MATERNAL HEALTH COUNSELING CARDS: PREGNANCY CARE
For Community Health Workers
Source Credit: Images taken from and counseling points adapted from CARE, CRS, World Vision, and NIPI ASHA maternal health flip charts.

PREGNANCY
Sheet A1
Regular Antenatal Care
Sheet A2
Key Components of ANC
Sheet A3
TT Vaccination
Sheet A4
Micronutrients
Sheet A5
Extra Food during Pregnancy
Sheet A6
Nutrition during Pregnancy
Sheet A7
Daytime Rest
Sheet A8
Manual Labor
Sheet A9
Prevention of Malaria
Sheet A10
Planning for Delivery
Sheet A11
Danger Signs (Referral to CK Doctor)
Sheet A12
Danger Signs (Referral to Facility)
Sheet A13
Safe and Clean Delivery
Sheet A14
Labor and Delivery

Counseling Cards for Pregnancy Care: A1: Antenatal Visits

A1 REGULAR ANTENATAL CARE IS ESSENTIAL
A pregnant woman can reduce many of the risks related to pregnancy and delivery if she regularly attends the antenatal clinic and receives proper care.
Ask, what do they see in the picture?

Women waiting at a hospital/clinic for an antenatal care visit.
____________________________________________________________________________________________
DISCUSS: 1) When should the pregnant woman initiate visits to the antenatal clinic?
2.) How many antenatal care visits are recommended?
MESSAGES:

During the first three (3) months, or as soon as you learn that you are pregnant, go immediately to a health facility your first antenatal care visit. You should also register at the health facility at the time of your first antenatal care visit.

A pregnant woman should have a minimum of four (4) visits for proper monitoring of your pregnancy.
She should have one visit each trimester, plus a fourth visit 15 days before EDD.
ADDITIONAL INFORMATION: If you come to the Calcutta Kids doctor for your first antenatal care visit, please remember to also go to a health facility (where you will deliver) to register.

Counseling Cards for Pregnancy Care: A2: Antenatal Visits

A2 KEY COMPONENTS OF ANTENATAL CARE
Ask, what do they see in the pictures?

Health worker giving a pregnancy health card to the woman

A woman taking a tablet

A woman getting an injection

A woman being weighed

A woman being examined

A woman is checked for blood pressure
____________________________________________________________________________________________
DISCUSS: 1) What are all the things checked and advised during antenatal care visits?
MESSAGES:

The woman is commonly checked for weight gain, uterus size, blood pressure, urine, and hemoglobin.

She will be given a routine blood test to check for anemia, high blood sugar (gestational diabetes), and venereal diseases.

She will be given vitamins and deworming medication.

She is also checked for any danger signs or complications

She will get vaccinated against tetanus: See next card

She will be recommended to get one ultrasound during her pregnancy.
ADDITIONAL INFORMATION: Pregnant woman are encouraged to attend all ANC checkups either through CK or at the facility where they have registered.

Counseling Cards for Pregnancy Care: A3: Tetanus Toxoid Vaccination

A3 TETANUS TOXOID (TT) VACCINATION
Ask, what do they see in the picture?

A woman being injected
____________________________________________________________________________________________
DISCUSS: 1.) When should TT vaccination be initiated?
2.) How many doses are to be taken?
MESSAGES:

TT vaccination should be initiated at the first ANC check up with the doctor.

Two TT doses are necessary for all pregnant women. Three TT doses are necessary for pregnant women in their first pregnancy.

The second dose should be given 4-6 weeks after the first dose. For first pregnancies, the third dose should be taken 6 months after the first dose is given.
ADDITIONAL INFORMATION: CK will provide TT vaccination for all pregnant women enrolled in their program.
The first dose will be given at the first ANC check up with the CK doctor. Subsequent doses can be given on
Immunization Days or at ANC checkups.

Counseling Cards for Pregnancy Care: A4: Micronutrient Supplements

A4 MICRONUTRIENT SUPPLEMENTS
Ask, what do they see in the picture?

