Core SMS + audio messages (updated Dec 2014)
Pregnancy
Month
Week
2
5
SMS Message
Audio
Welcome. You have just missed
your period, and you're already
5 weeks pregnant. Plan to go to
the clinic soon.
Welcome! You're pregnant. You might be feeling tired
and nauseous. Try having some ginger, mint or lemon
tea, and rest if you can.
5
Share the secret of your
pregnancy with your health
worker. She will give you iron
and folic acid tablets to help
your baby grow well.
5
Are you feeling sick? Most
women do in early pregnancy.
Try having some ginger, mint or
lemon tea, and rest if you can.
You might want to keep your pregnancy a secret. But
the best thing you can do is talk to a health worker.
She will be your friend on your journey to
motherhood; she will keep your secret and answer
your questions. Some women fear that by talking
about their pregnancy, the baby will have problems.
This is not so. By telling your health worker as soon as
you've missed a period, your baby is less likely to have
problems.
Regular clinic visits in pregnancy help detect problems
before they happen. Find out where your nearest
clinic is. Even though you are perfectly healthy, you
should have at least four clinic visits during pregnancy
to make sure you and your baby are well.
You can get iron and folic-acid tablets there. Take
these every day for you and your baby's health. You
can get them for free at the clinic.
Partner Notes
Please adapt the term 'health worker' to
suit local conditions.
Find out what benefits and barriers there
are to antenatal care in your community.
Include these in the message where
appropriate. Please remove any
barriers/benefits that you do not think
exist in your locality (e.g. the belief that
telling someone about the pregnancy may
result in harm.)
We have included four antenatal check-ups
throughout the messages, based on
minimum recommendations of WHO. Fit to
meet local expectations.
In 2010, just over half of all pregnant
women made the WHO-recommended
minimum of four prenatal visits. In Africa
and South-East Asia, less than half of all
births had skilled assistance.
Talk to your family about why you need to go to the
clinic regularly during pregnancy. Ask them for help
with transport.
If you want to do one good thing for your baby this
week, tell your health worker your happy secret.
References
http://www.who.int/mediacentre/factsheets/fs290/en
http://www.who.int/making_pregnancy_safer/countries/soa.pdf
DH. 2007. Maternity matters. London: Department of Health www.dh.gov.uk [pdf file, accessed September 2011]
Lynn F, McNeill J, Alderdice F. 2010. Current trends in antenatal screening services: results from a regional survey. Ulster Med J 79(1):12-15
NCCWCH. 2008. Antenatal care: routine care for the healthy pregnant woman. National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press.
www.nice.org.uk [pdf file, accessed September 2011]
Weekly Iron-Folic Acid Supplementation (WIFS) in Women of Reproductive Age: Its Role in Promoting Optimal Maternal and Child Health. WHO. 2011.
Report of the UNICEF/WHO Regional Consultation. 1999. Prevention and Control of Iron Deficiency Anaemia in Women and Children. Geneva, Switzerland
Overview of 12 by 12 Initiative. WHO, UNICEF.
Maternal and Neonatal Health Program. 2001. Birth preparedness and complication readiness: A matrix of shared responsibilities. USAID.
USAID. Counselling cards for maternal and neonatal health for community health workers
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
Khan, Wojdyla et al (2006). 'WHO analysis of the causes of maternal death: a systematic review', Lancet, 367:1066-74.
http://www.who.int/mediacentre/factsheets/fs290/en/
2
6
6
Your baby is the size of a lentil.
He already has tiny hands and
feet and his heart is beating.
Regular clinic visits in pregnancy
help detect problems before
they happen. Find out where
your nearest clinic is for a
healthy pregnancy.
Your baby is now the size of a lentil. He already has
tiny hands and feet and his heart is beating.
Replace 'lentil' with a local food to
illustrate the size of the fetus.
Slight bleeding is very common in early pregnancy.
You may worry that it's a sign of a miscarriage. But
there can be many reasons for bleeding. Some women
have bleeding when they would usually have their
period. Or it may mean that your baby is attaching
himself to your womb. Rest for a while if you can.
One in four pregnant women experiences
some bleeding in the first three months of
pregnancy. A woman has a one in five
chance of miscarrying.
Go to the clinic if the bleeding is heavy, or if it comes
with stomach pain. You need to go to the clinic
immediately if you cannot lift your arm above your
6
Spotting or light bleeding is
worrying but very common in
pregnancy. If you have bleeding
with pain, contact the clinic
immediately.
shoulder or if there is a pain in your shoulder.
If you are worried about your pregnancy, talk to your
health worker. She'll be happy to answer your
questions.
If you want to do one good thing for your baby this
week, take a moment to marvel at the baby your body
is creating.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution
real-time US. Radiology 182(2):501-5.
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2012]
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2012]
USAID. Counselling cards for maternal and neonatal health for community health workers.
2
7
7
7
Your baby's heart and brain are
forming. Take iron and folic acid
pills daily to help her stay safe.
You can get them free at the
clinic.
Eat well, so your baby will grow
well. Try to eat some meat,
eggs, bean or lentils every day
and green vegetables and milk,
yoghurt or soya.
Light bleeding about the time
Your baby's heart and brain are forming. Her hands
and feet are developing inside you.
Replace mention of foods with what is
available and appropriate to your area.
Eating well is very important now. Try to eat a variety
of foods including:
Amend if iron and folic acid tablets are not
free.
Energy-giving foods such as rice, wheat, and oats.
Maternal under-nutrition affects women's
chances of surviving pregnancy and the
incidence of low birthweight babies.
Serious maternal under-nutrition is
common in sub-Saharan Africa, South Asia
and South-East Asia, and is critical in
Bangladesh, Eritrea and India. Maternal
and child under-nutrition is the single
leading cause of health loss worldwide.
Body-building foods such as meat, eggs and lentils.
Protective foods such as vegetables and fruits. These
help reduce the risk of your baby being born with a
problem.
you would have had your period
is very common. If you have
bleeding with pain, contact your
health worker.
Calcium-rich foods such as milk, yoghurt and soya,
which will help your baby to grow strong bones.
(UNICEF, 2008; Blössner and de Onis,
2005.)
Iron-rich foods such as meat, leafy green vegetables,
lentils, beans, spinach and eggs. Getting enough iron
will help you be less tired and your baby will thrive.
Have some fresh fruit or juice with your meal to help
your body absorb the iron.
You also need iodine, which is in iodised salt. It helps
your baby's brain to develop.
The clinic will give you iron and folic-acid pills for free.
If you want to do one good thing for your baby this
week, talk to your family about the foods you need to
eat.
References
Seumo, E.F. and Abdallah F. Nutritional Counseling for Pregnant Women in Tanzania. USAID, ACCESS.
Blössner and de Onis (2005). Malnutrition - Quantifying the health impact at national and local levels, Environmental Burden of Disease Series, No. 12. WHO: Geneva.
Black R.E. et al. Maternal and child under-nutrition: global and regional exposures and health consequences. Lancet 2008; 371: 243-60 doi: 10.1016/S0140-6736(07)61690-0 pmid:18207566
FDA. Food Safety for Moms-to-Be- Educator's Resource Guide.
www.cfsan.fda.gov/pregnancy.html
Fisher, J., Tran, T., Biggs, B., Tran, T., Dwyer, T., Casey, G., et al. (2011). Iodine Status in Late Pregnancy and Psychosocial determinants of iodized salt use in rural Viet Nam. Bulletin of World
Health Organization, 813-820.
Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 1987; 65: 663–737
Kramer MS, Victora C. Low birth weight and perinatal mortality. In: Semba RD, Bloem MW, eds. Nutrition and health in developing countries. Humana Press, 2001
Langiano, E. 2011. Food safety at home: knowledge and practises of consumers. Journal of Public Health: 1-11.
UNICEF. (2008, October 1). Nutrition: Micronutrients - Iodine, Iron and Vitamin A. Retrieved November 14, 2011, from UNICEF: http://www.unicef.org/nutrition/index_iodine.html
USAID. Counselling cards for maternal and neonatal health for community health workers
Victora CG et.al. Worldwide timing of growth faltering: Revisiting implications for interventions.
Pediatrics 2010; 125:e473-e480.
WHO/UNICEF. (2007). Reaching Optimal Iodine Nutrition in Pregnant and Lactating Women and Young Children. Geneva: World Health Organization.
World Health Organization. (2011). Nutrition: Micronutrient Deficiencies. Retrieved November 14, 2011, from WHO: http://www.who.int/nutrition/topics/idd/en/
WHO. 2011. Background Paper 2 - A Review of health interventions with an effect on nutrition
pdf, 1.51Mb
UNICEF (2008). Progress for Children - A Report Card on Maternal Mortality.
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
2
8
8
8
Your baby is the size of a grape
and his bones are developing.
You may feel sick or vomit. Eat
when you can and drink plenty
of clean water.
Some medicines can harm your
baby. If your friends and family
suggest a medicine, check with
your health worker first before
taking it.
Plan how to get to the clinic for
your first visit. Go as soon as
you can, even if you feel well.
Ask your family for help to get
there.
Your baby is the size of a grape. His fingers and toes
are growing, and his bones are developing.
You may find that you're constantly feeling sick, and
may even vomit. This is very common. An empty
stomach can make the sickness worse. Try to have
small but frequent meals. Try to eat nourishing food.
It's important you drink lots of water.
Friends and family might offer remedies or tonics. A
good rule is to check with your health worker before
taking any medicines. She will be able to tell you
which medicine is safe for you and your growing baby.
It will soon be time for your first clinic visit. You may
need help from your family to get to the clinic, so talk
to them now. At the clinic, the health worker will
weigh you, check your blood pressure and test your
urine.
Choose a local food to illustrate the size of
the fetus.
In some Asian and African countries, 80%
of the population depends on traditional
medicine for primary health care. While
traditional medicines can play a part in
treating chronic and infectious conditions,
counterfeit, poor quality, or adulterated
herbal products in international markets
are serious patient safety threats.(WHO,
2008)
The use of traditional medicines has been
found to increase the risk of birth defects.
(Opaneye, 1998;Chuang, Chao-Hua et al,
2006; Thein, Koh et al., 1995.)
If you want to do one good thing for your baby this
week, make plans to get to the clinic for your first visit
in two weeks' time.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011]
Chuang, Chao-Hua et al, 2006. "Herbal Medicines Used During the First Trimester and Major Congenital Malformations: An Analysis of Data from a Pregnancy Cohort Study", Drug Safety, 29
(6): 537-548 (12).
A A Opaneye, 1998. "Traditional medicine in Nigeria and modern obstetric practice: need for cooperation", Central African Journal of Medicine, 44(10):258-61.
Thein, Koh et al., 1995. "Risk factors for birth defects in Singapore: a case control study". Annals, Academy of Medicine, Singapore. 24(3):421-7.
USAID. Counselling cards for maternal and neonatal health for community health workers
http://www.who.int/mediacentre/factsheets/fs134/en/
3
9
9
9
You are 2 months pregnant.
Even though the baby inside
you is tiny you may be very
tired. That's normal. Growing a
baby is hard work!
Inside you, your baby is now about the size of a grape.
Even though he is small he relies on you to help him
grow. Take iron and folic acid tablets every day. You
can get them free at the clinic.
Bad or stale food can make you ill. Try to cook fresh
Protect yourself from infections. meals every day. Store food in a cool, dry place.
Wash your hands with soap
Cook all meat and chicken well, until it has no pink
before you prepare meals, after
bits.
using the toilet and after
handling animals.
Cook eggs well, until they are firm. Boil milk to kill any
Bad or stale food can make you
ill. Make sure that all your food
is fresh. Cook fresh meals every
day. Store food in a cool, dry
place.
germs.
Do not eat food from stalls. It can have germs.
Instead, take a snack and clean water with you when
you go out.
Wash your hands with soap before you prepare meals,
after using the toilet and after handling animals.
Wash all dishes and cooking areas with soapy water to
get rid of any food remains.
If you have sores or cuts on your hands, keep them
clean and covered with a clean cloth.
Keep animals away from the kitchen. Animals can
spread germs and make you sick.
The woman is now two months pregnant
but moves into her third month of
pregnancy.
Replace 'grape' with a local food to
illustrate the size of the fetus.
In 2008, 2.6 billion people had no access to
a hygienic toilet or latrine and 1.1 billion
were defecating in the open. Inadequate
sewerage spreads infections such as
schistosomiasis, trachoma, viral hepatitis
and cholera. A review of more than 30
studies found that hand washing with soap
cuts the incidence of diarrhoea by nearly
half.(Fewtrell, Kaufmann et al., 2005;
WHO, 2011)
If you want to do one good thing for your baby this
week, keep your kitchen clean.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
NICEF. 2012. Diarrhoea. http://www.unicef.org/health/index_43834.html. [Accessed on 3 June 2014]
WHO. 2011. Zinc supplementation in the management of diarrhoea. http://www.who.int/elena/titles/bbc/zinc_diarrhoea/en/. [Accessed on 3 June 2014]
WHO. 2013. Diarrhoeal Disease. http://www.who.int/mediacentre/factsheets/fs330/en/ [Accessed on 3 June 2014]
3
10
10
10
Your baby is now the size of a
date. Arrange to go the clinic for
a check-up and for your iron
and folic acid pills. Take these
each day.
Giving birth puts you and your
baby at risk of tetanus. The
Tetanus vaccine can protect you
both. Ask your health worker
about it.
Iodine helps your baby's brain
develop. Salt often has iodine
added to it. Ask at the clinic
where you can buy iodised salt.
Your baby is now the size of a small date. He has
fingernails and hair, and is swallowing and kicking.
Replace 'date' with a local food to illustrate
the size of the fetus.
Have you made your first visit to the clinic? Go this
week, if you haven’t, even if you are feeling well. At
the clinic your health worker will give you iron and
folic acid tablets to take every day. These will help
keep you and your baby well.
Fit this tetanus message to the tetanus
schedule observed in your community.
You may also be given a dose of the Tetanus vaccine.
Tetanus is a serious disease which can kill. Giving birth
puts you and your baby at risk of getting tetanus. It
can be prevented by the Tetanus vaccine. Your health
worker may recommend a second vaccination at your
next visit for more complete protection. Vaccines
don't work as a cure but they do protect you from
disease. So make sure you get your tetanus vaccine.
Take some food and water with you to the clinic so
you can eat something while you wait. You may want
to ask a friend to come with you for company.
If you want to do one good thing for your baby this
Mention iodine supplements if iodised salt
is not available. Adapt to suit local strategy
for iodine deficiency prevention.
week, go to the clinic for your first check-up.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
WHO. 2006. Weekly Epidemiological Record. No. 20, 2006, 81, 197–208.
http://www.who.int/wer
Kayange et al. 2010. BMC Pediatrics 10:39
http://www.biomedcentral.com/1471-2431/10/39
Downey LC, et al. 2010. Risk factors and prevention of late-onset sepsis in premature infants, Early Hum Dev,,
doi:10.1016/j.earlhumdev.2010.01.012
WHO, International Confederation of Midwives. 2008. Education material for teachers of midwifery, Midwifery education modules - second edition.
Cipla. Infection Update. Neonatal Sepsis Protocol for Indian Neonatal Intensive Care Unit - The Algorithmic Way.
NNF Teaching Aids:Newborn Care Neonatal sepsis
Seale A.C., Mwaniki, M. et al. 2011. Maternal and early onset neonatal bacterial sepsis: burden and strategies for prevention in sub-Saharan Africa. Lancet Infect Dis 9: 428–38
3
11
11
11
You may be feeling less sick
about now. Your baby is the size
of your thumb and is protected
by the water he floats in, inside
your womb.
Your baby is now about the size of your thumb. Even
though she is very small, she will be kicking and
stretching! But you won't feel it yet.
At the clinic you’ll need a
tetanus shot and a blood test to
check your iron levels. Tests for
STIs like syphilis and HIV can
also be done.
At the clinic your health worker will take some blood
for testing. These tests will help to keep both you and
your baby safe.
Feeling dizzy? Sit down, eat and
You will need at least four check-ups during your
pregnancy. Regular check-ups at the clinic will
reassure you that your baby is growing well.
One test will be to measure the amount of iron in your
blood. Your body needs plenty of iron. It keeps you
strong, and helps your baby grow inside you. If you
have low iron levels, you may feel weak and
breathless. You will need to take an iron pill every day.
Change to fit local antenatal care practices.
In South Africa, no antenatal care was the
topmost reason for stillbirths. In 2010 just
over half of all pregnant women made the
WHO-recommended minimum of four
antenatal visits. In Africa and South-East
Asia, less than half of all births had skilled
assistance. (WHO).
20% of maternal deaths are due to
maternal iron-deficiency anaemia and
stunting in women. In India - 88% of
pregnant and 74% of non-pregnant women
are affected. In Africa, 50% of pregnant
and 40% of non-pregnant women are
anaemic. (The Lancet, 2006)
Antenatal care should be a platform for
programmes that tackle malnutrition,
drink something, until you feel
better. Get up slowly. Try to eat
little and often.
You can get them from the clinic.
The clinic may offer for sexually transmitted infections
like syphilis and HIV. Be sure to accept the test and to
return to learn the results. Knowing about any
infections you may have will make sure you get you
the right treatment early.
HIV/AIDS, sexually transmitted infections,
malaria and tuberculosis and promote
family planning. (WHO, Making Pregnancy
Safer, 2005)
If you want to do one good thing for your baby this
week, go to the clinic for your first check-up.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
USAID. Counselling cards for maternal and neonatal health for community health workers
WHO http://www.who.int/mediacentre/factsheets/fs290/en/
http://www.who.int/making_pregnancy_safer/countries/soa.pdf
WHO. 2014. Sexual reproductive health. http://www.who.int/reproductivehealth/topics/rtis/syphilis/pregnancy/en/ [Accessed on 23 May 2014]
WHO (2013). World Health Statistics 2013 http://www.who.int/gho/publications/world_health_statistics/2013/en/
Solarin & Black (2013). “They told me to come back”: Women’s Antenatal Care Booking Experience in Inner City Johannesburg. Matern Child Health J 17
Simkhada et al (2008) factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. Journal of Advanced Nursing 61 (3)
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2007.04532.x/pdf
3
12
12
Drinking alcohol is bad for you
and your baby. It could make
your baby weak and ill. Don't
drink in pregnancy.
Your baby is about the size of a lime! He can close his
fingers and curl his toes now. Drinking alcohol is bad
for you and your baby. It could make your baby weak
and ill. Don't drink alcohol in pregnancy.
If you have a fever, or start
shaking and feeling sick, go to
the clinic. A fever can affect
your baby as well as you, and
Tuberculosis can harm you and your baby. If you are
living with HIV, you are more likely to get TB. It
spreads through the air when people cough and
sneeze. If you have a cough, fever, feel exhausted and
Choose a local food to illustrate the size of
the fetus.
An estimated 1.7 million people died from
TB in 2011. The highest number of deaths
was in the Africa Region (WHO, 2011).
Inappropriate response to fetal
movements is one of top reasons for
stillbirth in South Africa (WHO, Making
12
needs treating.
breathless, or have lost weight, go to the clinic.
Wash your hands with soap and
water to help prevent
infections. Wash them after
handling animals, using the
latrine and before cooking.
People with TB should cover their mouths and noses
while coughing or sneezing, and wash their hands
afterwards. After taking medication for two days, they
will no longer give the disease to other people.
Pregnancy Safer).
If you think you may have been infected with TB, get
yourself tested. TB is curable if it is found early,
treated quickly, and if all the medicine is taken. It
takes at least six months to kill TB. You may feel better
sooner, but you need to finish all the medication.
If you want to do one good thing for your baby this
week, talk to your family about getting tested for TB.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
WHO (2013) Global Tuberculosis Report. http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf?ua=1
WHO (2014) Guidance for national tuberculosis programmes on the management of tuberculosis in children, Second edition;
http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf?ua=1&ua=1
WHO (2013) Guideline: Nutritional care and support from patients with Tuberculosis; http://apps.who.int/iris/bitstream/10665/94836/1/9789241506410_eng.pdf?ua=1
WHO (2012) Recommendations for investigating contacts of persons with infectious tuberculosis in low- and middle-income countries
http://apps.who.int/iris/bitstream/10665/77741/1/9789241504492_eng.pdf?ua=1
WHO (2013) Systematic screening for active tuberculosis: principles and recommendations. http://apps.who.int/iris/bitstream/10665/84971/1/9789241548601_eng.pdf?ua=1
WHO (2009) WHO policy on TB infection control in health-care facilities, congregate settings and households. http://whqlibdoc.who.int/publications/2009/9789241598323_eng.pdf?ua=1
Liefooghe R et al. (1997) From their own perspective. A Kenyan community's perception of tuberculosis Tropical Medicine & International Health, 2(8): 809–821,
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.1997.d01-380.x/abstractThe Nelson Mandela Aventis Project for Combating TB –an innovative public-private partnership in the
fight against TB.
WHO. 2011. ART in prevention of HIV and TB.
3
13
Your baby is as big as half a
banana! She is growing sucking
Your baby will be developing the sucking muscles in
her mouth now. This is to help her get ready to suckle
Please replace mentions of food items with
foods that are easily available in your
muscles in her mouth. She will
be ready to breastfeed as soon
as she is born.
13
You need to get some protein
from meat or fish, or lentils,
peas or beans. Ask your family
to buy these from the market.
13
Smoking harms you and your
baby. If you smoke, your baby
could be born weak and catch
infections easily. Stop smoking
and avoid smoky places.
your milk when she is born.
target area.
Here are three simple ways that will keep both you
and your baby healthy.
Maternal and child under nutrition is the
single leading cause of health loss
worldwide. (Blössner and de Onis, 2005.)
One: eat well. Try to make each meal contain some
fruits and vegetables. You should also get some
protein from meat or fish, or lentils, peas or beans.
Ask your family if you can buy these things from the
market. Explain that they will help you grow your
baby. Also drink lots of clean water and avoid alcohol.
Listing tips by numbers helps listeners
remember what has been said.
Two: go to the clinic. Regular check-ups with a health
worker will help spot any problems early. You will
then be able to get treatment and keep your baby
safe. If you haven't made your first clinic visit yet, go
this week.
Three: take iron and folic acid pills if your health
worker gives them to you. These pills will help you to
get enough iron and folic acid so that your baby can
grow well. The iron pills might make your stools dark,
but this is normal.
If you want to do one good thing for your baby this
week, discuss with your health worker how to have a
healthy pregnancy.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
Blössner and de Onis,2005. "Malnutrition - Quantifying the health impact at national and local levels", Environmental Burden of Disease Series, No. 12.
http://www.who.int/mediacentre/factsheets/fs290/en/
http://www.who.int/making_pregnancy_safer/countries/soa.pdf
Seumo, E.F. and Abdallah F. Nutritional Counseling for Pregnant Women in Tanzania. USAID, ACCESS.
Black R.E. et al. Maternal and child under-nutrition: global and regional exposures and health consequences.Lancet 2008; 371: 243-60 doi: 10.1016/S0140-6736(07)61690-0 pmid:18207566
Victora CG et.al. Worldwide timing of growth faltering: Revisiting implications for interventions. Pediatrics 2010; 125:e473-e480.
Kramer MS.Determinants of low birth weight: methodological assessment and meta-analysis.Bull World Health Organ 1987; 65: 663–737
Kramer MS, Victora C. Low birth weight and perinatal mortality. In: Semba RD, Bloem MW, eds. Nutrition and health in developing countries. Humana Press, 2001
WHO. 2011. Background Paper 2 - A Review of health interventions with an effect on nutritionpdf, 1.51Mb
http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf
Stoltzfus R.J. and Dreyfuss M.L. Guidelines for the Use of Iron Supplements to Prevent and Treat
Iron Deficiency Anemia. International Nutritional Anemia Consultative Group (INACG)
Essential Nutrition Actions - Improving Maternal-Newborn-Infant and Young Child Health and Nutrition. WHO. 2011
Weekly Iron-Folic Acid Supplementation (WIFS) in Women of Reproductive Age: Its Role in Promoting Optimal Maternal and Child Health. WHO. 2011.
Report of the UNICEF/WHO Regional Consultation. 1999. Prevention and Control of Iron Deficiency Anaemia in Women and Children. Geneva, Switzerland
UNICEF (2008). Progress for Children - A Report Card on Maternal Mortality.
4
14
Your baby is growing hair, and
he can also grasp, frown and
even suck his thumb! Try to eat
an extra mouthful of food at
each meal and extra snacks.
14
Many women begin to feel less
sick now and get hungry
instead. Eat fruit, vegetables,
and meat or lentils, peas, and
beans.
14
It’s very common for pregnant
women to crave non-foods such
as soil. Some non-foods can
harm your baby. Talk to a health
worker about it.
Inside you, your baby is about the size of a lemon, and
is covered with thin, fuzzy hair. He can suck his thumb,
which is good practice for breastfeeding once he is
born.
Many women begin to feel less sick now and get
hungry instead. Eat fruit, vegetables, and meat or
lentils, peas, and beans. Ask your family if you can buy
more of these foods. You need an extra mouthful of
food with each meal. You may also need a small snack
between meals.
Many pregnant women crave non-foods such as soil.
It’s a common symptom of pregnancy. Eating soil or
other non-foods can be harmful to you and your baby.
Soil can cause constipation or give you worms. Try not
to eat these non-foods. Talk to your health worker.
She may be able to help. There is no need to feel
Choose a local food to illustrate the size of
the fetus.
Cravings and aversions during pregnancy
are common (Walker et al. 1985; Caplan,
2001).
Pica may be more common than we
assume (ranging from (6%-38%). Many may
not report pica because they are ashamed
to report.
These complications may cause not only
discomfort during pregnancy but also
interfere with the dietary intake of the
pregnant woman and sometimes causing
serious problems (Caplan, 2001).
Maternal under nutrition affects women's
chances of surviving pregnancy and the
incidence of low birth weight babies.
Serious maternal under nutrition is
common in sub-Saharan Africa, South Asia
ashamed or embarrassed.
Craving non-foods may mean you need iron. Take the
iron and folic acid pills your health worker gave you.
and South-East Asia, and is critical in
Bangladesh, Eritrea and India. Maternal
and child under nutrition is the single
leading cause of health loss worldwide.
(Blössner and de Onis, 2005; WHO,2011)
If you want to do one good thing for your baby this
week, explain to your family that you need more food
to grow a healthy baby.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
Blössner and de Onis,2005. "Malnutrition - Quantifying the health impact at national and local levels", Environmental Burden of Disease Series, No. 12. WHO: Geneva.
Seumo, E.F. and Abdallah F. Nutritional Counseling for Pregnant Women in Tanzania. USAID, ACCESS.
Black R.E. et al. Maternal and child under-nutrition: global and regional exposures and health consequences.Lancet 2008; 371: 243-60 doi: 10.1016/S0140-6736(07)61690-0 pmid:18207566
WHO. 2011. Background Paper 2 - A Review of health interventions with an effect on nutrition pdf, 1.51Mb
"Progress for Children - A Report Card on Maternal Mortality". UNICEF, No. 7, September 2008
USAID. Counselling cards for maternal and neonatal health for community health workers
Walker ARP et al. (1985) Nausea and vomiting, cravings and aversions during pregnancy in South African women. British Journal of Obstetrics and Gynaecology 92,484-489.
Walker ARP et al. (1985) Nausea and vomiting, cravings and aversions during pregnancy in South African women. British Journal of Obstetrics and Gynaecology 92,484-489.
Caplan, C.D. (2001) Evolutionary causes and importance of pregnancy sickness. (http://www.geogle.com/derekeqplan.htm) site visited on 26/08/2006
Coronios-vargas, M. et al. (1991) Cultural influences on food cravings and aversions during pregnancy. Ecology of Food and Nutrition 27, 43-49.
