During pregnancy
Teach the woman and family which symptoms need prompt maternity assessment and where emergency care is available.
Pregnancy • Birth • Postnatal • Newborn
Maternal & Newborn Danger Sign Counselling
A practical, WHO-aligned guide to recognizing maternal and newborn warning signs early, explaining when urgent care is needed, and helping families act safely.
WHO-aligned
Early recognition
Urgent referral
Family counselling
Safety-netting
The core message
Danger-sign counselling is part of every stage of maternity care
WHO emphasizes recognition of conditions requiring additional care, clear family counselling and timely referral for mothers and newborns.
During labour & birth
Monitor maternal and fetal condition, recognize complications and escalate promptly according to the maternity protocol.
After birth
Teach families to recognize maternal and newborn danger signs and to seek care early between postnatal contacts.
Maternal warning signs
Pregnancy: signs that need prompt assessment
These are important warning signs. The urgency depends on the symptom and clinical context; severe or rapidly worsening symptoms require emergency care.
Vaginal bleeding
Any vaginal bleeding in pregnancy should be assessed promptly, particularly heavy bleeding or bleeding with pain, dizziness or weakness.
Severe headache or visual disturbance
Severe or persistent headache, blurred vision, flashing lights or other visual symptoms can be warning signs of hypertensive disorders and require assessment.
Severe abdominal pain
Severe or persistent abdominal pain needs clinical assessment and should not be managed at home as a routine pregnancy discomfort.
High fever or feeling very unwell
Fever with chills, weakness or other concerning symptoms can indicate infection or another serious illness.
Reduced or absent fetal movement
A change or reduction in the baby's usual movements later in pregnancy requires prompt maternity assessment according to local guidance.
Convulsions, collapse or loss of consciousness
This is an emergency. Arrange immediate emergency care and do not leave the woman alone.
Difficulty breathing or chest pain
Breathlessness at rest, severe difficulty breathing or chest pain requires urgent emergency assessment.
Sudden swelling with other symptoms
Sudden swelling, particularly when associated with headache, visual symptoms or abdominal pain, needs prompt assessment.
Labour & childbirth
Escalate concerning maternal or fetal conditions
During labour, danger-sign recognition is integrated with ongoing maternal and fetal assessment and the facility's emergency obstetric and newborn care protocols.
Heavy bleeding
Heavy vaginal bleeding during labour or immediately around birth requires urgent obstetric assessment and emergency management.
Convulsions or altered consciousness
Treat as an emergency and arrange immediate assessment and appropriate emergency response.
Severe maternal breathing difficulty
Urgent assessment is required for severe breathlessness, cyanosis or other signs of cardiorespiratory compromise.
Severe or persistent abdominal pain
Pain that is severe, persistent or clinically concerning needs immediate evaluation.
Fever with maternal or fetal concern
Fever during labour can indicate infection and requires assessment according to the maternity protocol.
Abnormal labour progress or other complications
Problems with labour progress, fetal condition or maternal condition require skilled assessment and escalation according to local protocols.
Clinical principle: A counselling page cannot replace skilled assessment during labour. If maternal or fetal condition is concerning, follow the facility's escalation, emergency response and referral protocols without unnecessary delay.
After childbirth
Postpartum maternal danger signs
The first weeks after childbirth are important for maternal recovery. Families should know which symptoms require urgent review.
Heavy bleeding or large clots
Seek emergency help for heavy postpartum bleeding or bleeding associated with weakness, dizziness, fainting or worsening condition.
High fever or chills
Fever, chills, worsening pain or feeling very unwell may indicate postpartum infection and require assessment.
Severe headache, visual symptoms or seizures
These may indicate a hypertensive or neurological emergency and require urgent assessment.
Chest pain or difficulty breathing
Seek emergency care for chest pain, severe breathlessness, fainting or other signs of serious illness.
Wound or perineal problems
Increasing pain, redness, swelling, pus, wound separation or other concerning changes need clinical review.
Severe emotional distress or safety concerns
Seek professional help for severe anxiety, inability to cope, thoughts of self-harm or harm to the baby, or violence/abuse.
WHO postnatal principle: women and newborns should receive care during the first 24 hours after birth and additional postnatal contacts during the first six weeks. Families should also know the maternal and newborn danger signs and where to seek care.
Newborn danger signs
Signs requiring prompt newborn assessment
WHO recommends assessment for these danger signs at postnatal contacts and early care-seeking if families identify them between visits.
