Once you know you're pregnant, or think you might be, you should see your GP to talk about your antenatal care. Your GP may test a sample of your urine to confirm that you’re pregnant.
Your GP will advise you to take a daily supplement of 400 micrograms (400µg) of folic acid, if you aren’t already taking this. This reduces the risk of your baby being born with a neural tube defect, such as spina bifida. You may need to take a higher dose of folic acid, up to 5 milligrams (5mg), if you have a family history of spina bifida, have diabetes, sickle cell disease or take medicines for epilepsy. Talk to your GP for more information.
Your GP will give you information about staying healthy in pregnancy, antenatal care appointments you will be offered and antenatal screening. It’s your choice whether to have any antenatal screening tests carried out, so you will need to understand the benefits, risks and limitations of the different options. You will be given written information to help you make the decision that you feel is right for you. If there is anything you don’t understand, ask your midwife, GP or doctor.
It’s important that you tell your GP if:
- you had any complications in a previous pregnancy or birth, such as having pre-eclampsia or having a baby prematurely
- you’re being treated for a long-term condition, such as diabetes or high blood pressure
- you or anyone in your family has previously had a baby with a birth defect, for example, spina bifida
- you have a family history of an inherited disease, for example, sickle cell anaemia or cystic fibrosis
- you took any prescribed or over-the-counter medicines around the time you became pregnant or since
Your GP will refer you for your first antenatal appointment, called the booking appointment.
The booking appointment will usually take place by week 10 of your pregnancy. It can take up to two hours because there are a number of tests to be carried out and you may have questions you want to ask.
Your midwife or doctor will talk to you about your health and any previous pregnancies to find out if you're going to need any special antenatal care.
You’re unlikely to need to have a vaginal or breast examination in this appointment or in any later ones.
Your midwife or doctor will need to take some blood samples from you. Checks carried out in these blood tests are listed below.
- Infections. These include hepatitis B, HIV and syphilis, if you want to be checked for these. Although these infections are rare, they are often without symptoms and there are treatments available to reduce the risk of harm to you and your baby.
- Immunity to rubella. Lacking immunity to this infection, which causes a mild illness similar to a mild attack of measles, could put your unborn baby at risk of sight or hearing problems if caught while you’re pregnant.
- Anaemia. This means your blood can't carry enough oxygen to meet the needs of your body, which may mean you need to take a supplement.
- Blood group.
- Rhesus D type. Rhesus D antigen is a protein that is found on blood cells. Your blood is either rhesus D positive or rhesus D negative. Women with rhesus D negative blood are usually offered injections at 28 and 34 weeks to help prevent problems if they have another baby in the future. The problems your baby can have include anaemia, jaundice or stillbirth. See our frequently asked questions for more information.
- Unusual blood antibodies. Antibodies normally fight infections, but occasionally abnormal ones can be present that can pass to your baby and cause anaemia.
Blood pressure and urine tests
Your midwife or doctor will check your blood pressure and test your urine for protein. These two checks will be carried out regularly in your antenatal appointments because they can be early warnings of pre-eclampsia. This is a form of high blood pressure that may develop in pregnancy and can affect your organs, such as your kidneys and lungs and lead to seizures (fits) if left untreated. If you have pre-eclampsia, this can put your unborn child at risk too.
Your midwife or doctor will also test your urine for sugar (glucose). Sugar found in your urine can be a sign that you’re developing gestational diabetes. This is diabetes that begins only in pregnancy and goes away after your baby is born. See our frequently asked questions questions for more information.
Body mass index (BMI)
Your midwife or doctor will measure your height and weight to work out your BMI on your first antenatal appointment. If your BMI is over 25, you may need extra care. You’re unlikely to have your BMI measured again during your pregnancy.
You will have ultrasound scans to monitor your baby's growth and check for physical abnormalities. The scan uses high-frequency sound waves and their echoes to create moving three-dimensional (3D) or four-dimensional (4D) images of your growing baby. The pictures (scans) are black, white and grey and are displayed on a screen. This type of scan is known to be safe for you and your unborn baby.
You will be offered at least two ultrasound scans. The first is usually booked for between week 10 and 13 of pregnancy and is called the dating scan. The second scan, between week 18 and 21, is called the anomaly or morphology scan.
The third possible scan, called the nuchal translucency scan, is used to screen for Down’s syndrome. This takes place before week 13, so may be combined with the dating scan.