Darkish, O.A., Amine, E.K. & Abdullah, S.M. (1982) Food habits during pregnancy and lactation in Iraq. Food and Nutrition Bulletin 4, 14-16.
Corbett RW et al. (2003) Pica in pregnancy: does it affect pregnancy outcomes? MCN Am J Matern Child Nurs. 2003 May-Jun;28(3):183-9; quiz 190-1.
http://www.ncbi.nlm.nih.gov/pubmed/12771697
Nyaruhucha CNM (2009), “Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania”, Tanzania Journal of Health Research, 11(1): 29-34
4
15
Inside you, your baby will just fit
in the palm of your hand. He
even has tiny fingernails and
eye lashes.
Inside you, your baby will fit in the palm of your hand.
He even has tiny fingernails and eye lashes. If you
haven't been for your first check up at the clinic, make
sure you go this week. Regular check-ups with a
health worker will help spot any problems early. You
will then be able to get treatment and keep your baby
safe.
15
Drinking alcohol can harm your
baby. It can affect her growth.
It's best not to have any alcohol.
Smoking or breathing in cigarette smoke whilst
Drink plenty of clean water.
WHO recommends smoking interventions
such as counselling and behaviour change
therapy. Check what services are available
in your area and add them to the
messages. Research shows that more and
more women in developing countries are
becoming smokers. Important to help
support mothers in quitting.
Smoking and drinking alcohol by pregnant
15
Open windows if your house is
very smoky. Try to give up
smoking while you are
pregnant, as it can harm your
baby.
carrying your baby is harmful. It can cause your baby
to be born weak and unhealthy. You can help prevent
this.
If you smoke, start cutting down or quit. It will be
hard, but it is definitely worth it for your baby. Start
by cutting down small amounts every day. If you are
finding it really hard to cut down, talk to your health
worker.
women is associated with low birth weight
and premature birth, as well as higher
rates of illness breathing problems, and
sudden infant death syndrome (SIDS). Can
also result in birth defects.(WHO, 2011)
Household smoke can also be harmful. If your house is
smoky, let in as much fresh air as possible. Open lots
of windows and doors. This will help. Explain to other
people what effect their smoking will have on your
baby.
Alcohol can also harm your baby. It can affect her
growth. It's best not to have any alcohol. This will
keep your baby safe and healthy.
If you want to do one good thing for your baby this
week, cut down on smoking and drinking alcohol.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
Seumo, E.F. and Abdallah F. Nutritional Counseling for Pregnant Women in Tanzania. USAID, ACCESS.
Black R.E. et al. Maternal and child under-nutrition: global and regional exposures and health consequences. Lancet 2008; 371: 243-60 doi: 10.1016/S0140-6736(07)61690-0 pmid:18207566
Victora CG et.al. Worldwide timing of growth faltering: Revisiting implications for interventions. Pediatrics 2010; 125:e473-e480.
Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 1987; 65: 663–737
Kramer MS, Victora C. Low birth weight and perinatal mortality. In: Semba RD, Bloem MW, eds. Nutrition and health in developing countries. Humana Press, 2001
WHO. 2011. Background Paper 2 - A Review of health interventions with an effect on nutrition
pdf, 1.51Mb
http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
4
16
16
16
Your baby is now the size of a
pear. He may have found his
first toy - the umbilical cord!
After the birth, keep the cord
stump clean.
Mosquitoes can cause illnesses
like malaria. Always sleep under
an insecticide-treated net to
prevent mosquitoes from biting
you.
Iron and folic acid tablets will
help you stay well and help your
baby grow well. Ask for them at
the clinic. They are free.
Your baby is now the size of a pear. He may have
found his first toy - the umbilical cord! After the birth,
you need to keep the cord stump clean.
Mosquitoes can cause illnesses like malaria and
dengue fever. They can make you very ill. You may
become anaemic, which makes you short of breath
and weak. It can also cause problems for your baby
inside you.
Protect yourself from mosquitoes by sleeping under
an insecticide-treated bed net. If there’s a hole in the
net, stitch a small piece over it. Keep a spare net, just
in case one gets damaged. If it’s hot and stuffy, open
the windows to let the air in. The net will keep you
protected from mosquitoes.
Mosquitoes live in stagnant water, rotting leaves and
damp areas. Check there are none of these around
your home. Ask your family to get rid of any of the
places where mosquitoes live.
Mosquitoes are attracted to dark colours. Wear lightcoloured clothing, especially if you go out in the
evening. Stop mosquitoes getting to your skin by
wearing long sleeves and full-length clothes. A
mosquito repellent on your skin will help keep
mosquitoes away. Use an indoor spray in the house as
Choose a local food to illustrate the size of
the fetus.
Change to suit local malaria prevention
strategy concerning IPT
Nearly 1 million deaths from Malaria in
2008 globally - with pregnant women at
especial risk. Indirect causes such as
Malaria count for 20% maternal deaths
(MCHIP-USAID; WHO, 2005).
Mention Intermittent Preventive treatment
for Malaria if routinely available in your
area.
20% of maternal deaths are due to
maternal iron-deficiency anaemia and
stunting in women. In India - 88% of
pregnant and 74% of non-pregnant women
are affected. In Africa - 50% of pregnant
and 40% of non-pregnant women are
anaemic. (The Lancet, 2006)
well.
The clinic may give you medicine to take to help
prevent malaria.
If you want to do one good thing for your baby this
week, make sure you use an insecticide-treated net to
sleep under.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
WHO. (2009). Dengue – Guidelines for diagnosis, treatment, prevention and control. http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf?ua=1 [Accessed on 23 May
2014]
WHO. 2014. Climate change and infectious diseases. http://www.who.int/globalchange/publications/climatechangechap6.pdf [Accessed on 23 May 2014]
WHO. 2014. Water sanitation health. http://www.who.int/water_sanitation_health/hygiene/emergencies/envsanfactsheets/en/index2.html [Accessed on 23 May 2014]
UNICEF. 2014. Press release - UNICEF supplies 150,000 mosquito nets in Bangui as rainy season approaches. http://www.unicef.org/media/media_72863.html [Accessed on 23 May 2014]
WHO, CDC, USAID, Republic of Ghana. Malaria in Pregnancy- Training Manual for Health Providers.
WHO. 2010. Guidelines for the Treatment of Malaria.
WHO Global Malaria Programme. World Malaria Report 2010.
WHO. 2005. Strategic Orientation Paper on Prevention and Control of Malaria.
WHO. 2004. Malaria Epidemics: Forecasting, Prevention, Early Detection and Control. From Policy to Practise.
WHO. Global Malaria Programme. Insecticide-Treated Mosquito Nets: a WHO Position Statement.
WHO. 2007. EMRO Technical Publications Series 34. Guidelines on prevention of the reintroduction of malaria.
WHO. 2004. A Strategic Framework for Malaria Prevention and Control During Pregnancy in the African Region.
USAID, ACCESS. 2007. Preventing Malaria in Pregnancy Through Focused Antenatal Care: Working with Faith-Based Organizations in Uganda.
WHO. 2007. Malaria in Pregnancy - Guidelines for measuring key monitoring and evaluation indicators
Gitau,G.M. and John M.E. 2005. Malaria in pregnancy: Clinical, Therapeutic and Prophylactic Considerations. Review. The Obstetrician & Gynaecologist 7 :5–11
4
17
17
Your baby is now the size of a
small mango. If you are
constipated, drink plenty of
clean water and eat fruit and
vegetables.
Keeping clean helps protect you
and your baby from infections.
Your baby is now the size of a small mango. The
umbilical cord which brings food and oxygen to your
baby is getting thicker.
Constipation is common in pregnancy. It affects many
pregnant women. Your growing womb presses on
your belly, and can slow the food going down. It's
Choose a local food to illustrate the size of
the fetus.
Safer water prevents 1.4 child deaths due
to diarrhoea; 500,000 deaths from malaria;
860 child deaths from malnutrition;
Dehydration can lead to complications,
spontaneous abortion or early labour.
Wash your hands with soap
after the toilet and before
meals.
17
You may need extra money
during pregnancy, for travel to
the clinic and for when your
baby arrives. Start saving a little
bit every day.
usually just uncomfortable.
(NCCWCH,2008)
Constipation can sometimes lead to piles. Piles are
small swellings that develop around the anus. They
may itch and bleed when you go to the toilet.
There are several things you can do to prevent
constipation and piles:
Drink plenty of clean water every day.
Eat cereal foods and plenty of fruit and vegetables.
If you need to go to the toilet, go! Not going when you
need to can make piles feel worse.
If nothing seems to help, or if you notice bleeding,
speak to your health worker.
If you want to do one good thing for your baby this
week, drink plenty of clean, safe water every day.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
Jewell DJ, Young G. 2001. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD001142.www.onlinelibrary.wiley.com
[Accessed October 2011]
NCCWCH. 2008. Antenatal care: routine care for the healthy pregnant woman. National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: NICE
www.nice.org.uk [pdf file, accessed October 2011]
PRODIGY. 2008a. Constipation. www.prodigy.clarity.co.uk [Accessed October 2011]
PRODIGY. 2008b. Haemorrhoids. www.prodigy.clarity.co.uk [Accessed October 2011]
Vasquez JC. 2010. Constipation, haemorrhoids and heartburn in pregnancy.BMJ Clinical Evidence. www.clinicalevidence.bmj.com [Accessed October 2011]
5
18
Your baby is twice the size he
was last week. He's moving
Your baby is nearly as big as a capsicum. He can kick
and roll over inside you. He will listen to your
Choose a local food to illustrate the size of
the fetus.
more and you will feel him
soon. He can hear your
heartbeat now.
heartbeat now.
18
Tired with headaches and
dizziness? You may need iron.
Remember to take your daily
iron and folic acid pills. Get
more from the clinic.
If you feel dizzy, sit or lie down. If you're in a stuffy
room, go outside. The fresh air will help. Take some
snacks with you when you go out. Always carry a
bottle of clean water, and wear a sun hat. Try to stay
indoors if it's hot.
18
It is common to have backache
in pregnancy. Lift heavy things
carefully. Divide loads evenly
between both hands. Ask your
partner for help.
Dizziness can be a sign of anaemia. Anaemia is caused
by not having enough iron in your blood. Anaemia can
make you feel weak and tired, too. You can get iron by
eating red meat and green leafy vegetables. Make
sure to take your Iron pills. They will help you feel less
tired. Take them every day. Always keep a good stock
of pills. Get more at the clinic before they run out.
Dizziness is common during pregnancy. You might get
dizzy if you haven't eaten for a while, or if you get hot.
Standing up quickly could make you dizzy, too.
20% of maternal deaths are due to
maternal iron-deficiency anaemia and
stunting in women. In India - 88% of
pregnant and 74% of non-pregnant women
are affected. In Africa - 50% of pregnant
and 40% of non-pregnant women are
anaemic. (The Lancet, 2006).
If you want to do one good thing for your baby this
week, ask at the clinic about iron pills.
References
Hadlock FP, Yogesh PS, Kanon DJ, Lindsey JV. 1992. Fetal crown-rump length: Re-evaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US. Radiology
182(2):501-5
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011]
Bothamley J, Boyle M. 2011. Medical conditions affecting pregnancy and childbirth. Oxford: Radcliffe Publishing, 31-49
CKS. 2008. Anaemia - Iron deficiency. Clinical Knowledge Summaries, Clinical topic. www.cks.library.nhs.uk [Accessed January 2010]
Murray I, Hassall J. 2011. Change and adaptation in pregnancy. In: Fraser DM, Cooper MA. eds. Myles Textbook for Midwives. 15th ed. Edinburgh: Churchill Livingstone, 189-225
NHS Choices. 2008. Fainting. NHS Choices, Health A-Z. www.nhs.uk [Accessed January 2010]
Rodriguez A, Bohlin G, Lindmark G. 2001. Symptoms across pregnancy in relation to psychosocial and biomedical factors. Acta Obstet Gynecol Scand80(3): 213-23
Khan, Wojdyla et al (2006). 'WHO analysis of the causes of maternal death: a systematic review', Lancet, 367:1066-74.
5
19
19
19
Your baby has all her major
organs now - the heart, liver
and kidneys. She's even started
developing taste buds on her
tongue!
Inside your womb, your baby is the size of a small
melon. She keeps busy, stretching her arms and legs.
Her heart and brain are well developed. She has all
her major organs now - the heart, liver and kidneys.
She's even started developing taste buds on her
tongue! Make a plan with your family to put your new
Ask about your blood group at
baby to the breast in the first hour. Your creamy first
the clinic. Check if relatives have milk will protect her from illness.
the same blood group. Ask
them if they will donate blood if During your pregnancy, you will have various tests at
the clinic. Some tests check for infection. Others will
you need it.
check your blood levels. Your health worker will also
Make a plan with your family to check that your body has enough iron. Make sure you
put your new baby to the breast have these tests done. They will help protect your
in the first hour. Your creamy
baby. It will soon be time to go to the clinic for these
first milk will protect him from
tests.
illness.
Sometimes there are complications during birth. Some
women lose a lot of blood and need a blood
transfusion. That’s why it's important to know your
blood group.
Once you know your blood group, talk to your
relatives and friends. Ask them to find out their blood
group at the clinic. If they have the same blood group
as you, ask them if they can donate blood if you need
it. Get their names and contact information. This may
be useful in the future.
If you want to do one good thing for your baby this
Choose a local food to illustrate the size of
the fetus.
In South Africa, postpartum haemorrhage
(PPH; excessive bleeding after birth) is the
third most common cause of death. In
India, 17% of maternal deaths are due to
PPH, making it the leading cause of
maternal deaths. WHO 2010.
week, find out your blood group the next time you go
to the clinic.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Lynn F, McNeill J, Alderdice F. 2010. Current trends in antenatal screening services: results from a regional survey. Ulster Med J 79(1):12-15
NCCWCH. 2008. Antenatal care: routine care for the healthy pregnant woman. National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press.
www.nice.org.uk [pdf file, accessed May 2011]
NHS Direct. 2010. Toxoplasmosis during pregnancy. NHS Choices, Common health questions. www.nhs.uk [Accessed May 2011]
NHS FASP. 2011. Implementation of Down's syndrome screening in England - Feb 2011 NHS Fetal Anomaly Screening Programme.fetalanomaly.screening.nhs.uk [pdf file, accessed May
2011]
NHS Scotland 2010. Your guide to screening tests during pregnancy.library.nhsggc.org.uk [pdf file, accessed May 2011]
RCOG. 2003. Prevention of early onset neonatal group B streptococcal disease. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 36. London: RCOG press.
www.rcog.org.uk [pdf file, accessed May 2011]
Maternal and Neonatal Health Program. 2001. Birth preparedness and complication readiness: A matrix of shared responsibilities. USAID.
WHO http://www.who.int/mediacentre/factsheets/fs290/en/
World Health Organization. 2010. WHO Technical Consultation on Postpartum and Postnatal Care.
World Health Organization. 2007. WHO Recommendations for the prevention of Postpartum Haemorraghing.
5
20
20
20
You're halfway through
pregnancy! Your baby floats in
fluid. This protects him from
bumps, keeps him warm and
lets him move around.
You'll start feeling your baby
kicking soon. Take time every
day to feel him move. Tell your
health worker of any changes.
Feeling out of breath when you
walk? Your womb is squashing
your lungs now. Go to the clinic
if you find you are breathless all
Congratulations! You are halfway through your
pregnancy! Your baby is now the size of a banana.
Your womb is full of water which protects your baby
from bumps and lets him move around.
It's exciting when you first feel your baby move! If this
is your first pregnancy, you may not be sure what the
movements are at first. They feel like gentle
butterflies fluttering in your belly.
In the next few weeks, your baby's movements will
get stronger and more regular. Your baby won't move
all the time. Like you, sometimes he'll just want to rest
and sleep.
You can get used to recognising the movements.
Remember his daily routine, when he is awake and
Choose a local food to illustrate the size of
the fetus.
Inappropriate response to fetal
movements is one of the top reasons for
stillbirth in South Africa (WHO, Making
Pregnancy Safer).
WHO recommends calcium
supplementation for pregnant women
from 20 weeks onwards. If calcium
supplementation is not routine in
pregnancy in your community, delete the
section on calcium pills from the audio
message.
the time.
when he goes to sleep. Tell your health worker if you
notice a change in his routine.
If you haven't felt your baby move yet, speak to your
health worker. She will be able to check that
everything is well.
Make sure to have lots of calcium-rich foods like milk,
yoghurt, dark green leafy vegetables. Calcium helps to
prevent problems later on in pregnancy.
You may need to start taking calcium pills daily to
prevent problems later on in pregnancy. Take one
every day, but don’t take them together with your
iron pills. If you take your iron pill in the morning, take
the calcium pill in the evening.
If you want to do one good thing for your baby this
week, take a moment to sit down and feel your baby
move inside you.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011]. "http://www.who.int/making_pregnancy_safer/countries/soa.pdf
Arulkumaran S, Anandakumar C, Wong YC, et al. 1989. Evaluation of maternal perception of sound-provoked fetal movement as a test of antenatal fetal health.Obstet Gynecol 73(2):182-6
Chutiwongse S, Tannirandorn Y, Sukcharoen N, et al. 1991. Maternal perception of sound-provoked fetal movement as a test of antepartum fetal wellbeing. J Med Assoc Thai 74(5):257-63
Gillieson M, Dunlap H, Nair R, et al. 1984. Placental site, parity, and date of quickening. Obstet Gynecol 64(1):44-5
Heazell AEP, Froen JF. 2008. Methods of fetal movement counting and the detection of fetal compromise. J Obstet Gynaecol 28(2):147-54
Hijazi ZR, East CE. 2011. Factors affecting maternal perception of fetal movement. Obstet Gynecol Surv 64(7):489-97
Holm Tveit JV, Saastad E, Stray-Pedersen B, et al. 2011. Maternal characteristics and pregnancy outcomes in women presenting with decreased fetal movements in late pregnancy. Acta
Obstet Gynecol Scand Nov 2, epub ahead of print.
Mangesi L, Hofmeyr GJ. 2007. Fetal movement counting for assessment of fetal wellbeing. Cochrane Database of Systematic Reviews (1):CD004909.mrw.interscience.wiley.com [pdf file,
accessed December 2011]
NCCWCH. 2008. Antenatal care: routine care for the healthy pregnant woman. National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press.
www.nice.org.uk [pdf file, accessed December 2011]
Olesen AG, Svare JA, 2004. Decreased fetal movements: background, assessment, and clinical management, Acta Obstet Gynecol Scand 83(9):818-26
O'Sullivan O, Stephen G, Martindale E, et al. 2011. Predicting poor perinatal outcome in women who present with decreased fetal movements J Obstet Gynaecol 29(8):705-10
Tveit JV, Saastad E, Stray-Pederson B, et al. 2011. Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement. BMC
Pregnancy Childbirth 9:32. www.ncbi.nlm.nih.gov [pdf file, accessed December 2011]
de Vries JI, Fong BF. 2006. Normal fetal motility: an overview. Ultrasound Obstet Gynecol 27(6):701-11.
WHO (2013). Calcium supplementation in pregnant women. http://apps.who.int/iris/bitstream/10665/85120/1/9789241505376_eng.pdf?ua=1 [Accessed on 2 May 2014]
5
21
Your baby can hear your
heartbeat and other noises
from inside your body. He can
hear your voice as well, so talk
and sing to him.
Your baby can hear your heartbeat and other noises
from inside your body. He can hear your voice as well,
so talk and sing to him.
In South Africa no antenatal care was the
topmost reason for stillbirths. In 2010 just
over half of all pregnant women made the
WHO-recommended minimum of four
antenatal visits. In Africa and South-East
Here are some signs you and your family should look
out for during pregnancy. If you see any of these signs, Asia less than half of all births had skilled
assistance. (WHO; Making Pregnancy Safer)
go to the clinic.
21
Drink plenty of clean water all
the day. It can help wash away
germs in your body. If you find
it painful to urinate, go to the
clinic.
A sharp pain in your tummy: this could be a stomach
bug or food poisoning.
A high fever: you may have an infection.
Any bleeding: it may be a sign of a pregnancy that
hasn't developed properly or of a miscarriage
If you're suddenly thirsty and have not been passing
water: it could be a sign of dehydration or diabetes.
21
Go to the clinic if you have a
fever, vomiting, bleeding or
pain when you pass urine. Make
sure your family know these
signs, too.
If it hurts or burns when you pass urine: it could be a
urine infection.
If you feel breathless all the time: it could be that you
are short of iron.
Vomiting could also mean you are ill. If you vomit
several times a day, you may get dehydrated and
weak.
If you want to do one good thing for your baby this
week, discuss these signs with your family. Ask them
to take you to the clinic if you have any of these signs.
References
Maternal and Neonatal Health Program. 2001. Birth preparedness and complication readiness: A matrix of shared responsibilities. USAID.
WHO http://www.who.int/mediacentre/factsheets/fs290/en/
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Baker P (Ed). 2006. Obstetrics by ten teachers. 18th edition. London: Arnold
BDA. 2007. Fluid – why you need it and how to get enough. British Dietetic Association. www.bda.uk.com [pdf file, accessed September 2011]
Cahill AG, Bastek JA, Stamilio DM et al. 2008. Minor trauma in pregnancy--is the evaluation unwarranted? Am J Obstet Gynecol. 2008 Feb;198(2):208.e1-5.
Crafter H. 2011. Problems of pregnancy. In: Fraser DM, Cooper MA. eds. Myles Textbook for Midwives. 15th ed. Edinburgh: Churchill Livingstone, 333-359
Gaufberg S. 2008. Abruptio Placentae. emedicine.www.emedicine.medscape.com [Accessed September 2011]
Murray I, Hassall J. 2011. Change and adaptation in pregnancy. In: Fraser DM, Cooper MA, eds. Myles Textbook for Midwives. 15th ed. Edinburgh: Churchill Livingstone, 189-225
NCCWCH. 2007. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health (NCCWCH). London: RCOG
Press. www.rcog.org.uk [pdf file, accessed September 2011]
NCCWCH. 2008a. Diabetes in pregnancy management of diabetes and its complications from preconception to the postnatal period. National Collaborating Centre for Women's and
Children's Health (NCCWCH). London: NICE.www.nice.org.uk [pdf file, accessed August 2011]
PRODIGY. 2008. Nausea and vomiting in pregnancy: Clinical topic.www.prodigy.clarity.co.uk [Accessed September 2011]
PRODIGY. 2011. Urinary tract infection (lower) in women: Clinical topic.www.prodigy.clarity.co.uk [Accessed September 2011]]
RCOG. 2006b. Preterm prelabour rupture of membranes. Royal College of Obstetricians & Gynaecologists, Green Top Guideline No. 44. London: RCOG Press. www.rcog.org.uk [pdf file
160KB; AccessedSeptember 2011]
Tieu J, Crowther CA, Middleton P. 2008. Dietary advice in pregnancy for preventing gestational diabetes mellitus. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD006674.
www.mrw.interscience.wiley.com[Accessed September 2011]
6
22
22
Your baby can turn over as well
as kick. This is a good sign. Tell
your health worker if you notice
your baby moving much less
than usual.
As your baby grows inside you,
he will need more food. Slowly
Your baby can turn over as well as kick. This is a good
sign. Tell your health worker if you notice your baby is
moving much less than usual.
As your baby grows inside you, he will need more
food. Slowly increase the amount of food you eat as
your stomach grows. Have an extra mouthful of food
Taking time to rest and relax was urged in
many midwife messages from a midwife
convention in Durban. Not getting enough
rest can lead to complications due to
exhaustion and dehydration.
increase the amount of food
you eat as your stomach grows.
22
Growing a baby can make you
feel very tired. Get as much rest
as you can. Ask your family to
help with shopping, cooking and
cleaning.
with each meal.
As your baby grows, she will start to press on your
bladder. This will make you want to pass urine more
often, perhaps disturbing your sleep. Try not to drink
anything for an hour before you go to bed. This may
help. Drink plenty of water throughout the day,
though.
You may also have leg cramps. Your leg muscles are
carrying the increasing weight of your baby. This can
make your legs ache or feel very tired. If you're woken
by a cramp, try to stretch the muscle. Straighten your
leg and flex your ankles and toes. You can also try
massaging the cramped muscle. Try not to stand for
long periods or sit with your legs crossed. This may
help.
Sleeping on your left side, with a cushion between
your knees, can help you get comfortable at night.
If you want to do one good thing for your baby this
week, follow these tips to get as much rest as you can.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
BAP. 2010. Consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. British Association for Psychopharmacology. Journal of
Psychopharmacology 0(0):1-25.www.bap.org.uk [Accessed May 2011]
CKS. 2008. Clinical topic: Nausea and vomiting in pregnancy - management. NHS Clinical Knowledge Summaries. www.cks.nhs.uk [Accessed May 2011]
CKS. 2011. Clinical topic: Insomnia. NHS Clinical Knowledge Summaries.www.cks.uk [Accessed May 2011]
Stacey T, Thompson JMD, Mitchell EA, et al. 2011. Association between maternal sleep practises and risk of late stillbirth: a case-control study. BMJ 342.www.bmj.com [Accessed June 2011]
6
23
23
23
Your baby now has definite
times of sleeping and waking.
He may wake you with his kicks.
Go to the clinic if the kicks slow
down or stop.
If a family member has TB, they
need treatment at the clinic. It
will help protect you against TB
too. You need to be healthy for
your baby.
The area around your nipples
may become darker and your
breasts may feel heavier now.
Your body is preparing to
breastfeed your baby.
Your baby now has definite times of sleeping and
waking. He may wake you with his kicks. Go to the
clinic if the kicks slow down or stop.
The weight of your growing baby makes you need to
pass urine more often. If you find that it is painful
when you pass urine, you might have an infection.
This can give you a high temperature, or make you
suddenly feel hot and cold. Other signs of infection
are blood in your urine, feeling nauseous, and shaking.
Sex might be painful, too.
Getting treated is very important. If left untreated, the
germs can give you a kidney infection.
You can also help prevent urine infections.
After going to the toilet, always wipe from 'front' to
'back'.
If you need to pass urine, go! Don't hold it in.
Always pass urine after sex, if you can, to get rid of
any germs.
Drink lots of clean, boiled water. This will help wash
out infections.
If you want to do one good thing for your baby this
week, be sure to drink plenty of safe water.
Urinary tract infections increase the risk of
premature birth, low birth weight,
perinatal death. Links have also been found
between UTIs and PET. (Schieve et al,
1994)
Infections, along with birth asphyxia and
complications, are linked to preterm
birth/LBW and account for 86% of neonatal
deaths (MCHIP-USAID).
Boiling has been identified as the best
method of preparing clean, safe water. But
there are other methods that can be
adopted if boiling is not feasible. Please
substitute with the method more
appropriate for your community.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Bercion, R., Mossoro-Kpinde D. et al. 2011. Increasing prevalence of antimicrobial resistance among Enterobacteriaceae uropathogens in Bangui, Central African Republic. J Infect
Developing Countries 2011; 3(3):187-190.
Latif, A.S. Urinogenital infections in the tropics. 2004. The Australasian College of Tropical Medicine.
Stamm, W.E. and Norrby, S.R. 2001. Urinary Tract Infections: Disease Panorama and Challenges. Journal of Infectious Diseases, 183(Suppl 1):S1-4.
Mizouni, S. 2006. Is a short course of antibiotics better than a long course in the treatment of uncomplicated UTI? EVMS.
