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Antenatal care

There’s a lot to think about when you’re pregnant, not least your own health, as well as your baby’s. Antenatal care is an important part of a healthy pregnancy for you and your baby. It’s the care you get from healthcare professionals during your pregnancy and includes information on services and support to make choices right for you.

Your care includes regular appointments with a midwife, ultrasound scans and screening tests for you and your baby.

A pregnant woman having her blood pressure taken by a nurse

Details

  • Overview Overview

    The National Institute for Health and Care Excellence (NICE) recommends that if you’re healthy, and it’s your first pregnancy, you should have10 antenatal appointments. If you’ve already had a healthy pregnancy, you might have fewer.

    If you’re fit and healthy and it looks like your pregnancy will be uncomplicated, you’ll be looked after by a small team of people during your pregnancy. This will include a midwife and your GP. If your pregnancy is more complicated, then an obstetrician (a doctor who specialises in pregnancy and childbirth) might be involved in your care too.

    Your appointments may be at a hospital maternity unit, your GP surgery, a local health centre or at home. As well as checking on the progress of you and your baby, you will be given information to help you have a healthy pregnancy and birth and to take care of your new baby.

    Infographic of how your baby develops in the womb
  • Your first appointment First contact with your GP or midwife

    When you find out you're pregnant, make an appointment to see your GP or a midwife. Your GP or doctor’s surgery can put you in touch with an NHS midwife, or you can find a private midwife through the Independent Midwives website (see other helpful websites for details).

    At your first appointment, you’ll be asked about:

    • your general health, including your mental health
    • any previous pregnancies, and how those were
    • any medical conditions you have and any family history of medical conditions
    • any medicines you’re taking

    You’ll also be given important information about your pregnancy including the following.

    • Taking folic acid. If you’re not already taking this, you should start as soon as possible. Most women take 400 micrograms (400µg) every day for the first 12 weeks of pregnancy. This reduces the risk of your baby being born with a neural tube defect, such as spina bifida. You may need to take a bigger dose of folic acid (5mg) if you’re very overweight (body mass index (BMI) is larger than 30), have another health condition, such as diabetes or epilepsy, or if you’ve already had a child with a neural tube defect. Your GP or midwife will tell you if you need to do this.
    • Staying healthy during pregnancy, including information about what foods to avoid, suitable types of exercise, stopping smoking if you smoke, and avoiding alcohol.
    • Antenatal screening. These are tests that tell you whether your baby has a high risk of having certain conditions, such as Down's syndrome. It’s your choice whether to have the tests; so it’s important to understand what the tests can and can’t do, and what the benefits and risks of screening are.

    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 after you to explain it. Your midwife, GP or obstetrician should all be able to answer your questions.

    Your GP will refer you for your first antenatal appointment, which is called your booking appointment. If your GP or midwife thinks you may have a more complicated pregnancy, you’ll be referred to see an obstetrician.

  • Booking appointment Booking appointment and initial tests

    You usually have a booking appointment with a midwife within the first 10 weeks of your pregnancy. The appointment can take around an hour, which is longer than appointments later on in your pregnancy.

    At the end of this appointment, you may be given your maternity notes to look after. These contain all the information about your health and care, and you’ll need to take them with you to every appointment. Some hospitals are changing from paper notes to digital notes, where your information is stored on a computer. Your midwife will advise you which system your hospital uses.

    At this appointment, you may be offered a small dose of vitamin D to be taken daily throughout your pregnancy to keep your bones strong.

    The midwife will take some blood samples, ask for a urine sample and take your blood pressure.

    Blood tests

    You will be offered blood tests to check your general health and blood type. The main tests are listed below:

    • Haemoglobin. This is a test to see whether you have anaemia. This is when your blood can't carry enough oxygen to meet the needs of your body. Around one in four women develop it when they’re pregnant. It can make you feel tired, dizzy and short of breath. If you develop anaemia, you may be asked to take iron tablets.
    • Infections, such as hepatitis B, human immunodeficiency virus (HIV) and syphilis (if you want to be checked for these).
    • Blood disorders, such as sickle-cell disease and thalassaemia. You’ll be offered this if you’re at risk of carrying the genes for these conditions and may pass them on to your baby. If you’re carrying the genes for either blood disorder, your baby’s father will need to have a blood test too.
    • Your blood group and your rhesus D type. Your blood is classed as either rhesus D positive or negative, which means you either have a substance called rhesus D on your blood cells, or you don’t. This matters because if you’re rhesus-negative, and your baby is rhesus-positive, it can cause serious health problems in future pregnancies. If you’re rhesus D negative, you may be offered anti-D injections. These are given either as a single dose at 28 weeks or as two doses at 28 and 34 weeks. They help prevent problems if you have another baby in the future. See our question and answer for more information.

