Hesperian Health Guides

Check the mother’s body

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HealthWiki > A Book for Midwives > Chapter 8: Prenatal Checkups > Check the mother’s body

Check for signs of anemia

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General good health and plenty of energy.

  • Pale inside of eyelids, fingernails, and gums.
  • Dizziness or fainting.
  • Weakness or tiredness.
  • Fast pulse (over 100 beats a minute).
  • Difficulty breathing.

There is also a blood test for anemia.

When someone has anemia, it usually means she has not been able to eat enough foods with iron. Iron helps the blood carry oxygen from the air we breathe to all parts of the body. Some kinds of anemia are caused by illness, not lack of iron. And some kinds of anemia are inherited (genetic). They cannot be cured by eating iron foods or iron pills.

Many pregnant women have anemia, especially poor women. Women with anemia have less strength for childbirth and are more likely to bleed heavily, become ill after childbirth, or even die.

foods including fish, beans, eggs, molasses, and liver.
iron-rich foods

How to treat anemia

Ordinary anemia can usually be cured by eating foods high in iron (like beans, yams and meat) and foods high in vitamin C (like citrus fruits and tomatoes), and by taking iron supplements. After using these methods, the mother should be checked again in about 4 weeks. If she is not getting better, get medical advice. She may have an illness, or she may just need a stronger iron supplement.

To treat anemia with iron supplements
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  • give 300 to 325 mg ferrous sulfate by mouth, 2 times a day

If a woman is very anemic in the 9th month of pregnancy, she should plan to have her baby in a medical center.

Check for signs of poor nutrition or lack of iodine

General good health and a lot of energy.

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Signs of general poor nutrition:

  • Not wanting to eat.
  • Not gaining weight.
  • Weakness and general ill health.
  • Sores, rashes, or other skin problems.
  • Sore or bleeding gums.
  • Stomach problems or diarrhea.
  • Burning or numbness of the feet.

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Signs of lack of iodine:

  • Goiter (swelling in the front of the throat).
  • Short children, or children with deafness or hypothyroidism, a disability that affects thinking.

See ways to get more iodine.

What to do for poor nutrition

The best way to prevent or cure poor nutrition is to help people eat well. Find out what the mother has been eating. See ways to help her eat better. Remember: vitamin pills and tonics can be helpful in pregnancy, but they cannot replace a good diet!

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A woman with poor nutrition is more likely to have a difficult birth, a too-small baby, and more difficulty recovering from birth. If you are worried that a woman may have a hard birth because of poor nutrition, get medical advice.

2 pregnant women standing together while one of them speaks with a health worker.
Rania is so much bigger than I am. Am I gaining enough weight?
You are both gaining good amounts of weight, a little each month. Don't worry!

Weigh the mother

Mother slowly and steadily gains between 9 and 18 kilograms (20 to 40 pounds) during pregnancy. This is the same as 1 to 2 kilograms (2 to 4 pounds) each month.

  • Mother is very thin or gains fewer than 9 kilograms (20 pounds) during pregnancy.
  • Mother gains more than 19 kilograms (42 pounds) during pregnancy.
  • Mother gains weight suddenly — more than 2 kilograms (4 pounds) in 1 week or 4 kilograms (8 pounds) in 1 month, especially in the last 2 months of pregnancy.

Most of the weight a woman gains during pregnancy is from her baby, the placenta, and the bag of waters. The mother also puts on some fat. This is healthy.

If you have a scale, weigh the mother at each visit. If possible, always use the same scale.

What to do if you find warning signs

Mother is very thin or does not gain enough weight

Some women are small or thin and may stay small or thin during pregnancy. That is normal. But all pregnant women should steadily gain weight. If the mother does not gain enough weight, try to find out why. Ask the mother about:

Mother is very fat or gains a lot of weight

Women of all sizes can be healthy and have safe births. But gaining a lot of weight can be a warning sign of diabetes. If a woman is very fat, or gains a lot of weight in pregnancy, look for other signs of diabetes.

Mother gains weight suddenly

If a mother gains weight suddenly near the end of her pregnancy, it may be a sign of twins or pre-eclampsia.

Check the mother's temperature

Temperature is close to 37°C (98.6°F). Woman does not feel hot-to-touch.

Woman has a fever — a temperature of 38°C (100.4°F) or above. Woman feels hot-to-touch.

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How to check the temperature

Put the back of one hand on the woman’s forehead, and the other on your own or that of another healthy person. If the woman has a fever, you should be able to feel that her skin is hotter than that of a healthy person.

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If you have a thermometer, clean it well with soap and clean water or alcohol. Shake with a snap of the wrist until the thermometer reads less than 36°C (96°F).

