ASHA ShikshaGuide
Danger signs in pregnancy and how to prepare for a safe birth
The warning signs every pregnant woman and her family must know, what the ASHA should do in an emergency, and how to make a birth plan.
Most deaths of mothers in pregnancy and childbirth happen because a problem is not recognised in time, the decision to go to hospital is delayed, or the family cannot reach a facility quickly. You can prevent all three delays: teach the danger signs, help the family make a birth plan, and act fast in an emergency.
Danger signs during pregnancy
If a pregnant woman has any of these signs, she must go to a hospital with a doctor at once. Call 108 or 102 for free ambulance.
- Any bleeding from the vagina
- Severe headache, blurred vision, swelling of the face and hands, or fits – signs of high blood pressure in pregnancy (pre-eclampsia or eclampsia)
- High fever
- Severe pain in the belly
- Breathlessness, or very pale eyes, tongue and nails (severe anaemia)
- The baby moves less or stops moving
- Water leaks from the vagina before labour pains start
- Labour pains for more than 12 hours
Teach these signs at your first visit and repeat them at every visit. Ask the woman and her family to tell them back to you.
Find high-risk pregnancies early
Some women need extra care and should deliver only in a hospital with a doctor. Inform your ANM if the woman:
- is younger than 18 or older than 35, or shorter than 145 cm
- had a caesarean operation, stillbirth, repeated abortions or heavy bleeding in an earlier pregnancy
- is expecting twins, or the baby is not lying head-down near term
- has high blood pressure (140/90 or more), diabetes, heart disease, or HIV, syphilis or hepatitis B infection
- has haemoglobin below 7 g/dl (severe anaemia)
Check-ups that keep her safe
- Register the pregnancy within the first 12 weeks and give the MCP card.
- At least four antenatal check-ups, the first in the first three months.
- Encourage the PMSMA check-up by a doctor on the 9th of every month in the second and third trimester.
- At each check-up: weight, blood pressure, haemoglobin, urine, blood sugar and the baby's growth.
Make a birth plan with the family
Sit with the woman and her family in the 7th or 8th month and decide together:
- Which hospital she will go to for delivery.
- How she will reach there: the 108/102 number and a back-up vehicle.
- Who will go with her and who will care for the home.
- Money kept aside for emergencies.
- A family member willing to donate blood if needed.
- The phone numbers of the ASHA, ANM and the hospital, written on the MCP card.
Under JSSK, delivery, medicines, tests, food, blood and transport are free in government hospitals. Under JSY, the mother gets cash assistance. Explain these benefits so that money is not a reason to stay at home.
What to do in an emergency
- Stay calm and call 108 or 102.
- Keep the woman lying on her left side. If she is bleeding, keep her warm.
- Do not give anything by mouth if she has fits or is drowsy.
- Go with her to the hospital if you can, and take the MCP card.
- Inform the ANM or Medical Officer on the way.
After delivery
The mother and baby should stay in hospital for at least 48 hours after a normal delivery. Heavy bleeding, fever, foul-smelling discharge, fits or severe sadness after delivery are also danger signs. Visit her at home on the day she returns.
Common questions
Is a little spotting in early pregnancy normal?
Any bleeding should be checked by a doctor. Do not decide at home that it is normal.
She feels well. Does she still need four check-ups?
Yes. High blood pressure and anaemia often cause no symptoms until they become dangerous. Only a check-up finds them early.
Can she deliver at home if earlier deliveries were normal?
Every delivery should be in a facility with trained staff. Problems such as heavy bleeding can happen in any delivery, without warning.
Sources: NHM ASHA training modules; MoHFW guidelines for antenatal care and skilled attendance at birth; PMSMA, JSSK and JSY guidelines; MCP card.