Hesperian Health Guides

Risks and Danger Signs during Pregnancy

Women who have extra risks

a small building with a sign that says ‘Health Center’
a large building with a sign that says ‘Hospital’
A woman who is likely to have a dangerous birth should plan to have her baby in a health center or hospital.

Women with any of the following problems can have more dangerous pregnancies and births. They should plan to go to a health center or hospital for birth, and they may need more prenatal care during pregnancy.

  • Weak blood (anemia) makes a woman more likely to bleed heavily (hemorrhage) during birth, become ill after childbirth, or even die.
  • Sugar sickness (diabetes) often causes very serious problems for the mother and the baby. The baby can die before birth or sometimes grows very large and gets stuck in the pelvis.
  • High blood pressure can lead to severe headaches, seizures, and even death.
  • Older mothers who have had many babies are more likely to have long, difficult labors, and heavy bleeding after the birth.
  • Mothers under the age of 17 are more likely to have eclampsia (seizures), long, difficult labors, babies born too early (premature), and blocked births, which may damage the bladder, vagina, and womb and can kill the mother (see information about fistulas).
  • Mothers who had problems with past pregnancies — such as seizures, birth by operation, heavy bleeding, a too-early or too-small baby, or a baby born dead — are more likely to have problems in another pregnancy or birth.
  • Women with disabilities, with a loss of feeling in the body or difficulty walking, can have problems during both pregnancy and birth.
  • Women with HIV risk having HIV spread to their babies, but can take medicines to prevent this.

Feeling very weak or tired (anemia)

If you feel very weak or tired, you could be anemic. Women who are very anemic are much more likely to have heavy bleeding after the baby is born.

What to do:
a bottle of iron tablets
  • Eat foods rich in iron — meat, fish, chicken, eggs, beans, peas, and leafy green vegetables.
  • Take 325 mg of iron 2 times a day, and 500 mcg of folic acid once a day, until the baby is born. If you take iron tablets with fruits like oranges, mangoes, or papayas, your body uses the iron better.

Pain in the lower belly (abdomen)

tubal pregnancy
a pregnancy growing in the tube that connects the womb and the ovaries
  1. Strong, constant pain in the first 3 months may be caused by a pregnancy that is growing outside the womb in the tube (a tubal pregnancy). As the tube stretches, it causes pain. If the pregnancy grows large enough, the tube will burst and bleed. This is very dangerous. You will bleed inside your abdomen and may die.
    Signs of tubal pregnancy (ectopic pregnancy):

    Strong pain in the abdomen does not always mean something is wrong with a pregnancy. For information about other possible causes, see Chapter 21, "Pain in the Lower Abdomen."

    a woman bent over in pain, holding one side of her abdomen
    • missed monthly bleeding, and
    • pain in the lower abdomen on one side, or
    • slight bleeding from the vagina, or
    • feeling dizzy, weak, or faint
    What to do:

    Go to the nearest hospital.

  2. Strong pain that comes and goes (cramping) in the first 6 months could mean you are losing the pregnancy (having a miscarriage ).

  4. Strong, constant pain in late pregnancy. This could mean the afterbirth (placenta) is coming off the wall of the womb. This is very dangerous. You could die if you do not get help. Go to the nearest hospital.
  5. Pain that comes and goes in the 7th or 8th month could mean you are going into labor too early.

Bleeding from the vagina

  1. Bleeding early in pregnancy. Light bleeding from the vagina for a few days during the first 3 months of pregnancy can be normal. But if you have pain with the light bleeding, it could mean a pregnancy is developing outside the womb, which is very dangerous . If the bleeding gets heavier and stronger than a normal monthly bleeding, you are probably losing the pregnancy (having a miscarriage).
  2. Bleeding later in pregnancy. Bleeding after the first 3 months can mean there is something wrong with the afterbirth (placenta). Both you and the baby are in danger.


What to do:
  • Go to the nearest hospital.
  • On the way, lie down with your feet up.
  • Do not put anything in your vagina.


Fever with shivering, body aches and headache can be caused by malaria. Malaria treatment depends on where you live. In the first 3 months of pregnancy, the best treatment is 600 mg of quinine by mouth 3 times a day and 600 mg of clindamycin by mouth 2 times a day. After 3 months, use the artemisinin combination therapy (ACT) recommended for your area. Take both for 7 days. See Where There Is No Doctor for more information.

High blood pressure, a sign of pre-eclampsia

Blood pressure of 140/90 or higher can be a sign of a serious problem called pre-eclampsia (toxemia). Pre-eclampsia can lead to seizures, and both you and the baby can die.

What to do:
  • Find someone who can check your blood pressure or check for protein in the urine.
    Go to a health center or hospital if necessary.
  • A woman at risk for pre-eclampsia can take a low-dose aspirin (81 mg) daily to help prevent it.
  • Rest as often as possible, lying down on your left side.
  • Try to eat more foods with a lot of protein every day.
  • Plan to have the birth in a health center or hospital.


IMPORTANT! A woman with high blood pressure and any signs of pre-eclampsia needs medical help fast. If she is already having seizures see information about what to do.

If the baby's head is down, the birth is more likely to go well.

Baby in the wrong position when labor starts

If the baby is buttocks first (breech) when labor starts, the birth can be more difficult. If the baby is lying sideways when labor starts, the baby cannot be born without an operation. (See how to check the baby's position.)

WWHND Ch6 Page 075-3.png

Lie on the floor with pillows under
the hips. Try to get the hips
higher than the

During the last month of pregnancy, it may be possible to change the baby's position by lying in this position for 10 minutes, 2 times a day:

Do this exercise every day with an empty stomach, until the baby changes to a head-down position and then stop. The baby's position should be checked each week.


  • If labor starts and the baby is still sideways, the mother must go to a health center or hospital where the baby's position can be changed, or where she can have an operation. Without medical help, the mother and her baby will almost certainly die.
  • If labor starts and the baby is still buttocks first, see information about what to do.
IMPORTANT! DO NOT try to change the baby's position by hand yourself unless you have been trained to do it and have done it before successfully. You can tear the womb and harm both the mother and the baby.

This page was updated:21 May 2021