Okonko, I.O. et al. 2011. Antibiotics Sensitivity and Resistance Patterns of Uropathogens to Nitrofurantoin and Nalidixic Acid in Pregnant Women with Urinary Tract Infections in Ibadan,
Nigeria. Middle-East Journal of Scientific Research 4 (2): 105-109.
http://www.who.int/immunisation/topics/tetanus/en/index.html
Schieve et al (1994). 'Urinary Tract Infection During Pregnancy: It's Association with Maternal morbidity and Perinatal Outcome', American Journal of Public Health, 84 (3)
6
24
24
24
Your baby's sense of taste is
developing, ready to enjoy your
milk! Your breastmilk will make
your baby grow strong. It's the
perfect food.
Your first milk is best for your
baby. Let your partner know
you want to breastfeed your
baby within the first hour. He
can support you.
It's time for your next clinic
visit. Get more iron and folicacid tablets. If the clinic is out of
stock, ask when to go back for
them.
This week your baby's sense of taste is developing,
ready to enjoy your milk!
It is not too early to start thinking about
breastfeeding. Breastfeeding is the best thing you can
do for your baby, as it helps protect her from illness.
Your baby needs only breastmilk and nothing else, not
even water for the first six months. Your breastmilk
will make your baby grow strong. It doesn't cost
anything, and is a lovely way to bond with your baby.
Talk to your family now to make a breastfeeding plan.
Let your partner and family know that you want to put
your baby to the breast in the first hour.
If you are living with HIV you can talk to your health
worker about how you can breastfeed without passing
HIV to your baby. She will guide you.
Talk to your family about the importance of visiting
WHO recommends calcium
supplementation for pregnant women
starting from 20 weeks gestation.
If calcium supplementation is routine in
your area, mention calcium pills, too.
Antenatal visits are in accordance with
WHO guidelines on ANC schedule, but fit to
meet local expectations.
WHO recommends that mothers should
breastfeed their babies within the first
hour after the birth. In cultures that do not
use clocks, you may need to amend the
wording to say 'straight away' or 'as soon
as possible'.
In South Africa, no antenatal care was the
topmost reason for stillbirths. In 2010, just
over half of all pregnant women made the
WHO-recommended minimum of four
antenatal visits. In Africa and South-East
the clinic regularly during your pregnancy.
Each visit, the health worker will check to make sure
you and your baby are well.
Continue taking your iron and folic acid pills every day.
They will keep you and your baby strong. The iron pills
may make your stools a darker colour than normal.
This isn't a problem.
Asia, less than half of all births had skilled
assistance. (WHO, Making Pregnancy Safer)
Immediate and exclusive breastfeeding has
been identified as important for child
nutrition. It is the safest nutritional option.
Globally, less than 40% of infants under six
months of age are exclusively breastfed.
Adequate breastfeeding support for
mothers and families could save many
young lives. (WHO,2001)
If you want to do one good thing for your baby this
week, go for your second clinic visit, even if you feel
well.
References
de Vries JI, Fong BF. 2006. Normal fetal motility: an overview. Ultrasound Obstet Gynecol 27(6):701-11
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
http://www.who.int/mediacentre/factsheets/fs290/en/
http://www.who.int/making_pregnancy_safer/countries/soa.pdf
Maternal and Neonatal Health Program. 2001. Birth preparedness and complication readiness: A matrix of shared responsibilities. USAID.
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
WHO http://www.who.int/mediacentre/factsheets/fs290/en/
6
25
25
Your baby is gaining fat. This fat
will help keep him warm when
he is born. You can help him by
eating a few extra mouthfuls at
each meal.
Your growing baby needs plenty
of iron. Try to eat meat, lentils,
Your baby is about the size of a ridge gourd. He is also
getting heavier because he is gaining fat that helps
keep him warm when he is born.
With your baby growing fast, you need to make sure
that you are eating enough.
Try eating a couple of extra mouthfuls at every meal.
Choose a local food to illustrate the size of
the fetus.
20% of maternal deaths are due to
maternal iron-deficiency anaemia and
stunting in women. In India , 88% of
pregnant and 74% of non-pregnant women
are affected. In Africa, 50% of pregnant
and 40% of non-pregnant women are
25
beans or chickpeas every day,
and take your iron pill.
Explain to your family that you need to make sure that
you get enough to eat to feed your growing baby.
A burning sensation at the top
of your stomach is heartburn.
Spicy and oily foods can make it
worse. A glass of milk may help
soothe it.
Eating a variety of foods will help your baby grow
strong.
Eat foods that will help your baby grow, like fish,
meat, lentils, beans and peas.
You will also need to eat plenty of iron to keep you
and your baby strong. You can get iron from meat,
fish, lentils, peas, beans and dark, leafy vegetables.
anaemic. (The Lancet, 2006)
Maternal under-nutrition affects women's
chances of surviving pregnancy and the
incidence of low birthweight babies.
Serious maternal under-nutrition is
common in sub-Saharan Africa, South Asia
and South-East Asia, and is critical in
Bangladesh, Eritrea and India. Maternal
and child under-nutrition is the single
leading cause of health loss
worldwide.(Blossner and de Onis, 2005)
A burning sensation at the top of your stomach is
heartburn. Spicy and oily foods can make it worse. A
glass of milk may help soothe it.
If you feel breathless, tired or dizzy, you may be short
of iron. Pale hands, eyelids or tongue are signs of
severe anaemia. If you notice these symptoms, go to
the clinic.
If you want to do one good thing for your baby this
week, explain to your family that you need to eat two
extra mouthfuls with every meal.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf
Black R.E. et al. Maternal and child under-nutrition: global and regional exposures and health consequences. Lancet 2008; 371: 243-60 doi: 10.1016/S0140-6736(07)61690-0 pmid:18207566
Blössner and de Onis,2005. "Malnutrition - Quantifying the health impact at national and local levels", Environmental Burden of Disease Series, No. 12. WHO: Geneva.
Seumo, E.F. and Abdallah F. Nutritional Counseling for Pregnant Women in Tanzania. USAID, ACCESS.
Stoltzfus R.J. and Dreyfuss M.L. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. International Nutritional Anemia Consultative Group (INACG)
"Progress for Children - A Report Card on Maternal Mortality". UNICEF, No. 7, September 2008
USAID. Counselling cards for maternal and neonatal health for community health workers
Essential Nutrition Actions - Improving Maternal-Newborn-Infant and Young Child Health and Nutrition. WHO. 2011
Weekly Iron-Folic Acid Supplementation (WIFS) in Women of Reproductive Age: Its Role in Promoting Optimal Maternal and Child Health. WHO. 2011.
Report of the UNICEF/WHO Regional Consultation. 1999. Prevention and Control of Iron Deficiency Anaemia in Women and Children. Geneva, Switzerland
Overview of 12 by 12 Initiative. WHO, UNICEF.
WHO. 2011. Background Paper 2 - A Review of health interventions with an effect on nutrition pdf, 1.51Mb
Khan, Wojdyla et al (2006). 'WHO analysis of the causes of maternal death: a systematic review', Lancet, 367:1066-74.
6
26
26
26
Your baby is about the size of a
pineapple. He is practising
moving the muscles in his chest,
so he will be ready to breathe at
birth.
Your baby is about the size of a pineapple. He is
practising moving the muscles in his chest, so he will
be ready to breathe at birth.
You may be thinking about where to have your baby.
Here are three reasons why it's best to choose a clinic
or a hospital birth or a birth with a skilled attendant.
Complications sometimes occur
when giving birth. It's best to try
First: a clinic is a clean place to have your baby. When
and have your baby at a clinic;
you go into labour, you become open to infection, and
that way there'll be help at
so does your baby. If you can't have your baby at a
hand.
clinic, have a skilled birth attendant with you.
As your baby grows, taking up
Second: having your baby in a clinic or a hospital or
more room in the womb, you
with an attendant will help if problems occur. They
may find it hard to eat big
can be spotted early and treated.
meals. Eat little and often to get
enough food.
Finally: being in a clinic or with a skilled attendant
means that if something does go wrong, there will be
someone there to keep you and your baby safe.
If you want to do one good thing for your baby this
week, choose to have your baby in a clinic or with a
skilled birth attendant.
References
Choose a local food to illustrate the size of
the fetus.
Local adaptation needed for whether the
baby will be born at home, a clinic or
hospital.
Replace the term 'skilled birth attendant'
with whatever is used locally.
30-40% of infections resulting in neonatal
sepsis deaths are transmitted at the time
of childbirth (Blencowe et al, 2011)
Every year an estimated 30 million
newborns acquire infection (MCHIPUSAID).
In Africa and South-East Asia, less than half
of all births had skilled assistance. (WHO,
Making Pregnancy Safer)
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Lang, J. B. and Elkin, E. D. (1997), A Study of the Beliefs and Birthing Practices of Traditional Midwives in Rural Guatemala. Journal of Midwifery & Women's Health, 42: 25–31.
Goldie SJ, Sweet S, 2010. Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis. PLoS Med 7(4): e1000264.
Mathai, M. (2011), To ensure maternal mortality is reduced, quality of care needs to be monitored and improved alongside increasing skilled delivery coverage rates. BJOG: An International
Journal of Obstetrics & Gynaecology, 118: 12–14.
Chuku, S.N. 2008. Low Birth Weight in Nigeria: Does Antenatal Care Matter?Institute of Social Studies, The Hague, The Netherlands.
Maternal and Neonatal Health Program. 2001. Birth preparedness and complication readiness: A matrix of shared responsibilities. USAID.
Blencowe et al (2011). 'Clean Birth and Postnatal Care Practises to reduce neonatal deaths from sepsis and Tetanus: A Systematic Review and Delphi Estimation of Mortality Effect', BMC
Public Health, 11 (3).
7
27
27
27
Babies dream at this stage in
pregnancy. Perhaps he's
dreaming about being born! If
he's not as active as usual, tell
your health worker.
Calcium helps your baby's
bones and teeth grow strong.
Drink milk and eat dried figs,
naan bread, beans or
vegetables to get plenty of
calcium.
Slightly swollen hands and feet
are common in pregnancy. But
if you have sudden swelling and
headaches, go to the clinic.
Your baby is the size of a cauliflower. You may be able
to tell when your baby is awake or asleep by his
movements. If he's not as active as he usually is, tell
your health worker.
You may be having some discomforts now.
Heartburn is caused by your baby pressing on your
stomach. Your family may suggest a herbal remedy,
but herbs can harm your baby. Try drinking some cool
boiled milk to soothe the burning.
Slightly swollen hands and feet are caused by the
extra blood in your body. Try to rest with your feet
raised. If you have sudden swelling and headaches, go
to the clinic. You may have very high blood pressure
which is dangerous for you and your baby. You can
help prevent this by drinking boiled milk and eating
figs, beans and vegetables.
Nosebleeds are common in pregnancy. If you have a
nosebleed, pinch your nostrils and lean forward
Choose a local food to illustrate the size of
the fetus.
Taking time to rest and relax was urged in
many midwife messages from a midwife
convention in Durban. Not getting enough
rest can lead to complications due to
exhaustion and dehydration.
In Nepal, mothers often skipped ANC
appointments because they viewed their
work load as heavy and unavoidable. Some
mothers-in-law prioritised work over their
daughter-in-law's health. (B. Simkhada et
al, 2010)
slightly. Keep pinching until the bleed has stopped.
If any of these discomforts continue, or if you get
bleeding, headaches or a pain down one side of your
stomach, go to the clinic.
If you want to do one good thing for your baby this
week, follow these tips to make your pregnancy more
comfortable.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
CKS. 2008. Dyspepsia: pregnancy associated. Clinical Knowledge Summaries, Clinical topic. www.cks.nhs.uk [Accessed May 2011]
NHS Choices. 2010. Indigestion (dyspepsia) in pregnancy. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2011]
Rodriguez A, Bohlin G, Lindmark G. 2001. Symptoms across pregnancy in relation to psychosocial and biomedical factors. Act Obstet Gynecol Scand80:213-23
Bamigboye AA, Smyth RMD. 2007. Interventions for varicose veins and leg oedema in pregnancy. Cochrane Database of Systematic Reviews(1):CD001066. mrw.interscience.wiley.com [pdf
file, accessed December 2011]
McNabb M. 2004. Maternal and fetal physiological responses in pregnancy. In: Henderson C, McDonald S. eds. Mayes' midwifery. 13th ed. London: Bailliere Tindall, 288-311
NHS Choices. 2011. Nosebleed. NHS Choices, Health A-Z. www.nhs.uk[Accessed December 2011].
7
28
28
28
Your baby responds to change she may move when you
undress! Feel thirsty and need
to urinate a lot? Tell clinic staff,
it may be diabetes.
Giving birth at home? At the
clinic, you can get a birth kit
with a plastic sheet, a sterile
cord-cutting tool and string to
tie the cord.
Drink plenty of water and eat
fruit to keep your stools soft. If
Your baby may move around more a lot more when
you undress. It shows she's responding to changes in
light and sound and that she's alert.
During pregnancy, some women get diabetes, even if
they haven't had it before.
Diabetes means your body can't control its sugar
levels. Signs of diabetes can be hard to spot, but you
may feel more tired than usual and be very thirsty.
You may have blurred vision and need to pass urine
frequently. If you spot any of these signs, tell your
health worker. She may give you a test at your next
Make necessary local changes concerning
whether tests will definitely be performed.
Diabetes can cause neonatal
hyperglycaemia and jaundice. Can also lead
to complicated birth due to larger baby.
This is a growing problem in low-resource
settings (Bellamy L et al, 2011).
Check local availability of birth kits for
home births.
If the use of chlorhexidine for home births
is recommended by the health authorities,
then include it in the message.
you have itching around the
anus, wash the area after you
open your bowels.
clinic visit.
You are more likely to get diabetes if you are
overweight or other people in your family have
diabetes. Eating well, exercising, and stopping
smoking will help prevent it.
If you want to do one good thing for your baby this
week, talk to your health worker about checking for
diabetes.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Bellamy L, Casas J, Hingorani AD, et al. 2011. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 373 (9677): 1773-1779
CEMACH. 2007. Diabetes in pregnancy: are we providing the best care? Findings of a national enquiry. Confidential Enquiry into Maternal and Child Health. www.cemach.org.uk [pdf file,
accessed August 2010]
Dempsey JC, Sorensen TK, Williams MA, et al. 2004. Prospective Study of Gestational Diabetes Mellitus Risk in Relation to Maternal Recreational Physical Activity before and during
Pregnancy. American Journal of Epidemiology 159(7): 663-6
NCCWCH. 2008. Diabetes in pregnancy management of diabetes and its complications from preconception to the postnatal period. National Collaborating Centre for Women's and
Children's Health (NCCWCH). London: RCOG Press.www.nice.org.uk [pdf file, accessed August 2010]
NHS Choices. 2010. Gestational diabetes: introduction. How common is gestational diabetes? www.nhs.co.uk [accessed August 2010]
Tieu J, Crowther CA, Middleton P. 2008. Dietary advice in pregnancy for preventing gestational diabetes mellitus. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD006674.
www.mrw.interscience.wiley.com [Accessed August 2010].
7
29
29
Your baby is the same size as a
large breadfruit. You may feel
him reacting to light and sound.
He may wriggle when you sing
to him.
Eat two extra mouthfuls of food
at each meal and a healthy
snack between meals. Eat
something extra before you go
Your baby is the same size as a large breadfruit. You
may feel him reacting to light and sound. He may
wriggle when you sing to him.
Your pelvis joints are opening up to make space for
your baby to be born.
Have you got swollen hands and feet? The weight of
your baby presses on your blood vessels and pushes
water down to your feet and ankles. This causes them
Choose a local food to illustrate the size of
the fetus.
WHO recommends that mothers with
eclampsia are given magnesium sulphate.
If this is local practice, please add.
Pre-eclampsia causes 12% of maternal
deaths globally -- an estimated 63,000
women per year (MCHIP-USAID).
29
to bed, too.
to swell.
If you need a blood transfusion,
your friends and family can
donate. Ask them to find out if
their blood group matches
yours.
The swelling will probably go after the birth.
However, if you suddenly get swelling, with a
headache or blurred vision, go to the clinic quickly. It
may be that your blood pressure is very high, and you
could have a fit.
Your health worker will be able to measure your blood
pressure and give treatment to prevent fits.
If you want to do one good thing for your baby this
week, talk to your family about these signs so they can
take you to the clinic immediately if needed.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, Forest JC, Giguère Y.Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy:
a meta-analysis. Obstet Gynecol. 2010 Aug;116(2 Pt 1):402-14
Prof Gus Dekker MD, Prof Baha Sibai MD; Primary, secondary, and tertiary prevention of pre-eclampsia The Lancet, Volume 357, Issue 9251, Pages 209 - 215, 20 January 2001
Hofmeyr GJ, Duley L, Atallah A. Dietary calcium supplementation for prevention of pre-eclampsia and related problems: a systematic review and commentary. BJOG 2007;114:933–43.
Meads CA, Cnossen JS, Meher S, Juarez-Garcia A, ter Riet G, Duley L, et al. Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness
literature with economic modelling. Health Technology Assessment 2008 12(6):1-270
Okafor UV, Efetie RE. Critical care management of eclamptics: challenges in an African setting. Trop Doct. 2008 Jan; 38(1):11-3.
Peng, CT. 2008. Review: Calcium Supplementation During Pregnancy Reduces the Risk of Pre-Eclampsia. EBM. (13:8), 38
Dr D Wilhelm Steyn, Hein J Odendaal; Randomised controlled trial of ketanserin and aspirin in prevention of pre-eclampsia; The Lancet, Volume 350, Issue 9087, Pages 1267 - 1271, 1
November 1997
Maternal and Neonatal Health Program. 2001. Birth preparedness and complication readiness: A matrix of shared responsibilities. USAID.
USAID. Counselling cards for maternal and neonatal health for community health workers
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
Khan, Wojdyla et al (2006). 'WHO analysis of the causes of maternal death: a systematic review', Lancet, 367:1066-74.
7
30
Your baby can open and close
his eyes. Inside your womb, he
Your baby's arrival is getting closer. It is time to make
Make necessary local changes about the
safest place to have a baby -- whether at a
can tell day from night by the
way the light changes.
30
It's best to give birth at the
clinic. Find out the fastest way
to get there. Get taxi numbers
and enough phone balance for
emergencies.
30
Not going to a clinic for the
birth? Make sure you have a
trained birth attendant and a
birth kit ready so you have a
safe, clean birth.
clinic, hospital, etc.
Some countries have a 'waiting hut' The clinic is the safest place to have your baby. Talk
somewhere for the mother to wait while
with your family about out how long it will take to get her labour progresses. If this is available in
your area, mention it here.
there. Find out the fastest way to get there. Make
sure you have ambulance and taxi numbers ready, and WHO recommends that the mother have a
social supporter with her during labour.
enough balance on your phone for an emergency.
We have only mentioned early labour here
in case mothers are not allowed people
Decide who you will have with you when you give
with them. If the mother is allowed
birth. Choose someone you trust.
someone with her during delivery, add this
to later messages.
If you are not having your baby at a clinic, it is vital to
have a skilled attendant. Make sure your family knows
how to contact the attendant. Your attendant may
have a birth kit. It will contain a plastic sheet, gloves,
clean string and tools for cutting your baby's cord. If
you cannot get a birth kit, find a clean sheet to have
your baby on and two cloths, one to dry your baby
and one to wrap her in. Have a clean, sharp knife or a
clean pair of scissors ready. Your attendant must wash
her hands and you must wash between your legs. Get
plenty of clean, boiled water and soap ready.
plans.
If you want to do one good thing for your baby this
week, plan how you will get to the clinic.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Maternal and Neonatal Health Program. 2001. Birth preparedness and complication readiness: A matrix of shared responsibilities. USAID.
Lang, J. B. and Elkin, E. D. (1997), A Study of the Beliefs and Birthing Practises of Traditional Midwives in Rural Guatemala. Journal of Midwifery & Women's Health, 42: 25–31.
Goldie SJ, Sweet S, 2010. Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis. PLoS Med 7(4): e1000264.
Mathai, M. (2011), To ensure maternal mortality is reduced, quality of care needs to be monitored and improved alongside increasing skilled delivery coverage rates. BJOG: An International
Journal of Obstetrics & Gynaecology, 118: 12–14.
Chuku, S.N. 2008. Low Birth Weight in Nigeria: Does Antenatal Care Matter? Institute of Social Studies, The Hague, The Netherlands.
Maternal and Neonatal Health Program. 2001. Birth preparedness and complication readiness: A matrix of shared responsibilities. USAID.
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
WHO http://www.who.int/mediacentre/factsheets/fs290/en/
8
31
31
31
If you could take a peek inside,
you would see if you have a boy
or girl, as the genitals have now
developed.
Have a trained birth attendant
present during birth. She will
know how to deliver the
placenta safely and can stop
you bleeding too much.
Have you felt your belly tighten
suddenly, then relax? This was a
practice contraction. Your body
is getting ready for labour.
If you could take a peek inside, you would see if you
have a boy or girl, as the genitals have now
developed.
You may be wondering how to know when you are in
labour.
When you start labour, you may see a jelly-like
discharge. This can happen a day or two before
labour, but you may not notice it.
For most women, the main sign is contractions.
Labour contractions are regular and painful. At first,
they may feel like mild tummy cramps or low
backache. As your labour goes on, the contractions
will come faster and harder.
Sometimes the first sign of labour is the breaking of
waters. Your baby has been sitting in a bag of fluid. If
the bag breaks when labour starts, there could be a
trickle or a gush.
The water will be almost clear with a yellow tinge. It
may be blood-stained. Once your waters have broken,
you are open to infection. Fetch your attendant or
head to the clinic.
Some countries have a 'waiting hut' where
women can wait as their labour progresses.
Mention this here if they are available in
your area.
12.1% of stillbirths were caused because of
a delay in seeking medical attention during
labour in South Africa (WHO).
Replace 'trained birth attendant' with
locally appropriate term.
If you want to do one good thing for your baby this
week, talk to your family about signs of labour.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Carfoot S, Williamson P R, Dickson R. Centre for Reviews and Dissemination; A systematic review of randomized controlled trials evaluating the effect of mother/baby skin-to-skin care on
successful breastfeeding.
Conde-Agudelo A, Belizán JM, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birth weight infants. Cochrane Database of Systematic Reviews 2011, Issue 3.
Art. No.: CD002771. DOI: 0.1002/14651858.CD002771.pub2
Cramer K, Wiebe N, Hartling L, Crumley E, Vohra S.; Heat loss prevention: a systematic review of occlusive skin wrap for premature neonates; Complementary and Alternative Research and
Education Program, Department of Paediatrics, University of Alberta, Alberta, Canada.
Ferber, Makhoul IR. 2004. Pediatrics. 113(4):858-65.; The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a
randomized, controlled trial.
Hartley. P. 2008. Neonatal Thermoregulation; http://www.ceufast.com/courses/63/63.htm
Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. Centre for Reviews and Dissemination; 'Kangaroo mother care' to prevent neonatal deaths due to preterm birth
complications
Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003519.
DOI: 10.1002/14651858.CD003519.pub2;
Mullany et al. 2010. BMC Medicine 2010, 8:43; http://www.biomedcentral.com/1741-7015/8/43
East of England Neonatal Benchmaking Group; NHS; Clinical Guideline: Thermoregulation; May 2011
USAID. Counselling cards for maternal and neonatal health for community health workers
Wariki WMV and Mori R. Interventions to prevent hypothermia at birth in preterm and/or low-birth-weight infants: RHL commentary (last revised: 1 June 2010). The WHO Reproductive
Health Library; Geneva: World Health Organization
Essential newborn nursing for small hospital in resource restricted countries: Learner's guide. Publication of Department of Pediatrics WHO-CC, New Delhi, 2004.
http://www.who.int/maternal_child_adolescent/countries/soa.pdf
8
32
Your baby is getting plump! This
body fat will keep him warm
when he is born. Have 2 cloths
ready. One to dry him and one
to wrap him in.
32
Have a hat or small cloth ready
to cover your new baby's head.
Babies lose lots of heat from
their heads. Hold him close to
Your womb is warm and cosy. It is warmer than the
weather outside, even if it is hot. This means your
newborn can get cold easily. Your newborn will be wet
when born, so dry him off and lay him on your bare
chest. Your body will keep him warm. Hold him firmly.
Lay a clean, warm blanket over both of you. Put a
small hat or cloth on him. Babies lose lots of heat
through their heads.
Holding your baby close to your body will make
Our breastfeeding advisors suggest that in
some cultures (notably Vietnam) it may be
appropriate to add 'international experts
advise breastfeeding in the first hour of
life'.
Immediate and exclusive breastfeeding has
been identified as important for child
nutrition. Is the safest nutritional option.
(MCHIP, USAID/WHO)
If colostrum is not seen as dirty or
poisonous in the community, mention of
32
keep him warm.
breastfeeding easy.
It's time for your next clinic
visit. Make plans to put your
baby to the breast as soon as he
is born. Do not give honey or
anything else.
The first thick and creamy milk is called colostrum. It is
creamy with goodness. Feed this precious gift to him
straight away to give him the best start in life.
It is especially created as baby’s first food. It is perfect
for your newborn. Feeding him honey or ghee is not
necessary and can harm your baby.
Breastfeeding immediately will help you to deliver the
afterbirth and reduce bleeding. It is best to put your
baby to your breast within the first hour of life.
If you want to do one good thing for your baby this
week, go to your third clinic check-up.
this should be removed from the audio and
replaced with whatever local beliefs exist.
Hypothermia at birth is one of the most
important risk factors for morbidity and
mortality in newborn infants of all birth
weights and gestational ages. Prevention
and management of hypothermia is one of
the key interventions for reducing neonatal
mortality and morbidity. According to
UNICEF, such interventions can help
reduce neonatal mortality or morbidity by
18%–42% (McCall et al, 2010).
Globally, less than 40% of infants under six
months of age are exclusively breastfed.
Adequate breastfeeding support for
mothers and families could save many
young lives. (WHO)
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Cheyne H, Dowding DW, Hundley V. 2006. Making the diagnosis of labour: midwives' diagnostic judgement and management decisions. J. Advanced Nursing 53(6):625–635.
Lauzon L, Hodnett E. 2001. Labour assessment programs to delay admission to labour wards. Cochrane Database of Systematic Reviews. Issue 3. Art. No.: CD000936.
www.mrw.interscience.wiley.com [Accessed December 2008]
Lewis P. 2004. Malpositions and malpresentations. In: Henderson C. Macdonald S. eds. Mayes' Midwifery: a textbook for midwives. 13th edition. Edinburgh: Ballière Tindall, 884-917.
Lindsay P. 2004a. Bleeding in pregnancy. In: Henderson C. Macdonald S. eds. Mayes' Midwifery: a textbook for midwives. 13th edition. Edinburgh: Ballière Tindall, 758-779.
Lindsay P. 2004b. Preterm labour. In: Henderson C. Macdonald S. eds. Mayes' Midwifery: a textbook for midwives. 13th edition. Edinburgh: Ballière Tindall, 853-861.
McCormick C. 2003. The first stage of labour: Physiology and early care. In: Fraser DM, Cooper MA. eds. Myles Textbook for Midwives. 14th edition. Edinburgh: Churchill Livingstone, 295320.
McNabb M. 2004. Physiological changes in labour. In: Henderson C, McDonald S. eds. Mayes' midwifery. 13th edition. London: Ballière Tindall, 410-27.
NCCWCH. 2007. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health. Clinical Guideline. London:
RCOG Press. www.nice.org.uk [pdf file 3.09MB; Accessed December 2008]
NCCWCH. 2008. Antenatal care: Routine care for the healthy pregnant woman. National Collaborating Centre for Women's and Children's Health. Clinical Guideline. London: RCOG Press.
www.nice.org.uk [pdf file 5.7MB; Accessed December 2008]
Walsh D. 2004. Care in the first stage of labour. In: Henderson C, McDonald S. eds. Mayes' midwifery. 13th edition. London: Ballière Tindall, 428-57.
Winter C, Cameron J. 2006. The 'stages' model of labour: Deconstructing the myth. BJM 14(8):454-6.
McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S. (2010) Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database of Systematic
Reviews
http://www.who.int/features/factfiles/breastfeeding/en/
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
8
33
33
33
Your baby may settle head
down now, the best position to
be born! You may find it harder
to walk. It's time to slow down.
If the bag of waters your baby is
in breaks, go to the clinic. Your
baby is at risk of infection. It
may be a trickle or a gush.
Leg cramps may wake you up at
night. Stretch your leg, walk
around and stand on something
cold to ease the cramps.
Your baby may settle head down now, the best
position to be born! You may find it harder to walk.
It's time to slow down.
12.1% of stillbirths were caused because of
a delay in seeking medical attention during
labour in South Africa (WHO).
Your baby is protected inside your womb in a bag of
fluid. If the bag of waters your baby is in breaks, go to
the clinic. Your baby is at risk of infection.
The amount of fluid varies. It may be only a slight
trickle, or it may be a large gush.
If it's a small trickle, make sure it's not your urine
leaking. Wear a sanitary pad or a clean cloth to absorb
it. It can be quite a shock if it's a gush of fluid. You may
need to use a towel to absorb the water.
If you want to do one good thing for your baby this
week, check your plans for getting to the clinic or
fetching your attendant.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Cheyne H, Dowding DW, Hundley V. 2006. Making the diagnosis of labour: midwives' diagnostic judgement and management decisions. J. Advanced Nursing 53(6):625–635.
Lauzon L, Hodnett E. 2001. Labour assessment programs to delay admission to labour wards. Cochrane Database of Systematic Reviews. Issue 3. Art. No.: CD000936.
www.mrw.interscience.wiley.com [Accessed December 2008]
Lewis P. 2004. Malpositions and malpresentations. In: Henderson C. Macdonald S. eds. Mayes' Midwifery: a textbook for midwives. 13th edition. Edinburgh: Ballière Tindall, 884-917.
Lindsay P. 2004a. Bleeding in pregnancy. In: Henderson C. Macdonald S. eds. Mayes' Midwifery: a textbook for midwives. 13th edition. Edinburgh: Ballière Tindall, 758-779.
Lindsay P. 2004b. Preterm labour. In: Henderson C. Macdonald S. eds. Mayes' Midwifery: a textbook for midwives. 13th edition. Edinburgh: Ballière Tindall, 853-861.
McCormick C. 2003. The first stage of labour: Physiology and early care. In: Fraser DM, Cooper MA. eds. Myles Textbook for Midwives. 14th edition. Edinburgh: Churchill Livingstone, 295320.
McNabb M. 2004. Physiological changes in labour. In: Henderson C, McDonald S. eds. Mayes' midwifery. 13th edition. London: Bailliere Tindall, 410-27.
NCCWCH. 2007. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health. Clinical Guideline. London:
RCOG Press. www.nice.org.uk [pdf file 3.09MB; Accessed December 2008]
NCCWCH. 2008. Antenatal care: Routine care for the healthy pregnant woman. National Collaborating Centre for Women's and Children's Health. Clinical Guideline. London: RCOG Press.
www.nice.org.uk [pdf file 5.7MB; Accessed December 2008]
Walsh D. 2004. Care in the first stage of labour. In: Henderson C, McDonald S. eds. Mayes' midwifery. 13th edition. London: Bailliere Tindall, 428-57.
Winter C, Cameron J. 2006. The 'stages' model of labour: Deconstructing the myth. BJM 14(8):454-6.
http://www.who.int/maternal_child_adolescent/countries/soa.pdf
http://www.who.int/features/factfiles/breastfeeding/en/
8
34
34
34
A baby born early needs extra
care and warmth. If he is too
weak to breastfeed, give him
expressed milk. Clinic staff can
show you how.
Sudden swelling of hands, face
and feet is a sign of a problem.
Tell your family, and ask them
to take you to the clinic if they
see this.
Your baby will drop lower now
ready to be born. You will
breathe more easily, but may
also have to urinate more
frequently.
Your baby wakes and sleeps now and can hear the
sounds around him. Sing to him and he will know the
song when he is born.
Most babies are born in the ninth month. But some
babies are born earlier, especially if they are twins. If
your baby arrives early, she will need lots of
breastmilk and warmth. The first milk you make is
very thick, creamy and full of goodness. Give your
baby this precious gift to help prevent illness.
Some early babies may not be strong enough to feed
at the breast. If this happens, feed her by expressing
your milk into a sterilised cup instead. Hold her on
your lap, and put a drop of milk on her tongue. Gently
tilt the cup so that it touches her lower lip and a little
milk enters her mouth. Your baby will learn to lap the
milk.
Secure your baby, without clothing except a nappy,
against your bare chest using a cloth. This will keep
her warm and comfort her and help her grow. Put a
hat on her, too. If you want to do one good thing for
12.1% of stillbirths were caused because of
a delay in seeking medical attention during
labour in South Africa (WHO)
Prevention and management of
hypothermia is one of the key
interventions for reducing neonatal
mortality and morbidity. According to
UNICEF, such interventions can help
reduce neonatal mortality or morbidity by
18%–42% (McCall et al, 2010).
your baby this week, make preparations in case you
go into early labour.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Butte, N.F. et al. 2002. Nutrient Adequacy of Exclusive Breastfeeding for the Term Infant During the First Six Months of Life. WHO.
Carfoot S, Williamson P R, Dickson R. Centre for Reviews and Dissemination; A systematic review of randomized controlled trials evaluating the effect of mother/baby skin-to-skin care on
successful breastfeeding.
Conde-Agudelo A, Belizán JM, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birth weight infants. Cochrane Database of Systematic Reviews 2011, Issue 3.
Art. No.: CD002771. DOI: 0.1002/14651858.CD002771.pub2
Cramer K, Wiebe N, Hartling L, Crumley E, Vohra S.; Heat loss prevention: a systematic review of occlusive skin wrap for premature neonates; Complementary and Alternative Research and
Education Program, Department of Paediatrics, University of Alberta, Alberta, Canada.
Ferber, Makhoul IR. 2004. Pediatrics. 113(4):858-65.; The effect of skin-to-skin
contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial.
Hartley. P. 2008. Neonatal Thermoregulation; http://www.ceufast.com/courses/63/63.htm
Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. Centre for Reviews and Dissemination; 'Kangaroo mother care' to prevent neonatal deaths due to preterm birth
complications
Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and
their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub2;
Mullany et al. 2010. BMC Medicine 2010, 8:43; http://www.biomedcentral.com/1741-7015/8/43
East of England Neonatal Benchmaking Group; NHS; Clinical Guideline: Thermoregulation; May 2011
Wariki WMV and Mori R. Interventions to prevent hypothermia at birth in preterm and/or low-birth-weight infants: RHL commentary (last revised: 1 June 2010). The WHO Reproductive
Health Library; Geneva: World Health Organization
WHO. 2011. Essential Nutrition Actions - Improving Maternal-Newborn-Infant and Young Child Health and Nutrition.
WHO, UNICEF. 2011. Baby-Friendly Hospital Initiative. Section 3 - Breastfeeding Promotion and Support in a Baby-Friendly Hospital.
Essential newborn nursing for small hospital in resource restricted countries: Learner's guide. Publication of Department of Pediatrics WHO-CC, New Delhi, 2004.
Breastfeeding and the Use of Human Milk. 2005. Pediatrics, 115 ( 2
McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S. (2010) Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database of Systematic
Reviews
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
8
35
Your body is designed to give
birth. It will stretch and open
with each contraction in labour,
making space for your baby to
be born.
By now, you should have decided where you want to
have your baby and have arranged transport. Make
sure you know the fastest route.
Most women give birth naturally, but sometimes it is
In Africa and South-East Asia, less than half
of all births had skilled assistance (WHO).
12.1% of stillbirths were caused because of
a delay in seeking medical attention during
labour in South Africa (WHO).
35
35
Breastfeeding is the best way. It
is safe, prevents illness, and
helps your baby grow strong.
Let your baby suckle whenever
he wants.
Sometimes an operation is the
safest way to have your baby.
Choose a clinic where you trust
the staff just in case you need
an operation.
safer if they have an operation.
Some operations are needed because the baby's
passage out of the womb becomes blocked.
Others are needed because the baby is not lying headdown.
If you're having twins or more, you may also need an
operation.
Sometimes the labour is long and slow, or there is
heavy bleeding and an operation becomes necessary.
Whatever the reason, if you have been asked to have
an operation, don't panic. There is a good reason why
you need it. It is the safest option for both you and
your baby at the time.
Just make sure to go to a clinic where you trust the
staff.
If you want to do one good thing for your baby this
week, choose a trusted clinic where you can give
birth.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
NCCWCH. 2004. Caesarean section National Collaborating Centre for Women's and Children's Health. Clinical Guideline. www.nice.org.uk [Accessed August 2011]
9
36
Your newborn baby will need
help to stay warm when he's
born. Have some cloths ready to
wrap and dry him with, and
Make sure you go to the clinic this week for another
check-up. If you are having your baby in a clinic, the
staff will have everything you need at the birth. But if
you are having the baby at home, make sure you, or
If clinic or hospital birth is the norm adapt
message on cutting the cord.
After the cord is cut, some hospitals apply
an antiseptic gel or a liquid on the cord
36
36
hold him close to you.
your trained birth attendant, are prepared.
To cut the cord, you need a new
razor blade or sterile knife and
two pieces of string about the
length of your hand. Get these
ready now.
Have at least two cloths ready. You will need one to
dry your baby and a clean cloth to wrap him in to keep
him warm. Try not to swaddle him too tightly or cover
his face. This might suffocate him.
You may need to continue
taking iron pills for 3 months
after your baby's birth. Go to
the clinic for a final check-up
and your iron pills.
Have boiled water and soap ready. Whoever cuts the
cord needs to wash their hands first. This will help
prevent infection.
stump. Adapt according to local hospital
guidelines and practices.
Neonatal sepsis causes 26% of all neonatal
deaths worldwide (Lawn et al. 2005)
Every year an estimated 30 million
newborns acquire infection and 1-2 million
of these babies die. (MCHIP/USAID)
30-40% of infections resulting in neonatal
sepsis deaths are transmitted at the time
of childbirth (Blencowe et al,2011).
Get a sharp tool such as a new razor blade, scissors or
a knife.
Cut two pieces of string about the length of your
hand.
If you want to do one good thing for your baby this
week, get the things you need to cut the cord safely.
Next week, we will tell you how to cut the cord and
care for it.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Blencowe et al. BMC Public Health 2011, 11(Suppl 3):S11, Clean birth and postnatal birth practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi
estimation of mortality effect.
Melal Mohammad Al.J et al. 2010. Placental Cord Drainage after Vaginal Delivery as part of Management of 3rd Stage of Labour. Medical Journal of Babylon 17:3-4 404-409
Mullany et al. Risk Factors for Umbilical Cord Infection among Newborns of Southern Nepal 2006, Vol. 165, No. 2
USAID. Counselling cards for maternal and neonatal health for community health workers
World Health Organization; Maternal and Newborn Health Safe Motherhood. Care of the Umbilical Cord: A review of the evidence (1998)
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? where? why? Lancet, 365: 891–900.
Blencowe et al (2011). 'Clean Birth and Postnatal Care Practises to reduce neonatal deaths from sepsis and Tetanus: A Systematic Review and Delphi Estimation of Mortality Effect', BMC
Public Health, 11 (3).
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
9
37
37
37
When the cord stops pulsing, tie
a piece of string 3 fingers from
you, another 3 fingers from the
baby. Cut the cord between the
strings.
A cord infection can make your
baby very ill. Sponge the cord
with clean water and leave it
uncovered to dry. Don't put
anything else on it.
Don't bathe your baby for the
first 6 hours of her life. Keep her
well wrapped up and her head
covered. The cord will drop off
after a week.
It is very important to take care of the baby's cord and
to keep it clean to prevent infections which can kill a
new baby.
The birth attendant should boil the sharp tool for ten
minutes and the string for three minutes to clean
them, just before you use them.
Have water and soap so whoever cuts the cord can
wash their hands very carefully.
Wait until the cord stops pulsing. Then, tie the two
pieces of string round the cord. One tie should be
about the length of your hand away from your baby's
stomach. The other, about three fingers away from
the first tie. Cut the cord in between the two ties.
Keep the baby's cord stump clean and dry until it
drops off. The cord will heal gradually and drop off in
about a week. It will look quite black and odd but that
is part of the healing.
If the cord stump is red, bleeding or smelly, take your
baby to the clinic.
For the first six hours of your baby's life, clean only the
cord. The rest of your baby does not need to be
bathed. Bathing your baby too soon could make her
sick and cold. Try to keep your baby away from direct
sunlight. The sun may be too strong for him.
If clinic or hospital birth is the norm, adapt
message on cutting the cord.
After the cord is cut, some hospitals apply
an antiseptic gel or a liquid on the cord
stump. Adapt according to local hospital
guidelines and practises.
If clorhexidine is recommended in your
locality, please add it to the message.
Neonatal sepsis causes 26% of all neonatal
deaths worldwide (Lawn et al. 2005).
Every year, an estimated 30 million
newborns acquire infection and 1-2 million
of these babies die. (MCHIP/USAID)
30-40% of infections resulting in neonatal
sepsis deaths are transmitted at the time
of childbirth (Blencowe et al,2011).
If you want to do one good thing for your baby this
week, make sure whoever helps with the birth knows
how to care for the cord.
References
Blencowe et al. BMC Public Health 2011, 11(Suppl 3):S11, Clean birth and postnatal birth practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi
estimation of mortality effect.
http://www.biomedcentral.com/1471-2458/11/S3/S11
Melal Mohammad Al.J et al. 2010. Placental Cord Drainage after Vaginal Delivery as part of Management of 3rd Stage of Labour. Medical Journal of Babylon 17:3-4 404-409
Mullany et al. Risk Factors for Umbilical Cord Infection among Newborns of Southern Nepal 2006, Vol. 165, No. 2
USAID. Counselling cards for maternal and neonatal health for community health workers
World Health Organization; Maternal and Newborn Health Safe Motherhood. Care of the Umbilical Cord: A review of the evidence (1998)
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? where? why? Lancet, 365: 891–900.
Blencowe etal (2011). 'Clean Birth and Postnatal Care Practices to reduce neonatal deaths from sepsis and Tetanus: A Systematic Review and Delphi Estimation of Mortality Effect', BMC Public Health, 11 (3).
9
38
38
38
Your baby is curled up inside
you all ready to be born. Talk to
your health worker about the
vaccinations your baby needs
when she is born.
A jelly-like substance on your
underwear is a sign that labour
will start soon. If you have
bleeding like a period, go to the
clinic.
Low back pain is a sign that the
baby is low down, ready to get
born. Make sure you can get to
the clinic in time.
Your baby is curled up inside you all ready to be born.
Your baby will not be strong enough to fight illnesses
by herself. She needs all the protection she can get.
Vaccinations protect babies from illnesses that can kill.
Vaccinations can fight germs if they enter your baby's
body. Vaccinations do not cure her once she gets the
illnesses. So it's important to get your baby vaccinated
at the right time.
Getting protection sometimes requires several doses
of vaccine. Your baby needs to take all the doses at
the right times for the best protection. He will get
some of his first vaccines straight after birth.
We will remind you when to get these vaccines. A
health worker will also tell you when your baby needs
them.
If you want to do one good thing for your baby this
If your community offers vaccines against
pneumonia, meningitis and diarrhoea, you
could also mention them in this message.
If your community also offers polio and
hepatitis vaccines at birth, also include this.
Immunisation prevents three million child
deaths each year. WHO estimates that 20%
of the remaining under-five deaths—
approximately two million deaths
annually—could be prevented with existing
vaccines. (MCHIP/USAID)
The Expanded Programme for
Immunisation (EPI) is part of WHO strategy
to tackle MDG 4 (WHO).
week, talk to a health worker about the vaccinations
your baby will need.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
http://www.who.int/immunisation/documents/positionpapers/
Argarwal. S. et al. 2005. Understanding and Addressing Childhood Immunisation Coverage in Urban Slums. Indian Pediatrics 42:653-663
Oyo-Ita A, Nwachukwu CE, Oringanje C, Meremikwu MM. 2011. Interventions for improving coverage of child immunisation in low- and middle-income countries (Review). Cochrane
Collaboration.
U.S. Department of Health and Services and the Centers for Disease Control and Prevention.2010. Rotavirus Vaccine: What You Need To Know.
USAID.2003. Immunisation Essentials: A Practical Guide.
WHO (2004) Immunisation in practice: a practical resource guide for Health workers – 2004 update.
Summary of WHO position papers – recommended routine immunisations for children (Tables 1 & 2)
http://www.who.int/immunization/policy/Immunization_routine_table1.pdf
http://www.who.int/immunization/policy/Immunization_routine_table2.pdf
9
39
It is natural to worry with the
birth so close, but you don't
have to do it alone. Talk to your
health worker, she can guide
you.
39
Your baby needs nothing else
apart from breastmilk for the
first 6 months. Your milk will
contain all the water and
goodness he needs.
39
Your baby will need the first
dose of vaccines against polio
and TB at birth. Make sure you
baby gets them as soon as he is
born.
The big day is almost here. It won't be long before you
can cuddle your baby.
The only food your baby needs is your breastmilk.
Your milk is full of goodness and protects her from
some diseases.
Your body knows exactly how to care for your new
baby. As she grows, the milk you make will change to
suit her. As long as you breastfeed your baby often
enough, your body will also make the right amount of
milk. This means that your baby will always have what
she needs.
Feed her the first milk you make which is thick and
creamy. It will give your baby protection and strength.
Feeding her honey or ghee is bad for her and a waste
Some cultures consider colostrum (the
creamy first milk) to be 'stale' or 'dirty';
women may be told to discard it. It is full of
antibodies and women should be
encouraged to give it to their baby.
Immediate and exclusive breastfeeding has
been identified as important for child
nutrition. It is the safest nutritional option.
Globally less than 40% of infants under six
months of age are exclusively breastfed.
Adequate breastfeeding support for
mothers and families could save many
young lives. (WHO,2001)
Women in most cultures will breastfeed,
but often people will offer other foods or
liquids such as honey, ghee or water, all of
which can cause infection or damage the
'virgin gut'. Feeding colostrum and feeding
nothing but breastmilk for the first six
of your special milk.
months is key to helping protect the baby
from infections.
Your baby will need nothing else apart from
breastmilk for the first six months. Water can make
your baby sick but your breastmilk is safe.
Breastfeeding will also help you recover after the
birth. It can help stop heavy bleeding. Feeding your
baby only breastmilk will also stop you becoming
pregnant too quickly.
Your breastmilk contains all the water your baby
needs. You don't need to give water separately. Water
can make your baby sick. Your breastmilk is safe.
If you want to do one good thing for your baby this
week, tell your family that you want to exclusively
breastfeed for the first six months.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
American Academy of Pediatrics. 2004. Breastfeeding and the Use of Human Milk. Pediatrics 115:2. 496-506
UNICEF and WHO. 2011. SECTION 3: BREASTFEEDING PROMOTION AND SUPPORTIN A BABY-FRIENDLY HOSPITAL: A 20-HOUR COURSE FOR MATERNITY STAFF.
WHO.2011. Essential Nutrition Actions: Improving Maternal-Newborn Infant and Young Child Health and Nutrition.
WHO.2010. WHO Technical Consultation on Postpartum and Postnatal Care.
WHO.2003. Global Strategy for Infant and Young Child Feeding.
WHO. 2002 NUTRIENT ADEQUACY OF EXCLUSIVE BREASTFEEDING FOR THE TERM INFANT DURING THE FIRST SIX MONTHS OF LIFE.
WHO.2001. REPORT OF THE EXPERT CONSULTATION ON THE OPTIMAL DURATION OF EXCLUSIVE BREASTFEEDING.
9
40
Your baby can hear, see, and
As soon as your baby is born, he needs to be
suck. He is snug and warm
examined by the health worker. The health worker
curled up inside you. He is ready will also give your baby his first vaccines.
to be born and will be able to
Every year, nearly 41% of all under-five
child deaths are among newborn infants;
babies in their first 28 days of life or the
neonatal period.
40
40
feed straight away.
Take your baby to the clinic if you see yellow eyes, or
yellow colouring on the palms of his hands or soles of
his feet;
Your newborn needs warmth.
Nurse him on your bare chest
under a blanket. Go to the
clinic, if his eyes, palms and feet
turn yellow.
Or if he is refusing to feed or sucking poorly;
Your new baby needs your care.
If she's having trouble breathing
or feeding, is too hot or too
cold, or doesn't respond, go to
the clinic.
Or if his cord stump is red or smelly;
Or wheezing, grunting, or breathing quickly.
Take your baby to the clinic if he is vomiting after
every feed for more than a day, or has a swollen
stomach;
Three-quarters of all newborn deaths occur
in the first week of life.
Up to two thirds of newborn deaths can be
prevented if effective health measures are
provided at birth and during the first week
of life. Sources: 2005 World Health Report:
Make Every Mother and Child Count
(WHO) and The Lancet's Newborn Survival
Series (2005) and UNICEF (2008)
Or if the baby has a fit, or is lethargic, or has bluish
skin or nails.
Go to the clinic if the baby is wheezing, grunting, or
breathing quickly.
A baby who suddenly feels cold or very hot to the
touch may be ill. Place your hand on his tummy, hands
and feet. They should all be warm, not too hot or cold.
If they are, take him to the clinic.
Also go to the clinic if he won't stop crying or if his cry
sounds unusual.
If you want to do one good thing for your baby this
week, talk to a health worker and family about signs
of illness.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Chowdhury, H., Thompson, S., Ali, M., Alem, N., Yunus, M., & Streatfield, P. (2011). Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh. BMC
Pediatrics.
Opiyo and English. 2011. What clinical signs best identify severe illness in young infants aged 0-59? A systematic review. Arch Dis Child 96: 1052-59.
USAID. Counselling cards for maternal and neonatal health for community health workers
Warren. C. (2010) 'Care of the newborn: Community perceptions and health seeking behavior', Ethiop. J. Health Dev. 2010;24 Special Issue 1
WHO, UNICEF. 2011. WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children.
WHO http://www.who.int/mediacentre/factsheets/fs290/en/
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
9
41
Like you, your baby is waiting
for labour. You do this together!
Make sure you have everything
ready for labour.
41
After birth you will bleed like a
heavy period, so be prepared.
Change pads every 4-6 hours.
Don't insert anything into your
vagina.
41
Breastfeeding helps to reduce
your bleeding after birth. Go to
the clinic if your bleeding
becomes heavy, clotted, smelly
or you feel faint.
Your baby is waiting for labour to start as well! Make
sure you have everything ready.
Sometimes a pill or injection is given to
lower the risk of PPH. Uterine massage
should also be given if the mother is
haemorrhaging. If the mother has received
After birth, your womb will shrink back to its normal
size. You might feel some cramping pains. You will also oxytocin and is not haemorrhaging, uterine
massage should not be given, other than to
lose some blood.
feel the tone of the uterus. WHO. 2O12.
Other experts advise this only if the
Breastfeeding your baby will help to shrink your
woman is haemorrhaging. Fit to local
womb and reduce blood flow. Having your baby with
practices.
trained attendants at a clinic will also help prevent
Replace 'trained attendant' with locally
heavy blood loss.
appropriate term
Nearly 34% of maternal deaths in Africa
The bleeding can last for a few weeks. It will look like a
and more than 30% in Asia are due to PPH.
heavy period. It should reduce slowly. You might
(MCHIP-USAID)
bleed a lot at the beginning, but it will slowly get
Hypertension and haemorrhage account
for the largest proportion of maternal
lighter. It will be a bright red colour and then change
deaths in developing countries (Khan et al,
to a browner or lighter colour. Change the pads or
2006).
rags you are using to soak up the blood every 4-6
hours or more frequently if bleeding is heavy.
Remember to wash the used pads properly or dispose
them safely.
Go to the clinic:
●
if you soak more than 2-3 pads in 20-30
minutes, or if your bleeding increases rather
than decreases;
● if your bleeding continues to be heavy for
over four days;
● if your bleeding suddenly becomes very
heavy, and you pass lots of large blood clots;
● if your bleeding has a bad smell;
● or if you feel faint or dizzy;
After the birth, you will need to rest and recover. This
will help to prevent heavy bleeding. The bleeding
should stop in about a month.
If you want to do one good thing for your baby this
week, prepare for the days after your baby's arrival.
References
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Chelmow. D. 2011. Postpartum Haemorrhage: Evidence. ClinicalEvidence. 04:1410 1-101
S. Fawcus et al. 2011. Management of Postpartum Haemorrhage. SAJOG. 17:2
Hum Lact. J. 1995. Infant Insufficient Milk Syndrome Associated with Maternal Postpartum Haemorrhage. International Lactation Consultant Association. 11:2
Hutton.E. et al. 2007. Late vs Early Clamping of the Umbilical Cord In Full Term Neonates. JAMA. 297:11 1241-1252
Lombaard. H. 2011. Common Errors and Remedies in Managing Postpartum Haemorrhage. Best Practice & Research Clinical Obstetrics and Gynaecology 23 317–326
Royal College of Obstetricians and Gynacologists. 2011. Prevention and Management of Postpartum Haemorrhage. Green Top Guideline 52 1-24
Sanghvi. H. 2006. Preventing Mortality from Postpartum Haemorrhage in Africa. Uganda Conference Report.
Khan, Wojdyla et al (2006). 'WHO analysis of the causes of maternal death: a systematic review', Lancet, 367:1066-74.
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
WHO. 2012. 'WHO recommendations for the prevention and treatment of postpartum haemorrhage.'
WHO (2006), Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf?ua=1
9
42
If your baby is still not here by
next week, visit the clinic. Make
sure you can get to the clinic
If your baby is still not here by next week, visit the
clinic. Being pregnant for too long can cause
WHO recommends that prolonged
pregnancies should be induced in order to
safeguard the safety and health of the
42
42
when labour does start.
problems.
Regular, strong contractions are
a sign of labour. If you feel
them, go to the clinic or fetch
your birth attendant. Don't
wait.
After the birth, your body needs time to heal. You may
feel tired and sore, but every day things will improve.
As your body recovers, there are three things you can
do to help speed up healing:
When your baby is here, you
can get help from your health
worker. Talk to your health
worker about anything. She is
your friend.
One: rest. This is very important. Try not to do any
physical labour. Ask family members to help with
household chores.
Two: breastfeed your baby as often as he wants and
for as long as he wants. Breastfeeding will help your
baby grow strong, and it will also help to reduce
bleeding and make your womb shrink back to its
normal size.
Three: eat well. Try to have meals with lots of fruits,
vegetables and meat or lentils. This will encourage
healing and help you make plenty of milk for your
baby. Make sure you drink plenty of clean water, too.
Breastfeeding is thirsty work! You may need to
continue taking iron pills for 3 months after the birth
of your baby.
If you want to do one good thing for your baby this
week, talk to your family about why you need to
breastfeed, rest and eat well.
References
mother and her baby.
Taking time to rest and relax was urged in
many midwife messages at the
International Midwives' Congress in
Durban in June 2011. Not getting enough
rest can lead to complications due to
exhaustion and dehydration.
Maternal under-nutrition affects women's
chances of surviving pregnancy and the
incidence of low birthweight babies.
Serious maternal under-nutrition is
common in sub-Saharan Africa, South Asia
and South-East Asia, and is critical in
Bangladesh, Eritrea and India. Maternal
and child under-nutrition is the single
leading cause of health loss worldwide.
(Blössner and de Onis, 2005.)
Globally less than 40% of infants under six
months of age are exclusively breastfed.
