Once you know you're pregnant, or think you might be, you may like to see your GP or midwife to talk about your antenatal care. They may test a sample of your urine to confirm that you’re pregnant.
Your GP or midwife 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. This is when your baby’s nervous system (including their brain and spine) doesn’t develop properly.
You may need to take a higher dose of folic acid if you, or your partner, has a family history of a neural tube defect. This higher recommended dose is 5 milligrams (5mg). You might also need to take this higher dose if you have diabetes, sickle cell disease or take medicines for epilepsy. Ask your GP for more information.
Your GP or midwife will give you information about staying healthy in pregnancy and antenatal care appointments, including the option of antenatal screening. It’s your choice whether to have antenatal screening tests so it’s important to understand the benefits, risks and limitations of the different options.
You’ll 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, no matter how small it may seem, ask whoever is looking is caring for you. Your midwife, GP or obstetrician (a doctor who specialises in pregnancy and childbirth) should all be able to answer your questions. See our frequently asked questions for more information.
It’s important that you tell your GP or midwife if you:
- had any complications in a previous pregnancy or birth, such as pre-eclampsia or a premature baby
- are being treated for a long-term condition, such as diabetes or high blood pressure
- have previously had a baby with a birth defect (or anyone in your family has), for example spina bifida
- have a family history of an inherited disease, for example sickle cell anaemia or cystic fibrosis
Your GP will refer you for your first antenatal appointment, which is called the booking appointment.
You will usually have your booking appointment within the first 10 weeks of your pregnancy. The appointment can take a long time – up to two hours – so be prepared for that. You will have a number of tests and there will be time for you to ask questions.
Your midwife or doctor will talk to you about your health and any previous pregnancies to find out if you need any special antenatal care.
Your midwife or doctor will take some blood samples from you. Some or all of the checks described here will be done on them.
- Infections. These include hepatitis B, HIV and syphilis (if you want to be checked for these). Some infections can have no symptoms so you might not know you have them. To be on the safe side, it's a good idea to be tested. If anything is found, there are treatments available to reduce the risk of harm to you and your baby.
- Immunity to rubella. If you aren't immune to this infection and catch it while you’re pregnant, it could put your baby at risk of sight or hearing problems.
- Anaemia. This means your blood can't carry enough oxygen to meet the needs of your body. Often this is caused by a lack of iron so you may be advised to take an iron supplement.
- Your blood group. This is useful to know in case you have any problems during your pregnancy or around the time you give birth, such as heavy bleeding. It will ensure that if you need to be given blood, you receive the right type.
- Your rhesus D type. Your blood is either rhesus D positive or negative. This is determined by a substance (Rhesus D) found on blood cells. If you have rhesus D negative blood (that is, you don’t have the substance on your cells), you may be offered anti-D injections. These are done at 28 and 34 weeks. These will help prevent problems if you have another baby in the future. Potential problems include anaemia, jaundice or a stillborn baby. See our frequently asked questions for more information.
- Unusual blood antibodies. Antibodies usually fight infections, but occasionally your body produces abnormal ones that can pass to your baby and cause health problems.
Blood pressure and urine tests
Your midwife or doctor will check your blood pressure and test your urine for protein. You will have these two checks done at all of your antenatal appointments because they can be early warnings of pre-eclampsia. This is a form of high blood pressure that can develop in pregnancy. It can affect your organs, such as your kidneys and lungs, and lead to seizures (fits) if you don't get treatment. Pre-eclampsia can put your baby at risk too.
Your midwife or doctor may test your blood for the level of sugar (glucose), as this can detect if 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 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 30 or more, you may need extra care because of the increased risk of complications for you and your baby. You may have your BMI measured again later in your pregnancy.
You will be offered ultrasound scans to monitor your baby's growth and check for physical abnormalities. This uses high-frequency sound waves to create images of your growing baby, which you can see on a screen.
