Hesperian Health Guides

Hesperian Health Guides

Caring for Pregnant Women

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HealthWiki > New Where There Is No Doctor > Pregnancy and Birth > Caring for Pregnant Women


The rest of this chapter offers instructions especially for midwives and health workers caring for pregnant women and babies. (Mothers can use this information too, to understand what is normal and what is dangerous.)

A midwife or other health worker should meet with a pregnant woman several times during the pregnancy. After about 8 months, meet every week. At these meetings, the midwife can:

  • answer questions.
  • teach about healthy eating, rest, and other needs of pregnant women.
  • check health signs that show whether the mother and baby are well or need help.
A health worker talking to a pregnant woman, asking her questions from a sheet of paper


Write down what you learn at each visit so you can answer such questions as, “is this mother gaining enough weight to support her baby?” and “is her blood pressure staying the same or getting higher?” (Rising blood pressure can mean pre-eclampsia.)

  
 Danger Signs In Pregnancy
Go to a medical center or hospital if you find any of these signs of serious health problems. They can endanger a pregnant woman’s life.
  • Bleeding from the vagina: Bleeding, like during a menstrual period, in the first few months of pregnancy is a sign of losing the pregnancy. Later in pregnancy, a little bleeding can be a sign of the placenta separating from the womb. This is an emergency. Get medical help.
  • Severe pain in the first 3 months of pregnancy can be caused by a pregnancy outside the womb. Get to a hospital right away. Severe pain late in pregnancy or during labor can be the placenta separating from the womb. This is an emergency, get medical help.
  • High fever (above 39°C or 102°F) is a sign of infection that can harm the mother or her baby. Fever in pregnancy can be caused by flu, malaria (see Some Serious Infectious Illnesses – in development), kidney infection (see Difficulties with Urinating – in development), womb infection, or any other illness that causes fever.
  • High blood pressure (140/90 or more), severe headaches, and severe swelling of the face are signs of pre-eclampsia.
  • Seizures can be caused by eclampsia. Get her to a medical center quickly.

Click here for a print quality version of this record of prenatal care chart.

A prenatal care chart

Contents

Questions to ask a pregnant woman

At the first meeting, ask questions to learn about the mother’s health. Add to this list of questions, depending on the health problems in your own community.

How long has she been pregnant? When is the baby due?
A woman counting on her fingers
At each meeting, figure out how many weeks pregnant the woman is. Recheck the day her last menstrual period started, and count how many weeks have passed since then.
Knowing how far along the pregnancy is will tell you if the baby is growing enough.

How were the previous pregnancies?

Did she have high blood pressure or seizures?
A pregnant woman having a seizure
High blood pressure or seizures (fits) during pregnancy may have been pre-eclampsia. Meet with this woman at least once a week after week 28 of pregnancy. At each meeting, check her blood pressure and check her urine for protein. Plan how you will get medical help fast if she needs it.
Did any babies die before birth? Why?
A sad pregnant woman"
There are many possible causes of a baby’s death during late pregnancy. Diabetes is one possible cause, so check the mother for signs of diabetes. But most often, no one ever knows the cause, and even the known causes may not happen again. No matter the cause, listen to this mother’s story with kindness.

How were the previous births?

Did she bleed a lot after a previous birth?
A woman lying down, bleeding a lot

Find a way for the woman to have this baby in a well-equipped hospital. If that is not possible, have medicines ready to treat bleeding at home.

Has she had very quick labors – or very slow ones?
If she had fast labors in the past, get to this birth as quickly as you can or have a plan for how to get her quickly to a clinic.
If she has had slow labors, she may have a small pelvis or another problem. Be ready to go to the hospital if this labor is slow too.
Have any of her babies been very small? Have they been very big?
Small babies can get breathing problems and infections more easily. Try to help the mother grow a bigger baby this time. If food is scarce, can you find ways to get her more?
Cigarette smoke and other poisons can also keep the baby small. What needs to change to protect the mother and baby from harm?
A large baby, over 4 kg, can be a sign of diabetes.
Did she have any births by surgery – called cesarean births? Has she had births with forceps? Does she know why?
A midwife delivering a baby with forceps
A cesarean or forceps delivery may have been necessary because of a very slow labor, which might happen again. Was the labor long too? If not, a cesarean may have been unnecessary.

