little water in the womb. Sometimes there is less water than usual, and everything is still OK. At other times, too little water can mean the baby is not normal or will have problems during the labor. If you think the mother has too little water, get medical advice.
  • The mother may be drinking alcohol, smoking, or using drugs. These can cause a baby to be small.
  • The baby may be dead. Dead babies do not grow, so the womb stops getting bigger. If the mother is 5 months pregnant or more, ask if she has felt the baby move recently. If the baby has not moved for 2 days, something may be wrong.


If the mother is more than 7 months pregnant, or if you heard the baby’s heartbeat at an earlier visit, listen for the heartbeat again. If you cannot find it, get medical help. Some medical centers may have equipment to see if the baby is still alive.

If the baby has died, it is important for the mother to give birth soon. She can give birth at home, but she may bleed more than other mothers, and is at more risk for infection. If labor does not start in 2 weeks, go to a medical center where she can get medicine to start her labor.

Note: When a mother loses a baby, she needs love, care, and understanding. Make sure she does not go through labor alone. If she gives birth in the hospital, someone should stay there with her during the birth.

Find the position of the baby



  • There is only 1 baby in the womb.
  • The baby is head down at the time of birth.


  • The baby is breech (feet or bottom down) at the time of birth.
  • The baby is sideways at the time of birth.
  • The mother has twins.


There are 2 methods for finding the baby’s position: feeling the mother’s belly, and listening to where the baby’s heartbeat is strongest. You may need both to be sure of the position of the baby.

Feeling the mother’s belly

It may be difficult to find the position of the baby before the 6th or 7th month. Try anyway. What you feel may not make sense now but may make sense the next time you feel for the baby. It will be easier to find the position during the last 2 months of pregnancy. The more you practice feeling the position of a baby, the better you will be at it.

To begin, help the mother lie on her back and give her support under her knees and head. Make sure she is comfortable.

Then feel the mother’s belly. You will be checking for 3 things:

  • Is the baby vertical (up and down)?
  • Is the baby facing front or back?
  • Is the baby head down or bottom down?
Is the baby vertical?
illustration of the below: feeling the sides of the mother's belly.
vertical:
head or bottom
down
sideways:
head and bottom
on the sides

Most babies are vertical by the 7th month.

To find out if the baby is vertical, lay one hand flat on each side of the belly. Press in gently but firmly, first with one hand, and then with the other.

Check the shape carefully. Do the ends of the baby seem to be in the mother’s sides? If so, the baby is probably lying sideways. Many babies lie sideways in the first months but most turn head down by 8 months or so. Babies cannot be born through the vagina from the sideways position. A baby that is sideways and cannot be turned when labor starts must be born by cesarean surgery in a hospital. If the baby is sideways after 8 months, get medical help.

It can be difficult to feel the position of the baby if the mother has very strong muscles on her belly, or if she has a lot of fat on her belly. If you have a hard time feeling the position, ask the mother to take a deep breath and let it out slowly, and to relax her body as you feel.

Is the baby facing the mother's front or her back?

Next, feel the mother’s belly for a large, hard shape (the baby’s back). If you cannot feel the baby’s back, feel for a lot of small lumps.

A large, hard shape probably means the baby is facing the mother's back. If you feel a lot of small lumps instead of a large hard shape, you are probably feeling the arms and legs. The baby is probably facing the mother's front.
See about when the baby is facing the mother's front.


head
down
bottom down
(breech)
Is the baby head down or bottom down?

By the last month before birth, most babies are lying with their head toward the cervix. This is called a head-down position. The head-down position is easiest for childbirth.

If a baby is head up, with her bottom toward the birth opening, this is called a breech position.

By the 7th or 8th month, the baby’s head has usually moved down in the mother’s pelvis. Here is how to feel for the baby’s head:

a health worker speaking to a pregnant woman who is lying down.
I can feel the top of your pubic bone right here.
pubic
bone
  1. Find the mother’s pubic bone with your fingers. You can feel it just under the skin under the mother’s pubic hair. Ask the mother to take a deep breath in and then let it out slowly.

    As she breathes out, press deeply just above her pubic bone. Be gentle and stop if you hurt her.

    If you feel a round, hard object that you can move a little from side to side, it is probably the back or side of the baby’s head.


    If you do not feel anything in the mother’s lower belly, the baby may be lying sideways.


    If the shape is not clearly round, it may be the baby’s face or the baby’s bottom.
    Or sometimes
    the baby’s
    bottom is up,
    but the head is
    not straight
    down.


    The head may be bent to the side, or the chin may be up. (These could be signs that the baby will not fit through the mother’s pelvis at birth.)

  2. If the lower part of the baby is not too deep in the mother's pelvis, try moving that part of the baby from side to side.

