Hesperian Health Guides
Talk with the mother
Start the checkup by talking. Ask the mother how she has been feeling and how her pregnancy is going. Find out if she has any complaints or questions.
Contents
Observe her general health
Mother looks, sounds, and feels healthy and happy.
Mother looks, sounds, or feels unhealthy or unhappy.
While you are talking with the mother, notice everything that you can about her general health. For example:
- Does she have plenty of energy, or is she tired and ill?
- Does she move easily, or is she stiff and slow?
- Does she seem to think and talk clearly, or is she confused or withdrawn?
- Does she have clear skin, or does she have sores and rashes?
- Does she seem happy, or is she sad?
If the mother’s general health seems poor, give her extra care, even if you do not know exactly what is wrong. Pay attention if you have a feeling that something is wrong, and remind her to tell you right away if things get worse. She may need medical advice.
Ask if she has any nausea or vomiting
Mother has no nausea or vomiting, or mild nausea in the first 3 or 4 months.
- Mother has severe vomiting, or is unable to keep even water in her stomach.
- Mother can only urinate a little bit, or stops urinating, or her urine is very dark.
- Mother gains less than 1 kilo (2 pounds) in a month after the first 3 months.
Many women have nausea in the first 3 or 4 months of pregnancy. This is not usually dangerous. But if a woman vomits a lot, feels too sick to eat, or cannot keep down even fluids, she will have problems. She and her baby may become malnourished. The nausea may also be a sign that something else is wrong.
If the nausea is mild and in early pregnancy, see some helpful remedies to give the mother. If these remedies do not work, or if vomiting is severe, get medical advice. There are medicines that help calm the stomach so she can eat.
If the mother has diarrhea (loose watery stool) or other signs of illness along with vomiting, get medical advice. She should be checked for infection, malaria, ulcers (sores in the stomach), and parasites (harmful worms or other tiny animals living in people’s intestines).
If the mother has parasites but they are not causing too many problems, she should probably wait until after the birth to take medicine. Some medicines for parasites harm the baby, especially during the first 3 months of pregnancy. If illness from parasites is severe and the woman is not gaining weight normally or has other signs of illness, get medical advice.
If the mother is unable to keep fluids down and stops urinating, get medical help immediately. She may already have severe dehydration, which is very dangerous. She will need intravenous fluids (fluids given in the veins, which are also called IV fluids) and medicine. If you are trained in starting IV fluids, start them while you are traveling to get medical help.
If other people in the area also have trouble with nausea, vomiting, or diarrhea, there may be a problem with the local water. It will not help to give the mother medicines for parasites if she will get parasites again from bad water. If the water is bad, she should only drink it after boiling it or cooking with it. See the book Where Women Have No Doctor for simple ways to purify water.
Ask if she feels weak
Mother has plenty of energy.
Mother feels weak or tired all of the time, especially after the 4th month.
It is normal for a pregnant woman to feel tired or sleepy in the first 3 months and in the last 4 to 5 weeks of pregnancy. But during the rest of pregnancy she should have plenty of energy.
If a woman is weak or tired for a long time, she may be suffering from one or more of the following problems:
- poor nutrition
- anemia
- depression
- too much work
- illness
Help her find out what is causing her weakness. A mother who feels very weak is more likely to have problems in labor and birth. She may have a long, difficult labor, bleed heavily, or get an infection after the birth. Her baby is also more likely to get sick.
Ask if she has any bleeding from the vagina
- No bleeding.
- Very light bleeding or spotting for a few days during the first months, with no cramps.
- Pink or slightly bloody mucus 2 to 3 days before labor begins. This mucus is called show or the mucus plug.
- Bleeding as much as monthly bleeding at any time during pregnancy.
- Bleeding with pain at any time during pregnancy.
- Bleeding with no pain in the second half of pregnancy (placenta previa).
Bleeding with cramps during the first 6 months
If the mother has bleeding with cramps, she may be having a miscarriage. If the bleeding is light (spotting), the risk is low.
Get medical help if:
- the bleeding is like a monthly bleeding or heavier.
- the mother is more than 3 months pregnant.
- the mother has a fever.
- there is severe pain or a bad smell from her vagina.
See Chapter 22 to learn how to help a woman with problems after a miscarriage.
Placenta previa
Bleeding with no pain, especially in the second half of pregnancy, may mean the placenta is covering, or partially covering, the cervix instead of being near the top of the womb where it should be. This is called placenta previa. When the cervix starts to open near the end of pregnancy, the womb side of the placenta is not protected. It is like a raw wound. The mother’s blood flows through the placenta and out the vagina. This is very dangerous. The mother and baby may die.