It is possible to have a vaginal birth after a cesarean. But it is best to try in a hospital in case of a problem.
Did any babies die in the weeks after the birth?
Newborn death has many causes. Tetanus, pneumonia, diarrhea, and sepsis are some common causes that can all be prevented. Learn how to prevent and treat these infections in the Newborn Babies and Breastfeeding chapter.
Did she have trouble breastfeeding?
See information abouthelp with breastfeeding.

How is her health now?

Does she have any serious infections, like malaria, TB, HIV, or others?


Look for ongoing health problems that are not getting better such as a lasting cough, fevers, or weight loss.

Any serious infection must be treated.
A woman coughing very hard"
Does she have itching, sores, a bad smell, or yellow discharge from the vagina? Does she have pain inside the vagina or lower belly when she has sex?
An increase in white or clear discharge from the vagina is normal in pregnancy. But discharge that smells bad or pain in the vagina are signs of infection. See Genital Problems and Infections (in development).
Does she have pain or burning when she urinates? Or pain on the sides or in the middle of the back?
A woman in pain, holding her side"
Check for urinary tract infection (bladder infection), see Difficulties with Urinating (in development).
A woman bleeding from the vagina
Has she had any bleeding from the vagina?
Bleeding before 20 weeks is usally a loss of the pregnancy, and is usually not dangerous to the woman's health. Bleeding after week 20 (4 ½ months) is an emergency. Get help.
Does the mother have diabetes (too much sugar in the blood)?
Urine dipsticks
A woman with diabetes should continue to take her insulin during pregnancy. It is important to check the blood sugar after each meal, if she can. She will need medical help to have a safe birth.
It is also possible to get diabetes of pregnancy, called gestational diabetes. Check the urine for sugar with urine test strips. If she has sugar in the urine, she needs a blood test for diabetes.
Is she taking any medicines?

Use the Index of Medicines (in development) or another reference to learn about any medicines the woman is taking. Ask yourself, “is this medicine necessary?” and, “is it safe in pregnancy?” If it is necessary but not safe, look for another, safe medicine she can use instead.
Is she allergic to any medicines?
A woman scratching at a rash on her chest
Note any medicine allergies. Avoid giving her medicines to which she is allergic and plan to use another, safer medicine if necessary.
Does she take herbs or natural medicines?
Some plant medicines can cause harm in pregnancy. See Medicines, Tests, and Treatments (in development) for help deciding which may be safe.
Are strong chemicals used in her home or work? Of particular danger are pesticides, strong cleansers, and chemicals and materials used in factories.
Strong chemicals can be dangerous for everyone. Some can also cause a baby to be born with disabilities or be born dead. How can you help protect this mother from dangerous chemicals?
Containers of strong chemicals such as bleach, paint thinner, and insecticide
What does she eat on a normal day?
Use the Good Food Makes Good Health chapter to talk with the woman about how to eat well each day.
Does anyone help with her other children and household work? Does someone bring food, water, and fuel when she needs it?
A pregnant woman sitting and sewing, while another woman is cooking
Talk with the pregnant woman’s family about helping more with household chores. If the family is not helping enough, neighbors, people from her church or mosque, or fellow workers can all be encouraged to help her.
Where is she planning to have the baby?
Several people helping a pregnant woman get into a car
If she plans to give birth at home, decide how she will get medical help in case of emergency.
If she hopes to have the baby in a hospital or clinic, make a plan about how to get there, including how to pay for transportation and admittance.


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