Adequate breastfeeding support for
mothers and families could save many
young lives. (WHO)
Hill M. 2011. Development week by week. University of New South Wales Embryology. embryology.med.unsw.edu.au [Accessed August 2011].
Medline. 2011. Fetal development. Medline Plus Medical Encyclopedia. www.nlm.nih.gov [Accessed August 2011].
Blössner and de Onis (2005). Malnutrition - Quantifying the health impact at national and local levels, Environmental Burden of Disease Series, No. 12. WHO: Geneva.
World Health Organization. 2010. WHO Technical Consultation on Postpartum and Postnatal Care.
World Health Organization. 2007. WHO Recommendations for the prevention of Postpartum Haemorraghing.
Nice. 2010. Weight management before, during and after pregnancy. National Institute for Health and Clinical Excellence. Public health guidance 27.
NICE. 2006. Routine postnatal care of women and their babies. National Institute for Health and Clinical Excellence, Clinical guideline, 37. London: NICE.
USAID/BASICS/ Ministry of Health, Louga, Senegal. (n.d.). Counseling Cards for Maternal and Neonatal Health.
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
Baby
Week
New
born
New
born
New
born
SMS Message
Congratulations, your baby's
here! Give him the best by
breastfeeding. If he refuses to
feed or has difficulty breathing,
go to the clinic.
Hold your newborn baby close to
you and let him breastfeed
straight away. Go to the clinic if
he's too hot, cold or a bluish
colour.
Keep the cord clean and dry to
prevent infection. Sponge it with
clean water. Leave it uncovered.
If it is red or smelly, go to the
clinic.
Audio message
Congratulations! You're a new mother.
Your newborn needs all your love and care. Here are four things you can do to
give him the best start:
One - feed him your precious colostrum straight away. Anything else is harmful.
Two - Sponge the cord stump with clean water and leave it uncovered, clean
and dry. If the navel becomes red, swollen or smelly, take him to the clinic.
Three - keep your baby warm. Cover his head and cuddle him skin-to-skin. Don't
bathe him for at least six hours. When you do, use warm water, dry him quickly
and wrap him in a clean, dry cloth. Try not to swaddle him too tightly when you
wrap him. Don’t put him in direct sunlight.
Four - look out for signs of illness. Take your baby to the clinic if he:
● Has a fit
● Is floppy or inactive
● Has bluish skin or nails
● Is wheezing, grunting, or breathing quickly
● Is very hot or very cold
● Has sunken or swollen soft spots on his head
Partner Notes
Replace 'colostrum' with local word for it
If chlorhexidine is recommended in your
locality, please add it to the message.
The recommendation is to feed the baby
colostrum within the first hour of birth. We
have said 'straight away' instead of 'within
first hour' because the mother, having just
given birth, may not be conscious of the
time and there may not be a clock in the
room visible to the mother. Replace 'straight
away' with 'within first hour' if you feel it is
more appropriate for your community.
Every year, nearly 41% of all under-five child
deaths are among newborn infants; babies
in their first 28 days of life or the neonatal
period.
Three-quarters of all newborn deaths occur
●
●
●
Won't stop crying or is crying strangely
Is not suckling well
Is passing urine less than six to eight times daily.
If you want to do one good thing for your baby this week, feed him your
precious breastmilk.
References
Lancet 2005. Newborn Survival Series
World Health Organization. 2010. WHO Technical Consultation on Postpartum and Postnatal Care.
World Health Organization. 1998. Maternal and Newborn Health Safe Motherhood. Care of the Umbilical Cord: A review of the evidence.
WHO Technical Consultation. 2004. 'Towards the development of a strategy for promoting optimal fetal growth', Report
of a meeting (draft), World Health Organization, Geneva.
in the first week of life.
Up to two thirds of newborn deaths can be
prevented if effective health measures are
provided at birth and during the first week of
life. Sources: 2005 World Health Report:
Make Every Mother and Child Count (WHO)
and The Lancet's Newborn Survival Series
(2005) and UNICEF (2008)
If the practise is to give an antiseptic on the
cord stump, it's important to let the mother
know that nothing else should be put on the
baby's cord stump.
If babies are routinely given eye ointment or
eye drops at hospital, add it here.
In some countries (such as Senegal), a
mother is given Vitamin A after birth, before
she goes back home from the health facility.
Please add this if applicable in your target
area.
Please choose which term is most applicable
(hospital / clinic / health centre).
Use the local term for 'health worker'.
WHO/UNICEF joint statement: Postnatal
care visits for facility birth on day three and
seven of the newborn's life.
PNC visits for home births: days one, three
and seven of the newborn's life.
WHO. 2005. World Health Report: Make every mother and child count
UNICEF. 2004. Low Birth Weight: Country, Regional and Global Estimates; Geneva.
National Neonatology Forum of India- WHO Collaborating Centre for Training and Research. 2005. Teaching Aids on Newborn Care. New Delhi.
Opio, N., & English, M. (2011). What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A systematic review. Arch Dis Child,1052–1059.
Chowdhury, H., Thompson, S., Ali, M., Alem, N., Yunus, M., & Streatfield, P. (2011). Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh. BMC Pediatrics.
USAID/BASICS/ Ministry of Health, Louga, Senegal. (n.d.). Counseling Cards for Maternal and Neonatal Health.
WHO (2006), Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf?ua=1
1
Keep your baby quiet and warm.
If his eyes are yellow, breastfeed
him more often. If the yellow
stays longer than a week, go to
the clinic.
1
Let your baby feed often. He
needs a good mouthful of breast
to get your milk. You will see his
jaw moving as he feeds and hear
him swallow.
Take your baby to the clinic if he
won't stop crying, has sunken or
swollen soft spots on his head or
is not suckling well.
1
Your baby can blink, suck, grasp and search for your nipple.
Your baby's skin may develop a yellowish tinge a few days after she is born. You
may also notice a yellowish colour in the white of her eyes. Your breastmilk will
help get rid of this yellowness. Breastfeed more often. If your baby was born
after 9 months of pregnancy, it may take up to a week for her skin and eye
colour to return to normal. It may take longer if she was early. If your baby's
eyes are still yellow by the end of this week, take her to your health worker.
She will give your baby treatment.
Sticky eyes are common, too. You can treat it at home. Wipe each eye with a
clean cloth soaked in cool boiled water. Use a different cloth for each eye and
wash your hands before and afterwards. If your baby's eyes are still sticky, take
her to the clinic. It could be an infection.
If you want to do one good thing for your baby this week, help her get stronger
by feeding her ONLY your breastmilk and plenty of it.
Every year, nearly 41% of all under-five child
deaths are among newborn infants; babies
in their first 28 days of life or the neonatal
period.
Jaundice is a common condition in newborn
infants caused by high levels of bilirubin,
which may cause chronic bilirubin
encephalopathy (kernicterus). Jaundiced
newborns have yellowing of the skin and the
whites of the eyes. This condition is common
in more than 70% of newborns. Source:
WHO Medical Devices.
References
NICE. 2006. Routine Postnatal Care of Women and Their Babies. National Institute of Health and Clinical Excellence.
NICE. 2010. Neonatal jaundice. National Institute of Health and Clinical Excellence.
National Neonatology Forum of India- WHO Collaborating Centre for Training and Research. 2005. Teaching Aids on Newborn Care. New Delhi.
Opio, N., & English, M. (2011). What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A systematic review. Arch Dis Child,1052–1059.
Chowdhury, H., Thompson, S., Ali, M., Alem, N., Yunus, M., & Streatfield, P. (2011). Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh. BMC Pediatrics.
USAID/BASICS/ Ministry of Health, Louga, Senegal. (n.d.). Counseling Cards for Maternal and Neonatal Health.
WHO. Medical Devices : Jaundice - Innovative LED Photography http://www.who.int/medical_devices/initiatives/poster_1.2.pdf
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge
Rotunda Hospital Dublin. Partent Factsheet: Newborn Eyes.
WHO (2006), Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf?ua=1
2
Some bleeding after birth is
normal. But if you soak more than
After all the changes of pregnancy and the hard work of labour, your body is
healing. Your womb, which stretched to fit your baby, is now shrinking.
Postpartum haemorrhage (PPH; excessive
bleeding after birth) is a leading cause of
2-3 pads in 20 minutes or the
bleeding gets heavier, go to the
clinic.
2
2
Look out for signs of infection. If
your discharge smells, your
tummy hurts or you have a fever,
go to the clinic for help.
Are you irritable and weepy? This
is quite common among new
mothers. Talk to someone about
it, get some rest, and make sure
you eat well.
It's normal to lose some blood after birth. This is because the lining of your
womb is breaking up. You might bleed a lot at first, but it will slowly get lighter
and stop.
Change your pads or rags every 4-6 hours, or you may want to change more
frequently if bleeding is heavy. Remember to wash the used rags properly or
dispose of them safely.
Breastfeeding helps to prevent heavy bleeding.
It is common to feel nauseated or have a headache. It will pass in a couple of
days. However, sometimes there are problems with a mother's recovery. Look
out for these signs:
● Sudden heavy bleeding, or if you soak more than 2 pads in 30 minutes
● Large blood clots
● Faintness or dizziness
● Smelly discharge
● Tummy pain
● Fever
● Pain in private parts
● Painful urination or dribbling urine.
If you spot any of these signs, get help at the clinic fast. Clinic staff will be able
to help you and give you any treatment you need.
Also go to the clinic if you had fits during labour or after birth. It may be a sign
of a serious illness, such as eclampsia, malaria or meningitis.
You may feel irritable and weepy. This is usually because of all the changes your
body is going through. You will feel better in a few days, but if you don't, talk to
a health worker about it. Have a daily wash. This will make you feel clean and
fresh.
If you want to do one good thing for your baby this week, keep breastfeeding
him to prevent heavy bleeding.
maternal death.
Main causes of mortality are due to a lack of
skilled help and a failure to prevent
haemorrhage from occurring.
In many developing countries, confinement
rules mean that the mother may not be able
to make postnatal visits to the clinic. If this is
the case in your area, address the issue and
emphasise the importance of seeing a health
worker as soon as possible.
WHO/UNICEF recommends:
-
Postnatal care visits for facility birth
on Day 3 and 7 of newborn's life
-
PNC visits for home births: Days 1, 3
and 7 of newborn's life.
It is important that women and their families
recognise the early signs of illness in their
babies and seek help.
References
World Health Organization. 2010. WHO Technical Consultation on Postpartum and Postnatal Care
NICE. 2006. Routine postnatal care of women and their babies. National Institute for Health and Clinical Excellence, Clinical guideline, 37. London: NICE.
USAID/BASICS/ Ministry of Health, Louga, Senegal. (n.d.). Counseling Cards for Maternal and Neonatal Health.
WHO (2006), Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf?ua=1
3
Your breastmilk is making your
Your baby will grow well on your breastmilk. He needs nothing else, not even
WHO recommendation: Exclusive
3
3
baby strong. Feed him 8-10 times
a day, with night time feeds too.
Don't give him water or anything
else.
A well fed baby will have a full
belly and a sleepy smile! During
growth spurts he will feed more.
This will increase your milk
supply.
The longer your baby feeds each
time, the richer your milk will
become. Let her fall asleep at the
breast. You can rest while you
feed.
water.
Feed your baby at least eight to ten times a day. During growth spurts, he will
feed more often to increase your milk supply.
If your nipples are sore, check that he has some of the dark area around the
nipple in his mouth, and that his jaw is moving up and down. He needs plenty of
the breast in his mouth to get enough milk.
Listen; can you hear him gulping the milk, with short rests in between
swallows? If his cheeks are sucked in or you hear a clicking noise, he is not
properly on the breast. Take him off and try again.
The longer he feeds, the richer your milk will become. Let him feed until he has
had enough so he gets plenty of rich hind-milk, which will help him grow, put
on weight and sleep.
Make sure you empty one breast before switching to the next. The next time
you breastfeed, start with the other breast.
If you want to do one good thing for your baby this week, check that he is
feeding well.
breastfeeding for six months. Introduction of
solids at six months and continued
breastfeeding for two years.
Breastmilk provides all the energy and
nutrients that an infant needs during the
first six months of life. Exclusive
breastfeeding reduces infant deaths caused
by common childhood illnesses such as
diarrhoea and pneumonia, hastens recovery
during illness, and helps space births. MCHIP
FAQs 2004.
Breastfeeding has to be learned and many
women encounter difficulties at the
beginning. Nipple pain, and fear that there is
not enough milk to sustain the baby, are
common issues. Mastitis, as a result of
engorgement, can be fatal if not properly
treated. It can lead to reduced feeding due
to pain and increased risk of HIV
transmission. WHO 2007
References
Pellegrini L, Sguassero Y.(WHO) Support for breastfeeding mothers: RHL commentary (last revised:24 September 2007) The WHO Reproductive Health Library
World Health Organization. 2010. WHO Technical Consultation on Postpartum and Postnatal Care.
World Health Organization. 2003. Kangaroo Mother Care: A Practical Guide.
MCHIP. 2004. Exclusive Breastfeeding: The Only Water Source Young Infants Need. http://www.mchip.net/sites/default/files/FrequentlyAskedQuestions_Water_eng.pdf
MCHIP. 2008. Community-Based Care for Low Birth Weight Newborns:The Role of Community Skin-to-Skin Care. Washington, DC., http://www.mchip.net/sites/default/files/KMC_Meeting_Report_08-25-08.pdf
USAID/BASICS/ Ministry of Health, Louga, Senegal. (n.d.). Counseling Cards for Maternal and Neonatal Health.
4
4
Your baby will look into your eyes
now as you talk to her. If she is
floppy and unresponsive, take her
to the clinic to get checked out.
You can be sure your baby's
getting enough milk if he wets 6-8
Your baby is now a month old! She is holding your gaze steadily and can
probably lift her head when lying on her stomach.
Here are three ways to know your baby is getting enough milk.
One: count her wet nappies. Six to eight wet nappies a day shows that she is
getting enough to drink.
Two: check that she has a healthy colour, and that her tummy looks full after a
When a baby suckles ineffectively, transfer
of milk from mother to baby is inefficient. As
a result, the breast may become engorged,
or may develop a blocked duct or mastitis
because not enough milk is removed.
Additionally, the baby's intake of breastmilk
nappies daily. If not, feed him
more and get him checked at the
clinic.
4
After a feed, your breasts should
feel soft and empty. Let your
baby feed until she comes off the
breast, so she gets lots of lovely
milk.
feed. She should also seem settled.
Three: your breasts should feel emptier and softer after feeds. This means that
your baby is able to latch on and suck well. She will get not just the watery
foremilk, which is a good drink for her, but also the richer milk that comes later
in the feed, which helps your baby grow. Feed her until she is done. Your
nipples should not be sore if your baby is fixed on properly.
Take your baby to the clinic if you don't see these signs. The health worker will
find out why she is not feeding well.
If you want to do one good thing for your baby this week, check the number of
wet nappies she has.
may be insufficient, resulting in poor weight
gain. WHO Infant and Young Child Feeding
2006.
References
World Health Organization. 2006. Infant and Young Child Feeding: An Integrated Course.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge
5
5
5
Do you have sore, pink, cracked
nipples? It could be a yeast
infection. Go to the clinic with
your baby. You will both need
treatment.
Vaccines protect your baby
against diseases which can kill.
This week your baby will need
vaccines. Take him to the clinic
for them.
You should feel stronger now. If
you have smelly or painful
discharge or bleeding, visit the
clinic. Take iron pills for another 2
months.
Have you noticed your baby smiling? Encourage him to smile by cuddling,
tickling, and playing with him.
It's important your baby gets his vaccines on time. Vaccines protect him from
dangerous illnesses, such as tuberculosis and polio. They help your baby fight
off diseases.
Your baby will sometimes need more than one dose of the vaccine to be fully
protected from the disease. It's important you take your baby for all the doses
at the right time, so he gets all the protection he needs.
This week, your baby is due to get vaccinated against many dangerous diseases.
Get your baby vaccinated, even if he has a cold. It's safe. Don't leave the clinic
before finding out when you should come again for more vaccinations.
It can be upsetting to watch your baby get vaccinated. Give him a cuddle and
breastfeed him. This will help calm you both. He may be a bit sore for a few
days where he got the jab, but this will pass.
If you want to do one good thing for your baby this week, make plans with your
family to make sure you baby has all his vaccines on time.
Replace “tuberculosis” and “polio” with the
more feared diseases of the area.
Vaccinations at 6 weeks:
Bangladesh: DTP, Hib, HepB, OPV
India: DTP, HepB, OPV
South Africa: DTP, Hib, IPV, OPV, Hep B,
Rotavirus, Pneumo conj
In some countries (such as Senegal), mothers
are given Vitamin A and deworming
treatment in the postpartum period. Please
suggest these if applicable in your target
area.
Adapt to vaccine schedule in your country.
Use this link to the WHO to check your
country's immunisation programme:
http://apps.who.int/immunization_monitori
ng/en/globalsummary/ScheduleSelect.cfm
This message should be moved to week 7 or
8 in countries where the first vaccines (after
the birth doses) begin at 2 months rather
than 6 weeks.
References
www.cdc.gov
USAID. 2003. Immunisation Essentials: A Practical Field Guide.
MCHIP/USAID. (n.d.). Immunisation Ready Reference for Health Workers. Retrieved November 7, 2011, from MCHIP: http://www.mchip.net/node/510
WHO. 2006. Tetanus vaccine: WHO Position Paper. Weekly epidemiological record 20.
USAID/BASICS/ Ministry of Health, Louga, Senegal. (n.d.). Counseling Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill
Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: RoutledgeCards for Maternal and Neonatal Health.
Summary of WHO position papers – recommended routine immunisations for children (Tables 1 & 2)
http://www.who.int/immunization/policy/Immunization_routine_table1.pdf
http://www.who.int/immunization/policy/Immunization_routine_table2.pdf
WHO (2006), Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf?ua=1
6
6
6
When you pick your baby up, you
will notice he is getting heavier.
This is a good sign. Your milk
alone is helping him grow.
Feed your baby ONLY breastmilk.
This prevents pregnancy until
your baby turns 6 months as long
as your menses haven't returned.
Take some time every day to
watch your baby breathing. If it is
rapid and shallow, he may be ill
and need treatment at the clinic.
thrush
References
Your baby can probably recognise you and your partner. She may smile when
she sees you both, and coo or kick with happiness.
Breastfeeding is the best thing for your baby, but it's not always simple.
Some women and babies suffer from a yeast infection. It can affect your breasts
and your baby's mouth. It can make breastfeeding painful.
If your nipples are sore, pink, cracked or itchy, you may have a yeast infection.
There may also be white areas in the folds of your nipples.
Your baby may have small white patches in her mouth. The patches will be on
the tongue and on the sides of the mouth. She may pull away from the breast
when feeding because it's sore. Don't wash her mouth with water. Washing
could make things worse.
If you notice any of these signs, go to the clinic. You can still breastfeed whilst
being treated.
If you want to do one good thing for your baby this week, look out for signs of a
yeast infection and keep breastfeeding.
Healthy babies under two years old often get
oral thrush. If left untreated, the infection
can pass between the mother's nipples and
the baby's mouth.
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.
The Lancet. 2006. Family planning: the unfinished agenda. The Lancet sexual and reproductive series.
WHO. 2005. Report of a WHO Technical Consultation on Birth Spacing USAID/ACCESS. 2008. THE LACTATIONAL AMENORRHEA METHOD (LAM): A Postpartum Contraceptive Choice for Women Who Breastfeed.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge
7
When you talk to your baby, he'll
respond by waving his arms and
legs. Take him to the clinic every
month to make sure he is growing
well.
7
Is your baby floppy, pale or not
feeding well? He is ill. Keep him
warm with a blanket and hat and
go to the clinic.
7
A healthy baby is curious, gains
weight and turns towards sounds.
If you are worried about your
baby, get help at the clinic.
Your baby may stop what he's doing to listen to you when you speak. Talk
directly to your baby, repeating his coos and noises.
You probably have lots of questions about whether your baby is doing well. You
can tell your baby is healthy if he is:
● Curious. He may also be quiet sometimes. This shows that he is
watching the world around him.
● Gaining weight. Is he getting heavier to pick up? This shows he is
feeding well.
● Turning towards new sounds. This shows that he hears well and is
learning about different sounds.
All babies develop at different speeds. Take your baby for regular checkups.
Your health worker at the clinic will monitor his growth.
If your baby is ill, take him to the clinic. The staff at the clinic can find out what's
wrong and give your baby the right treatment straight away. Check with your
health worker before giving your baby any medicine.
If you want to do one good thing for your baby this week, explain to your family
the importance of taking your baby to the clinic for regular check-ups even if he
is healthy.
This message alerts the mother to early signs
of ill health and encourages her to seek
timely care for her baby.
References
Opio, N., & English, M. (2011). What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A systematic review, Arch Dis Child, 1052–1059.
Chowdhury, H., Thompson, S., Ali, M., Alem, N., Yunus, M., & Streatfield, P. (2011). Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh. BMC Pediatrics.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge
WHO. 2008 Fact Sheet.
http://www.who.int/mediacentre/factsheets/fs134/en/
8
Keep your baby off the ground,
away from direct sunlight. Put
Your baby is now two-months-old. Well done! She is growing very fast, but with
your help she can grow to be even stronger and healthier.
Breastmilk provides all the energy and
nutrients that an infant needs during the
him on his tummy on a clean
blanket or mat to play. He can lift
his head now.
8
8
Stools have germs that cause
many diseases. Get rid of stools
safely and wash your hands with
soap afterwards. This prevents
illness.
Your baby does not need water
even when it's hot. Your
breastmilk has all the water he
needs, and it's clean and safe.
Water may not be.
Here are three ways to help your baby stay healthy:
First: breastfeed your baby as often as she wants, day and night. Your
breastmilk contains everything your baby needs to thrive. Don't give her
anything else, not even water.
Second: make sure your baby has all her vaccinations. Vaccinations will protect
her from serious illnesses at the start of her life. It's important that you take
your baby to the clinic for her vaccines.
Third: keep your home and your hands clean. Wash your hands with soap to
keep your hands clean and germ-free. Wash your hands whenever you use the
toilet and before cooking and eating. Clean them whenever you change your
baby's nappy and after you dispose of her stools. Dispose of your baby’s stools
in a latrine. Keep your baby's clothes, bedding and play area clean, too.
If you want to do one good thing for your baby this week, ask your family
members to wash their hands with soap often.
first six months of life. Exclusive
breastfeeding reduces infant deaths caused
by common childhood illnesses such as
diarrhoea and pneumonia, hastens recovery
during illness, and helps space births. MCHIP
FAQs 2004.
Immunisation has been called the most
important public health intervention in
history, after safe drinking water. It has
saved millions of lives over the years and
prevented hundreds of millions of cases of
disease.
(www.cdc.gov))
Handwashing interventions reduced the
incidence of diarrhoeal diseases by 32% in
low and middle income countries, and 39%
in high income countries (Ejemot et al. 2008)
If soap is not readily available, mention
where the mother can get some from, or
alternatives she could use.
References
Ejemot. R.I. et al 2011 Hand washing to prevent diarrhoea (review) Cochrane Library
www.cdc.gov
USAID. 2006. Immunisation Essentials: A Practical Field Guide 2003
World Health Organization. Infant and Young Child Feeding: An Integrated Course.
UNICEF. 2011. Water, Sanitation and Hygiene Annual Report 2010
WHO. 2000. Food borne disease: a focus for health education.
WHO. 2003. Healthy Villages – A Guide for Communities and Community Health Workers.
WHO. 2001. Water for Health: Taking Charge.
World Health Organization. 2006. Infant and Young Child Feeding: An Integrated Course.
USAID. 2003. Immunisation Essentials: A Practical Field Guide
WHO. 2010. Nutrition health topics: exclusive breastfeeding. World Health Organization
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
9
Your baby is 2-months-old. Your
precious milk will help him gain
nearly a kilo this month. Keep
breastfeeding. He needs nothing
else.
Are your baby's stools suddenly
loose and watery? Breastfeed him
often and see your health worker.
Give extra breastfeeds after he
recovers.
Your baby's next set of vaccines is
due. Take her to the clinic for
them. If she cries soon after, your
breastmilk will help soothe her.
Your baby is growing steadily. To help him stay safe and healthy, remember to
get his vaccinations. They are due soon. Make sure you can get to the clinic for
them.
Some young breastfed babies pass stools four times a day or more; others may
only pass stools once every three days. Both are normal. Your baby's stools will
be soft and easy to pass. He may strain and cry, but it doesn't mean there's a
problem.
Your baby probably passes stools at the same time every day. They will range in
colour from greenish-brown to bright mustard yellow. They may smell slightly
sweet.
If you see bright green and frothy stools in your baby's nappy, he's probably not
getting enough rich hind-milk. Try feeding your baby on each breast until that
breast is empty so he gets the rich hindmilk. Next time you breastfeed, start
with the other breast.
Babies who get only breastmilk and nothing else suffer less from diarrhoea or
constipation than babies who are given water or other foods.
But if he has diarrhoea, his stools will be loose and watery. Give him extra
breastfeeds to replace the fluid he is losing.
If you want to do one good thing for your baby this week, keep giving
breastmilk and nothing else.
Leading causes of death in under-five
children are pneumonia, diarrhoea, malaria
and health problems during the first month
of life.
Nearly two million children die from
diarrhoea every year.
Source: WHO / UNICEF 2011
Most countries recommend basic vaccines
(OPV and DTP-Hib-Hep B) at 6, 10, & 14
weeks, but some use a 2, 3 and 4 months
schedule (and there may be other variations
that I'm unfamiliar with). In these cases, the
vaccine messages should be moved to
appropriate weeks.
References
WHO/UNICEF. 2011. Diarrhoea: why children are still dying and what can be done
MOST. 2005. Diarrhoea Treatment Guidelines.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
UNICEF. 2012. Diarrhoea. http://www.unicef.org/health/index_43834.html. [Accessed on 3 June 2014]
WHO. 2011. Zinc supplementation in the management of diarrhoea. http://www.who.int/elena/titles/bbc/zinc_diarrhoea/en/. [Accessed on 3 June 2014]
WHO. 2013. Diarrhoeal Disease. http://www.who.int/mediacentre/factsheets/fs330/en/ [Accessed on 3 June 2014]
10
Your health worker may give you
iron and folic-acid pills to take for
the next few months. They will
help you recover from the birth.
Swaddle your baby with a cotton
Your baby will have regular times when she is awake and wants your attention.
Talk to her and smile at her. Watch her respond.
You need to be fit and well to look after your baby. Eat two extra mouthfuls at
meals, or an extra snack during the day.
Ask a health worker if you need to take iron and folic-acid pills. These pills will
In many areas iron and folic-acid
supplements are given for the first three
months after the birth.
In India, 88% of pregnant women and 74% of
non-pregnant women have anaemia. In
cloth to help her feel warm and
secure. But don't swaddle her too
tightly or cover her face. It may
suffocate her.
Eating well makes you strong. Try
to eat 2 extra handfuls of food
every meal. Eat plenty of meat,
eggs, lentils, peas and beans.
make you strong again. Take them with some orange or citrus juice. This will
help your body to absorb the iron.
There is also iron in meat, fish, eggs, lentils, beans, and chickpeas. Eat some of
these foods daily.
Coffee, tea and milk may prevent your body from absorbing iron. Try not to
have more than one cup of tea or coffee per day. Drink them two hours before
or after having iron. Only drink alcohol occasionally as it can reduce the amount
of milk your baby takes.
If you want to do one good thing for your baby this week, share and discuss this
message with your family so they help you eat well.
Africa, 50% of pregnant and 40% of nonpregnant women are anaemic. UNICEF/WHO
1999.
Please suggest food items that are easily
available in your area.
References
UNICEF/WHO. 1999
Prevention and Control of Iron Deficiency Anaemia in Women and Children.