A pregnant woman taking vitamin supplements from a health worker
____________________________________________________________________________________________
DISCUSS: 1) What micronutrients should be taken during pregnancy?
2.) Why should they be taken?
3) How many, how long?
MESSAGES:

Folic acid, iron, calcium, and iodine (in the form of iodized salt).

Folic acid should be taken to prevent spinal bifida- a condition in which the spinal cord has not developed properly which can cause many problems for the baby. Iron should be taken to prevent anemia, which can lead to having a small baby or increase risk of death for the mother. Calcium should be taken for the growing baby to build strong bones and teeth, and grow a healthy heart, nerves, and muscles. Iodized salt should be consumed to prevent miscarriages or the early death of the newborn, and damage to the baby’s brain.

Folic acid should be taken every day during the whole pregnancy. Iron should be started at the second trimester and continue until three months after the delivery. Calcium should start at the third trimester and continue to three months after delivery
ADDITIONAL INFORMATION:
• Take iron tablets with meals to reduce side effects (nausea, vomiting, diarrhea, and constipation).
• Taking iron tablets can result in dark-colored stools; this is no cause for worry.
• When taking iron tablets, consume foods rich in vitamin C such as oranges, lemon, guava, green leaf vegetables, and tomatoes. Avoid drinking tea or coffee immediately after taking the tablets because this reduces the absorption by your body.

Calcium tablets should be taken at a separate time from the iron tablet. If taken at the same time, it will not be absorbed by the body. They must be taken at least 2 hours apart.

Calcium tablets can cause constipation so be sure to eat more fruits and vegetables and drink more water to reduce constipation.

Counseling Cards for Pregnancy Care: A5: Eating More During Pregnancy

A5 EATING MORE DURING PREGNANCY
Ask, what do they see in the pictures?

A pregnant woman eating her meal.

Meals at four different times during the day.
____________________________________________________________________________________________
DISCUSS: 1.) Should a woman change her eating habits during pregnancy?
2.) How many times a day should a pregnant woman eat?
MESSAGES:

A woman requires more food during pregnancy. Food will give energy to you and the baby growing in your womb. It allows adequate physical and mental growth of the baby. It develops immunity to fight against illness. The baby gets its food only from you, so if you are healthy then your baby will also be healthy.

A woman should eat one more serving at each meal, plus at least one nutritious snack each day. If possible, eat two snacks. The snack can be a banana, an egg, a ladoo, a potato or sweet potato, etc

Counseling Cards for Pregnancy Care: A6: Nutrition During Pregnancy

A6 NUTRITION DURING PREGNANCY
Ask, what do they see in the pictures?

A flag with different colors and types of food.
____________________________________________________________________________________________
DISCUSS 1) What kinds of foods should be consumed during pregnancy?
2) Why are these foods good for a woman during pregnancy?
MESSAGES:

A pregnant woman must have all types of food- white (rice/roti, fish, banana, egg, etc.), orange (daal, carrots, pumpkin, papaya, orange, etc), green (all vegetables, especially leafy ones), liquids (milk, juice, water). Use iodized salt only. There are no foods that are harmful during pregnancy. There is no specific hot/cold food that should be avoided during pregnancy.

At each meal, she should eat either an egg, a small fish, or a handful of spinach. These foods will provide vitamins and protect from night blindness. Eating meat will provide strength, and whenever you cook meat at home, make sure you eat the liver piece.

These foods are good for a woman because they have high nutritious value, which will allow the woman to gain weight and be strong and healthy during her pregnancy, which will make her baby healthy.

Counseling Cards for Pregnancy Care: A7: Daytime Rest

A7 DAYTIME REST
Ask, what do they see in the picture?

A woman lying down and resting during the day.
____________________________________________________________________________________________
DISCUSS: 1) Why do you need extra rest during pregnancy?
2) How many extra hours of rest during the day are needed?
MESSAGES:

A woman needs to rest more during pregnancy because her body is under many stresses. The body is working hard to nourish and support the growing baby in her womb. A woman will feel fatigued during her pregnancy if she does not have the extra rest during the day.