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Put the thermometer under the tongue and leave it there for 3 minutes. The woman should keep her mouth closed.

thermometers with Celsius and Fahrenheit scales, showing normal temperature at 37 and 98.6 degrees, fever up to 39 and 102 degrees, and high fever up to 42 and 108 degrees.
high fever

Take the thermometer out and turn it until you see the silver line. The point where the silver stops marks the temperature.

There is usually a little arrow at the “normal” point.

Always clean the thermometer with soap and cool water or with alcohol after you use it. Do not use hot water — it can break the thermometer!

What to do if the woman has a fever

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A fever can be caused by:

A mild fever can also be caused by dehydration.

Find the cause of the fever, and then treat it. Along with treating the cause, a high fever needs to be lowered right away.

To lower a fever
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  • give 500 to 1000 mg paracetamol
by mouth, every 4 to 6 hours

And have her drink 1 cup of water every hour. If she is too sick to drink, give rectal fluids or IV fluids.

If the fever does not come down in 8 hours, get medical help.

Check the mother's pulse

Pulse is about 60 to 80 beats a minute when the mother is resting.

Pulse is 100 or more beats a minute when the mother is resting.

The pulse tells you how fast the heart is beating. Everyone’s pulse is different. That is normal.

How to check the pulse

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You can find the pulse on the side of the throat, under the jaw... or on the wrist below the thumb.
  1. Wait until the mother is resting and relaxed.

  2. Put the pads of two fingers on the pulse. Do not use your thumbs.

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  4. Count the number of beats in a minute:
    • If you have a watch with a second hand, count the number of beats in the mother’s pulse for 1 minute. Write the number down. (At first, have someone watch the clock for you and tell you when a minute has passed. Many people find it hard to count accurately while looking at a watch. They tend to count one pulse beat every second, no matter how fast the pulse is really beating.)
    • If you do not have a watch with a second hand, check the pulse anyway. You can learn to tell if it is slow, normal, or fast compared to your own pulse, and to other women’s. Or you can make a homemade timer to use instead of a watch.

What to do if the woman has a fast pulse

If the mother's pulse is 100 beats or more a minute, she may have one or more of the following problems:

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If you suspect any of these causes, click on the link for more information. If you do not know what is causing the fast pulse, get medical advice.

Note: Some healers check other traits of the pulse. For example, in many parts of Asia, healers feel how strong and how easy to feel the pulse is. In this book, we only teach how to check how fast the pulse is beating. If you usually check the pulse for other traits, try checking how fast it beats too.

Check the mother's blood pressure

Blood pressure stays between 90/60 and 140/90 and does not go up much during pregnancy.

High blood pressure. The mother has high blood pressure if either of these is true:

  • The top number is over 140.
  • The bottom number is over 90.

(Very low blood pressure is also a warning sign, but is usually only caused by heavy bleeding or shock.)

A woman’s heart is like a pump, pumping her blood through her body. High blood pressure means that the heart must work harder to press the blood through tight or shrunken blood vessels (veins and arteries). Blood pressure numbers show how hard the blood has to press.

When a woman has high blood pressure during pregnancy, it is harder for her blood to bring food to the baby. The baby then grows too slowly. Very high blood pressure can also cause the mother to have kidney problems, bleeding in the womb before birth, or bleeding in the brain.

High blood pressure can also be a sign of pre-eclampsia. Pre-eclampsia can cause premature birth, bleeding, convulsions, or even death for the mother.

For these reasons it is very important to check the mother’s blood pressure.

How to check blood pressure

There are several types of blood pressure equipment.

Some have a tall gauge that looks like a thermometer. Others have a round dial. Blood pressure equipment usually comes with a stethoscope. (See how to make a homemade stethoscope.)
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When you take the mother's blood pressure, first tell her what you are going to do and why.

1. Fasten the cuff around the bare upper arm. 2. Close the valve on the rubber bulb by turning the screw to the right. The screw will get shorter.
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3. Feel for a pulse just below the cuff, on the inside of the elbow. Put the stethoscope over the pulse and put the ear pieces in your ears. 4. Pump the cuff up by squeezing the bulb.
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5. As you pump, the needle will move. When it reaches 200, stop pumping. 6. Then open the valve just a little so that the air leaks out slowly. 7. The needle will begin to go back down. (If the valve is closed, it will stay at 200.)
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8. As the air leaks out, you will start to hear the mother's pulse through your stethoscope.

Notice where the needle or mercury is:
1. when you start to hear the pulse (this will be the top number), and
2. when the pulse disappears or gets very soft (this will be the bottom number)
a dial with the needle at 100; arrows from the text point to 100 and 60.
If you start to hear a pulse here
and then cannot hear it anymore when the needle is here
then the blood pressure is: 100/60

a chart showing a different blood pressure each month from September to January.
This woman's blood pressure goes up and down a little from month to month. This is normal.