World Health Organization. 2006. Infant and Young Child Feeding: An Integrated Course.
World Health Organization/ Food and agriculture organization. 2006. FAO/WHO technical consultation on national food-based dietary guideline.
11
Baby crying? Try breastfeeding
her, swaddling or rocking her
gently. These will all help to
soothe her.
Take some time every day to
watch your baby breathing. If it is
rapid and shallow, he may be ill
and need treatment at the clinic.
Crying is normal for babies, but if
your baby is crying non-stop, or
cries strangely, get him checked
at the clinic. He may be ill.
All babies cry. It's how they communicate. Some cry more than others. There
are many reasons why babies cry. Sometimes hunger is the reason. So if he
cries, let him breastfeed as long as he wants. He will soon be soothed as his
tummy fills.
Babies also cry if they feel uncomfortable. Check if your baby's clothes are too
tight, or if his nappy is soiled.
He may also be feeling too warm or too cold. Check how many layers of
clothing he has on. He should be cosy with just one more layer of clothing than
you.
Your baby may also just want to rest or be held.
Here are three ways to comfort your crying baby:
One: swaddle him in a blanket. Babies like to feel snug and secure like they did
in the womb.
Two: hold him against you with a sling. The rhythm of your heartbeat may
soothe him.
Crying is something all parents will
experience. This message gives the mother
the tools she needs to cope with it. This will
empower her.
Recognizing that unusual crying is a sign of
illness is important to ensure prompt
medical attention is sought.
Three: sing to him or rock him gently.
If your baby cries nonstop, or the cry is more high-pitched than normal, take
him to the clinic.
If you want to do one good thing for your baby this week, try different ways of
comforting your baby and take him to the clinic is he continues to cry.
References
St James-Roberts. 2008. Infant crying and sleeping: helping parents to prevent and manage problems. Primary Care 35(3):547-67
NCCPC. 2006. Postnatal care: Routine postnatal care of women and their babies. National Collaborating Centre for Primary Care. www.nice.org.uk
USAID/BASICS/ Ministry of Health, Louga, Senegal. (n.d.). Counseling Cards for Maternal and Neonatal Health.
12
Your baby loves the sound of your
voice. Talk and sing to him every
day. Make eye contact and smile.
He will smile back!
A fever, shivering and rapid
breathing are signs of an ill baby.
Go to the clinic. They will give the
right medicine.
Your breasts may feel softer now.
Don't worry, you still have plenty
of milk. Your body now knows
just how much milk your baby
needs.
Congratulations! Your baby is three months old! She is making great progress.
She'll love hearing your voice. Try telling her stories. It will help her learn how
to talk later on.
You may worry whether your baby is well. Here are three signs to look out for:
One: if your baby has a fever, she needs to be checked at the clinic. Check your
baby's temperature by feeling her tummy, hands and feet. They should all be
warm - not too hot or cold.
Two: if your baby is crying non-stop, it could mean she is ill. If she is crying more
than usual, her cry is high-pitched, or if she's constantly whimpering and
moaning, take her to the clinic.
Three, watch out for fewer feeds. If your baby refuses feeds for more than eight
hours, or if she feeds less than usual, take her to the clinic.
If you want to do one good thing for your baby this week, make sure she
breastfeeds enough.
Every year, nearly 41% of all under-five child
deaths are among newborn infants, babies in
their first 28 days of life or the neonatal
period.
Up to two thirds of newborn deaths can be
prevented if effective health measures are
provided.
Sources: 2005 World Health Report: Make
Every Mother and Child Count (WHO) and
The Lancet's Newborn Survival Series (2005).
References
The Lancet. 2004. Executive Summary of Lancet Neonatal Survival Series.
World Health Organization. 2010. Countdown to 2015.
Opio, N., & English, M. (2011). What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A systematic review. Arch Dis Child,1052–1059.
Chowdhury, H., Thompson, S., Ali, M., Alem, N., Yunus, M., & Streatfield, P. (2011). Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh. BMC Pediatrics.
USAID/BASICS/ Ministry of Health, Louga, Senegal. (n.d.). Counseling Cards for Maternal and Neonatal Health.
WHO. 2005. World Health Report: Make Every Mother and Child Count
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
13
Your baby will stay awake for a
longer time during the day now.
All the more time to play with
him!
You can express breastmilk and
leave it for someone else to feed
your baby with a spoon. Keep
your milk in a cool place for up to
6 hours.
Are you feeling sad all the time?
Talk to your health worker about
this. Ask your family to help you
eat well and get plenty of rest.
Look out for signs of your baby rolling over – he may surprise you! Don't leave
her where she could roll off and hurt herself.
If you want to leave your baby with someone else, express your milk by
squeezing just behind the nipple. Massage your breast or warm it with cloths
dipped in warm water to help the milk flow. Store it in a clean container. It
remains fresh for six hours in a cool place. Your baby can drink the breastmilk
from a clean cup or spoon. Put a little on her tongue so she gets the taste. Then
put the cup or spoon next to her lip. She will learn to lap the breastmilk with
her tongue.
If you want to do one good thing for your baby this week ask your health
worker about expressing and storing your milk.
It is important that the mother continues to
exclusively breastfeed her baby throughout
the first six months. Expressing milk is the
best way to ensure this happens if the
mother has to go out without her baby.
Globally less than 40% of infants under six
months of age are exclusively breastfed.
Adequate breastfeeding support for mothers
and families could save many lives.
WHO. 2011. Factsheet
References
World Health Organization. 2000. Mastitis: Causes and Management.
World Health Organization. 2006. Infant and Young Child Feeding: An Integrated Course.
WHO/UNICEF. 1993. Breastfeeding counseling: a training course.
Pellegrini L, Sguassero Y. (WHO) Support for breastfeeding mothers: RHL commentary (last revised:24 September 2007) The WHO Reproductive Health Library
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
14
Your baby probably loves hearing
voices. Why not sing a lullaby or
tell her a bed-time story before
bed today? Dads can join in as
well.
Your baby's next set of
immunisations are due. They will
help protect against many
diseases. Ask at the clinic.
Let your baby sleep inside an
insecticide-treated net so
mosquitoes don't bite him. If the
Your baby probably loves hearing voices. Why not start telling her a bed-time
story before bed today? Dads can join in as well.
Mosquitoes can give your baby illnesses such as malaria and dengue. Malaria
and dengue are harmful, but easy to prevent.
Mosquitoes breed in still water. Clear away any water that has gathered in or
around your house. Empty old pots and vases.
Dark colours attract mosquitoes. Dress your baby in light-coloured, longsleeved clothes.
Make sure your baby sleeps under an insecticide-treated bed net all year round.
This will also protect her from bites. Insecticide-treated nets are cheap and
effective.
Sprays and creams are also very good. Some aren't safe for babies, though, so
check first. Don't spray your baby, instead spray her clothes.
About 5.5 lives can be saved each year for
every 1000 children protected with ITNs
(Insecticide-Treated Nets). C. Lengeler 2004.
8% of deaths of children aged under five
were caused by malaria in 2008. WHO 2008
We have suggested asking an NGO for a net.
If nets are available elsewhere, please
mention this.
If Intermittent Preventative Treatment for
infants is practised in your country, please
add information about it.
If ITNs are provided by the government,
net has a hole, stitch a piece of
cloth over it.
If your baby has a fever, shakes or breathes fast, she might have malaria or
dengue. Take her to the clinic as soon as you notice a fever or chills.
To keep your baby safe from other illnesses, make sure you take her to the
clinic to get her vaccinations.
If you want to do one good thing for your baby this week, use an insecticidetreated net.
please adjust.
References
Lengeler. C.2011. 'Insecticide-treated Bed Nets and Curtains for Preventing Malaria (Review) Cocharane Collaboration
WHO. 2008. http://www.who.int/gho/child_health/mortality/causes/en/index.html
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
WHO. (2009). Dengue – Guidelines for diagnosis, treatment, prevention and control. http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf?ua=1 [Accessed on 23 May 2014]
WHO. 2014. Climate change and infectious diseases. http://www.who.int/globalchange/publications/climatechangechap6.pdf [Accessed on 23 May 2014]
WHO. 2014. Water sanitation health. http://www.who.int/water_sanitation_health/hygiene/emergencies/envsanfactsheets/en/index2.html [Accessed on 23 May 2014]
UNICEF. 2014. Press release - UNICEF supplies 150,000 mosquito nets in Bangui as rainy season approaches. http://www.unicef.org/media/media_72863.html [Accessed on 23 May 2014]
WHO, CDC, USAID, Republic of Ghana. Malaria in Pregnancy- Training Manual for Health Providers.
WHO. 2010. Guidelines for the Treatment of Malaria.
WHO Global Malaria Programme. World Malaria Report 2010.
WHO. 2005. Strategic Orientation Paper on Prevention and Control of Malaria.
WHO. 2004. Malaria Epidemics: Forecasting, Prevention, Early Detection and Control. From Policy to Practise.
WHO. Global Malaria Programme. Insecticide-Treated Mosquito Nets: a WHO Position Statement.
WHO. 2007. EMRO Technical Publications Series 34. Guidelines on prevention of the reintroduction of malaria.
WHO. 2004. A Strategic Framework for Malaria Prevention and Control During Pregnancy in the African Region.
USAID, ACCESS. 2007. Preventing Malaria in Pregnancy Through Focused Antenatal Care: Working with Faith-Based Organizations in Uganda.
WHO. 2007. Malaria in Pregnancy - Guidelines for measuring key monitoring and evaluation indicators
Gitau,G.M. and John M.E. 2005. Malaria in pregnancy: Clinical, Therapeutic and Prophylactic Considerations. Review. The Obstetrician & Gynaecologist 7 :5–11
15
Your baby is looking at the world
around him now. Give him
different toys and objects to look
at. Keep his toys clean.
Wash your hands before cooking
and eating and after using the
toilet. Set up a washstand with
soap and water near the kitchen
When you place your baby on his stomach, he may lift his head and shoulders
high, using his arms for support. Give him different toys and objects to look at.
Washing your and your baby's hands is one of the easiest ways to preventing
illness. Use clean water and soap.
Wash your hands after going to the toilet, or when disposing of stools. Toilets
and stools are home to germs. Try to keep latrine areas clean. This will prevent
germs from breeding.
Wash your hands before preparing your family's food, and before expressing
your breastmilk.
Diarrhoea remains the second leading cause
of death among children under five globally.
Nearly one in five child deaths – about 1.5
million each year –are due to diarrhoea. It
kills more young children than AIDS, malaria
and measles combined.
(WHO/UNICEF 2011)
Handwashing interventions reduced the
incidence of diarrhoeal diseases by 32% in
and toilet.
If your baby has diarrhoea,
breastfeed him more. If it lasts
over a day, visit the clinic. He may
need oral rehydration salts (ORS)
and zinc.
If your baby passes more stools than usual, or his stools are very watery, he
probably has diarrhoea. If he has diarrhoea, it's important he keeps
breastfeeding so he stays nourished and doesn't lose fluids. If your baby's
diarrhoea lasts for more than a day, take him to clinic. He may be given ORS
and zinc.
If you want to do one good thing for your baby this week, set up a washing
stand with soap and water near where you prepare food and where you go to
the toilet.
low and middle income countries, and 39%
in high income countries. (Ejemot et al.
2008)
References
Ejemot. R.I. et al 2011 Hand washing to prevent diarrhoea (review) Cochrane Library
WHO/UNICEF. 2011. Diarrhoea: why children are still dying and what can be done.
MOST. 2005. Diarrhoea Treatment Guidelines.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
UNICEF. 2012. Diarrhoea. http://www.unicef.org/health/index_43834.html. [Accessed on 3 June 2014]
WHO. 2011. Zinc supplementation in the management of diarrhoea. http://www.who.int/elena/titles/bbc/zinc_diarrhoea/en/. [Accessed on 3 June 2014]
WHO. 2013. Diarrhoeal Disease. http://www.who.int/mediacentre/factsheets/fs330/en/ [Accessed on 3 June 2014]
16
Your baby can see more clearly
now. He can see your clothes and
hair and will try to grab them! If
his eye gets infected, visit the
clinic.
Smoke from cooking inside can
lead to breathlessness and illness.
Open windows when cooking to
keep you and your loved ones
healthy.
Your body is able to make as
much breastmilk as your baby
wants. Feed him only your
breastmilk whenever he wants.
He needs nothing else.
Your baby is probably curious about everything now. You might notice she
stops and pays attention if you talk to her. She may even make noises back. She
can see more clearly now, and may grab at your clothes and hair. If her eye gets
infected, visit the clinic.
Your baby's appetite may have increased. So give her more feeds. Breastmilk is
still all she needs. Nothing else.
Here are the top three reasons why you are doing such a great job
breastfeeding.
Breastmilk is packed with goodness. It has everything your baby needs to grow
smart and strong and stay protected against diseases.
Breastmilk changes to suit your baby. As she grows, the type and amount of
milk you make will change. Your baby will always have what she needs.
Breastfeeding can act as a method of family planning. By feeding your baby only
breastmilk for six months, day and night, you can help to delay your period.
If you want to do one good thing for your baby this week, keep breastfeeding,
and don't give your baby anything else, not even water.
Breastmilk contains all the nutrients an
infant needs in the first six months of life. It
protects against common childhood diseases
such as diarrhoea and pneumonia. It may
also have longer-term benefits, such as
lowering mean blood pressure and
cholesterol, and reducing the prevalence of
obesity and type-2 diabetes.
Source MCHIP 2004 Factsheet.
Short birth to pregnancy intervals (six
months or less), are associated with a high
risk of maternal morbidity. Intervals of 18
months or less are associated with higher
rates of infant mortality, preterm birth and
low birth weight. Source: WHO (in
accordance with USAID) Technical
Consultation on Birth Spacing.
References
MCHIP. 2004. Exclusive Breastfeeding: The Only Water Source Young Infants Need. http://www.mchip.net/sites/default/files/FrequentlyAskedQuestions_Water_eng.pdf
World Health Organization. 2005. Report of a WHO Technical Consultation on Birth Spacing.
WHO/UNICEF. 1993. Breastfeeding counseling: a training course.
WHO. 2006. Infant and young child feeding counselling : an integrated course.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. Family planning: the unfinished agenda.
The Lancet. 2006. The Lancet sexual and reproductive series.
WHO. 2005. Report of a WHO Technical Consultation on Birth Spacing USAID/ACCESS. 2008. THE LACTATIONAL AMENORRHEA METHOD (LAM): A Postpartum Contraceptive Choice for Women Who Breastfeed.
17
A routine helps your baby to
know what to expect. It also helps
you manage your time. Stick to
roughly the same time and length
for naps.
Put your baby to sleep on her
back. This is the most important
way to help your baby sleep
safely through the night.
Protect your baby from
mosquitoes. Dress him in light
coloured clothing. Use an
insecticide-treated bednet every
night. Fit window screens.
Your baby's sleep patterns are probably settling down, but not many babies
sleep right through the night yet.
When your baby sleeps, make sure he is comfortable. See that he doesn't get
too hot. Wearing just one more layer than you is perfect. Check that your baby
isn't too hot or cold by feeling his stomach. If he's too hot, remove a blanket. If
he's too cold, add one.
Put your baby to sleep on his back. Make sure the mattress fits the bed and
there are no gaps. He won't need a pillow. If you want, your baby can sleep
with you.
You can also keep your baby safe by putting him to bed under an insecticidetreated net.
To help your baby sleep well, try to stick to a routine. Make naps and bedtime
the same each day. This will help your baby to settle.
If you want to do one good thing for your baby this week, make sure he sleeps
on his back, under an insecticide-treated mosquito net.
References
Creery D and Mikrogianakis A. 2006. Sudden infant death syndrome. BMJ Clinical Evidence. clinicalevidence.bmj.com
DH. 2011. Reduce the risk of cot death. Department of Health. www.dh.gov.uk[Accessed March 2011]
Engelberts A.C. et al. 1990. Choice of Sleeping Position for Infants: Possible Association with Cot Death. Archives of Disease in Childhood. 65:462-467
FSID. 2010. Cot death facts and figures. Foundation for the Study of Infant Deaths. fsid.org.uk [Accessed March 2011]
FSID. 2011a. Babyzone: how to keep your baby safe and healthy. Foundation for the Study of Infant Deaths.
The causes of cot death are disputed, but
there are some factors that are believed to
be linked to it. Studies have shown mixed
results, but some have found that a prone
sleeping position is linked to cot death. E.A.
Mitchell et al 1991; A.C. Engleberts et al
1990.
If malaria is not a problem in your area,
replace the malaria messages with messages
on a more important local issue.
FSID. 2011b. What is cot death? Foundation for the Study of Infant Deaths.
GP Notebook. n.d. SIDS Risk factors. www.gpnotebook.co.uk
NHS. 2010. Sudden infant death syndrome. NHS Choices, Health A-Z.www.nhs.uk [Accessed March 2011]
Patient UK. 2011. Reducing the risk of cot death.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
18
If your baby gets a cold,
breastmilk will help her recover.
Try feeding her sitting up. It will
make it easier if she has a blocked
nose.
Babies get colds easily. If you
want to give her traditional
remedies, talk to clinic staff first.
Some may be harmful.
Is your baby teething? Let him
suck on a clean finger to ease the
pain. Wipe any drool off his chin
with a soft, clean cloth.
Your baby can now understand most of the noises you are making. Soon she'll
try to make noises, and start entertaining herself. You may even hear her say
"ma-ma" or "da-da".
Babies can get colds easily. It can be upsetting, but colds are easy to deal with
and soon over.
Your baby may have a cough, a runny nose and red eyes. She may also have a
fever, a sore throat or earache. She will probably be irritable and not feel like
eating.
Breastfeeding helps your baby recover. Try breastfeeding her sitting up if she
has a blocked nose.
Don't give your baby any remedies or medicines without talking to your health
worker first.
Your baby can't blow her own nose, so wipe it often. But don’t put anything in
her nostrils. Be gentle, so her nose doesn't get sore.
It's always best to take your baby to the clinic whenever she is ill, especially if
she has a fever. If she's very hot, take her to the clinic as soon as possible.
In the days after she has recovered, breastfeed more than usual. She will be
extra hungry.
If you want to do one good thing for your baby this week, take your baby to the
clinic of she is very hot or seems unwell.
This message gives mothers practical tips on
how to care for their child.
Adapt 'ma' and 'da' to whatever is
applicable.
A cold is a viral infection that affects the
nose, throat and sinuses. There are more
than 200 different cold viruses. While adults
usually have two to four colds a year,
children can catch as many as seven to 10.
NHS Choices 2011.
References
Arroll B. 2008. Common cold. BMJ Clinical evidence.
NHS. 2011a. Common cold. NHS Choices, Health A-Z.
NHS. 2011. Common cold. NHS Choices, Health A-Z. http://www.nhs.uk/conditions/cold-common/pages/introduction.aspx
DH. 2011. Department of Health. Birth to five: Chapter 8 Treating illnesses, infections and injuries.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
19
Your baby is making lots of noises
now as he tries to copy words. Try
encouraging him by talking to him
during the day.
Babies who are inactive, grunting,
feverish or a blue colour are ill. If
your baby has these signs, take
him to the clinic quickly.
Is your baby playful and feeding
and sleeping well? These are signs
she's healthy! Take her to the
clinic if she is listless or not
feeding
Your baby is developing a sense of humour. Encourage his laughter, giggles and
smiles with funny faces and games of peek-a-boo. There is nothing quite as
wonderful as the sound of your baby giggling.
As his mother, you will know when your baby is not well. But here are three
simple ways to be sure he is healthy.
One; he feeds often and well. You may feel like you're constantly feeding your
baby. This is a good thing. If he's eating well and putting on weight, he is well.
You can be proud that it is your milk that is making him grow big and strong.
Two; he is playful and curious. Your baby is developing and growing up. His new
personality and playful nature are signs he's doing well.
Three; he sleeps well. Your baby probably sleeps about 15 hours a day. You may
still find yourself getting up at night for feeds, but he'll sleep for most of the
night.
If you want to do one good thing for your baby this week, be proud of what you
have done so far. Keep it up!
This message highlights to the mother signs
of good health in her baby. This will
encourage her to seek medical help if she
thinks her baby is not well.
References
WHO. 2006. Infant and young child feeding counselling: an integrated course
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
20
Your baby's skin is very sensitive
to the sun. Make sure you cover
him with a hat and long cotton
clothes in sunny weather.
Keep your baby away from
smoke, from the fire and from
cigarettes - all can make it hard
for him to breathe.
Make your home safe for your
baby. Check that there are no
small objects on the floor and
keep sharp objects out of reach.
Your baby may be putting everything in his mouth now. You will need to take
extra precautions to keep him safe. Make sure his toys are too big for him to
swallow. See that his toys don't have small buttons or eyes. Pick up small items
from the floor. This will help prevent choking.
You can also keep him safe and healthy by keeping him away from smoke.
Smoke can make him ill. Open the windows, if your house gets too smoky from
cooking. If you live in a cold area where opening doors and windows is not
possible, make sure there is someone to watch your baby and keep your baby
away from the fire when it there is too much smoke. If a family member
smokes, ask him to smoke outside. Open windows and ask people to smoke
outside.
If your baby is putting everything in his mouth, it might be a sign that he is
about to get a new tooth. He might also drool and be irritable. Put some shea
Change shea butter and coconut oil to
suitable local products.
In 2008, 3% of deaths of children aged under
five were caused by injuries. WHO, 2008.
butter or coconut oil on his chin to protect it from the drool. Gently use a very
soft cloth to clean the drool away. Letting him suck on your well-washed finger
can help ease the pain.
If you want to do one good thing for your baby this week, clear small items
from the floor.
References
BDHF. 2010. Children's teeth British Dental Health Foundation. www.dentalhealth.org
CKS. 2011. Clinical topic: teething. www.cks.nhs.uk
World Health Organization. 2008. Tackling injuries, the leading killers of children. Regional Office of Europe-World Health Organization.
21
Babies love to laugh. Try making
your baby giggle by playing with
him and pulling silly faces. It is a
sign that he is developing well
Thinking about having another
baby? Wait at least two years so
your next baby is healthy. Find
out about family planning now.
You need iron to stay strong and
healthy. Try to eat pulses, leafy
green vegetables or meat every
day. These foods contain lots of
iron.
Your baby is learning how to make new sounds. She may enjoy blowing
raspberries or bubbles! At this age, babies are so thrilled by any new skill that
they repeat it. It can get annoying, but it's a sign of her development.
The first few months with your baby have probably passed very quickly. Now
you are used to having her around, you may have started to think about having
another baby. Perhaps you want to give your baby a sibling to play with.
It's best to wait before getting pregnant again. Getting pregnant too soon puts
a strain on you and can lead to complications for you and your baby.
Wait at least two years to keep you and your future babies healthier. It's also a
good age gap between siblings. Explain to your partner and family why this is
important.
To delay pregnancy, there are lots of family planning methods. There will be
one that is right for you. Talk to your health worker to find out what is
available.
If you want to do one good thing for your baby this week, talk to your health
worker about family planning methods.
Short birth to pregnancy intervals (six
months or less), are associated with a high
risk of maternal morbidity. Intervals of 18
months or less are associated with higher
rates of infant mortality, preterm birth and
low birth weight (WHO 2005).
WHO recommendations: Spacing of two
years between the birth of a baby and
getting pregnant again.
MChip recommendations: three years birth
to birth interval.
Please choose the recommendation
followed by your country.
References
UNDP/UNFPA/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction. Family planning: the unfinished agenda
The Lancet Sexual & reproductive health series. 2006
World Health Organization. 2005. Report of a WHO Technical Consultation on Birth Spacing.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
22
Your baby's first tooth will be
coming through soon. He may like
it if you rub his sore gums with
your clean finger.
If your baby tries to bite at the
breast, pull him in close to you.
Your breast will cover his nose
and make him let go to breathe.
Your baby still needs only your
breastmilk. Don't be tempted to
give him any other foods or
liquids until he is six months old.
Your baby may be cutting a tooth. This can make breastfeeding uncomfortable
and you may wonder if this is a sign that he should start solid food.
You may also worry that your breastmilk is not enough. But your breastmilk is
still the best food for him. It's a miracle; it changes to give him what he needs.
Even when he starts solids, he will still need breastmilk.
Your baby will be ready for solids soon, but not yet. His neck muscles are
getting stronger, and he can turn his head. The noises he makes develop his
tongue muscles, which he will use when he swallows food. He may be
interested in what you are eating, too. These are signs that he is almost ready.
But he is not ready yet. It's important to wait till he is 6 months old. Feeding
solids too early or too late is harmful.
If your teething baby is making breastfeeding painful, pull your baby against
you when he bites. He will let go to breathe.
If you want to do one good thing for your baby this week, give him breastmilk
and nothing else for another few weeks.
“6 months old” is understood differently in
each culture. First test the best way to
phrase this: “It’s important to wait till he
completes his sixth month” or “starts his
seventh month”...or…?
This message combats the issue of
introducing solids too early.
Breastmilk contains all the nutrients an
infant needs in the first six months of life
(MCHIP 2004 Factsheet).
For optimal growth, infants and young
children need complementary foods with a
high micronutrient density at 6-12 months,
but not before (WHO 2011).
References
MCHIP. 2004. Exclusive Breastfeeding: the only water source young infants need. http://www.mchip.net/sites/default/files/FrequentlyAskedQuestions_Water_eng.pdf
WHO. 2000. Complimentary Feeding: Family Foods for Breastfed babies.
WHO. 2006. Infant and young child feeding counselling : an integrated course.
WHO. 2011. Essential Nutrition Actions. http://www.who.int/nutrition/EB128_18_backgroundpaper2_A_reviewofhealthinterventionswithaneffectonnutrition.pdf
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
23
Play peek-a-boo with your baby
today. He'll love it. He's learning
how an object might still be there
even if it disappears.
Putting your baby to sleep on
pillows can be dangerous. He may
slip under them and suffocate. He
doesn't need one yet.
Your baby is almost six months old. She is probably alert to new sounds. Try
making different sounds, and see how she reacts.
You and your partner might be thinking about having another child. But there
are three reasons why it's best that you wait.
First: if you become pregnant before your baby is two years old, your body does
not have enough time to recover from the first birth.
Second: waiting two years keeps your next baby healthy, too. Getting pregnant
too soon can mean that the next baby will be weak or early.
Short birth to pregnancy intervals (six
months or less), are associated with a high
risk of maternal morbidity. Intervals of 18
months or less are associated with higher
rates of infant mortality, preterm birth and
low birth weight (WHO 2005).
WHO recommendations: Spacing of two
years between the birth of a baby and
Your periods might return soon.
Talk to your health worker about
family planning methods. Space
your babies for their health and
yours.
Third: waiting means you have more time for your baby and other family
members. Waiting also gives you and your partner time to earn more money.
You can use this money to save for the future. This will make it easier for you to
pay for clinic visits and supplies.
A brother or sister for your baby might be just what your family wants. But
waiting until your baby is two will give you a healthier and happier family.
If you want to do one good thing for your baby this week, talk to your partner
about why it's best to wait for two years.
getting pregnant again.
MChip recommendations: three years birth
to birth interval.
Please choose the recommendation
followed by your country.
References
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. Family planning: the unfinished agenda
The Lancet Sexual & reproductive health series. 2006
World Health Organization. 2005. Report of a WHO Technical Consultation on Birth Spacing.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
24
Around now your baby will begin
to recognise her own name.
Watch and you will see her turn
when you call her name.
Breastfeeding is the best thing
you can do for your baby. In a few
weeks, he will be ready to try
some other foods and water, but
not yet.
Enjoy the baby you have - she'll
only be a baby for a short while.
Spacing your family gives you
time to help each baby develop
and learn.
