Hesperian Health Guides
Good care during pregnancy
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Every pregnant woman needs the love and support of her family and community, whether she is married and already has children, or is very young, alone, or pregnant for the first time. She also needs access to good health care and proper nutrition.
Comfort her if she feels ill, tired, or afraid. As women’s bodies change during pregnancy, their feelings often change too.
Help her with daily chores so she does not have to lift or carry heavy things. Doing light work is good exercise.
Make sure she has water to bathe or wash regularly.
Make sure she gets enough rest. A pregnant woman needs to avoid sitting or standing for too long. She will feel better if she can lie down and rest for a few minutes when she is sleepy or tired. Resting often is good for a pregnant woman.
A pregnant woman and her family can learn about pregnancy and birth by talking with midwives and health promoters in the community. Also, books such as Where Women Have No Doctor explain what to expect during pregnancy, including healthy signs and common discomforts.
Prenatal care with a trained health worker
Prenatal check-ups are important to make sure the baby is developing well and that the mother is staying healthy. Good prenatal care requires some training, but it is not difficult to learn and does not require expensive equipment.
A pregnant woman should try to have at least 3 to 4 check-ups, one as soon as she thinks she is pregnant, the next one after about 6 months of pregnancy, and then 2 more during the month before the baby is expected.
Prenatal check-ups give women and their partners a chance to ask questions and learn about healthy pregnancy as well as danger signs. If there are problems, a health worker will be able to find and try to take care of them early in a pregnancy before they become dangerous. A health worker can also help a woman be tested for sexually transmitted infections, including HIV, so she can take medicines if necessary. Health workers can talk to the woman about her feelings and fears, and help her and her partner plan for a safe birth.
Midwives provide good care
For thousands of years, since long before there were doctors or hospitals, midwives have been the guardians of safe motherhood. This is still true today. We use the word "midwife" to talk about any person trained to give women complete prenatal and birth care. Some midwives are trained by other midwives; some go to school and receive a certificate or a diploma. Most midwives do both. Midwives play an important role in women’s health because:
- they are often the only health workers in poor communities, or the only health workers women can afford.
- they usually live in the communities they serve, so families know and trust them.
- they usually spend more time with women than a doctor or other health worker would, which helps them notice danger signs and better understand women’s needs.
- they are usually women, and many pregnant women feel more comfortable talking to and being examined by another woman.
- they help women give birth in ways that respect their desires and traditions.
Good nutrition for a healthy pregnancy
A woman who eats well and takes good care of her body is much more likely to have a healthy pregnancy and healthy baby. Eating well helps the baby grow in the mother’s womb, helps prevent heavy bleeding after birth, and helps a mother recover her strength quickly.
A pregnant woman needs to eat enough food every day, especially foods rich in iron, such as meat, fish, chicken, eggs, beans, peas, and leafy green vegetables. If there is not enough food for everyone in the family, the woman should always get as much as, and if possible even more than, everyone else. She should also take folic acid and should ask her health worker if she needs to take other vitamins. A healthy diet includes:
- main foods (starches such as rice or cassava)
- foods that help build the body (protein foods such as meat, beans, eggs, and milk)
- energy foods (fats and small amounts of natural sweets)
- protecting foods (foods with lots of vitamins and minerals such as fruits and vegetables)
Just as eating well has many good effects, eating poorly or not enough can be harmful to a pregnant woman and her baby. Poor nutrition can cause anemia, which leads to weakness, difficulty fighting infections, and other health problems. It can cause a baby to be born very small or with birth defects, and it can increase the chances of a baby or mother dying during or soon after birth.
Poor families may simply not have enough food, and the food they do have may not be shared equally between males and females. Sometimes customs or beliefs prevent women from eating enough. See Chapter 3: Gender and Health, for ideas about how to prioritize women’s health and needs. It is possible for communities to find solutions to problems such as gender inequality and poverty. See some stories and strategies in Chapter 2: Communities Organize for Women's Health, for how people have mobilized to make changes that help everyone be able to lead healthier lives.
Activity Build a house for healthy pregnancy
This activity lets everyone share ideas about what local foods help a woman have a healthy pregnancy and birth.
To prepare: You will need materials to build a frame of a little house, such as sticks of similar size, and some paper or cloth to cover the frame. You will also need paper, tape, crayons or markers for people to draw with, or pictures of foods that you have made or cut out of magazines.
To begin, share information about good nutrition for pregnant women and then ask
how building a strong house relates to good nutrition for a woman and her baby.
