Which of the following are probable signs of pregnancy select all that apply?

It is important to share information with women and their families about the early detection and recognition of danger signs and complications as part of birth and emergency planning. You need to discuss with them what the danger signs are and help them to think about and decide where they will go if they experience one or any of these.

What skills will I develop?

• To provide information about danger signs and complications during pregnancy and childbirth

• To support women in planning where to go and how to get there quickly if an emergency arises.

What am I going to learn?

By the end of this session you should be able to:

1. Know the danger signs and complications.

2. Be able to effectively communicate danger signs to women and their families.

3. Be able to effectively communicate how to access emergency care when a danger sign is recognized.

Danger signs and complications

All pregnant women, their partners and families should be aware of the signs of complications and emergencies and know when to seek care from the skilled attendant.

DANGER SIGNS DURING PREGNANCY

If any of the following signs occur, the woman should be taken immediately to the hospital or health centre.

• severe headaches with blurred vision

• fever and too weak to get out of bed

• fast or difficult breathing.

If she has any of these signs she should go to the health centre as soon as possible:

• Swelling of fingers, face and legs

Communicating danger signs

Most women have uneventful pregnancies and childbirth but sudden and unpredictable complications may happen at any time to any woman. Where problems do occur it is important to ensure that they are acted upon without delay. You need to find a way to explain in familiar terms (using local words) the danger signs, so that the woman, her family and others in the community can recognize them if they should occur, and to ensure they know where to go in case of an emergency. It would also be helpful here to refer to Session 7 on birth and emergency plans as many elements, including transport, where the nearest health facility is located, and logistical details regarding persons to support the family, should already have been discussed and planned in advance.

Activity 1

2 hours 55 minutes

To begin reflecting on how to inform pregnant women and their families on the danger signs during pregnancy and build on women's past experience where possible.

1. Review the list of danger signs above.

   • What problems do women and families have in identifying each of these? Are there local terms that are used for any of them? Are there any local beliefs, explanations, or ways of handling danger signs that stop people from seeking care in a timely manner?

   • How do women prioritize the main danger signs? Are there certain signs that they feel need more urgent attention than others?

   • Are all women told about danger signs or just those women who are thought to be at high risk?

2. Organize a discussion with a group of women. Ask the group for their past experience with danger signs and complications.

   • Have any of the women experienced danger signs before? If so, how did they recognize them?

   • What did they do? Who did they see?

   • Did they find transport urgently? If not, what could be done next time?

   • What information did they have or were there any gaps?

   • How could health workers have better prepared them?

3. Review the list of danger signs once again.

   • Is the community aware and able to recognize danger signs in pregnancy?

   • Think of ways to help the broader community in identifying danger signs and supporting women to reach appropriate care in a timely fashion.

   • Do you or other health agencies currently discuss danger signs in pregnancy with the broader community? What are the advantages of doing so?

4. What kind of support materials might improve the communication of danger signs?

   • Take into account the educational and cultural background of your audience (e.g. the counselling context) and the resources you have to develop, or to obtain materials.

5. Finally, think about whether there are any other groups or providers in the community that you could work with to help alert the whole community to the danger signs in pregnancy and labour.

Write down some ideas in your notebook that could help you discuss danger signs with women and their families, both on a one-to-one basis and in a group setting.

Our View

WHO recommends that health services work with women, their families and the broader community so that they have appropriate and comprehensible information on the danger signs during pregnancy, as any woman can develop complications, and to ensure that all are aware of where to seek care in the case of an emergency.

Explore with women what they know about danger signs and make sure they know them all. Some danger signs are more difficult than others to recognize such as oedema. When counselling women about danger signs you need to explore with them what is normal, what is unusual and what is a danger sign.

The next important step is to help the woman and her family plan where they will go and how they will reach the skilled attendant if they have any of these signs. Refer to Session 7 as much of this information should already have been discussed and drafted into a birth and emergency plan.

HOW CAN YOU HELP WOMEN AND FAMILIES BETTER UNDERSTAND THE DANGER SIGNS?

Women and their families need to be able to recognize danger signs accurately and act appropriately. For example, bleeding requires immediate transport to a health facility because a woman, particularly with anaemia, can die in a matter of hours.

Knowing about the danger signs in advance will help communities and families implement their birth and emergency plans.

If you have a highly literate population you might consider communicating all the danger signs in a leaflet or fact sheet or some other method that can be given out at routine antenatal care. If your population is less literate, you will have to rely on verbal or pictorial methods. It is difficult to remember all the danger signs, particularly if a person has little formal education. You need to work with the community and with other health providers to increase awareness of women and other community members of the danger signs, and of the importance of reaching an appropriate care provider urgently if any should appear. Once again it is important to ensure emergency transport schemes are in place (Session 7).

All women and their families need to be given information on danger signs

Communicating danger signs without fear

Research has shown that using fear-based messages about danger signs is not effective unless used correctly.

It will be hard to communicate danger signs without creating fear. When discussing danger signs with women and their families, provide a realistic description that would help them to identify the signs in an emergency. Avoid frightening the woman with the worst-case scenario of what might happen. While complications such as bleeding, obstructed labour or infection are relatively rare, the focus should be on recognition of the signs and awareness of what to do if they occur. While as a health worker you are used to seeing complications, remember for the woman it can be very frightening. Reassure her that you will do everything you can to help her, try to alleviate her fears, and support her, but remember to answer her questions and concerns truthfully. It will not be helpful to make false promises or reassurances about pregnancy outcomes.

REMINDER

Pregnancy is a normal and natural process. Most women do not experience emergencies during pregnancies, but any woman could. Women need to know when to seek care from an appropriate provider. A good counsellor will get the balance right between informing women and their families of the possible danger signs and what to do, and supporting women and their families to enjoy their pregnancy as a happy experience.

What did I learn?

You have considered how to communicate danger signs to a woman and her family, as well as the larger community. This has helped you to decide what format can be used to convey issues relating to danger signs. Furthermore, it is important to link discussions of danger signs with a concrete plan (such as the birth and emergency plan in Session 7) in order to ensure that women and their families know where to go during an obstetric emergency, and how to get there urgently.

Do you feel confident about communicating danger signs to women and their families? What else could you do to improve the way you communicate danger signs? What kinds of support materials can you develop? Who else can you work with in the community to raise awareness of emergency signs and the importance of seeking appropriate care when they occur?

The next time you counsel a woman about danger signs, write up what happened and what you did in your notebook. You could then share this with a colleague and ask for feedback on what could have been improved or done differently, as well as what you did well.

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