Antenatal care

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).

About antenatal care

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, but sometimes you may see a doctor. There are other health professionals who may be part of your antenatal care team. See our common 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 common questions for more information.

First contact with your GP

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. See our common questions for more information.

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.

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.

Blood tests

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 common 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 common 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.

Ultrasound scans

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.

Dating scan

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.

Anomaly scan

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.

Tests for inherited disorders

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.

Down's syndrome

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.

Antenatal appointments in later pregnancy

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.

Week 36

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 common 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.

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

For sources and links to further information, see Resources.