You will be offered at least two ultrasound scans during pregnancy but if it’s progressing normally, you probably won’t need any more than this. This type of scan is safe for you and your baby so if you do have additional ones, they won’t pose any increased health risk.
The first scan is usually booked for between weeks 10 and 14 of your pregnancy and is called the dating scan. It's used to work out when your baby is due and to check to see if you’re pregnant with more than one baby.
The second scan, between weeks 18 and 21 of your pregnancy, is designed to pick up problems with your baby’s development. Ultrasound images will show up the main organs of your baby’s body, which you’ll be able to see on a screen.
Examples of health conditions that can be picked up by this scan include:
- neural tube defects (problems with the developing nervous system), such as spina bifida
- heart defects
- kidney problems
- some brain developmental abnormalities
- limb defects
This scan can be used to check the position of your placenta inside your womb (uterus). If your placenta is low in your womb, you will have another scan later in the pregnancy to check where it’s lying. This is to make sure it won’t cause any difficulties when you come to give birth.
Nuchal translucency scan
The nuchal translucency scan, together with a blood test, is used to screen for Down’s syndrome. It’s entirely up to you whether or not you have this or any other screening test. If you decide that you wish to go ahead, it's done at the same time as the dating scan. If you find out you're pregnant later (after 14 weeks) but wish to have screening for Down’s syndrome, you can have just the blood test. Although you can have this up to 20 weeks into your pregnancy it’s less accurate than having it in combination with the scan.
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 before you’re 10 weeks pregnant – this is done with 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 need to have a blood test too.
From the results of these two 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 baby and your family.
There are two types of screening test for Down’s syndrome. These calculate the risk of your baby having the condition.
- A blood test and nuchal translucency (ultrasound) scan. The blood test will measure two proteins associated with pregnancy. The ultrasound scan will measure the thickness of the nuchal area – this is a pocket of fluid at the back of your baby’s neck. These two results are combined and will give an indication of whether your baby has Down’s syndrome.
- Quadruple blood test. This test will measure four proteins associated with pregnancy. This result is combined with your age and used to work out your risk of having a baby with Down's syndrome.
There are two tests that can diagnose Down's syndrome, rather than just working out your possible risk.
- Chorionic villus sampling. In this test, your doctor will take a sample of cells from your placenta and these are tested for specific signs of Down’s syndrome.
- Amniocentesis. Your doctor will take a sample of amniotic fluid (the fluid around your baby inside your womb) and this will be tested for the condition.
There is a risk of complications for you and your baby with both tests, including a higher risk of miscarriage. For more information, ask your midwife or doctor.
In your third trimester (from week 25), you will have between five and seven antenatal appointments. These are likely to be shorter than the ones you had earlier. At each appointment your midwife or doctor will measure the size of your womb, your blood pressure and test your urine for protein.
Your midwife or doctor will check the size of your womb and your baby's growth. He or she will measure the distance from the top of your womb (called the fundus) to your pubic bone.
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, be sure to mention this. Your baby may need to be monitored more closely.
You may have the opportunity to hear your baby’s heartbeat at antenatal visits.
In this appointment, your midwife or doctor will discuss and give you information about labour, birth and preparing to look after a newborn baby. See our frequently asked questions for more information.
Your midwife or doctor will check the position of your baby too. If your baby is in the bottom downwards position (breech), your midwife or doctor will discuss the options available to you. It may be that you want to consider a procedure to turn your baby from the outside of your abdomen (tummy). This technique is called external cephalic version (ECV).
Weeks 38 to 41
In appointments at weeks 38 and 40, you’ll have the chance to discuss your options and choices if your pregnancy lasts longer than 41 weeks.
If your pregnancy lasts 41 weeks, you will have another antenatal appointment in which your midwife or doctor will offer you a membrane sweep. This involves examining your vagina to encourage the release of natural hormones. This technique can help to start labour naturally.
