Where There Is No Doctor 2011 251
3. Minor problems
Ask the mother if she has any of the common problems of pregnancy. Explain
that they are not serious, and give what advice you can (see p. 248).
4. Signs of danger and special risk
Check for each of the danger signs on p. 249. Take the mother’s pulse each
visit. This will let you know what is normal for her in case she has problems later
(for example, shock from pre-eclampsia or severe bleeding). If you have a blood
pressure cuff, take her blood pressure (see p. 410). And weigh her. Watch out
especially for the following danger signs:
• high blood pressure (140/90 or greater)
• protein in the urine
• sudden weight gain
• swelling of hands and face
• headaches
} signs of pre-eclampsia
(p. 249)
• dizziness and blurred vision
• pain high in the belly
Some midwives may have paper ‘dip sticks’ or other methods for measuring the
protein and sugar in the urine. High protein may be a sign of pre-eclampsia. High
sugar could be a sign of diabetes (p. 127).
If any of the danger signs appear, see that the woman gets medical help as soon
as possible. Also, check for signs of special risk, page 256. If any are present, it is
safer if the mother gives birth in a hospital.
5. Growth and position of the baby in the womb
Feel the mother’s womb each time she visits; or show her how to do it herself.
9 months
8 months
7 months
6 months
5 months
4 months
3 months
Normally the womb will be
2 fingers higher each month.
At 4 ½ months it is usually
at the level of the navel.
Each month write down how many finger widths the
womb is above or below the navel. If the womb seems
too big or grows too fast, it may mean the woman is
having twins. Or the womb may have more water in it
than normal. If so, you may find it more difficult to feel
the baby inside. Too much water in the womb means
greater risk of severe bleeding during childbirth and
may mean the baby is deformed.
Try to feel the baby’s position in the womb. If it
appears to be lying sideways, the mother should go to a
doctor before labor begins, because an operation may
be needed. For checking the baby’s position near the
time of birth, see page 257.