  3. If moving the lower part of the baby makes its whole back move, then the baby may be breech. If the back does not move, then the baby may be head down.


  4. Now feel the top of the mother’s womb. Does it feel round and hard, like a head? Or is it a different shape — like a bottom, a back, or legs? If the top of the womb feels more like a head than what you felt in the mother’s lower belly, the baby may be breech.
  5. Put one hand on the baby’s back. At the same time, with your other hand, push the top end of the baby gently sideways.


If the whole back moves when you move the top end, the baby is probably in a head-down position.
If the back stays where it is while you move the upper part of the baby, you may be moving the head (because the neck can bend, the back stays in place). If you are moving the head, the baby is breech.


See more information on breech babies during pregnancy. See information on when the baby is breech at the time of birth.


When you check the baby’s position, you might think you feel 2 heads or 2 bottoms. The mother may have twins.

fetoscope 1-ear
fetoscope

Listening to the baby's heartbeat

The baby’s heartbeat gives information about the baby’s position inside the mother and about the health of the baby. Listen to the heartbeat at each visit starting at 5 months.

By the last 2 months, you can often hear the baby’s heartbeat in a quiet room by putting your ear on the mother’s belly. The heartbeat will be easier to hear if you have a fetoscope or a stethoscope. You can make a simple fetoscope from wood, clay, or a hollow tube of bamboo. Or you can buy a fetoscope.

2-ear fetoscope stethoscope 1-ear fetoscope


The baby’s heartbeat is quiet and quick. It may sound like a watch ticking under a pillow, only faster. The baby’s heartbeat is about twice as fast as a healthy adult heartbeat — usually 120 to 160 beats a minute.

Note: If you hear a “swishy” sound (shee-oo shee-oo shee-oo), you are probably hearing the baby’s pulse in the cord. Cord sounds tell you how fast the baby’s heart is beating, but they do not help you find the baby’s position.
If the heartbeat sounds slow, you are probably hearing the mother’s pulse instead of the baby. Try listening to a different place on her belly.


illustration of the front and back of a baby with arrows pointing to spots on a baby's chest and back at the level of the arms.
This is where the heartbeat is loudest:
Find the baby's heartbeat

Think about which way the baby seems to be lying. Then start listening for the heartbeat near the spot where you think the baby’s heart should be. You may need to listen in many places before you find the spot where the heartbeat is the most loud and clear.

Find the baby's position by listening to the heartbeat

Is the heartbeat loudest above or below the mother’s bellybutton?

If you hear the heartbeat loudest below the mother’s bellybutton, the baby is probably head down. If you hear the heartbeat loudest above the mother’s bellybutton, the baby may be breech.
a baby in the womb, with arrows pointing to the mother's bellybutton and to a spot on the baby's back.
mother's bellybutton
baby's heartbeat is loudest here
head down
baby's heartbeat is loudest here
mother's bellybutton
breech



Sometimes when the baby is facing the mother’s front, the heartbeat is harder to find because the baby’s arms and legs get in the way. Listen near the mother’s sides, or directly in the middle of her belly to hear the heart.

If you can, keep a record of where you heard the baby’s
heartbeat by making a simple drawing.

a circle with a dot in the middle and an ‘x’ below it and to one side.
mother's bellybutton
baby's heartbeat

In this picture, the dot in the middle is the mother’s bellybutton, and the X shows where the heartbeat was found.

a paper that lists each month of pregnancy from 5 to 9 with the date and a drawing as described above.
a record of the baby's position

In this record, for example, the baby did not turn head down until 7 months. Even then the baby moved from side to side, so the X moves from the left side to the right side of the mother’s belly and then back again. This kind of movement is normal.

Check how fast the baby's heart beats

Baby's heartbeat is between 120 and
160 beats a minute.

A baby whose heartbeat is slower than 120 or faster than 160 beats a minute may be having trouble. A baby whose heartbeat is slower than 100 or faster than 180 needs medical help. Follow these steps to check how fast the baby’s heart beats:

  1. Use a clock or a watch with a second hand, as you would for checking the mother’s pulse. If you do not have a clock or watch, compare the baby’s heartbeat to your own pulse when you are resting and calm. (Or make a timer out of homemade materials.) The baby’s heartbeat should be about 2 times as fast as your pulse.
  2. Count the number of heartbeats in one minute. If you have trouble watching the clock and counting at the same time, have someone tell you when to start and stop counting. If the baby’s heartbeat seems very slow, feel the mother’s pulse in her wrist while you listen. If the mother’s pulse and the heartbeat you hear are the same, you are hearing the mother’s heartbeat by mistake.
  3. Keep a record of where you found the heartbeat and how fast it beats.


If the baby’s heartbeat is above 160, wait a few minutes and check it again. Sometimes the heartbeat is faster when the baby moves. If the heartbeat stays above 160 (especially if it is 180 or more) the mother may have an infection. Check if she has a fast pulse or a fever.