What happens in each scan is described below. If your pregnancy is progressing as expected, you won’t be offered any other ultrasounds.
This early ultrasound scan is used work out when your baby is due and to check to see if you’re pregnant with more than one baby.
This scan is designed to pick up problems with your baby’s development. The main organs of your baby’s body are seen on a screen using ultrasound. Although not all problems can be detected, examples of issues that can be picked up include spina bifida, heart defects, kidney problems, some brain developmental abnormalities and limb defects. It can’t detect learning disability and it’s not a test for Down’s syndrome.
This scan can be used to check the position of your placenta inside your womb (uterus). If your placenta is lying low in your womb, you will have another scan later in the pregnancy to check that it has moved.
Sickle cell anaemia and thalassaemia
Sickle cell anaemia and thalassaemia are inherited blood conditions that affect the way your blood carries oxygen. You will be offered screening for thalassaemia in early pregnancy (before week 10) by having a blood test. You may be offered screening for sickle cell anaemia too, depending on your family history. If you’re found to have the genes for either blood disorder, your baby’s father will be asked to have the same blood test as well. From the results of these two blood tests, the chance of your baby inheriting the disorders can be worked out. You can have counselling to discuss the results and what this means for you, your family and your unborn baby.
Screening for Down’s syndrome involves you having blood tests and a nuchal translucency scan before week 13. This ultrasound scan of the nuchal area at the back of your baby’s neck, combined with the results of the blood test, can give an indication of whether your baby may have Down’s syndrome. If the fluid volume in the nuchal area is greater than expected, this may be a sign of Down’s syndrome and you will be offered further tests.
These tests involve sampling the fluid or cells around your baby in the womb. Two tests are available – amniocentesis and chorionic villus sampling. Both tests have a risk of complications for you and your baby. You can have counselling with a specially trained health professional to help you decide whether to have either test – ask your midwife or doctor about this.
In your third trimester (from week 28), you will have around five to seven antenatal appointments, which are likely to be shorter than the ones you had in earlier pregnancy. At each appointment your midwife or doctor will measure the size of your womb, measure your blood pressure and test your urine for protein.
Checking the size of your womb involves using a tape to measure the distance from the top of your womb (called the fundus) to your pubic bone. This is carried out to check your baby’s growth. Your midwife or doctor may also ask you about your baby’s movements. If you notice a change in how your baby moves, or the movements appear to have slowed or stopped, tell your midwife or doctor. Your baby may need to be monitored more closely.
You will have the opportunity to hear your baby’s heartbeat at antenatal visits.
In this appointment, your midwife or doctor will discuss with you and give you information about labour, birth and preparing for having a newborn baby to look after. See our frequently asked questions for more information.
Your midwife or doctor will check the position of your baby. If your baby is in the bottom downwards (breech) position, your midwife or doctor will discuss the options available to you, including a procedure to turn your baby from the outside of your abdomen (tummy), using a technique called external cephalic version (ECV).
Weeks 38 to 41
In your appointments at weeks 38 and 40, your midwife or doctor will discuss your options and choices with you for if your pregnancy lasts longer than 41 weeks.
If your pregnancy lasts as long as 41 weeks, you will have another antenatal appointment in which your midwife or doctor will offer you a membrane sweep. This technique can help to start labour naturally. Your midwife or doctor will also talk to you about your further options and choices for having your labour induced. Having labour induced means starting labour artificially, rather than waiting for labour to begin in its own time. This may involve using medicines, or breaking your waters artificially, so that labour begins sooner.
Which health professionals will I see during my pregnancy?
There are a number of health professionals who you may see at different times during your pregnancy. They will be working together as a team to provide care and information to enable you to have a healthy pregnancy.
Although you may see a number of different people as part of your antenatal care, there are a few key people who you’re more likely to see more regularly. One of these people is your midwife. You may not be able to see the same midwife throughout the whole of your pregnancy, but you will have one midwife who leads your team of carers. You will meet with a midwife from early in your pregnancy and a midwife will be there when you give birth.
If you’re at a low risk of complications during your pregnancy and labour, you may choose to have midwife-led care. Evidence suggests the following benefits.
- There’s less chance of you needing to have an epidural for pain relief.
- It’s less likely that any instruments (such as forceps) will need to be used to deliver your baby.
- You’re more likely to give birth vaginally.
- There’s less chance of your baby being born too soon.