Around now your baby will begin to recognise her own name. Watch and you
will see her turn when you call her name. Your baby may be able to roll in both
directions. When your baby is on her back, try shaking a toy on one side. This
will encourage her to roll.
Short birth to pregnancy intervals (six
months or less), are associated with a high
risk of maternal morbidity. Intervals of 18
months or less are associated with higher
rates of infant mortality, preterm birth and
It’s important to space your babies. Wait at least 2 years before you try for
low birth weight. Source: WHO (in
another baby.
accordance with USAID) Technical
Consultation on Birth Spacing.
There are many safe, modern, reliable methods to delay pregnancy. You can get WHO recommendations: Spacing of two
them at the clinic or the pharmacy or from a health worker.
years between the birth of a baby and
getting pregnant again.
You can talk about your options with your health worker. The health worker will MChip recommendations: a three year birth
explain the various methods available to you. Decide with your partner if you
to birth interval.
need a short term family planning method like contraceptive injection, or a long Please choose the recommendation
term one such as IUD. Or you could use one that you need daily like the pill, or
followed by your country.
a method you can use during sex like condoms. You and your partner can find
Fit to the contraceptive practices in your
one that suits you both.
country.
If you want to do one good thing for your baby this week, discuss your family
planning options with your partner.
References
Amir L. 1991. Candida and the lactating breast: predisposing factors. J Hum Lact, 7 (4); 177-181
Horowitz BJ, Edelstein SW et al. 1984. Cited in: Hoover K, 2002. The Link Between Infants' Oral Thrush and Nipple and Breast Pain in Lactating Womenwww.hooverfam.net [Accessed September 2011]
Jones W, Sachs M. 2011. Thrush and breastfeeding. Paisley: The Breastfeeding Network. www.breastfeedingnetwork.org.uk [Accessed September 2011]
Rashid S, Collins M, Corner J et al. 1984. Survival of Candida albicans on fabric after laundering.Br J Vener Dis 60; 277
http://www.nhs.uk/chq/Pages/2448.aspx?CategoryID=54&SubCategoryID=135
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
25
Let your baby lie on a clean floor
to protect him from infection.
Clean the floor with soap and
water or put him on a clean
blanket.
Look out for signs of illness. If
your baby vomits more than 5
times during a day, go to the
clinic. Give her plenty of extra
breastfeeds.
Germs can cause nasty infections.
You can help prevent them by
washing your hands with water
and soap after changing nappies.
Your baby may hold toys in her hand. She may prefer using her right or her left
hand, but you won't be able to tell which hand she will always use.
Most babies will vomit at some point. Babies may vomit when they have a cold
or an infection. Your baby will get better faster if she gets lots of liquids. Give
her short feeds, but more often. This way she will get the watery foremilk,
which stops her from going thirsty.
If your baby vomits more than five times or vomits for more than a day, take
her to the clinic. Clinic staff will give her treatment.
You can help prevent vomiting. Wash your hands often with soap. Take care
that your baby always plays on a clean floor and clean her toys regularly. Feed
your baby only breastmilk and do not give your baby water. These steps will
help keep your baby healthy.
If you want to do one good thing for your baby this week, wash your hands with
soap often.
It is normal for babies and children to vomit
during their childhood.
In most cases, the vomiting will last no
longer than one or two days and is not a sign
of anything serious.
But persistent vomiting can be a sign of
something more serious and needs to be
investigated.
References
NICE. 2011. National Institute of the Health and Clinical Excellence. Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than five years.
www.nice.org.uk
MOST. 2005. Diarrhoea Treatment Guidelines.
NHS Choices 2011 http://www.nhs.uk/conditions/vomiting-children-babies/pages/introduction.aspx
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
26
Slowly but surely your baby is
becoming more independent. He
may roll over already. Before you
know it, he'll be crawling and
walking!
Next week you can try giving your
baby mashed foods. Get a cup, a
small spoon and a dish ready.
Wash them well. Do not use a
bottle.
Your milk is still your baby's main
source of food, even after he
starts eating soft food. Keep
breastfeeding, it protects him
from illness.
Your baby is probably starting to move more now – perhaps even crawling!
Keep him comfortable by dressing him in soft, loose clothing.
Next week, you can try giving your baby mashed foods. Get a cup, small spoon
and dish ready. Wash them well. Don't use a bottle.
Although your baby will start to eat food soon, your milk will still be his main
source of goodness.
Your milk has changed – it used to be perfect for a newborn, and now it's
perfect for your bigger baby. It still helps your baby grow strong, and protects
against illness. When your baby is ill, it may be all he wants to eat.
Continuing to breastfeed will also give you and him comfort. It's a good way to
stay close to your baby and have a cuddle.
Keep breastfeeding whenever your baby wants. It is best to continue
breastfeeding for at least two years.
Your milk has helped your baby to grow so far. By continuing to breastfeed you
can help him even more!
If you want to do one good thing for your baby this week, keep breastfeeding.
WHO (2011) recommends giving babies
Vitamin A supplements from six months at
intervals of 4-8 weeks. Our message on
Vitamin A occurs at week 38 as this is when
it is administered in India and Bangladesh
(along with the Measles vaccine). Change
this to fit with local practises.
Breastfed children at 12-23 months of age
receive on average 35-40% of total energy
needs from breast milk with 60-65% covered
by complementary foods.
By continuing to breastfeed until the baby is
two years old, along with improvement of
exclusive breastfeeding practices and
adequate and timely complementary
feeding, it could be possible to save the lives
of 1.5 million children under five years of age
each year (WHO 2011).
References
MCHIP. 2004. Exclusive Breastfeeding: the only water source young infants need. http://www.mchip.net/sites/default/files/FrequentlyAskedQuestions_Water_eng.pdf
WHO. 2000. Complimentary Feeding: Family Foods for Breastfed babies.
WHO. 2006. Infant and young child feeding counseling: an integrated course.
WHO. 2011. Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
27
Now your baby is 6 months, he
can have some soft, mashed
foods. Give him mashed fruit,
vegetables or thick porridge 2-3
times a day.
Your baby's stools have germs
Your baby may become attached to a toy, blanket or even a piece of cloth. This
acts as a comforter, and shows that she is becoming independent.
Your baby is growing fast, and needs to eat food now. Go slowly. Your baby
cannot chew yet, so start by feeding her soft or mushy food.
Thick, creamy porridge is a good start, or fruit such as mango or banana. Mash
them with a little breastmilk to make it easier for her to swallow. Make it thick
Please suggest food items that are easily
available in your area.
A working definition refers to
complementary feeding as the process
starting when breastmilk or breastmilk
substitutes alone is no longer sufficient to
which can make him ill. Dispose
of his stools in a latrine to keep
your baby safe.
Your baby may become attached
to a toy, blanket or even a piece
of cloth. This comforts her and
helps her to become
independent.
enough to stick to a spoon.
Give your baby soft, thick food two times a day. Afterwards, offer her your
breast.
Your baby will only need a few spoonfuls of food. She still needs lots of
breastmilk. As your baby gets older, she will need more food. For now, tiny
portions will be just right.
Sit your baby facing you and talk and smile at her while you feed her.
If you want to do one good thing for your baby this week, feed her a few
spoons of thick porridge twice a day.
meet the nutritional requirements of infants,
and therefore other foods and liquids are
needed, along with breastmilk or a
breastmilk substitute. The target range for
complementary feeding is generally taken to
be six to 23 months (WHO 2011).
References
WHO. 2000. Complimentary Feeding: Family Foods for Breastfed babies. 2000
WHO. 2006. Infant and young child feeding counselling : an integrated course.
WHO. 2011. Essential Nutrition Actions. http://www.who.int/nutrition/EB128_18_backgroundpaper2_A_reviewofhealthinterventionswithaneffectonnutrition.pdf
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
28
Hand washing helps keep your
family healthy. Set up a
washstand with soap and water
near where you prepare food.
Protect your baby from
diarrhoea. Make sure his food is
well-cooked and fresh. Give him
only clean, safe water.
Beans, lentils, and eggs are a
great source of energy for your
baby now. Mash them up with
other vegetables and offer them
2-3 times a day.
Your baby may be becoming more confident. He might start to challenge you.
He isn't being naughty, he's just curious.
Now your baby is eating food, it is important that the food you give him is safe.
It will help prevent your baby from getting diarrhoea.
Here are three ways you can keep your baby's food safe.
One: wash your hands before you begin cooking. This will get rid of germs. Use
plenty of soap and water. You could set up a washing stand with soap and
water, near where you prepare food.
Two: feed your baby only fresh food. Food that has been left out or food that
has been cooked some time ago could make your baby ill.
Three: make sure that all of your baby's food is well cooked. Food that is not
fully cooked still contains germs. Cooking food well kills those germs. By doing
this you can easily keep your baby's food safe.
If you want to do one good thing for your baby this week, teach your baby to
eat with love, patience, and good humour.
Diarrhoea remains the second leading cause
of death among children under five globally.
Nearly one in five child deaths – about 1.5
million each year – are due to diarrhoea. It
kills more young children than AIDS, malaria
and measles combined (WHO/UNICEF 2011).
Handwashing interventions reduced the
incidence of diarrhoeal diseases by 32% in
low and middle income countries, and 39%
in high income countries (Ejemot et al.
2008).
It has been widely demonstrated that the
private home setting is considered the first
place in which foodborne diseases develop.
This is due to poor personal and/or
environmental hygiene with an increased
risk of infection (Istituto Superiore di Sanità
2003; Comodo et al. 2000; Fara and Proietti
2000; Griffith et al. 1998; Istituto Superiore
di Sanità 2006; Kagan et al. 2002; Redmond
and Griffith 2003; Scott 2001).
References
Ejemot. R.I. et al 2011 Hand washing to prevent diarrhoea (review) Cochrane Library
Langiano, E. 2011. Food safety at home: knowledge and practises of consumers. Journal of Public Health: 1-11.
WHO. 2000. Complimentary Feeding: Family Foods for Breastfed babies.
WHO. 2006. Infant and young child feeding counseling: an integrated course.
WHO. 2000. Food borne disease: a focus for health education.
WHO/UNICEF. 2011. Diarrhoea: why children are still dying and what can be done
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
29
Your baby can hold toys well now
and pass them from hand to
hand. She may also learn how to
clap her hands!
Teething can be painful. Rub a
clean finger over his gums to
numb the pain. Put some cream
on his chin to protect it from
drool.
With a baby to look after, it is
easy to forget about yourself. Eat
well and get some gentle exercise
every day. It will keep you
healthy.
Your baby will be learning lots now, such as how to move a toy from one hand
to the other, clapping her hands, or banging things together.
As she begins teething, she will start putting objects in her mouth.
Babies can get their first teeth any time between three months and one year.
Teething can be painful, and can make your baby's gums red and swollen. She
may drool a lot, seem unsettled, and not sleep well. The pain may prevent her
from feeding well.
Your baby might get a red rash on her chin from dribbling. Wipe off the dribble
with a clean, soft cloth and put some mild cream or oil on her chin.
Rub a clean finger over your baby's sore gums to help numb the pain.
Try giving your baby soft, cold foods, such as yoghurt or thick porridge.
If your baby is in a lot of pain, go to the clinic.
Once her teeth have grown, keep them clean by wiping them with a soft, clean
cloth.
If you want to do one good thing for your baby this week, check for signs of
teething.
All parents will experience teething. This
message equips the mother with practical
things to do to help her baby through it. This
will give her greater confidence in her ability
to care for her baby.
A note on cold and hot foods: In some
cultures "cold" and "hot" refer to qualities
other than temperature. Amend if
necessary.
References
Macknin ML, Piedmonte M, Jacobs J, Skibinski C. 2000. Symptoms associated with infant teething: A prospective study. Pediatrics 105:747-52
McIntyre GT and McIntyre GM. 2002. Teething troubles? British Dental Journal192(5):251-5. www.nature.com/bdj
NHS. 2010. Teething. NHS Choices, Health A-Z. www.nhs.uk
Wake M, Hesketh K, Lucas J. 2000. Teething and tooth eruption in infants: A cohort study. Pediatrics 106:1374-9
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
30
Your baby now begins to
understand when you are happy
or sad. If you're sad, he may be
sad, too. If you are laughing, he
may join in.
Your baby will be teething soon. If
he bites when feeding, take him
off the breast and say 'no' loudly!
Don't stop feeding him your milk.
As a mother, you will know when
something is wrong with your
baby. Trust your intuition and go
to the clinic for help.
Your baby's emotions will be clearer now. He may laugh when you do, or blow
you kisses!
Your baby may have started biting during feeds. This is painful, but there are
ways to stop him.
If your baby bites, stay calm, and firmly tell him "no". If he continues, bring him
in closer to your breast, squashing his nose. To breathe, he will have to open his
mouth and stop biting.
Some babies bite because they are teething. If his gums are sore, try giving him
a cold, clean, wash cloth to bite on.
A very hungry baby may bite out of frustration. Express a little breastmilk onto
the nipple, so he can taste milk immediately and focus on feeding.
A bored baby may see your breast as something to play with. Learn to recognise
when your baby has finished feeding, and take him off your breast straight
away.
If you want to do one good thing for your baby this week, remember that even
though he is eating some foods, your breastmilk is still very important to help
him grow.
A biting baby may encourage the mother to
halt breastfeeding too early. But by
continuing to breastfeed until the baby is
two years old, along with the improvement
of exclusive breastfeeding practises and
adequate and timely complementary
feeding, it could be possible to save the lives
of 1.5 million children under five years of age
each year.
Breastfed children at 12-23 months of age
receive on average 35-40% of total energy
needs from breastmilk with 60-65% to be
covered by complementary foods (WHO
2011).
References
WHO. 2006. Infant and young child feeding counselling: an integrated course.
WHO. 2011. Essential Nutrition Actions. http://www.who.int/nutrition/EB128_18_backgroundpaper2_A_reviewofhealthinterventionswithaneffectonnutrition.pdf
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
31
Your baby is now on the move.
Keep an eye on him as he plays.
Always leave your baby with a
responsible adult, to prevent
accidents.
There are many safe, modern,
Your baby probably has lots of energy, and may have begun to crawl or lunge
forward. Cleaning her play area with soap and water will protect her from
germs.
Now that your baby is eating soft foods, she will need fewer breastfeeds. This
means that your periods may start soon. If you haven't started using a family
planning method yet, talk to your health worker.
If your mother had babies close together, she may not understand why you
Short birth to pregnancy intervals (six
months or less) are associated with a high
risk of maternal morbidity. Intervals of 18
months or less are associated with higher
rates of infant mortality, preterm birth and
low birth weight (WHO 2005).
WHO recommendations: Spacing of two
reliable methods to space babies.
Get them for free at the clinic or
the pharmacy or from a health
worker.
Your family may want you to have
another baby. Explain that your
next baby will be healthier with a
gap of at least 2 years.
want to wait. Your husband may want another baby, too.
Explain to them that delaying the next pregnancy is best for you, for your baby
and for the next baby, too. Your body needs to recover from pregnancy and
birth and your baby needs your breastmilk. Your next baby will be healthier if
there is a gap of at least two years between pregnancies.
There are many different family planning methods. You are sure to find the
right method for you.
If you want to do one good thing for your baby this week, ask your health
worker about family planning.
years between the birth of a baby and
getting pregnant again.
MChip recommendations: three years birth
to birth interval.
Please choose the recommendation
followed by your country.
If other types of contraception are available
locally, please amend.
References
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. Family planning: the unfinished agenda
The Lancet Sexual & reproductive health series. 2006
World Health Organization. 2005. Report of a WHO Technical Consultation on Birth Spacing.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
WHO/UNICEF, 2008, World report on child injuries. http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf?ua=1
32
Your baby may love playing with
animals, but they are dirty. If he
strokes any animals, wash his
hands with soap and water
afterwards.
If your baby swallows anything
poisonous, like kerosene or
detergents, rush to the clinic.
Take some of what she has
swallowed with you.
Having a baby will change your
relationship with your partner.
You can stay close by making
Is your baby crawling yet? He may try to push onto his hands whilst he's sitting he is trying to crawl!
Now that your baby is more active, you need to make sure that he plays
somewhere clean.
Make sure your baby's play area is away from water. Lakes, ponds and puddles
are dangerous and they contain germs and can make your baby sick. His play
area should also be far from animals and their stools. Your baby may love
playing with animals, but they are dirty. If he strokes any animals, make sure
you wash his hands with soap and water afterwards.
Playing near latrines can also lead to sickness. Try to keep your baby away from
these areas.
The ground can also be home to worms. If you can, clean the floor with soap
and water before your baby plays there. This will help keep him safe. If you
cannot clean the floor, lay down a large, clean blanket or mat.
If you want to do one good thing for your baby this week, give your baby a
Worms are parasites that live in human
bowels (intestines). Some worms are big
enough to see with the naked eye, while
others are very small and are harder to see.
Some worms can enter the body through the
mouth as worm eggs; others enter through
the skin as larvae. It is therefore important
for children to develop the habit of washing
their hands properly, keeping nails short and
clean and always wearing footwear when
playing on the ground (soil).
(WHO. Urbani school health kit).
some time for each other every
day.
clean, safe area to play.
References
WHO. 2005. The evidence is in: Deworming helps meet the Millennium Development Goals. World Health Organization.
WHO. Urbani School Health Kit: A Lively and Healthy Me: A Campaign on Preventing and Controlling Worm Infections for Health Promoting Schools. (date unknown).
WHO/UNICEF, 2008, World report on child injuries. http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf?ua=1
33
If your baby has diarrhoea,
breastfeed her after every loose
stool. When she is better, give
her an extra meal every day for 2
weeks.
Your baby is too precious to take
risks with. If she is ill, go to the
clinic for good care. Don't wait.
Babies can get ill very quickly.
Leaving your baby with someone
else can be hard. But it will give
you some time to yourself and
will help him learn how to
socialise.
Your baby may get anxious if she's away from you – she's very attached to you!
Sometimes, your baby will be unwell.
An ill baby needs more sleep. Let her sleep whenever she wants. If you can, nap
whenever your baby does.
Your baby will also need plenty of food. When she is unwell, she may not want
new foods. She will probably prefer your breastmilk. Feed your baby whenever
she wants. Your milk will help her to fight off the illness. Once she is feeling
better give her one extra meal every day for at least 2 weeks.
Try to keep your baby close to you, in a sling or pouch. She will need more of
your attention. Try not to worry about getting all your housework done. Catch
up on work when your baby is well again.
If your baby does not improve, or if she has a fever, refuses to feed, makes
grunting noises or cries strangely, go to the clinic. She may need treatment.
If you want to do one good thing for your baby this week, think about these tips
for helping an ill baby.
This message equips the mother with
practical things to do. This will empower her
and boost confidence.
Appropriate home care and timely
treatment of complications were identified
as a key strategy in tackling MDG 4 by WHO.
References
WHO. Factsheet http://www.who.int/topics/millennium_development_goals/child_mortality/en/
34
With your baby shuffling, crawling
or standing, he is bound to get a
few bumps! A kiss and a cuddle
will soon set him right again.
Prevent burns by keeping your
baby out of the cooking area. If
he gets burnt, wash the burn with
Your baby is probably becoming more mobile now. He may have a few bumps
In 2008, 3% of deaths of children aged under
and falls.
five were caused by injuries. WHO, 2008.
Here are four ways you can keep him safe in your home:
Add additional safety issues in your area.
First: check your home every day for objects that your baby could pick up. Make
sure no small objects which could choke him, such as coins, are within his
reach. Put away sharp objects, such as knives, scissors and pens, and anything
that's not safe to eat or drink.
cold water. Go to the clinic for
treatment.
For your baby's safety, cover
water containers with a lid, clear
the floor of objects he can
swallow, and keep sharp objects
out of reach.
Second: check that nothing can fall on your baby. Make sure everything is
secure. All cords should be rolled up safely.
Third: keep your baby away from fire. Your baby wants to explore; he may
touch flames and burn himself. Make sure that he cannot touch anything hot
whilst you are cooking. Try putting up a barrier. If your baby gets burned, pour
cool water over the burn, and nothing else. Take him to the clinic as soon as
possible.
Fourth: Keep him away from large containers of water; try keeping them in the
bath, with tight-fitting lids on top, so he doesn't fall in.
Always keep an eye on your baby. If you’re not around, make sure a responsible
adult is watching your baby.
If you want to do one good thing for your baby this week, follow these tips to
keep your baby safe from harm.
References
World Health Organization. 2008. Tackling injuries, the leading killers of children. Regional Office of Europe-World Health Organization.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
WHO/UNICEF, 2008, World report on child injuries. http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf?ua=1
35
Your baby could be exploring
different objects by shaking,
banging and throwing them.
Playtime may get a bit noisy!
Before drinking water or using it
to cook, boil it to clean it. This will
kill germs and will keep your baby
safe and healthy.
You can now give your baby food
3-4 times a day. Try mashing
potato with meat, eggs, fish or
beans. Keep breastfeeding!
Your baby may be exploring different objects by shaking and banging them. She
might even pick up pieces of food – she's beginning to feed herself.
Your baby may now enjoy more filling foods. Try giving her hard-boiled eggs,
well-chopped meat or fish, or mashed peas and beans, or a hard biscuit if she's
teething. Make sure the biscuit doesn't crumble as she could choke.
Your baby needs to eat 3-4 times a day. Give her snacks like fruit or bread, as
well as food at family mealtimes.
Wash her hands with soap and water before she eats.
Your breastmilk still has lots of goodness for your baby. Breastfeed whenever
she wants. Your baby can also have clean, safe water. Don't give her tea, coffee
or sugary drinks.
Her food needs to be soft enough for her to mash up with her tongue and
swallow. Stay with her when she is eating, in case she chokes.
If you want to do one good thing for your baby this week, start giving her tasty
new foods.
Complementary foods should supplement
breastmilk and provide a variety of
nutrients.
Delete instructions to eat meat and fish in
vegetarian communities, but replace foods
with others that are high in protein such as
beans.
Suggest food available locally that would be
suitable for a baby's first foods.
References
WHO. 2000. Complimentary Feeding: Family Foods for Breastfed babies.
WHO. 2000. Food borne disease: a focus for health education.
WHO. 2006. Infant and young child feeding counselling : an integrated course.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
36
Disciplining your baby can be
hard, but it is necessary
sometimes. Be firm but don't
shout. Put him in an area where
he can calm down.
Chest pain and a cough that lasts
over three weeks are signs of TB.
You can protect your baby by
getting treatment from the clinic.
If a family member has TB, take
your baby to the clinic for
preventive medicine. This will
prevent him from catching TB,
too.
Your baby may be more assertive now. He may spit out food, or cry loudly at
bedtime. This behaviour will pass.
Babies can easily get sick. They can catch TB if an infected person coughs or
sneezes near them. TB is dangerous for babies.
If a family member has TB, take your baby to the clinic to get tested. He may
also get medicine to prevent him from catching TB.
Signs of TB include:
● a cough that won't go away;
● regular chest infections;
● slow weight gain or weight loss;
● fever;
● swollen glands; and
● breathing difficulties.
If you notice any of these signs, take your baby to the clinic. Staff will give you
medication which your baby needs for six to nine months, even if he seems
better. Give it every day at the same time. Take him to the clinic regularly for a
check-up.
Your baby won't be infectious after he's taken his medicine for a few weeks. TB
doesn't spread through touching or bathing, so keep cuddling him.
Breastfeeding is safe, too.
To prevent your baby getting TB, make sure your baby has had the TB vaccine.
If he didn't have it at birth, make sure he has it now. Feed him healthy, fresh
food, too.
Keep your house clean and dry to keep germs away.
If you want to do one good thing for your baby this week, ask your family to get
screened for TB.
An estimated 1.7 million people died from
TB in 2011. WHO Factsheet.
References
WHO (2013) Global Tuberculosis Report. http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf?ua=1
WHO (2014) Guidance for national tuberculosis programmes on the management of tuberculosis in children, Second edition;
http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf?ua=1&ua=1
WHO (2013) Guideline: Nutritional care and support from patients with Tuberculosis; http://apps.who.int/iris/bitstream/10665/94836/1/9789241506410_eng.pdf?ua=1
WHO (2012) Recommendations for investigating contacts of persons with infectious tuberculosis in low- and middle-income countries
http://apps.who.int/iris/bitstream/10665/77741/1/9789241504492_eng.pdf?ua=1
WHO (2013) Systematic screening for active tuberculosis: principles and recommendations. http://apps.who.int/iris/bitstream/10665/84971/1/9789241548601_eng.pdf?ua=1
WHO (2009) WHO policy on TB infection control in health-care facilities, congregate settings and households. http://whqlibdoc.who.int/publications/2009/9789241598323_eng.pdf?ua=1
Liefooghe R et al. (1997) From their own perspective. A Kenyan community's perception of tuberculosis Tropical Medicine & International Health, 2(8): 809–821,
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.1997.d01-380.x/abstractFarrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh:
Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
37
Your baby should be sitting
confidently now. He may even be
trying to pull himself up ready to
stand. If he is not, go to the clinic.
If your baby is unwell, has a rash
or a fever, take her to the clinic
straight away. Clinic staff can help
you.
If your baby gets bitten or
scratched by an animal, get her
checked at the clinic. Clinic staff
can help prevent infection.
A playful baby may get scratches and bites. It's worrying to see your child hurt,
but many injuries can be treated at home.
If the cut or bite is on an exposed part of her body, place a clean cloth over it
and bandage it up. Otherwise leave it open to the air.
If the wound is bleeding, apply a clean cloth to it and press with your fingers. If
the bleeding doesn't stop after a few minutes, cover the wound with a bandage
and go to the clinic right away. The most common problem following a bite or
scratch is infection. Make sure your baby has had all her vaccinations. It's
possible to catch tetanus from cuts and bites.
Animal bites can put your baby at risk of rabies. Rabies is a virus passed through
saliva. It can be dangerous, so take your baby to the clinic if she is bitten.
If you want to do one good thing for your baby this week, keep her safe from
animals.
Complications that arise from animal bites or
scratches are uncommon, but if they do
occur they can be serious. One possible
complication is a bacterial infection that
spreads through the bloodstream, known as
sepsis (NHS Choices 2010).
Rabies is a preventable viral disease of
mammals most often transmitted through
the bite of a rabid animal. The rabies virus
infects the central nervous system,
ultimately causing disease in the brain and
death. Once a person begins to exhibit signs
of the disease, survival is rare. To date, less
than 10 documented cases of human
survival from clinical rabies have been
reported and only two have not had a
history of pre- or post-exposure prophylaxis.
CDC, 2011.
If rabies is not an issue in your area, please
remove reference to it.
If there are poisonous insects in your area
that you would like to mention, please add
to this message.
References
CKS. 2011. Clinical topic: Bites – human and animal. NHS Clinical Knowledge Summaries. www.cks.nhs.uk
NHS. 2010. Bites, human and animal. NHS Choices, Health A-Z. www.nhs.uk
www.cdc.com
38
Putting your baby down to sleep
at the same time every day will
help her to settle. Calm her by
singing a lullaby or telling a story.
Help your baby fall asleep alone.
Don't rock him to sleep. Put him
down when he's sleepy. If he
wakes, don't go to him straight
away. Stay quiet.
Feeling tired? Rest when your
baby naps, drink plenty of clean
water and make sure you eat
well. Ask your family to help with
baby care.
Your baby needs plenty of sleep. You can help her get enough.
Creating a daily nap and bedtime routine will help your baby know what to
expect. This will make her feel secure.
Try playing a quiet game with your baby before bed, or telling her a story. If you
do this every day at the same time, your baby will settle more easily at
bedtime.
If your baby wakes up calling for you, delay going to her so she can learn to fall
asleep on her own.
After the bedtime routine, put your baby to bed. If your baby usually falls
asleep in your arms, gently wake her before putting her to bed. Don't fuss. This
will keep her feeling sleepy. Then leave her and wait. Check if she is asleep. If
your baby doesn't settle, go back to her.
