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

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

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

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

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

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

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

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

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

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

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

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

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Counselling for Maternal and Newborn Health Care: A Handbook for Building Skills. Geneva: World Health Organization; 2013.

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

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

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