Pregnancy danger signs that mean going to a facility today
Set off for a health facility today, whatever the hour, if you see any of these: bleeding, a fit or convulsion, a severe headache with blurred vision, a high fever, waters breaking early, severe belly pain, or a baby that has stopped moving. Go soon, but not this minute, for swelling of the face and hands or for breathlessness and dizziness after a short walk. If you cannot tell which sign you are looking at, treat it as the serious one and travel.
- Bleeding at any stage is a same-day journey. There is no amount small enough to watch and see.
- Fits or convulsions are an emergency. Turn her onto her left side, put nothing in her mouth, do not hold her down, and start moving her to a facility at once.
- A headache that will not go, with blurred vision or a swollen face and hands, is not ordinary tiredness.
- A baby that has gone quiet for a day needs checking that day, even when everything else feels normal.
- Travelling and being told it was nothing is a good outcome. Waiting and being right is not worth it.
General information, not medical advice. If you are worried about a mother or a child, go to your nearest health facility or speak to your village health team.
Signs that mean setting off today, whatever the hour
These do not wait for morning and they do not wait for the next clinic day. If any of them appears, start arranging the journey while you are still thinking about it.
You do not need to work out which one it is, or how bad it is. One sign from this list is enough.
- Bleeding from the vagina, at any month, any amount
- A fit or convulsion, or losing consciousness
- A bad headache that will not go, especially with blurred or spotty vision
- A fever that stays high, or fever with shaking chills
- Severe pain in the belly that is constant rather than coming and going
- Waters breaking before the pregnancy is at term, or fluid that is green or smells bad
- No movement from the baby for a day, or a clear drop from the usual pattern
- Vomiting so much that nothing stays down and you have stopped passing urine
Signs that mean going soon, but not this minute
These are serious without usually being a matter of minutes. Go, and go before the next clinic day rather than saving them up for it.
Say the sign plainly at the health centre and say when it started. What you are describing may be the thing that changes where and how you are advised to deliver.
- Swelling of the face, the hands or around the eyes, especially if it came on quickly
- Breathlessness or dizziness after walking a short distance
- Pale palms, pale inner eyelids, and being tired in a way that is new
- Burning when passing urine
- Itching all over the body without a rash
What to do in the first ten minutes
Do not start with bathing, cooking or finding a good dress. Start with the ride.
Send a child or a neighbour to the boda rider you have already agreed with, and phone the second rider yourself. Phone your village health team member and say what the sign is. Pick up the antenatal card and the bag if it is packed. Take somebody with you, because the mother should not be the one negotiating a fare or answering questions at the counter.
If she is bleeding heavily, keep her lying down and keep her warm on the way. Do not give anything by mouth to a woman who is drowsy or fitting. Do not stop at a drug shop first: a drug shop cannot manage bleeding in pregnancy and the stop costs time you may need.
What to do if she is having a fit
Move anything hard away from her. Turn her onto her left side so that anything in her mouth drains out rather than down. Do not force anything between her teeth, and do not hold her limbs down.
Once the fit stops, keep her on her side, keep her covered and get her moving to a facility immediately. Do not wait to see whether another one comes.
Tell the health worker at arrival that there was a fit, how long it lasted and how many there were. That single fact changes what they do first.
Where should you head, the health centre or straight to the hospital?
For most signs, the nearest facility that can see you is the right first stop, because the priority is being assessed by somebody trained rather than travelling further while nothing is being done.
For heavy bleeding, or a fit, the destination matters more, because what may be needed is an operation or a transfusion and not every facility can offer either. This is why the question to ask at an antenatal visit, well in advance, is which facility near you can do those things.
If you are sent onward from the first facility, that is not a wasted trip. It usually means somebody has already started treatment and has phoned ahead. Ask for a referral note and keep it with the card.
What changes when it happens at night
Almost everything. Riders sleep with their phones off, the price doubles, and a road that is passable in daylight is a different proposition in the dark on a wet murram surface.
This is why the transport plan is made in the seventh month and not on the night. Two riders, both numbers saved in two different phones, the price agreed out loud beforehand, and the money kept separate from household money.
If nobody answers, go to the LC1 chairperson or the nearest household with a vehicle and say it is a woman in labour or bleeding. In most villages that sentence gets a different response from a general request for a lift. Send somebody on foot rather than making one more call.
What if it turns out to be nothing?
Then you have spent a fare and a morning, and you go home. That is the correct outcome of the correct decision, and nobody at the facility will treat you as a nuisance for it.
The cost of the other mistake is not comparable. A fare can be earned back and a morning can be made up. A night spent at home waiting to be sure cannot be given back to you, and the conditions on this list are the ones that get harder to treat with every hour they are left.
How to make this list useful before you need it
Read it once with the person who would be at home with you, and once with whoever would arrange the ride. The person who needs to recognise a danger sign is often not the mother, who may be too unwell to argue her case.
Say out loud, now, who calls the rider, who has the money, who stays with the other children and which facility you are heading to. A plan that lives in one person's head is not a plan.
This guide describes what generally happens, not what will happen at your facility or your school. Costs, timetables and rules differ between districts and they change. Check anything that matters with your health worker, the head teacher, or your district office. If something here is wrong or out of date, tell us and we will correct it.
Questions people ask
- The bleeding has stopped. Do we still go?
- Yes. Bleeding that stops on its own still needs to be assessed, because the cause has not gone anywhere. Go the same day and say how much there was and how long it lasted.
- Her waters broke but there are no pains. Is that an emergency?
- Go to the facility the same day. Once the waters have gone the baby is less protected from infection, and the health worker will want to know exactly when it happened and what the fluid looked like.
- It is two in the morning and no rider is answering. What now?
- Send somebody on foot to the rider's home rather than calling again, and at the same time send somebody to the LC1 chairperson or to any household with a vehicle. Say the words woman in labour or bleeding. If a village health team member is nearer than the facility, get them involved while transport is being found.
- How much movement is normal in the last months?
- What matters is your own baby's pattern rather than a number. You will know the times of day your baby is usually active. A clear drop from that pattern, or a day with almost nothing, is a reason to be seen that day.
- The health centre III sent us on to the hospital. Did we go to the wrong place?
- No. Facilities are set up in levels, and the smaller one refers when what is needed is beyond what it stocks or staffs. Being seen quickly and referred is faster than travelling past help to a hospital that may also have a queue.