There is also the possibility of having your labour induced. This means starting labour artificially, rather than waiting for it to begin in its own time, and can be done in different ways. Your options include using pessaries (medicine that's inserted into your vagina) or a being given hormones through a drip to stimulate contractions. Alternatively, it may involve breaking your waters artificially, so that labour begins sooner.
Which health professionals will I see during my pregnancy?
You will see a number of health professionals at different times during your pregnancy. They will work together as a team to provide care and information to help you to have a healthy pregnancy.
Although you’ll see different people as part of your antenatal care, there are some key ones who you’re likely to see more regularly. One of these is your midwife. You may be able to see the same midwife throughout the whole of your pregnancy. You will meet with them early in your pregnancy and, if possible, they will be there when you give birth. If your midwife isn't available, they will have made arrangements for your care.
If you’re at a low risk of complications during your pregnancy and labour, you may choose to have midwife-led care. This has been shown to have a number of benefits.
- There’s less chance of you needing to have an epidural for pain relief.
- It’s less likely any instruments will need to be used (such as forceps) to deliver your baby.
- You’re more likely to give birth vaginally.
- There’s less risk 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 results of your antenatal tests indicate there is a chance of a complication, a paediatrician will be with you when you give birth. A paediatrician is a doctor who specialises in children’s health. He or she will also be available if your results suggest your baby may have a birth defect.
When you go for antenatal scans, you will see a sonographer. Sonographers are technicians who are trained to carry out ultrasound examinations.
Other health professionals may be involved in your care if you have any extra needs. For instance, your care team may include an obstetric physiotherapist to help you cope with physical changes before and after birth. They can suggest exercises and positions to help you in labour, and ways to stay fit during your pregnancy and after your baby is born. 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.
If you decide to have an epidural for pain relief when you give birth, or have a caesarean, you will meet an anaesthetist.
Why is my blood sugar being checked?
Blood sugar (glucose) levels are affected by pregnancy. In as many as 18 in every 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 throughout your pregnancy.
Usually the level of sugar (glucose) in your blood is controlled by a hormone called insulin. During pregnancy, your body needs more insulin and gestational diabetes develops if your body can’t produce enough. This can lead to health problems for you and your baby if it isn’t treated.
When you have your booking appointment, your midwife or doctor will ask you about your medical history. At the same appointment they will assess your risk of developing gestational diabetes. This is greater if you:
- are overweight or obese (your body mass index is over 30kg/m2)
- have previously given birth to a large baby weighing 4.5kg or more
- had gestational diabetes in a previous pregnancy
- have a family history (parent, brother or sister) of diabetes
- have a history of polycystic ovary syndrome (PCOS)
Your family origin may also increase your risk of getting gestational 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, your midwife or GP will measure your blood sugar level early in your pregnancy. If your risk is low, you will have a blood sugar test between weeks 24 and 28. Even with a low risk, some women develop gestational diabetes.
If you’re found to have gestational diabetes, your midwife or doctor will give you advice about exercise and making changes to your diet. Your doctor may also prescribe medicines to lower your blood sugar levels. It’s important to treat gestational diabetes because it can increase the risk of complications during pregnancy, labour and birth. High blood sugar levels can also affect your baby.
What will I learn at antenatal classes?
Antenatal classes will help you with many aspects of healthy pregnancy, looking after a newborn and parenting. There are different types of class available, so choose one that you feel comfortable with. Most antenatal classes are aimed at helping women and their partners during their first pregnancy. However, ‘refresher’ classes may be available if you have already had a baby.
The topics and areas that are covered in antenatal classes vary from place to place. They will also depend on the type of class you decide to attend. You can expect to cover a range of 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 (for example equipment and medicines)
- how to give birth without any intervention, if that’s an option that’s right for you
- caring for your baby, including breastfeeding
- 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 midwife or doctor will take a blood sample at your booking appointment to check what’s known as your rhesus D antigen status. If you’re rhesus D negative, you will be offered injections of a substance called anti-D in weeks 28 and 34 of your pregnancy. This is because although it won’t affect your current pregnancy, it could cause problems if you get pregnant again. If you’re rhesus D positive, you won’t need any treatment.
