Slow growth can be a sign of one of these problems:

The mother may have too little water (amniotic fluid) in the uterus. Sometimes there is less water than usual, and everything is still OK. At other times, too little water can mean the baby is not normal, or will have problems during the labour.
The mother may have a poor diet. Find out what kind of food the mother has been eating. If she is too poor to get enough good food, try to find some way to help her and her baby. Healthy mothers and children make the whole community stronger.
The mother may have high blood pressure (hypertension). High blood pressure can keep the baby from getting the nutrition it needs to grow well. You learned how to check her blood pressure in the previous study session.
The mother may be drinking alcohol, smoking, or using drugs. These can cause a baby to be small. Try to find some way to help her to stop these damaging behaviours.
The baby may be dead. Dead babies do not grow, so the uterus stops getting bigger.

If you do not have the right equipment to check her blood pressure, and the uterus is growing too slowly, refer her to the nearest health centre for evaluation.

How to tell if the baby is dead

If you suspect that the baby may have died, refer the mother to a health centre for the stillbirth.

If the mother is five months pregnant or more, ask if she has felt the baby move recently. If the baby has not moved for two days, something may be wrong. If the mother is more than seven months pregnant, or if you heard the baby's heartbeat at an earlier visit, listen for the heartbeat again.

If the woman reports no fetal movements and you cannot hear the heartbeat, the baby may have died. If so, it is important for a dead baby (stillbirth) to be delivered soon, because the woman may bleed more than other mothers, and she is at more risk of infection.

When a mother loses a baby, she needs love, care and understanding (Figure 10.8). Make sure that she does not go through labour alone. If she gives birth to a dead baby in the hospital, someone she trusts should stay there with her during the birth.

A HEP comforting a mother who has lost a baby

Figure 10.8 When a mother loses a baby, she needs love, care and understanding.