This factsheet is for people who would like information about antenatal care.
Antenatal care involves monitoring the health of you and your baby while you’re pregnant (antenatal means before birth).
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 appointment. If you have already had a healthy pregnancy, you will probably have seven antenatal appointments.
Your appointments may be at a hospital maternity unit, your GP surgery or home. For most of your appointments you will see a midwife. And, evidence suggests that having your care primarily led by a midwife rather than a doctor has several benefits for women who are at low risk of complications during their pregnancy and labour. Alternatively your care may be led by your doctor and other health professionals may be part of your antenatal care team too. See our frequently asked questions for more information.
As well as monitoring you and your baby during your pregnancy, your midwife or doctor will provide you with information to help you have a healthy pregnancy. See our frequently asked questions for more information.
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:
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.
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.
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 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).
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.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
Bupa's range of Health Cash Plans allow you to claim money back for ongoing costs such as optical and dental treatments. Read more on Bupa Health Cash Plan or call 0500 000 125 quoting ref. 4096.
See a Private GP in confidence to discuss any concerns you may have about your health or your family's health or call 0845 600 3458 quoting ref. HFS GP.
This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.
Produced by Louise Abbott, Bupa Health Information Team, March 2012.