Hesperian Health Guides
Check Health Signs
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Check the mother’s health signs at every visit.
- Check her weight and blood pressure.
- If she feels ill or seems unwell, also check her temperature, pulse, and breathing. Learn how to check these health signs in Examining a Sick Person (in development).
- Check the baby’s growth and position and listen to the heartbeat.
If you have a scale, check the mother’s weight at each visit. She should gain weight, a little at a time, through the whole pregnancy. In general, a healthy pregnant woman gains between 12 and 16 kilos (25 to 35 pounds) during pregnancy. Starting at 4 months, it is healthy to gain a little less than ½ kilo (1 pound) each week — more if she starts underweight, less if she starts fat.
If the woman is not gaining weight, help her to get and eat more food.
Diabetes can cause sudden weight gain. Sudden weight gain in the last weeks of pregnancy can also be caused by twins or pre-eclampsia.
Blood pressure of 140/90 or higher is not healthy. If the blood pressure is steadily rising each time you check it, that is also a danger sign.
High blood pressure early in pregnancy is hypertension. See the chapter Heart Disease and High Blood Pressure. Pregnancy and birth are dangerous for a woman with hypertension and she will need medical help.
High blood pressure after about 28 weeks (6 ½ months) of pregnancy may be pre-eclampsia. This is a dangerous problem that can lead to seizures and death. She needs medical help.
Pre-eclampsia is a dangerous disease of late pregnancy. There is no way to prevent it. The main sign is high blood pressure which gets worse and worse until the mother has seizures (eclampsia). You can save her life by watching for signs of pre-eclampsia throughout pregnancy and getting treatment quickly if she has signs of severe pre-eclampsia.
If her blood pressure becomes too high, or if there are seizures, medication can help. But the only way to cure the problem is for the baby to be born.
Signs of pre-eclampsia
- Blood pressure of 140/90 or more after 28 weeks (the last 3 months or so of pregnancy) AND
- Protein in the urine (see Examining a Sick Person - in development).
If you find high blood pressure in late pregnancy, check for protein in the urine. If there is high blood pressure and protein, the mother has pre-eclampsia and needs medical help or she will quickly get worse.
If there is no protein in the urine, continue to watch her carefully and check her blood pressure at least once a week. Get medical help if you see signs of severe pre-eclampsia.
Signs of severe pre-eclampsia or eclampsia
- Severe headaches.
- Blood pressure of 160/110 or higher.
- Blurry vision.
- Pain in the pit of the stomach.
- Severe swelling, including swelling of the face.
- Mental confusion.
If at any time the mother has signs of severe pre-eclampsia, get medical help right away. The mother’s life is in danger and she must give birth as soon as possible.
- Stay calm.
- If the mother is having a seizure, turn her on her side. This keeps her from choking on her vomit or spit.
- If you have it, give oxygen.
- To stop the seizures, inject 5 grams magnesium sulfate into each buttock. You can repeat this in 4 hours. Do not give magnesium sulfate if she is breathing less than 12 breaths a minute. (Magnesium sulfate comes in different concentrations so be sure you have the right amount.)
The baby’s growth
After 3 months of pregnancy you should be able to feel the top of the womb at the bottom of the mother’s belly, just above her pubic bone. At about 5 months the womb should be about as high as her belly button, and then should continue to grow about one finger-width each week.
If the womb grows bigger or faster than you would expect, the woman may be farther along in pregnancy than you thought. Or she may have twins. Or she may have diabetes or another health problem.
If the womb and baby grow very slowly the mother may not be as far along in pregnancy as you thought. Other causes of small growth are not eating enough food, or being exposed to smoke or poisonous chemicals.
The baby’s position
The baby moves around at the beginning of pregnancy. Toward the end, the baby gets into position for the birth.
With practice you can feel whether the baby is head down (a safe position) or is butt down (breech, a position where problems are more likely to occur).
Use two hands and firm, deep pressure. Ask the mother to slowly blow out all her breath and you will be able to press your fingers deeper to feel the baby.
|Feel the top of the belly with two hands. Do you feel a hard, movable head? Or a soft butt?||Feel the part in the pelvis. Is it hard or soft? When you hold it, can you move the rest of the body freely?|
If the baby is breech at the time of birth, it may be safer to give birth in a hospital. If you are helping a woman have a breech baby, see more information.
A sideways baby cannot be born through the vagina. If the baby is sideways when labor starts, get to a hospital. Cesarean surgery is needed.
The baby’s heartbeat
By week 20 (about 4 ½ months) you should be able to hear the baby’s heartbeat with a fetoscope and a few weeks later with a regular stethoscope. A healthy baby’s heart speeds up and slows down a lot but stays between 120 and 160 beats each minute. This is about twice as fast as an adult. It may be slower when the baby is sleeping. (If you hear a heartbeat between 60 and 80, you are probably hearing the mother’s heart, not the baby.) Use a watch with a second hand or a 1 minute timer to count the beats.
baby’s heartbeat loudest here
|A fetoscope is for listening to the baby through the mother’s belly.||After about week 20 of pregnancy, a baby’s heartbeat can show you the baby’s position.|
If the heart stays slower than 120, or faster than 160, or always seems to go at the same speed with no changes, then the baby may be having trouble and you should go for help.
Finally, if you notice two separate baby heartbeats, there may be twins.
Make a plan for emergencies
Every common emergency of birth is treatable. Bleeding, seizures, infection, labors that go on and on, all can be stopped with the right medicines or sometimes surgery in a well-equipped medical center. The hard part is getting this help when it is needed. Remember that there is rarely much warning before something goes wrong in birth. Money, transportation, and cooperation from family or neighbors are all better arranged in advance, before labor begins.
Bring together the mother and the people who care for her: her husband, mother-in-law, or whoever else, and decide what will be needed in case of an emergency. This might include:
- the use of someone’s car or other vehicle.
- money to pay for care.
- permission in advance from those who make family decisions.
If you are very far from medical help, consider spending the weeks before the birth with a relative who lives closer to a hospital.