If the baby’s heartbeat is slow, the baby may be in danger. If the heartbeat is between 100 and 120 beats a minute, try moving the baby a little from the outside. The baby may be sleeping. Check if the heartbeat is faster when the baby is awake.

If the heartbeat is slower than 100 beats a minute, get medical help. The baby is in danger! At a hospital the woman may be able to get a cesarean surgery to help the baby to be born early.

Note: A quiet heartbeat does not mean that the baby is weak. It just means that the baby’s chest or back is far from your ear, or that the mother’s belly is hard to hear through. For example, the wall of the belly might be thick if the mother is fat.

What to do if you find warning signs

Baby is breech

Breech babies are often born without any trouble, especially if the mother has had other children and her births were easy. But breech babies are more likely to get stuck or have other serious problems.

It may be possible to get the baby to turn. Try these methods:

  • Lift the mother’s hips. This lifts the baby out of the pelvis so he can turn around and put his head down. The mother lies on her back and puts something soft
    (like a pillow) under her hips for 15 minutes, 3 times every day. It is best to do this when the baby is moving a lot.

    After lying this way for 15 minutes, the mother should walk around for about 5 minutes. If she thinks she felt the baby turn, she should not lift her hips like this again until you have checked to see if the baby is still breech.
  • Ask the mother to get on her knees with her head resting on the floor. This is another way to move the baby out of the pelvis so that he can turn.
  • Try talking to the baby, shining a flashlight, or playing music low on the mother’s belly, near her pubic bone. The baby may turn to be closer to the light or sounds.
  • You may have plant medicines in your area that can help.

WARNING!   Only try massage to turn the baby if you have been taught how to do it safely and can get medical help. Trying to turn the baby by pushing on the womb is very dangerous.

Never turn a baby if the mother’s waters have broken or if she has ever had vaginal bleeding, high blood pressure, surgery on her womb, or cesarean surgery.


A doctor can pull the baby out with forceps.

If the baby is not head down when labor starts, it is safer for the mother to give birth in a medical center or hospital. Doctors can use forceps (pulling tools) if the baby gets stuck. Or they can do a cesarean surgery.

If a breech baby is going to be born at home, it is important for a very skilled midwife to be there (see information about how to deliver a breech baby).

Remember, there are some times when breech birth is even more dangerous. Do not try to deliver a breech at home if:

  • this is the mother’s first baby.
  • the mother has had long or difficult births in the past.
  • the baby is big.
  • the mother is weak or has been ill, so she cannot push well.
  • the midwife is not very skilled or experienced with breech births.
Baby is sideways

If the baby is sideways — not head down or head up — by 8 months, you can try lifting the mother’s hips. If the baby does not turn, you should make arrangements for a hospital birth by cesarean surgery.

a baby lying sideways in the womb.
This baby must be born by cesarean.

Sideways babies cannot fit through the mother’s pelvis to be born. If you try to deliver the baby without surgery, the mother’s womb will break during labor, and she and the baby will die without medical care.

If the baby turns head down at any time — even on the day the mother goes into labor — it is OK for the mother to give birth at home. But remember that turning a sideways baby by hand is just as dangerous as trying to turn a breech baby.

Twins

It can be very difficult to know for sure that a mother is pregnant with twins.

a woman thinking while 2 women listen to her belly and tap with their hands.
Their tapping is different. I may have twins.

Signs of twins:

  • The womb grows faster or larger than normal.
  • You can feel 2 heads or 2 bottoms when you feel the mother’s belly.
  • You can hear 2 heartbeats. This is not easy, but it may be possible in the last few months.


Here are 2 ways to try to hear the heartbeats of twins:

  1. Find the heartbeat of 1 baby. Have a helper listen for other places where the heartbeat is easy to hear. If she hears a heartbeat, have her listen to one place while you listen to the other. Each of you can tap the rhythm of the heartbeat with your hand. If the rhythms are the same, you may be listening to the same baby. If the rhythms are not exactly the same, you may be hearing 2 different babies.
  2. If you do not have a helper but you have a watch with a second hand, or a homemade timer, try timing each heartbeat separately. If the heartbeats are not the same, you may be hearing 2 different babies.


If you think there might be twins, even if you can find only one heartbeat, get medical help. At a medical center or hospital, someone can use a sonogram to see if there are twins.

Because twin births are often more difficult or dangerous than single births, they are safer in a medical center. Since twins are more likely to be born early, the mother should try to have transportation ready at all times after the 6th month. If the medical center is far away, the mother may wish to move closer in the last months of pregnancy. Be sure to have a plan for how to get help in an emergency.

If the babies must be born at home, 2 very skilled midwives should attend the birth. Watch for labor starting too soon. See more about twin births.



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