Not feeding well
A newborn who is not feeding well or has stopped feeding should be assessed promptly.
Fast breathing or severe chest indrawing
WHO identifies fast breathing (>60 breaths/minute) and severe chest indrawing as newborn danger signs requiring referral.
Convulsions
A history of convulsions or a seizure is an emergency sign requiring urgent evaluation.
No spontaneous movement / very lethargic
A baby who is not moving normally, is unusually floppy or is difficult to arouse needs urgent assessment.
Fever or low temperature
WHO postnatal guidance identifies temperature >37.5 °C or <35.5 °C as danger signs in newborns.
Jaundice in the first 24 hours
Any jaundice during the first 24 hours of life requires prompt clinical evaluation.
Yellow palms or soles
Yellow discoloration of the palms and soles at any age is a newborn danger sign requiring evaluation.
WHO newborn danger-sign set: not feeding well; history of convulsions; fast breathing >60/minute; severe chest indrawing; no spontaneous movement; fever >37.5 °C; low temperature <35.5 °C; any jaundice in the first 24 hours; or yellow palms and soles at any age.
Other newborn concerns
Additional symptoms that should not be ignored
These concerns may have different causes and urgency. A newborn with concerning symptoms should be assessed by a qualified health professional.
Persistent vomiting or inability to keep feeds down
Prompt assessment is needed, especially when associated with poor feeding, lethargy, dehydration or breathing difficulty.
Bleeding
Any unexplained bleeding in a newborn requires prompt medical assessment.
Cord infection signs
Redness spreading around the umbilicus, pus, bleeding or worsening swelling should be assessed.
Eye discharge or skin pustules
Pus from the eyes or multiple skin pustules may indicate infection and should be assessed.
Diarrhoea or dehydration concerns
Seek medical advice promptly for significant diarrhoea, poor feeding, reduced urine/wet nappies or other dehydration concerns.
Baby feels unusually cold
Cold stress or low temperature can be dangerous in newborns and requires warming and prompt assessment.
Referral pathway
What to do when a danger sign is recognized
The exact clinical response depends on the condition, provider scope, available resources and local emergency/referral protocols.
1
Recognize
Identify the warning sign and consider maternal or newborn emergency status immediately.
2
Stabilize within scope
Provide appropriate immediate supportive/emergency measures according to training, facility protocol and available resources.
3
Refer urgently
Do not delay referral when a danger sign indicates possible serious illness. Arrange the appropriate level of care.
4
Communicate
Explain the reason for referral clearly to the woman/family and communicate with the receiving facility when possible.
5
Transport safely
Help arrange suitable transport and avoid leaving a seriously ill mother or newborn without appropriate supervision.
6
Document
Record the assessment, danger sign, actions taken, referral destination, communication and accompanying person where applicable.
Family emergency plan
- Know the facilityIdentify the nearest appropriate maternity/newborn facility before an emergency occurs.
- Know the contactKeep important phone numbers available and make sure family members know how to use them.
- Plan transportDiscuss how the mother or newborn will reach care at night, on weekends and during emergencies.
- Take recordsCarry maternity/newborn records, prescriptions and relevant referral documents when seeking care.
- Do not delayIf a serious danger sign develops, seek care rather than waiting for the next scheduled visit.
How to counsel families
- Use simple languageExplain danger signs using words and examples the family can understand rather than relying only on medical terminology.
- Show what to look forDemonstrate observable signs such as difficult breathing, poor feeding, heavy bleeding or jaundice when appropriate.
- Give an actionEvery danger sign should be linked to a clear action: who to contact, where to go and how urgently to seek care.
- Check understandingAsk the woman or caregiver to repeat the key signs and the planned response in their own words.
- Plan aheadDiscuss transport, emergency contact numbers, referral facility, costs and who can accompany the mother or baby.
- Safety-netEncourage families to seek help between scheduled visits if a danger sign develops or if they are worried about the mother or baby.