Check the mother’s blood pressure at each visit. Write it down on a chart or on one piece of paper, so you can look for changes over time.

If her blood pressure is going up, ask her to come back every week until you are sure that it is not still rising.

If it is ever higher than 140/90, then the blood pressure is too high and can be a warning sign.

If her blood pressure is 140/90 or higher

If the mother’s blood pressure is high the first time you take it, have her lie on her left side. Help her relax (stress or fear can cause blood pressure to go up). In 10 to 30 minutes, take her blood pressure again.

  • If the blood pressure goes down to a normal level, things are probably OK. If possible, have the mother come back in a few days so you can take her blood pressure again. Ask her to rest on her side every day.
  • If the blood pressure does not go down, there may be a problem. To find out, take her blood pressure later that day, or the next day. If the blood pressure stays high, get medical advice. Teach the mother the danger signs of pre-eclampsia and check to see if she has any of those signs. If she has these signs, get medical help fast. It will probably be safest for her to give birth in a medical center.
  • If the top number of the blood pressure is over 150, or if the bottom number is over 100, get medical help now. She must get medical help. In some cases, she may need to stay at a medical center until she has the baby.

Home care for moderately high blood pressure (between 140/90 and 150/100)

If the mother cannot see a doctor or if the doctor advises her to rest at home, she should:

foods including milk, yogurt, fish, beans, nuts, and eggs.
  • Rest often during the day. She should rest as much as she can during the day, even if it is just for several minutes every hour. When she rests in bed, it is best if she rests on her left side. The mother can practice relaxing and feeling peaceful during these rest times. It is especially important to rest in the last 3 months of pregnancy.
  • Eat a good diet. Help the woman eat a variety of vegetables, fruits, and protein. Foods high in protein, calcium, or magnesium all may help prevent pre-eclampsia. Eating cucumbers, beets, bananas, or lemon or lime juice might help lower blood pressure.
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  • Drink a lot of liquid. Have the woman drink plenty of clean water, herb teas, soups, or other healthy fluids.
  • Avoid very salty foods. A little salt is fine, but women with high blood pressure should avoid foods with a lot of salt like potato chips, salted nuts, or processed meats.

Check for signs of pre-eclampsia (toxemia of pregnancy)

Pre-eclampsia is a very dangerous problem that can happen in late pregnancy, during labor, or in the few days after a woman has a baby. It can lead to convulsions (eclampsia) and even death.

Normal blood pressure.

The 2 most sure signs of pre-eclampsia are:

If a woman has both of these signs, she already has pre-eclampsia and needs medical help right away.
If she has high blood pressure and any of these signs of pre-eclampsia, she probably has pre-eclampsia — and you should get medical help:

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  • Strong headaches.
  • Vision changes such as spots, blurriness, or double vision.
  • Steady, severe pain in the top of the belly or the right side just under the ribs. It may feel like acid indigestion.

    If you think the pain may be caused by indigestion, you can give an antacid. If the pain does not get better in 20 minutes, it is a danger sign.
  • Overactive reflexes. Check the foot for overactive reflexes:
1 hand holding a woman's heel while the other hand pushes up on the ball of the foot.
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Have the woman lie down and hold her foot like this. Give a sharp push, then let go. If the foot jerks 2 times or more, it is a danger sign.

Get medical help immediately if you also see any of these signs:

  • Baby seems too small. Your measurements of her womb show the baby's growth is too slow.
  • Little urine. She is drinking enough liquid but making only a little urine.
  • Trouble breathing, or wet-sounding lungs.

Other warning signs of pre-eclampsia are:

  • swelling of the face and hands (especially if she has the swelling when she first wakes up in the morning).
  • sudden weight gain.

If she has these signs, continue to check her regularly.

Checking for pre-eclampsia

a blood pressure dial with the needle pointing above 140.
high blood pressure
  1. Check the woman's blood pressure. High blood
    pressure is always a warning sign.
  2. If possible, check for protein in the urine. There are 2 methods for doing this.

    Method 1: Use small plastic strips called Uristicks, Albusticks, or Labsticks to check for protein.
    illustration of sticks described below.
    Dark green means protein

    You may be able to get a bottle of these sticks from the local health authority or pharmacy. The strips have different color squares that turn from yellow to dark green. Ask the mother to urinate on the stick, and then compare the color of the squares with the color chart on the bottle. If the square turns dark green, there is protein in the urine. This is the most accurate way to check for protein.

    Method 2: Heat the mother's urine to check for protein.

    holding a tube of urine over a flame, using tongs.
    Heating urine to test for protein

    Ask the mother to wash her genitals well and then urinate into a clean container. Then pour the urine into a test tube to within 2½ centimeters (or one inch) of the top of the tube. Heat the upper part of the tube over a small burner, low flame, or candle until the urine boils. (Keep turning the test tube or the glass will break.)