A house needs good walls to hold up the roof, just like a woman’s body needs good foods to keep her standing and able to do her work.
- Work with the group to build a little house by making a frame out of sticks, and cover it with paper or some cloth.
- Ask the group to draw pictures of local foods or gather the pictures you have cut out of magazines. Be sure to include fruits, vegetables, beans, and other nutritious foods.
- Ask people to put the main foods on one wall, the foods that help build the body (protein foods) on another wall, energy foods (fats and small amounts of natural sweets) on another wall, and water and milk on the fourth wall. Ask them to choose protecting foods (fruits and vegetables) for the roof. Also ask them to point out which foods give pregnant women the 5 important vitamins and minerals they need: iron, folic acid, iodine, calcium, and Vitamin A. Remind them that the most important foods for a pregnant woman are protein foods.
- To conclude, look at the house you have built. Which walls are the weakest (have the fewest foods)? Are there other, easily available foods that can be added to strengthen the walls or the roof? Do pregnant women in the community eat all of these foods? If they do not, why not? Ask the group to think about ways to ensure that all pregnant women in the community eat the foods they need.
Mapping the way to safe motherhood
Safe motherhood requires conditions in the community that promote and support the health of women and girls, and it requires easy access to prenatal care and other health services.
Making a map with a group, based on what they see or know about their community, is a good way to collect and share information. Making and discussing a map can help people identify community resources or strengths they may not have been aware of that support women and girls. Maps can also help people identify problems that need to be addressed to make motherhood safe for all women. Here is an example of community mapping to look at all the conditions and services that support the health of girls and women in the community. You can adapt this to look at specific health issues.
Activity A map to safe motherhood
This activity can be done over the course of several meetings or during a longer workshop.
- To begin, ask people about maps and how they use them. You can explain that a map is a picture of a place — a workplace, a community, a country, or a health center — that uses symbols to show where certain things are located in that place. For example, squares can show houses, blue lines can show rivers, and black lines can show roads.
- Form teams to work on making the map, and together agree on their assignments. For example a team might visit the health center to look at what services are available and how friendly and accessible the staff is. Another team might go to the local market to see what foods are available. And a third team might go to the high school to see what support girl students receive to promote their health.
- Walk and talk. Each team will walk around and make notes about the problems they see — things that may prevent women and girls from being healthy and becoming healthy mothers. Also make note of all the things that are available and accessible to help women and girls be healthy. The teams can interview people to learn more.
Draw the maps! Provide each team with a large sheet of paper, pencils, markers, or other materials they can use to make their maps. Ask them to describe to each other what they observed during their visit and then begin sketching a map. To start, you can ask them to draw landmarks on their map, for example, stairs, rooms, offices, signs, and other things they saw inside or outside the health center.
I don’t draw very well, but this actually helps everyone feel comfortable and participate. We can all laugh at my simple stick people, and when everyone sees they can draw at least as well as I can, they are more willing to draw too.
Ask each team to describe and draw onto the map things they saw or learned about that promote or are helpful for the health of women of all ages. This can include physical things, such as a safe place for children to play during prenatal check-ups in the health center, or different kinds of staff such as a nurse who visits the high school to provide health education. It can also include things such as food that supports good nutrition. Or a community health worker who is trusted and respected.
Next, ask each team to draw the things they found that are barriers to health for women and girls, or to care for pregnant women. Barriers can be physical things, such as stairs that make it hard for women with disabilities to get into the building, or lack of space or a bench for women to wait comfortably. Barriers can also be things that discourage some women from seeking care.
- Put the maps together! Have each team hang their map on a wall. Try to arrange them on the wall in a way that people can recognize as their community (even though the maps will not be drawn in the same way). You could draw in a road, big buildings or larger landmarks to help everyone in the group see how the maps relate to each other. Allow time for everyone to look at each other’s maps.
Discuss the maps. Ask each team to explain their map to the rest of the group. Each team then marks or circles the problems or barriers on their map in one color, and the strengths or positive things in another color to make them easier to see.
Discuss the strengths in the community that make it possible for girls and women to be healthy and become healthy mothers. How can those strengths be built upon or better used?
Discuss the barriers to good health, and barriers to health care services for women and girls. Which problems or barriers seem the most important to address in order to improve the health of girls and women?
- The group might then decide to make an action plan to build on the strengths or address the barriers they have identified. Ask the group to consider how they can share their maps or conclusions with others in the community.