Getting your baby to fall asleep on her own can take time. Be patient and you
will both get there!
If you want to do one good thing for your baby this week, start teaching your
baby to fall asleep by herself.
Providing a routine for the baby will help the
parents to rest.
References
Davis KF, Parker KP, Montgomery GL. 2004. Sleep in Infants and Young Children: Part One: Normal Sleep. Journal of Pediatric Health Care 18: 130-7
Ficca G, Fagioli I, Salzarulo P. 2000. Sleep organization in the first year of life: developmental trends in the quiet sleep-paradoxical sleep cycle. J Sleep Res9(1):1-4
Hames P. 1998. NCT book of sleep. NCT Publishing, London
Mindell JA, Kuhn B, Lewin DS et al. 2006. Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children. Sleep 29(10): 1263-1276
True D, Flenady V, Woodgate P et al. 2002. Behavioural interventions for children under five years with sleep difficulties. The Cochrane Database of Systematic Reviews Issue 4. www.mrw.interscience.wiley.com
[Accessed June 2011].
39
Your baby's babble may have
started sounding like proper
words now. Keep talking to your
baby so he can learn more.
It is time for your baby to get the
measles vaccine. Take her to the
clinic to get her protected.
If your baby is standing and
gripping the furniture, he may be
trying to walk. Encourage him by
holding his hands while he walks.
Your baby may be sitting up now, and even pulling herself up to stand! Even
though she's stronger than ever, she could still get diseases such as measles.
Measles is spread through coughs and sneezes. If your baby comes into contact
with someone with measles, she can get it.
Measles starts like a cold. A baby with measles will have a fever, a runny nose,
red eyes, a sore throat and a cough. After a few days, rashes may appear on the
face, chest, stomach and neck. Measles rashes are blotchy and red. If you see
any of these signs, take your baby to the clinic immediately.
Measles is a serious illness, but you can protect your baby. The best way to
protect her is with a vaccination, which she can get now. Take her to the clinic
to get it. This will keep her healthy and strong for the future.
If you want to do one good thing for your baby this week, get your baby the
measles vaccine.
If your community offers malaria
preventative treatment for infants, include
this and the timings for it in this message.
Measles is one of the leading causes of
death among young children, even though a
safe and cost-effective vaccine is available.
An estimated 164 000 people died from
measles in 2008 – mostly children under the
age of five.
Source: WHO Factsheet 2010.
Adapt this message to fit your local
immunisation schedule. Vitamin A may also
be given; check if this is the case in your
locality.
Vaccinations at 38 weeks:
Bangladesh: Measles, OPV and Vitamin A at
38 weeks
India: Measles and Vitamin A at nine months
South Africa: Measles and Pneumo conj at
nine months
Fit to local vaccination schedule - check the
timings and the type of vaccinations given at
this stage. These can vary widely in different
countries.
References
USAID. 2003. Immunisation Essentials: A Practical Field Guide.
WHO. 1993. Measles: The Immunological Basis for Immunisation. Geneva: World Health Organization
PAHO. 1999. Measles Eradication Field Guide, Technical Paper No. 41. Washington, DC: Pan American Health Organization.
http://www.who.int/immunisation/documents/positionpapers/en/
www.cdc.gov
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
Summary of WHO position papers – recommended routine immunisations for children (Tables 1 & 2)
http://www.who.int/immunization/policy/Immunization_routine_table1.pdf
http://www.who.int/immunization/policy/Immunization_routine_table2.pdf
40
Many babies crawl by this age,
but some never crawl and go
straight to walking. Both are
normal. Make sure he is safe now
he's exploring.
Keeping goats and chickens out of
the kitchen means fewer germs.
Shoo them away and wash your
hands before cooking to stay
healthy.
Your partner may feel left out.
Suggest he gives the baby his
baths. That will help them both
bond. It'll also be fun!
Your baby will be very active during the day. To keep him healthy, keep his play
area clean.
Wash floors with soap and water.
Make it a family habit to wash hands when you get home. Wash hands before
cooking and eating, and after handling animals.
If there's a toilet near your home, use it. Wash your hands with soap
afterwards. If you don't have a toilet, relieve yourself far from your home.
Always put clean nappies on your baby. Wash dirty nappies in boiling water.
Wash your hands with soap afterwards.
Food that remains on plates can make your baby sick. So wash plates, cups and
cutlery and soak them in boiling water.
If your baby plays outside, check that he plays in clean areas.
Keep him away from latrines and watery areas. These areas are full of germs
and could give your baby worms.
Your baby may love playing with animals, but wash his hands after he touches
them. Keep him away from their stools.
If you want to do one good thing for your baby this week, make sure his play
area is clean.
References
Ejemot. R.I. et al 2011 Hand washing to prevent diarrhoea (review) Cochrane Library
Langiano, E. 2011. Food safety at home: knowledge and practises of consumers. Journal of Public Health: 1-11.
WHO/UNICEF. 2011. Diarrhoea: why children are still dying and what can be done
If housing does not usually have proper
flooring, please make necessary changes.
Diarrhoea remains the second leading cause
of death among children under five globally.
Nearly one in five child deaths – about 1.5
million each year – are due to diarrhoea. It
kills more young children than AIDS, malaria
and measles combined.
(WHO/UNICEF 2011.)
Handwashing interventions reduced the
incidence of diarrhoeal diseases by 32% in
low and middle income countries, and 39%
in high income countries. (Ejemot et al.
2008)
It has been widely demonstrated that the
private home setting is considered the first
place in which foodborne diseases develop.
This is due to poor personal and/or
environmental hygiene with an increased
risk of infection. (Istituto Superiore di Sanità
2003; Comodo et al. 2000; Fara and Proietti
2000; Griffith et al. 1998; Istituto Superiore
di Sanità 2006; Kagan et al. 2002; Redmond
and Griffith 2003; Scott 2001.
UNICEF. 2011. Water, Sanitation and Hygiene Annual Report 2010.
UNICEF. 2012. Diarrhoea. http://www.unicef.org/health/index_43834.html. [Accessed on 3 June 2014]
WHO. 2011. Zinc supplementation in the management of diarrhoea. http://www.who.int/elena/titles/bbc/zinc_diarrhoea/en/. [Accessed on 3 June 2014]
WHO. 2013. Diarrhoeal Disease. http://www.who.int/mediacentre/factsheets/fs330/en/ [Accessed on 3 June 2014]
41
Your baby is starting to
understand simple words. Keep
talking to him and encourage him
to talk. He'll soon be able to
answer you!
ORS made up with clean water is
vital when your baby has
diarrhoea. ORS won't cure it, but
will restore the water your baby is
losing.
Protect your baby from
dehydration by giving him lots of
clean water. Keep him inside on
hot days. Dress him in loose
cotton clothes, too.
Your baby's babble is sounding more like real words now, but she's not ready to
talk yet.
On hot days, your baby could get a heat rash. The rash appears where clothing
fits snugly, around the chest, neck, groin and armpits. Your baby may also get
dehydrated if she gets too warm.
You can help protect your baby from dehydration and heat rash:
First: stay at home on hot days.
Second: dress your baby in cotton clothes.
Third: if your baby seems warm, loosen her clothes, or remove a layer.
Fourth: make sure your baby drinks enough clean, safe water. Boil enough
water to last your family for the whole day.
Fifth: keep breastfeeding. Your breastmilk is 80% water so it can quench your
baby's thirst. If your baby refuses feeds, take her to the clinic.
If your baby gets a heat rash, wipe her with a wet cloth and let the air dry her
skin. Give her time without her nappy, too.
Ask your health worker for cream to soothe the red areas of her skin.
If you want to do one good thing for your baby this week, make sure your baby
drinks plenty of clean, safe water.
This message equips mothers with practical
tips to care for their baby in hot weather.
Include whatever method is used in your
community to clean water.
Annually, safer water could prevent:
1.4 million child deaths from diarrhoea;
500 000 deaths from malaria;
860 000 child deaths from malnutrition.
WHO Q&A 2008.
There are many ways to prepare clean, safe
water. Please substitute “boiling” with the
best method of appropriate to your
community.
References
UNICEF. 2011. Water, Sanitation and Hygiene Annual Report 2010.
The Lancet. 2004. Executive Summary of Lancet Neonatal Survival Series.
World Health Organization. 2010. Countdown to 2015.
WHO. 2008. Guidelines for drinking water quality, 3rd edition. Geneva: WHO.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
42
If your baby has a cold, a fever
and pulls his ear, it could be an
ear infection. Don't put anything
in his ear. Take him to the clinic.
You can now give your baby food
Your baby's beginning to understand simple words and phrases. Encourage him
by repeating his words back to him using adult language.
Ear infections are common. If your baby has a cold and then a fever, it may be
because he has an ear infection.
Ear infections can be painful; swallowing and sucking can hurt. Your baby may
The message gives the mother practical tips
which will boost her confidence in her ability
to care for her baby.
Ear infections are common in babies and
3-4 times a day. Try mashing
potato with meat, fish or beans
and give fruit or eggs. Keep
breastfeeding!
Your baby probably keeps you up
at night. Try to get some sleep
when he sleeps. You'll feel better.
pull at his ear or be unsettled. There could be a bad smell from his ear.
If you think your baby has an ear infection, go to the clinic. Staff will give him
the medicines he needs.
A baby with an ear infection will cry a lot, and may keep you up at night.
Do not put oil or any other herbal medicine in your baby's ears, as it might
worsen the infection.
Breastfeeding your baby will reduce the risk of ear infections, especially if you
feed him sitting upright. Keeping your baby away from smoke will also help.
If you want to do one good thing for your baby this week, keep breastfeeding
him to keep him healthy.
small children. NHS Choices, 2011.
References
WHO. 2001. Model chapter for textbooks, Integrated Management of Childhood illnesses. Geneva: WHO.
CKS. 2011. Clinical topic: Otitis media – acute. NHS Clinical Knowledge Summaries. www.cks.nhs.uk [Accessed February 2011]
NHS. 2010. Otitis media. NHS Choices, Health A-Z. www.nhs.uk [Accessed February 2011]
NHS Choices 2011 http://www.nhs.uk/planners/birthtofive/pages/childhoodillnesses.asp
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
43
If your baby is hot, irritable and
feeding poorly, she may have a
fever. Take her to the clinic.
If your baby's forehead, chest or
back feel hot, bathe her in cool
water. Give her plenty of
breastmilk or boiled water.
If your baby has a fever that lasts
more than a day, take her to the
clinic. Staff there can help.
Your baby now understands simple instructions, such as "give it to me". She
Fever is a sign of illness. Early detection and
may ignore you when you say "no", though. Use "no" sparingly, so it will mean
treatment can help reduce child mortality.
more.
WHO Factsheet 2010.
You can tell if your baby has a fever by touching her forehead, chest or back. If
she's warm to the touch, she has a fever. She may also be irritable and feeding
poorly.
If you see any of these signs, take her to the clinic. Staff there will try to find the
cause of the fever and treat it.
After taking your baby to the clinic, you can help your baby recover.
Give your baby plenty of fluids. Offer her your breast regularly along with boiled
water. This will give her strength.
Let your baby rest if she wants to. Illness can make her very tired.
You can also sponge her face, neck, arms and legs with lukewarm water to bring
down the fever.
If you want to do one good thing for your baby this week, try playing a game
with simple instructions such as: "Give mummy the toy." "Well done." "You are
a clever baby."
References
The Lancet. 2004. Executive Summary of Lancet Neonatal Survival Series.
World Health Organization. 2010. Countdown to 2015.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
44
Your baby now understands
simple instructions. That doesn't
mean he'll listen! He's exploring
his independence.
If your baby gets a cut, wash it
well to prevent infection. Then
rub some antiseptic cream. You
can get antiseptic cream at the
clinic.
If your baby's eyes are sticky or
pink, he may have an eye
infection. Bathe his eyes in cool
clean water. Go to the clinic.
By now your baby may be making lots of sounds, and may know when to use
them. Encourage him by listening to him and answering him.
Eye problems are quite common in babies. They are sometimes caused by dust
or smoke. If your baby has a cold, he may also develop an eye infection. You
may notice a sticky yellow discharge that makes the eyelids stick together. Or,
your baby's eyes may be pink and watery.
If your baby has any of these signs, go to the clinic. Staff will give him
treatment. An eye infection is rarely serious, but it is painful.
If your baby has an eye infection, it can easily spread. It is very important to
keep the eye clean. Make sure no one else uses your baby's wash cloths.
Bathe your baby's eyes in cool, boiled clean water daily to soothe his eyes.
Wash your hands before and after doing this.
If you want to do one good thing for your baby this week, sit your baby facing
you and talk and smile at her while you help her feed herself.
Children are prone to eye infections. If left
untreated, severe cases can permanently
damage the eye. NHS Choices, 2010.
If trachoma is prevalent in your area, urge
mothers to seek clinic help quickly if the
baby shows these signs:





Discharge from the eye
Swelling of lymph nodes just in front
of the ears
Swollen eyelids
Turned-in eyelashes
Cloudy cornea
References
USAID. 2007. The USAID Child Blindness Program.
CKS. 2007. Clinical topic: Conjunctivitis – infective. NHS Clinical Knowledge Summaries.
CKS. 2011. Clinical topic: Conjunctivitis – allergic. NHS Clinical Knowledge Summaries
NHS. 2010a. Conjunctivitis, allergic. NHS Choices, Health A-Z.
NHS 2010b. Conjunctivitis, infective. NHS Choices, Health A-Z.
NHS Choices. 2010. Conjunctivitis. http://www.nhs.uk/Conditions/Conjunctivitis-infective/Pages/Introduction.aspx
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
45
Wash fruit and vegetables to
remove dirt and germs. Use
As your baby grows up, it is important to keep her clean and healthy.
Here are some simple tips to do this:
Handwashing interventions reduced the
incidence of diarrhoeal diseases by 32% in
45
45
boiled water and wash them well
before feeding them to your
baby.
If your child refuses to eat, be
patient. Don't force him. Give him
fresh foods with lots of colours,
tastes and textures.
Food that has gone bad can cause
diarrhoea and make your baby ill.
Buy fresh foods regularly.
Ensure your family washes their hands before cooking or eating, after using the
toilet and after handling animals. Why not set up a stand with clean water and
soap near to where you prepare food?
Wash your hands and your baby's hands with soap. Clean wrists and nails, too.
Air-dry hands, or use a clean towel, changed often.
Second, wash beans, potatoes, vegetables and fruits, unless they are peeled,
before cooking and eating. Dirt contains germs, which are harmful.
Third, use only fresh food. Food that's been left out, or cooked some time ago,
can be harmful. Food must be warm, but cool enough for her to eat. Check the
temperature by putting some on your wrist.
Fourth, check that food is well cooked. Meat shouldn't be pink in the middle
and fish should be cooked so it flakes. Eggs should be firm.
If you want to do one good thing for your baby this week, remind your family to
wash their hands with soap often and always before preparing food or feeding
the baby.
low and middle income countries, and 39%
in high income countries. (Ejemot et al.
2008)
It has been widely demonstrated that the
private home setting is considered the first
place in which foodborne diseases develop.
This is due to poor personal and/or
environmental hygiene with an increased
risk of infection. (Istituto Superiore di Sanità
2003; Comodo et al. 2000; Fara and Proietti
2000; Griffith et al. 1998; Istituto Superiore
di Sanità 2006; Kagan et al. 2002; Redmond
and Griffith 2003; Scott 2001.
References
Ejemot. R.I. et al 2011 Hand washing to prevent diarrhoea (review) Cochrane Library
Langiano, E. 2011. Food safety at home: knowledge and practises of consumers. Journal of Public Health: 1-11.
UNICEF. 2011. Water, Sanitation and Hygiene Annual Report 2010.
WHO. 2000. Food borne disease: a focus for health education.
WHO. 2003. Healthy Villages – A guide for communities and community health Workers.
WHO. 2001. Water for Health: Taking Charge.
UNICEF. 2012. Diarrhoea. http://www.unicef.org/health/index_43834.html. [Accessed on 3 June 2014]
WHO. 2013. Diarrhoeal Disease. http://www.who.int/mediacentre/factsheets/fs330/en/ [Accessed on 3 June 2014]
46
46
New foods may make your baby's
stools hard. Feed her mashed
fruit. Give her boiled water from
a cup, not a bottle. Breastfeed
her whenever she wants.
Even though your baby is eating
solids, breastmilk is still an
important part of his food. Keep
breastfeeding until he is 2 years
old.
Your baby may be bigger, but he can still get diarrhoea or constipation. Check
your baby's stools to spot these problems.
If your baby is making loose, watery stools, he may have diarrhoea. This causes
your baby to lose lots of fluids.
To replace them, offer your breast and boiled water.
If your baby still has diarrhoea after a day, go to the clinic. Staff there can give
you a solution which will help your baby replace the fluid, salt and sugar that
he's lost.
If your baby is straining hard to pass stools, they are hard, bloody or he isn't
passing stools often, he's probably constipated.
Check where mothers can get ORS in your
community and amend the message
accordingly.
Also check where mothers should seek
treatment for diarrhoea in their babies.
Diarrhoea remains the second leading cause
of death among children under five globally.
Nearly one in five child deaths – about 1.5
million each year – are due to diarrhoea. It
kills more young children than AIDS, malaria
46
Diarrhoea makes your baby lose
lots of fluid. Help him recover by
breastfeeding. Take him to the
clinic for ORS and zinc.
Offer him your breast, along with boiled water, fruit and cooked vegetables.
This will help to get things moving! A baby who has been unwell will need extra
food once he recovers. Offer him more breastfeeds and one extra meal every
day for two weeks after he feels better. This will give him the energy he needs
to recover.
If you want to do one good thing for your baby this week, give him extra
breastfeeds if he has been unwell to help him recover.
and measles combined.
(WHO/UNICEF 2011)
References
WHO/UNICEF. 2011. Diarrhoea: why children are still dying and what can be done.
MOST. 2005. Diarrhoea Treatment Guidelines.
WHO/UNICEF. 2011. Diarrhoea: why children are still dying and what can be done
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
UNICEF. 2012. Diarrhoea. http://www.unicef.org/health/index_43834.html. [Accessed on 3 June 2014]
WHO. 2011. Zinc supplementation in the management of diarrhoea. http://www.who.int/elena/titles/bbc/zinc_diarrhoea/en/. [Accessed on 3 June 2014]
WHO. 2013. Diarrhoeal Disease. http://www.who.int/mediacentre/factsheets/fs330/en/ [Accessed on 3 June 2014]
47
Your baby may be crawling
everywhere. Expect bumps and
bruises now your baby is mobile.
Your baby is nearly 1 year old.
Good job! She needs more food
now. Start giving her the food you
eat.
It can take many tries before your
baby learns to enjoy a new food.
Introduce foods one at a time, so
that you know if anything upsets
her stomach.
Now that your baby is moving, be prepared for bumps and bruises. Hugs and
kisses will help her feel better!
With your baby exploring, you need to keep her safe.
Put cushioning on the corners and edges of tables and chairs. Keep sharp
objects out of reach. Fires can lead to nasty burns. Keep matches and lighters
out of reach. If you smoke, never smoke near your baby and make sure you get
rid of cigarettes properly. When cooking, keep an eye on your baby, or ask
someone to watch her.
Keep kerosene, detergents, medicines and harmful materials sealed on high
shelves. If your baby has swallowed something poisonous, work out what,
when and how much she swallowed. Go to the clinic immediately, with the
container of poison, too.
Clear the floor of buttons, pebbles and other small objects. Don't give her small
pieces of food, such as nuts or raisins. These things can choke her.
Keep breakable cups or plates somewhere safe.
If you want to do one good thing for your baby this week, follow these tips to
help keep your baby safe.
In 2008, 3% of deaths of children aged under
five were caused by injuries. WHO, 2008.
References
World Health Organization. 2008. Tackling injuries, the leading killers of children. Regional Office of Europe-World Health Organization.
WHO/UNICEF, 2008, World report on child injuries. http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf?ua=1
48
Your baby can now remember
things. Play games like pat-a-cake
and peek-a-boo each day and see
how quickly she learns them.
When your baby's unwell,
members of your community may
suggest treatment. But don't give
your baby anything before
checking at the clinic.
Offer new foods to your baby
every so often. If she refuses,
encourage her by trying different
food combinations, textures and
tastes.
Your baby may be able to say "ma" and "baba". Talk to her; soon you'll have
long conversations! You can play clapping games and peek-a-boo now as well.
Now your baby has expanded her food options, try to make feeding a fun
activity. This gets more and more important as your baby gets older. Making
eye contact with your baby while feeding her will help your baby really enjoy
feeding times and will also help you bond with your baby.
It's important to know when your baby is hungry. Feed her as soon as she
shows signs of hunger, and stop when she has shown signs of being full.
Try to offer new foods every now and then. She may refuse at first but with a
little encouragement she will eventually accept them. You could try different
food combinations, textures and tastes to make meals more appealing.
If your baby gets easily distracted while eating, preventing her from eating well,
then try to minimise the distractions. You could go to a corner and face away
from everyone else and your baby's toys.
If you want to do one good thing for your baby this week, learn how to tell if
your baby is hungry and full.
Responsive feeding (RF), or the interaction
between caregiver and child during feeding,
has become an important issue for scientific
inquiry—and a component of nutrition
programming—in response to studies
showing an association between caregiver
feeding behaviors and child acceptance of
food.
References
http://www.unicef.org/nutrition/training/5.3.1/3.html
http://www.iycn.org/2011/07/what-is-the-role-of-responsive-feeding-in-child-undernutrition/
NHS Choices, Birth to five. www.nhs.uk[Accessed May 2011]
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
49
Your baby may be able to feed
himself with his fingers. Make
sure his hands are clean. It may
be messy, but try to let him do it
himself.
Being a mother can be hard
You have probably experienced many highs as a mother, but it can be stressful,
too. This can leave you feeling tired and run down.
Not getting enough sleep can make the simplest tasks difficult. Try to make
some time for yourself to rest. Why not ask a trusted friend or family member
to look after your baby for a while? If your baby still takes a long time to settle,
make sure you stick to a bedtime routine. Go to bed as soon as your baby is
This message encourages the mother to
focus on her own health, too. It also offers
practical tips to help her cope with
motherhood.
Estimates of the incidence of depression in
women in developing countries vary widely,
sometimes. Why not try talking to
your mother or an elder? Don't
be scared to ask for help.
Your baby's desire to explore is
stronger than his desire to listen
to your warnings now. Keep your
eye on him to keep him safe.
asleep.
Eating well can relieve stress. Eat three meals a day and have some snacks, too.
Fruit and vegetables are good snacks.
Sometimes all you need is to talk to somebody. Why not try talking to your
mother or an elder? Talk to your partner to see if he can help. Maybe together
you can find time for you to relax. Your health worker is also there to help you
with any questions or worries you have.
If you want to do one good thing for your baby this week, take some time for
yourself and relax.
from 15–57%. Depression in these women
has a complex etiology involving factors as
diverse as poverty, marital conflict, domestic
violence and lack of control over economic
resources.
Research in developing countries suggests
that poor maternal mental health, in
particular maternal depression, may be a risk
factor for poor growth in young children.
(WHO 2011. Bulletin. Depression and Early
Childhood Growth in Developing Countries:
Systematic Review and Meta Analysis.)
References
Nice. 2010. Weight management before, during and after pregnancy. National Institute for Health and Clinical Excellence. Public health guidance 27.
World Health Organization/ Food and agriculture organization. 2006. FAO/WHO technical consultation on national food-based dietary guidelines.
MIND. 2006. How to look after yourself. National Association for Mental Health.www.mind.org.uk
APNI. 2007. Post natal depression. The Association of Post Natal Illness. www.apni.org [pdf file, accessed December 200CKS. 2011. Postnatal depression. Clinical Knowledge Summaries.www.cks.nhs.uk
WHO 2011. Bulletin. Depression and Early Childhood Growth in Developing Countries: Systematic Review and Meta Analysis.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
50
Your baby might get scared when
you leave him. Say goodbye
quickly, with a kiss. He should
calm down after you've gone.
During the next year your baby
will need some more vaccines.
Stay in touch with your health
worker so you know when to go
to the clinic.
Some worms are picked up from
the ground and can make your
baby ill. Thick socks or shoes will
Your baby is starting to be independent, but might still get scared when you
leave him. Say goodbye quickly, with a kiss. He should calm down after you've
gone.
Your baby is nearly a year old! He's changed from the newborn you first held.
You have also changed. You are probably feeling more confident as a parent
now. If you have any questions, talk to your health worker. She can help.
As your baby gets older, he may need other vaccinations, including more doses
of DTP, measles and polio. Your clinic will know which ones are due and when
they have to be given.
Your baby may like to play outside but, in some areas, worms are a problem.
Worms are picked up from the mud and soil, and can cause stomach pain,
coughing and fever. Thick socks or shoes will help protect your baby. Wash his
This message encourages the mother to
reflect on how far she and her baby have
come. This will help to boost her confidence.
Some worms can enter the body through the
mouth as worm eggs; others enter through
the skin as larvae. It is therefore important
for children to develop the habit of washing
hands properly, keeping nails short and
clean and always wearing footwear when
playing on the ground (soil).
(WHO. Urbani school health kit)
help protect your baby when he
plays outside.
hands well with soap, and clean his nails regularly. This will prevent him from
swallowing any worm eggs.
If you want to do one good thing for your baby this week, when you have to
leave him, give the person who is looking after him a t shirt that you have worn.
Your baby will be reassured by your smell.
Change to fit local deworming practices:
some countries offer deworming treatments
every six months after the first year of age.
Also check when or if your community offers
Vitamin A infections.
References
WHO. 2005. The evidence is in: deworming helps meet the Millennium Development Goals. World Health Organization.
WHO. Urbani School Health Kit: A Lively and Healthy Me: A Campaign on Preventing and Controlling Worm Infections for Health Promoting Schools. (date unknown)
http://www.who.int/immunisation/documents/positionpapers/en/
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.
Summary of WHO position papers – recommended routine immunisations for children (Tables 1 & 2)
http://www.who.int/immunization/policy/Immunization_routine_table1.pdf
http://www.who.int/immunization/policy/Immunization_routine_table2.pdf
51
There are many ways to prevent
getting pregnant too soon. Talk to
your health care worker to find
out more.
Keep breastfeeding your baby.
She still needs your milk for at
least another year. It still has
plenty of goodness for her.
Your almost one-year-old is very
different to the tiny baby you
gave birth to, and all because of
your loving care. Goodbye and
good luck!
References
Congratulations. Your baby is now a year old. If she's not walking already, she is
likely to take her first steps soon. It's normal for some babies to take a few
more months, though.
Here are three things to remember :
One: the next year with your baby will be just as interesting, exciting and
probably as exhausting as the last one. Your baby has grown from a tiny
helpless newborn to a bright and lively one-year-old. And you have grown from
a new parent worried about everything your newborn did to a capable, wise
mother.
Two: Your baby will learn something new every day. This time next year she will
be talking as well as walking, running, climbing, singing and dancing. And she
will be doing all those things because of your loving care. Keep taking her to the
clinic for regular check-ups, and watch as she grows.
Three: keep breastfeeding her. Your baby still needs your milk for at least
another year. It still has plenty of goodness for her.
Good luck!
Encourages parent-child interaction.
Inspires confidence in the mother, and helps
her to see her achievements so far.
Encourages the mother to continue
breastfeeding.
WHO. 2000. Complimentary Feeding: Family Foods for Breastfed babies.
Farrell P, Sittlington N. 2011. The normal baby. In Fraser DM, Cooper MA. eds. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingstone, 763-83
Sheridan M. 2008. From birth to five years: children's developmental progress. London: Routledge.