📞When to Call Your Midwife: A Practical Guide to What Can't Wait
A clear, honest guide to the symptoms that need same-day assessment, the ones that can wait for your next appointment, and the ones that need an ambulance.
6 min readWeeks 1–42By The MMF Team
When to Call Your Midwife: A Practical Guide to What Can't Wait
One of the genuinely useful things you can do in pregnancy is decide in advance, calmly, which symptoms warrant a phone call — rather than making that decision at 2am while Googling in a panic.
Here is that decision guide.
## Call 999 / 991 (Emergency Services) Immediately
These symptoms need an ambulance. Do not drive yourself. Do not wait for a callback.
Heavy vaginal bleeding: Soaking through a maternity pad in less than an hour, or any bleeding accompanied by severe pain.
Severe abdominal or pelvic pain that is constant (not in waves like contractions): Especially if accompanied by shoulder tip pain (which can indicate internal bleeding from a ruptured ectopic in very early pregnancy, or other internal bleeding later on).
Suspected placental abruption: Sudden severe abdominal pain with or without bleeding, often with a rigid, tender abdomen and foetal distress signs.
Seizure or loss of consciousness: Call emergency services first. Eclampsia (seizures caused by severe pre-eclampsia) is life-threatening and requires immediate hospital management.
Difficulty breathing or chest pain: Can indicate pulmonary embolism (blood clot in the lungs), which is more common in pregnancy and postpartum.
Suspected umbilical cord prolapse (cord visible at vaginal opening, especially if membranes have broken): Call 999 immediately and get on all fours. This is an obstetric emergency.
## Call Your Maternity Unit Immediately (Do Not Wait for Morning)
Reduced or absent foetal movements after 28 weeks: Your baby should have a consistent pattern of movement. A significant reduction from their normal pattern — or no movement for 2 hours during a period when they are normally active — requires same-day assessment. Do not be reassured by drinking cold water, lying on your side, or eating. Go in and be monitored.
Severe headache not relieved by paracetamol + visual disturbance: Pre-eclampsia sign. Requires same-day blood pressure check and blood tests.
Sudden severe swelling of face, hands, or feet.
Waters breaking at any gestation: Once membranes rupture, assessment is needed within a few hours to confirm gestation, establish if fluid is clear (or meconium-stained), check the baby's position, and discuss management plan.
Regular contractions before 37 weeks: Preterm labour requires assessment. Do not wait to see if they settle.
Fever above 38°C in pregnancy: Can indicate chorioamnionitis (uterine infection) or other serious infection requiring antibiotic treatment.
Any bleeding in pregnancy, even if light: Particularly in the second and third trimester, where it warrants assessment.
Any symptom that causes you genuine concern: This is not irrational. Maternal instinct — the sense that something is wrong — has a clinical reputation for being correct at rates above chance. Trust it enough to make a phone call.
## Mention at Your Next Appointment
Mild, intermittent ankle swelling without sudden onset or facial involvement.
Heartburn, constipation, round ligament pain (brief sharp pain in the lower abdomen when changing position).
Mild nausea beyond 14 weeks that is manageable.
Braxton Hicks contractions that are irregular, not increasing in intensity, and stop with rest or position change.
Lower back pain without other symptoms.
Vaginal discharge that is white or clear, without itch or offensive smell (leucorrhoea — normal in pregnancy).
## The Key Principle
Maternity triage teams would rather receive 100 calls that turn out to be unnecessary than miss one that was significant. They are not judging you for calling. They are not inconvenienced by your concern. If you are unsure whether a symptom warrants a call, the answer is: call and ask. That is exactly what the service exists for.
Save your maternity unit's triage number in your phone now, at whatever gestation you are at. You should not be searching for it at 3am.
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Around the World
Cultural practices & traditions — medically contextualised
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Zambia / Uganda
In Zambia and Uganda, the primary emergency number is 991 (Zambia) or 999 (Uganda/UK). Many maternal deaths in sub-Saharan Africa occur because women or families delay seeking care — sometimes due to transport barriers, sometimes due to underestimating the severity of symptoms, sometimes due to cultural expectations of enduring pain. The 'three delays' model (delay in recognising danger, delay in reaching care, delay in receiving care at facility) is the major driver of preventable maternal mortality in low-resource settings.
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UK
In the UK, NHS Direct (111) can advise on whether a symptom requires emergency care. For pregnancy-specific concerns, the maternity triage number of your booking hospital is often more directly useful than 111 — save this number in your phone from early in pregnancy. The rule for any pregnancy symptom you are unsure about: if you are worried enough to Google it at 2am, you are worried enough to call.
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West African
In many Nigerian, Ghanaian, and Senegalese communities, a 'strong woman' narrative around pregnancy can discourage women from seeking care for symptoms they fear will be dismissed as weakness. The data on maternal mortality in West Africa consistently shows that women who arrive at facilities with severe complications have often had warning symptoms for 12-24 hours that were not acted on. Recognising and responding to warning signs is not weakness — it is clinical competence on behalf of yourself and your baby.
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South Asian
In South Asian communities, the involvement of older female relatives in interpreting pregnancy symptoms is culturally embedded. While experienced grandmothers and aunts often have genuinely useful traditional knowledge, some warning signs — particularly severe headache with visual disturbance (pre-eclampsia), reduced foetal movement, or heavy bleeding — require urgent medical assessment regardless of what a home remedy or traditional interpretation suggests. Cultural wisdom and medical care are not in opposition when warning signs are serious.
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Latin American
'Mal de ojo' (evil eye) and 'susto' (fright) are cultural explanatory frameworks used across Latin American communities to interpret illness and discomfort, including pregnancy symptoms. Where cultural interpretation delays medical help-seeking for clinical emergencies, the outcomes can be serious. Respecting cultural belief does not mean accepting delays in accessing care for bleeding, severe headache, or absent foetal movement.
Cultural practices are presented for educational purposes. Always discuss traditional remedies and practices with your midwife or health worker before adopting them during pregnancy or postpartum.