A pregnant woman should rest at least 2 hours during the day.

Counseling Cards for Pregnancy Care: A8: Manual Labor
Light work
Heavy work

A8 MANUAL LABOR
Ask, what do they see in the pictures?

A woman sweeping, a woman cooking

A woman milling, a woman fetching water, a woman carrying a heavy load
DISCUSS: 1) Why should a pregnant woman refrain from heavy manual labor?
2) What kind of work can a pregnant woman do?
MESSAGES:

Heavy manual labor such as lifting heavy objects can be strenuous for a woman during pregnancy, particularly in late pregnancy when her balance and center of gravity has changed. Doing work which involves standing for more than 4 hours is also risky for pregnant women because it can lead to blood clots, dizziness, and fatigue for the mother, and decreased blood supply for the fetus.

A pregnant woman should be asked to only do light household work like sweeping and cooking. Her husband and other family members should share her workload.

Counseling Cards for Pregnancy Care: A9: Prevention of Malaria

A9 PREVENTION OF MALARIA
Ask, what do they see in the picture?

A man, woman, and child sleeping under a mosquito net.
____________________________________________________________________________________________
DISCUSS: 1) Why does a pregnant woman need to protect herself from malaria?
2) How does a pregnant woman protect herself from malaria?
MESSAGES:

If a woman contracts malaria during pregnancy, she can face serious complications. She will be at much greater of risk of having a miscarriage or a stillbirth.

She can protect herself from malaria by sleeping under an insecticide-treated bed net.
ADDITIONAL INFORMATION:
 The mosquito net must be treated with insecticide after a period as advised by the manufacturer.
 If the woman is living in an area that is high risk for malaria, then anti-malarial prophylaxis should be recommended.

Counseling Cards for Pregnancy Care: A10: Planning for Delivery

A10 PLANNING FOR DELIVERY
A pregnant woman can reduce many of the risks associated with pregnancy and delivery if she makes specific plans for her delivery such as those noted below.
Ask, what do they see in the pictures?

Cloths, cap, clothes, socks, napkins, a woman

A hospital, transport vehicles, money
____________________________________________________________________________________________
DISCUSS: 1) What plans should you make for the delivery?
2) What must the pregnant woman keep ready for her delivery?
MESSAGES:

Preparing for the delivery allows you to plan for the best available quality of care.

You should:
- Identify the place of your delivery with your health worker. Register at the facility early in your pregnancy.
-Identify a means of transport to the facility for delivery.
- Save enough money for medical expenses.

To prepare for bringing the newborn baby home from the facility, keep aside the following materials:
Five clean cloths, a cap, clothes, socks, small napkins

Support from a friend/relative/neighbor during delivery and afterwards may be very useful.
ADDITIONAL INFORMATION
• For the delivery go to the health facility to benefit from the help of a qualified professional.
• Identify a means of transport for rapid evacuation in case of an emergency

Counseling Cards for Pregnancy Care: A11: Danger Signs- Facility Referral
Fluid Leaking Bleeding
Convulsions

A11 DANGER SIGNS IN PREGNANCY- Facility Referral
It is important for a pregnant woman and the family to recognize the danger signs in pregnancy so she can be taken, when necessary, to a qualified health professional.
Ask, what do they see in the pictures?

A woman leaking, a woman bleeding, a woman shaking
DISCUSS: 1) Why is leakage of fluid a danger sign during pregnancy?
2) Why is bleeding a danger sign during pregnancy?
3.) Why are convulsions a danger sign during pregnancy?
4.) What should the pregnant woman do when she recognizes one of these danger signs?
MESSAGES:
 Leakage of fluid can result in infection in yourself or your baby.
 Loss of blood is a sign of a complication of pregnancy.
 Convulsions are a symptom of pre-eclampsia/eclapmsia, which can cause the death of the mother or the baby.
 When you have a leakage of fluid or blood, or convulsions go to the nearest health facility immediately to receive appropriate care.
ADDITIONAL INFORMATION:

Persistent vomiting is also a serious danger sign. Intractable vomiting can cause dehydration and weight loss which is dangerous for the pregnant woman. She may need intravenous fluids and possibly intravenous nutritional supplements.