Never do a vaginal exam for a woman who might have placenta previa. Treat her for shock and get medical help immediately!
Ask if she has any unusual pain in the belly, back, or legs
No pain in the belly, back, or legs. Only common aches and pains that are not dangerous, just uncomfortable, such as:
- mild, irregular cramps high in the belly, all over the belly, or inside the belly (also called practice contractions.
- sudden, sharp pains low in the front but to the side that last a few minutes and then go away.
- lower back pain that feels better with rest, massage, or exercise.
- sharp pain in the buttocks that runs down the leg and feels better with rest.
If the mother has any of the following pains, there may be a problem.
- Cramps or belly pains in the first 6 months that get stronger or come regularly may mean that a miscarriage is starting.
- Pain in one leg that does not go away can be a sign of a blood clot in the leg.
- Constant pain in the lower belly that goes through the sides into the back, or back pain that does not get better with rest, massage, or exercise, especially if the mother also has a fever, may be caused by a bladder or kidney infection.
- Any belly pain with fever can be a sign of womb infection.
- Constant belly pain in late pregnancy may mean the placenta is coming off the womb wall.
- Strong, constant belly or side pain in the first 3 months may mean that this is a tubal pregnancy.
(See below.)
Constant pain early in pregnancy (tubal pregnancy)
Constant pain in the belly during the first 3 months may be a sign that the pregnancy is growing in the wrong place.
The baby usually grows in the womb, where it belongs. But in rare cases, it may start to grow in the tube that leads from the ovary to the womb. This is called a tubal pregnancy. Tubal pregnancy is very dangerous.
 tubal pregnancy
womb
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A pregnancy in the tube will make the tube break and bleed. |  |
At first the tube stretches. But as the pregnancy grows, the mother may feel a sore lump or pain on her side. Then, sometime before she is 3 months pregnant, the tube breaks and bleeds. This bleeding usually stays inside the body where no one can see it, but it can bleed enough to kill the woman. If you think that the pregnancy may be growing in the tube, get medical help immediately! Watch for signs of shock.
Constant pain and bleeding late in pregnancy (detached placenta)
Pain in the belly during the last few months of pregnancy may mean the placenta has come off the wall of the womb. This is called a detached placenta, or abruption of the placenta. The mother may be bleeding heavily inside. A womb full of blood may feel hard. This is very dangerous — the mother and baby may die. Get medical help immediately! Watch for signs of shock.
Ask if she has shortness of breath
Some shortness of breath, especially late in pregnancy, is normal.
A lot of shortness of breath, especially with other signs of illness, is a warning sign.
Many women get a little short of breath when they are 8 or 9 months pregnant. As the baby gets bigger, it squeezes the lungs so there is less room to breathe. Breathing may get easier when the baby drops lower in the belly shortly before labor begins. Shortness of breath can also be caused by:
- allergies
- anemia
- heart problems
- tuberculosis (a contagious lung disease)
- asthma
- lung infection
- a blood clot in the lung
If the mother has trouble breathing all of the time, or severe trouble even one time, or if you think she may have any of the illnesses above, get medical advice.
Check for signs of diabetes
If a woman has some of the following warning signs, she may have diabetes. Women with diabetes do not always have all of these signs. But the more signs a woman has, the more likely it is that she has diabetes.
- She had diabetes in a past pregnancy.
- One of her past babies was born very big (more than 4 kilograms or 9 pounds), or was ill or died at birth and no one knows why.
- She is fat.
- She is thirsty all the time.
- She has frequent yeast infections.
- Her wounds heal slowly.
- She has to urinate more often than other pregnant women.
- Her womb is bigger than normal for how many months she has been pregnant.
When a woman has diabetes, her body cannot use the sugar in her blood. There is a blood test for diabetes. Ask your local health department if they can give the test. The best time to do this test is at about 6 months (24 weeks) of pregnancy.
A simple test for diabetes
Ask a woman to urinate into a container like a pot or a cup, and leave the container outside. If ants climb into the container, there is probably sugar in the woman’s urine — a sign of diabetes.
How to help a woman with diabetes
Diabetes can make a woman very sick and childbirth more dangerous. Her baby may be very big, have birth defects, or it may become very ill and die after the birth.
Usually diabetes in pregnancy will improve if the woman eats a good diet and exercises. Sometimes medicine is needed to prevent serious problems.
If you think that a woman has diabetes, she should get medical help. She should probably plan to have her baby in a medical center. She must eat a variety of healthy foods, avoid candy and sugar, and eat frequent small meals.
For more information about diabetes, see Hesperian's booklet Diabetes, the NEW Where There Is No Doctor or another general health book.