    If the urine is clear, there is no protein in it. If the urine becomes cloudy and white, add a few drops of vinegar (2% acetic acid). If the cloudiness goes away there is no protein in the urine. If it stays cloudy or gets whiter, there is protein in the urine. If the woman has protein and high blood pressure, she has pre-eclampsia. When a woman has severe pre-eclampsia, the urine may become very cloudy, white, and thick.

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  4. Ask the mother if she has had any headaches, dizziness, or trouble seeing. If these problems are severe or happen often, especially if they start in the last 3 months of pregnancy, they can be signs of pre-eclampsia.
  5. Check for swelling. Swelling is also called water weight, water retention, or edema.
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    Swelling is common during pregnancy, and it is not usually a serious warning sign. Swelling is normal when it is on the ankles and feet, and when it goes away after the woman rests with her feet up. If the woman is having swelling, she should drink plenty of water, take more breaks during the day, and put her feet up when she can.
    Swelling can be a sign of pre-eclampsia if:

    • the woman’s hands or face are puffy or swollen and
    • the woman has swelling when she first wakes up in the morning

What to do if you find warning signs

If a mother has warning signs, get medical help (even if the birth is several months away). It may be safer for her to give birth in a medical center. If you must do the birth at home, be prepared for problems. Read the sections on bleeding, convulsions, and small babies.

If the mother is told to rest at home, encourage her to follow the instructions for home care for high blood pressure.

Check for signs of bladder or kidney infection

illustration of parts described below.
kidney tube

The kidneys, kidney tubes, bladder, and urethra (the opening where urine comes out of the body) are all connected and work together to get rid of body wastes. First the kidneys clean the blood and turn waste into urine. Then the urine goes down the kidney tubes to the bladder. The urine stays in the bladder until you urinate.

When harmful germs get into the urethra, it can become infected. That infection can easily spread to the bladder or kidneys.

No pain, itching, or burning when urinating.

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Pain along the sides of the back may be normal or — especially if only on one side — it may be a sign of kidney infection.

Bladder infection

  • constant feeling of needing to urinate, even after having just urinated
  • pain or burning while or just after urinating
  • pain in the lower belly, behind the front of the pelvis
  • protein in the urine

Kidney infection

  • any signs of bladder infection
  • cloudy or bloody urine
  • pain in the lower back, sometimes on the sides
  • fever
  • feeling very sick or weak

Sometimes a woman has a bladder infection but she has no signs.

(Back pain along the spine is common in pregnancy. It can be helped with massage, exercise, or hot compresses.)

A woman is more likely to get infections of the urethra, bladder, or kidneys during pregnancy than at other times. Bladder and kidney infections can be dangerous for the mother and can also cause her to start labor too early if they are not treated right away.

Note: Itching or burning while urinating can be a sign of infection of the vagina or a sexually transmitted infection. See Chapter 18 to learn more about treating these infections.
What to do if you find signs of bladder infection

Encourage the mother to drink 1 glass of liquid every hour while she is awake. Liquids help wash infection out of the body. Water and fruit juices are especially good to drink.

Encourage the mother to eat fruits that have a lot of vitamin C, like oranges, guavas, kiwis, mangos, or jujubes.

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Boil a large handful of corn silk in water and drink 1 or 2 cups.

Use local plant medicines that fight infection or heal injured tissues. Two plant medicines that you might be able to use are:

  • corn silk tea — boil the tassels from an ear of corn (maize) and then drink.
  • marshmallow tea — soak chopped pieces of the root of the marshmallow plant (Althaea officinalis) in cold water overnight and then drink.

If the infection does not start to improve quickly, or if the woman has any signs of kidney infection, give antibiotics. The longer you wait to treat an infection, the more difficult it will be to cure. If she is not better after 2 days of antibiotics, get medical help.

See the Medicines (green pages) at the end of this book before giving this or any medicine.

For an infection that is not getting better, or for a kidney infection
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  • give 500 mg amoxicillin
by mouth, 3 times a day for 7 days
If the woman is allergic to amoxicillin
  • give 960 mg cotrimoxazole
by mouth, 2 times a day for 7 days
(160 mg trimethoprim and 800 mg sulfamethoxazole)
But do not give cotrimoxazole in the last 3 months of pregnancy.
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Prevent bladder infections

To prevent bladder infections, teach women how to keep germs in stool away from the urethra by wiping from front to back after urinating or passing stool. Remind women’s partners to clean their hands and genitals before sex. Women should also urinate right after having sex.

This page was updated:11 Sep 2019