However, if you need extra care when you’re pregnant, or you develop any complications, you will be referred to an obstetrician. This is a doctor who specialises in pregnancy and childbirth.
If tests have shown that there is a chance of a complication or that your baby may have a birth defect, a paediatrician will be at the birth. Paediatricians specialise in identifying and treating conditions in children.
When you go for antenatal scans, you will be seen by a sonographer. Sonographers are specially trained to carry out ultrasounds, but they may not be able to interpret all the images that are made, which means you may be referred to a doctor to get your complete results.
There are other people who may be involved in your care, if you have any extra health needs. For instance, your care team may include an obstetric physiotherapist to help you cope with physical changes before and after birth. He or she can suggest exercises and positions to help you in labour, as well as ways to stay fit during pregnancy and after the birth of your baby. Another person you may see is a dietitian who can help you manage your diet during pregnancy if you have gestational diabetes or other conditions.
When you give birth, if you decide to have an epidural for pain relief, or if you need to have a caesarean, you will meet an anaesthetist.
Why is my blood sugar being checked?
Blood sugar (glucose) levels are affected by pregnancy hormones. In around four in 100 pregnant women this can lead to gestational diabetes. This is diabetes that begins in pregnancy and goes away after your baby is born. Your blood sugar can be checked using blood or urine samples routinely throughout your pregnancy.
When you have your booking appointment, your midwife or doctor will ask you about your medical history, so that he or she can assess your risk of developing gestational diabetes. The risk of developing gestational diabetes is greater if you:
- are overweight or obese
- have previously given birth to a large baby weighing 4.5kg or more
- had gestational diabetes in a previous pregnancy
- have a family history of diabetes (parent, brother or sister who has the condition)
- have polycystic ovary syndrome
Your family origins may also increase your risk of getting diabetes. The condition particularly affects people whose family backgrounds are South Asian (specifically women whose families come from India, Pakistan or Bangladesh), African-Caribbean or Middle Eastern.
If your risk of developing gestational diabetes is high, you will have your blood sugar levels measured early in your pregnancy. If your risk is low, you will have a blood sugar test carried out between weeks 24 and 28 because even with a low risk some women develop gestational diabetes.
Blood sugar can also be monitored using the urine samples you will be asked to provide at each antenatal appointment. Excess sugar in the blood can be found in urine, so this is a quick and easy check that doesn’t require you giving a blood sample.
If you’re found to have gestational diabetes, you will be given a combination of advice about exercise and dietary changes, as well as medicines to lower your blood sugar levels. It’s important to treat gestational diabetes because without treatment you will be at a higher risk of complications during pregnancy, labour and birth. High blood sugar levels can also affect your unborn baby.
What will I learn at antenatal classes?
Antenatal classes will help you with many aspects of having a healthy pregnancy, looking after a newborn and parenting. There are different types of classes available, so you will likely be able to find one that you feel more comfortable attending. Most antenatal classes will be aimed at helping women and their partners during their first pregnancy, but ‘refresher’ classes may be available for people who have already had a baby.
The topics and areas that are covered in antenatal classes vary from place to place and will also depend on the type of class you decide to attend.
You can expect to cover topics that may include:
- your health in pregnancy
- exercises to keep you fit during pregnancy and help you in labour
- what happens during labour and birth
- coping with labour and information about different types of pain relief
- how to help yourself during labour and birth
- relaxation techniques
- information on different kinds of birth and intervention
- how to give birth without any intervention, if that is an option you would like to take
- caring for your baby, including feeding
- your health after the birth
- your emotions during pregnancy, birth and the early postnatal period
What is the importance of my rhesus D antigen status during pregnancy?
Your rhesus D antigen status is checked in your booking appointment blood tests because it can affect subsequent pregnancies. If you’re found to be rhesus D negative, you will be offered treatment in weeks 28 and 34 of your pregnancy. If you’re rhesus D positive, you won’t need any treatment.
Rhesus D antigen is a protein found on red blood cells. You can be rhesus D positive or negative. If you’re rhesus D negative it’s possible for you to be pregnant with a baby who is rhesus D positive, if the baby’s father is rhesus D positive.
During pregnancy and birth small amounts of your baby’s blood can get into your bloodstream. This can cause your immune system to make antibodies against the rhesus D antigen. This is unlikely to affect your current pregnancy, but if you’re pregnant again with a subsequent baby who has rhesus D positive blood, your antibodies can affect the baby and he or she may be born with problems including jaundice. To prevent this happening, you will be offered two injections at weeks 28 and 34 that prevent the antibodies being produced. This reduces the risk of you getting rhesus D sensitivity that can affect subsequent pregnancies. This treatment is safe for you and your unborn baby.