Counseling Cards for Pregnancy Care: A12: Danger Signs- CK Doctor Referral
Swelling
High Fever Anemia

A12 DANGER SIGNS IN PREGNANCY- Referral to CK Doctor
Ask, what do they see in the pictures?

A woman having swelling of feet and hands, a women having fever, a woman with pale tongue and eyelids
____________________________________________________________________________________________
DISCUSS: 1) Why are swollen face and hands danger signs?
2) Why is high fever a danger sign?
3.) Why is anemia (excess fatigue, dizziness, paleness) a danger sign?
4) What should a pregnant woman do when she recognizes on these danger signs?
MESSAGES:
 Swollen face and hands are signs of a dangerous condition associated with high blood pressure in the mother that can also harm her baby.
 A high fever during pregnancy is a sign of infection or other complications which need to be monitored.
 If a woman has excess fatigue, dizziness, or is pale (particularly her fingernails, eyelids, lips), she may be anemic. Anemia is a danger sign because it can make you weak during pregnancy and during delivery, and it can cause serious problems for the baby (higher risk of preterm delivery, low birth weight, stillbirth, and newborn death).
 When you have any of the above symptoms, go immediately to the CK doctor to receive care. If it happens at night when the CK doctor is not available, go immediately to a facility.
Additional Information: If the woman has blurred vision, persistent headache, excess or foul smelling discharge, painful or difficult urination, or anything else she feels is unusual, she can also be referred to the CK Doctor.

Counseling Cards for Pregnancy Care: A13: Safe and Clean Delivery

A13 SAFE AND CLEAN DELIVERY
Ask, what do they see in the pictures?

Hospital

Skilled attendant/doctor/nurse

Soap and hand washing

Gloves and clean clothes

Blade and thread
DISCUSS: 1.) Where can you go to have a safe and clean delivery?
2.) Why is a clean delivery necessary?
3.) What are all the clean practices to be followed during delivery?
MESSAGES:

Deliveries at hospitals are conducted by skilled personnel and are safe and clean.

Clean delivery is necessary to prevent infection and tetanus in the baby and prevent infection in the mother.

Clean practices during delivery include:
-clean hands (hand washing with soap and water)
-clean surface and clean surroundings
-clean/new blade and clean thread to cut the cord
-clean set of clothes for mother and baby

Counseling Cards for Pregnancy Care: A14: Labor and Delivery

A14 LABOR AND DELIVERY
Ask, what do they see in the pictures?

Woman in labor

Woman immediately after delivery
____________________________________________________________________________________________
DISCUSS: 1.) When should a woman go to the facility for delivery?
2.) What are the stages is the labor and delivery process?
MESSAGES:



In the last few weeks of pregnancy, the baby moves lower into the womb. This allows the mother to breathe more easily, but she may need to urinate more often. A small plug of mucous may come out several days before labor begins or when labor is starting. She can go to the facility as soon as her EDD is approaching; she is urinating frequently, and feeling discomfort. These are signs of impending labor.
A woman MUST go to the facility as soon as she starts feeling contractions, or if her water breaks (and she is not yet feeling contractions).
There are three stages of labor and delivery. The first stage of labor usually lasts 12 to 18 hours for the first birth and less for subsequent births. More than 18 hours is prolonged labor, which is very dangerous for the mother and baby. The first stage starts from the beginning of strong contractions until the baby’s head moves into the birth canal. The second stage of labor starts from when the baby’s head moves into the birth canal, through the pushing, until the birth of the baby. The third stage of labor starts from the birth of the baby until the placenta (afterbirth) comes out.