Antenatal care

Published by Bupa's Health Information Team, April 2010.

This factsheet is for women who would like information about antenatal care.

Antenatal care means how your health, and the health of your baby, is monitored while you're pregnant (antenatal means before birth).

About antenatal care

Once you know you're pregnant, or think you might be, you should make an appointment with your GP to talk about your antenatal care. Your GP may test a sample of your urine to confirm that you're pregnant. However, you may not need to have another pregnancy test if you have had a positive result from a home test.

Your GP will advise you to take a daily supplement of 400 micrograms (0.4mg) of folic acid. This reduces the risk of your baby being born with a neural tube defect, such as spina bifida. You should take a higher dose (5mg) if you have a family history of spina bifida, you take medicine for epilepsy, or you have diabetes or sickle cell disease.

Your GP will refer you for your first antenatal appointment, called the booking appointment. This could be at a hospital maternity unit, at your GP surgery or at home.

Arrangements for antenatal care vary but the National Institute for Health and Clinical Excellence (NICE) recommends that healthy women have 10 check-ups for a first pregnancy, including the booking visit. If you have already had a healthy pregnancy, you will probably have seven antenatal appointments.

First antenatal appointment

The first antenatal appointment should be as early as possible in your pregnancy, ideally before 10 weeks.

You will usually see a midwife, but in some circumstances you may see a doctor. He or she will talk to you about your health and previous pregnancies to find out if you're going to need any special antenatal care.

Your midwife or doctor will also take some blood samples for testing, or arrange for a blood test. This is to check whether you have any conditions that may affect you or your baby's health. These tests include:

• your blood group
• your rhesus (RhD) type - your blood is either rhesus positive or rhesus negative - women with RhD-negative blood are usually offered injections at 28 and 34 weeks to help prevent problems with the baby in future pregnancies, such as anaemia, jaundice or stillbirth
• a test for anaemia
• routine tests, if you want them, for infections that can affect you or your baby - hepatitis B, syphilis and HIV
• your immunity to rubella (German measles)

Your midwife or doctor will measure your height and weight, and work out your BMI (body mass index) once - usually on your first antenatal appointment. If your BMI is under 18 or over 35, you may need extra care.

Your blood pressure will be checked and your urine tested for infection. You won't need to have a vaginal or breast examination.

Dating scan

You will be offered an ultrasound scan called a dating scan between 10 and 13 weeks to estimate when your baby is due (your estimated due date or EDD). The scan also shows you whether you are expecting more than one baby.

Checking your baby

Your doctor or midwife will offer tests to look for conditions affecting your baby. These include screening tests and diagnostic tests. It's your choice whether or not to have any test during your pregnancy.

Screening tests estimate the risk of your baby being born with certain conditions, such as Down's syndrome. They don't give a definite answer. Diagnostic tests confirm whether a baby has a certain condition and are offered if the screening tests predict an increased risk of a problem.

Screening for Down's syndrome

There are various screening tests for Down's syndrome. The National Institute for Health and Clinical Excellence recommends that women have a test called the combined test. This happens between weeks 11 and 14 of pregnancy, and includes a nuchal translucency scan and a blood test for two substances associated with pregnancy.

If you can't have the nuchal translucency scan or your booking was later than 14 weeks, you can have a blood test between 14 and 20 weeks for either three (triple test) or four (quadruple test) substances associated with pregnancy.

Another test called the integrated test involves either two blood tests, one at 11 to 14 weeks and another at 14 to 20 weeks, or a nuchal scan and a later blood test.

Nuchal translucency scan

This is an ultrasound scan between 11 and 13 weeks, which may be done at the same time as your dating scan. It measures the thickness of the layer of fluid at the back of the baby's neck (the nuchal area). A thicker than normal layer of fluid may suggest that the baby has an increased risk of Down's syndrome.

Results of Down's syndrome screening

The results of the screening are an estimated chance of your baby having Down's syndrome.

Your doctor will offer a diagnostic tests if, based on the screening test, the estimated chance of your baby having Down's syndrome is higher than one in 250. But the choice about whether or not to have a diagnostic test is yours. You can have counselling with a specially trained health professional to help you decide - ask your doctor or midwife about this.

Diagnostic tests

Amniocentesis

This can test for chromosome disorders in the baby such as Down's syndrome, neural tube defects, and genetic diseases such as cystic fibrosis.

Chorionic villus sampling (CVS)

This test looks for similar conditions to those confirmed by amniocentesis, but it can be done earlier in pregnancy. Your doctor inserts a fine instrument either through your cervix or abdomen into your womb and removes a tiny sample of your placenta (from a part called the chorionic villi, tiny finger-like projections in the placenta).

Screening for sickle cell anaemia and thalassaemia

Sickle cell anaemia and thalassaemia are inherited blood conditions that are most common in people from Africa, the Caribbean, the Middle East and the Mediterranean. Screening for this condition involves a blood test, which you will have at around 10 weeks, and questions about your family history.

Ultrasound scans

You will be offered a mid-pregnancy ultrasound scan, known as an anomaly or morphology scan, between 18 and 20 weeks of pregnancy. The scan is to check for problems with the baby's development, such as spina bifida. It also looks at the heart, although it can't pick up all heart problems. The mid-pregnancy scan can't diagnose Down's syndrome.

Scans later in pregnancy

If your pregnancy proceeds normally and your baby's measurements show that growth is good, you don't normally have any further scans during your pregnancy.

If an early scan suggests that your placenta is lying low in your womb, your doctor may recommend that you have another scan at 32 weeks to see if this has resolved. If the placenta remains low, after 28 weeks it is called a placenta praevia and may have implications for how your baby is born.

No test can rule out all problems, but by far the majority of babies are healthy.

Additional antenatal appointments

At each antenatal appointment after your booking visit, your midwife or doctor will measure your blood pressure, and test your urine for protein. Protein in the urine and raised blood pressure are signs of pre-eclampsia, which can be harmful to both mother and baby. You will be offered another blood test for anaemia at 28 weeks.

As your baby grows, your womb (uterus) rises out of your pelvis and becomes the 'bump'. The top of this is called the fundus. Your doctor or midwife will measure the height of the fundus to check how your baby is growing.

Your midwife or doctor will ask about your baby's movements and, after 36 weeks, try to find out the position of your baby by feeling your abdomen. Towards the end of your pregnancy, the baby's head usually drops down in the pelvis into a position ready for delivery (when the head is said to be engaged). The head may not engage until labour starts if you have had a baby before.

You may want to listen to your baby's heartbeat. Your midwife or doctor can put an ultrasound listening device on your abdomen to make the heartbeat sound louder.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.