MOTHER AND BABY CARD BABY CARD BABY CARD Pregnancy [PDF]

MOTHER AND BABY CARD Pregnancy Woman's name:

Danger signs during pregnancy

______________________

House identification: ______________________ Village/community:

______________________ Vaginal bleeding

Severe abdominal pain

Date of CHW visits: visits: First pregnancy visit _____________ _______________ Second pregnancy visit _____________ ANC visits at heal health centre done (tick): (tick):

ANC 1 ______ ANC 2 ______ ANC 3 ______ ANC 4_____ Birth preparedness:
Counselled on importance of health facility birth?
Counselled on preparations for birth?

Fits

Severe headache

Fever

Fast or difficult breathing

CONTACT YOUR CHW AS SOON AS THE BABY IS BORN CHW's CHW's name:

___________________ __________________________ ___________

CHW contact contact details: details: _______________________ __________________________ _______ ________________ __________________________ ______________

WHO/UNICEF

Go to the health facility immediately if

MOTHER AND BABY CARD After Birth

MOTHER HAS:

Name of the baby/mother: _______________________ Date of birth: birth: __________ Place of birth: ___________ CHW home visits: Visit 1 made on Day ___

Heavy bleeding

Severe abdominal pain

Fits

Severe headache

Stops breastfeeding well

Has fits

Fever

Visit 2 made on Day ___ Visit 3 made on Day ___ Date of first postnatal visit at a facility: facility: ___________ BIRTH WEIGHT

Difficult breathing

BABY:

In kg : _____ Encircle zone zone on scale: Red

Yellow

Green

If twins, record for the second twin below: In kg : _____ Encircle zone on scale: Red

Yellow

Green

FOLLOWFOLLOW-UP VISITS

Has difficult or fast breathing

For a small baby: First follow-up visit on day ___ Second follow-up visit on day ___ For danger signs: On day ___

Fever or unusually cold

Becomes less active Whole body becomes yellow