Postnatal contacts
Use every contact to reinforce danger-sign education
| Timing | Key counselling opportunity | Safety-net message |
|---|---|---|
| Within 24 hours | Review maternal recovery and newborn condition; reinforce feeding, warmth, hygiene and danger signs. | Explain where and how to obtain urgent care for either mother or baby. |
| 48–72 hours | Reassess feeding, maternal symptoms, newborn condition and family concerns. | Recheck understanding and update the emergency plan if needed. |
| Days 7–14 | Review maternal and newborn recovery, feeding, infection concerns and emotional well-being. | Reinforce that new danger signs require care between scheduled visits. |
| Week 6 | Complete postnatal assessment and continue longer-term health, breastfeeding, contraception and well-being counselling. | Confirm the family knows how to access care for future concerns. |
For midwives, nurses & educators
Teach, check, document and follow up
Danger-sign counselling is most useful when the family leaves with a clear, practical action plan.
Document
Record that danger-sign counselling was provided, the topics covered, family understanding and the agreed referral/emergency plan.
Include the family
Where the woman agrees, include the chosen support person or caregiver so more than one person understands the warning signs and response.
Use teach-back
Ask the woman/caregiver to explain what they would do if a warning sign occurs. Correct misunderstandings before discharge.
Respectful communication matters: provide information clearly, maintain privacy and dignity, invite questions, and avoid blaming the woman or family for seeking care late or having difficulty accessing services.
Frequently asked questions
Maternal & newborn danger-sign FAQs
What are maternal danger signs during pregnancy?
Important warning signs include vaginal bleeding, severe headache or visual disturbance, severe abdominal pain, high fever or feeling very unwell, convulsions or loss of consciousness, difficulty breathing or chest pain, and reduced or absent fetal movement. The appropriate response depends on the clinical situation, but concerning signs should receive prompt professional assessment.
What are the WHO newborn danger signs?
WHO postnatal guidance identifies not feeding well, a history of convulsions, fast breathing greater than 60 breaths per minute, severe chest indrawing, no spontaneous movement, fever above 37.5 °C, low temperature below 35.5 °C, jaundice in the first 24 hours, and yellow palms and soles at any age as newborn danger signs requiring further evaluation.
When should a family seek help for a newborn?
Families should seek care promptly when a newborn has a danger sign, and should not wait for the next routine postnatal visit. If the baby is severely unwell, emergency services or the nearest appropriate facility should be contacted immediately.
Should parents wait to see whether a newborn danger sign improves?
No. A recognized newborn danger sign can indicate serious illness. WHO recommends early care-seeking and referral for further evaluation when these signs are present.
What should be included in danger-sign counselling before discharge?
Counselling should cover maternal and newborn warning signs, where to seek care, emergency contact/transport arrangements, feeding concerns, temperature concerns, bleeding, breathing difficulty, jaundice and the importance of attending postnatal contacts.
Why is teach-back useful?
Teach-back asks the woman or caregiver to explain the danger signs and response plan in their own words. It helps identify misunderstandings and supports safer transition from facility to home.
Can this page replace a clinical examination?
No. Danger-sign counselling is intended to help families recognize possible problems early. It cannot diagnose the cause or replace examination, vital-sign assessment, laboratory testing or treatment by qualified health professionals.
Guideline references
Evidence base
Key WHO resources supporting this educational page.
WHO recommendations on maternal and newborn care for a positive postnatal experience (2022)
This guideline includes assessment of mothers and newborns, danger-sign recognition, referral and counselling as part of routine postnatal care.
WHO postnatal care guideline
WHO recommendations on maternal health (2025)
The current WHO maternal-health compilation includes recommendations relevant to pregnancy, childbirth and postnatal care and incorporates newborn danger-sign guidance.
WHO maternal health recommendations
WHO Essential Newborn Care Course, second edition (2025)
WHO's updated training resource includes recognition and response to newborn danger signs, referral and essential newborn care.
WHO Essential Newborn Care Course
WHO Essential newborn care
WHO identifies recognition and response to danger signs and timely, safe referral as core components of essential newborn care.
WHO Essential Newborn Care
WHO counselling for maternal and newborn health care
The WHO counselling handbook supports communication with women, partners and families about pregnancy, childbirth, postpartum and newborn care.
WHO counselling handbook
WHO pregnancy, childbirth, postpartum and newborn care guide
WHO's essential-practice guide provides evidence-based guidance for health professionals on maternal and newborn care and recognition of complications.
WHO PCPNC guide
Educational information: This page is intended for health education and counselling support. It does not diagnose or treat a medical condition and does not replace examination, vital-sign assessment, emergency care or local clinical protocols. If a mother or newborn has a serious or rapidly worsening symptom, seek urgent professional medical care. Exact referral pathways, emergency numbers and treatment should follow the local health system and facility protocol.