What information will I be given in my antenatal appointments?
There is a lot of information you can expect to be given and to discuss over the course of your antenatal appointments. Some information may be given to you in a written format. It’s important to take time to understand the information you’re given because it will help you to make informed decisions about the care for you and your baby. If you have any questions about the information given to you, ask your midwife, doctor or GP about it.
In your first appointment with your GP, he or she will give you information that is aimed to help you have a healthy pregnancy. This information will be about:
- the importance of folic acid supplements
- nutrition and diet, including food hygiene
- lifestyle issues that are particularly important when you’re pregnant, such as smoking, drinking alcohol and illegal drug use
- antenatal screening tests
In your booking appointment, your midwife or doctor will give you further information on topics including:
- more information about nutrition and diet, including the importance of vitamin D supplements
- how your baby develops during pregnancy
- options of where to give birth, which will depend on local arrangements
- exercise during pregnancy, including pelvic floor exercises
- breastfeeding, including workshops that may be available
- antenatal classes
- antenatal screening tests
Your midwife or doctor will also ask you about your mental health, so that if you need further support during pregnancy, or after the birth of your baby, this can be offered to you.
You will be given your hand-held maternity records that you need to bring to each antenatal appointment and any other appointments you have with a health professional during your pregnancy.
In your third trimester (from week 28) appointments, your midwife or doctor will provide you with information including:
- further breastfeeding information
- how to prepare for labour and birth
- your birth plan
- how to recognise being in active labour
- ways of coping with pain in labour
- feeding and caring for your newborn baby
- vitamin K and screening tests for your newborn baby
- your health after your baby is born, including recognising the ‘baby blues’ and postnatal depression
At each appointment, your midwife or doctor will be able to answer questions you may have about the information you have been given and any other concerns you have about your pregnancy. You may find it helpful to bring with you a list of questions you would like help with.
- National Childbirth Trust
0300 330 0700
- Antenatal care: routine care for the healthy pregnant woman. National Institute for Health and Clinical Excellence (NICE), March 2008. www.nice.org.uk
- Antenatal care – uncomplicated pregnancy – management. Prodigy. www.prodigy.clarity.co.uk, published March 2011
- De-Regil L, Fernández-Gaxiola A, Dowswell T, et al. Effects and safety of periconceptional folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews 2010, Issue 10. doi:10.1002/14651858.CD007950.pub2
- The Pregnancy Book 2009. Department of Health. www.dh.gov.uk, published 29 October 2009
- Arulkumaran S, Symonds I, Fowlie A. Oxford handbook of obstetrics and gynaecology. 1st ed. Oxford: Oxford University Press; 2004
- The use of anti-D immunoglobulin for rhesus D prophylaxis. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published March 2011
- Hypertension in pregnancy – background information. Prodigy. www.prodigy.clarity.co.uk, published November 2010
- Diabetes in pregnancy. National Institute for Health and Clinical Excellence (NICE), March 2008. www.nice.org.uk
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- Pre-conception – advice and management. Prodigy. www.prodigy.clarity.co.uk, published July 2007
- Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published January 2011
- Sickle cell disorder. Sickle Cell Society. www.sicklecellsociety.org, accessed 29 December 2011
- Sickle cell and thalassaemia. Antenatal Results and Choices. www.arc-uk.org, accessed 13 January 2012
- Down's syndrome screening. Map of medicine. www.mapofmedicine.com, published 17 October 2011
- Invasive diagnostic tests. Antenatal Results and Choices. www.arc-uk.org, accessed 12 January 2012
- Kayem G, Grangé G, Bréart G, et al. Comparison of fundal height measurement and sonographically measured fetal abdominal circumference in the prediction of high and low birth weight at term. Ultrasound Obstet Gynecol 2009; 34(5):566–71. doi:10.1002/uog.6378
- Induction of labour. National Institute for Health and Clinical Excellence (NICE), July 2008. www.nice.org.uk
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- Antenatal and postnatal mental health. National Institute for Health and Clinical Excellence (NICE), February 2007. www.nice.org.uk
- Sandall J, Soltani H, Gates S, et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2013, Issue 8. doi: 10.1002/14651858.CD004667.pub3
- National Childbirth Trust
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