Rhesus D is a substance found on red blood cells. You can be either rhesus D positive (which means you have the substance) or negative (you don’t). If you’re rhesus D negative and your baby’s father is rhesus D positive, your baby may be rhesus D positive.
While you're pregnant, and when you give 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. However, if you have another baby with rhesus D positive blood, your antibodies will be activated to fight against rhesus D. Your baby could then be born with health problems, such as jaundice.
To prevent this happening, you will be offered one or two injections of anti-D in your third trimester. These will reduce the risk of your body producing the antibodies. You will also be offered anti-D injections if you have any injury to your tummy during your pregnancy.
What information will I be given in my antenatal appointments?
There is a lot of information you can expect to be given and 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 everything you receive. This 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, obstetrician or GP.
In your first appointment with your GP or midwife, they will give you information to help you have a healthy pregnancy. This will include information about:
- the importance of folic acid supplements
- nutrition and diet
- 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 ask you about your mental health and if you need further support while you're pregnant, or after you give birth.
You will be given your maternity records. It's important to bring these 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 when you’re 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 answer any questions you have about the information you're given. They will also address any concerns you have about your pregnancy. You may find it helpful to write down anything you’re worried about or want to ask. You can then bring this list with you.
- National Childbirth Trust
0300 330 0700
- Quality standard for antenatal care. National Institute for Health and Care Excellence (NICE), September 2012. www.nice.org.uk
- Antenatal care. National Institute for Health and Care Excellence (NICE), March 2008. 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.
- Antenatal examinations. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 October 2011
- Map of Medicine. Antenatal care. International View. London: Map of Medicine; 2013 (Issue 4).
- Antenatal care. PatientPlus. www.patient.co.uk/patientplus.asp, published 13 October 2012
- Antenatal care – uncomplicated pregnancy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2011
- The pregnancy book. Department of Health. www.dh.gov.uk, published 2009
- Rubella and pregnancy. PatientPlus. www.patient.co.uk/patientplus.asp, published 14 March 2012
- Blood transfusion, pregnancy and birth. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published February 2009
- Pre-eclampsia and eclampsia. PatientPlus. www.patient.co.uk/patientplus.asp, published 20 December 2012
- Diabetes in pregnancy. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published March 2008
- Obstetric ultrasound. Radiological Society of North America. . www.radiologyinfo.org, published 16 July 2013
- NHS fetal anomaly screening programme. NHS Screening Programmes. www.screening.nhs.uk, published January 2010
- Placenta praevia. PatientPlus. www.patient.co.uk/patientplus.asp, published 20 April 2011
- Screening for Down’s syndrome: UK NSC policy recommendations 2011–2014 model of best practice. NHS Screening Programmes. www.screening.nhs.uk, published November 2011
- NHS sickle cell and thalassaemia screening programme. NHS Screening Programmes. www.screening.nhs.uk, published October 2011
- Chorionic villus sampling and amniocentesis. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published September 2011
- Your baby’s movements in pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published August 2012
- Induction of labour. National Institute for Health and Care Excellence (NICE), July 2008. www.nice.org.uk
- Intrapartum care. National Institute for Health and Care Excellence (NICE), September 2007. www.nice.org.uk
- Gestational diabetes. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published March 2013
- Gestational diabetes testing protocol. Medscape. www.emedicine.medscape.com, published 18 September 2012
- Routine antenatal anti-D prophylaxis for women who are rhesus D negative. National Institute for Health and Care Excellence (NICE), August 2008. www.nice.org.uk
- Antenatal and postnatal mental health. National Institute for Health and Care Excellence (NICE), 24 April 2007. www.nice.org.uk
- National Childbirth Trust
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