    Blood pressure, urine and other checks

    You should have your height and weight measured to work out your body mass index (BMI). If your BMI is 30 or more, it means you’re obese and 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’ll have your blood pressure and your urine checked at every appointment. This is done to check for pre-eclampsia. Pre-eclampsia is a type of high blood pressure that can develop when you’re pregnant. It can affect your organs, such as your kidneys and lungs, and lead to seizures (fits) if it isn’t treated. Pre-eclampsia can cause serious health problems for your baby too.

    If you have any risk factors for pre-eclampsia, such as a BMI over 30 or a family history of pre-eclampsia, you may be offered low dose aspirin (75mg) per day from 12 weeks of your pregnancy. This helps to reduce your risk of developing pre-eclampsia, though it cannot take away this risk completely.

    If your midwife or doctor thinks you might be more likely to develop diabetes while you’re pregnant, for example, if your BMI is greater than 30, or if you had diabetes when you were pregnant before, you’ll be offered a test for this. This is usually carried out between 24 and 28 weeks. See our question and answer for more information.

    There will be time for you to discuss anything else, or any concerns you have, with your midwife.

  • Scans Ultrasound scans

    If everything is going well with your pregnancy and you’re fit and well, you’ll be offered two ultrasound scans. Ultrasound scans are safe for you and your baby. They show images of your growing baby, which you can see on a screen.

    When you’re having any scan, it’s important to remember that they aren’t completely accurate. Some conditions can be difficult to see and diagnose. Other factors, such as the way the baby is lying during the scan, can affect how much can be seen.

    You should have your first scan when you’re between 11 and 14 weeks pregnant. This scan is called your dating scan. It's used to work out when your baby is due and to see if you’re pregnant with more than one baby. You will have your second scan when you’re between 18 and 21 weeks pregnant. This scan is to check that your baby is healthy and developing as it should be. Ultrasound images should show your baby clearly, including the main organs of your baby’s body.

    This scan can show a number of health conditions, such as:

    • problems with your baby’s developing nervous system, such as spina bifida
    • heart and kidney conditions
    • brain development problems

    This scan is also used to check the position of your placenta inside your womb (uterus). If your placenta is low in your womb, you will be asked to have another scan later in the pregnancy to check it. This is to make sure it won’t cause any problems, such as bleeding, when you give birth.

  • Down’s syndrome testing Tests for Down’s syndrome and other inherited conditions

    You’ll be offered a screening test to see how likely it is that your baby could have Down’s syndrome, or other conditions caused by abnormal chromosomes. The test is usually done by the time you’re 14 weeks pregnant, but part of the test can be done up to 20 weeks.

    It’s entirely up to you whether you have this or any other screening test. Before you choose whether to have it or not, talk to your midwife and make sure you have all the information you need to make the decision.

    There are two parts to the screening test.

    • Nuchal translucency screening. This is done at your first ultrasound scan. It’s a measure of the fluid at the back of your baby’s neck.
    • Blood tests which measure specific proteins in your blood. The blood test can be done alongside the nuchal translucency scan when you’re in your first trimester. It’s the most accurate way of screening.

    If your first scan is later than 14 weeks or you’re further on than you realised, the nuchal translucency measurement can’t be done. Instead, you can have a blood test on its own when you’re up to 20 weeks pregnant, but this is less accurate.

    Using the results of these tests plus other factors such as your age and weight, your midwife or doctor can then tell you your chances of having a baby with Down’s or another type of chromosomal problem. If there’s a strong likelihood that your baby might have a syndrome caused by abnormal chromosomes, you’ll be offered testing to diagnose it.

    You can choose to have one of two tests.

    • Chorionic villus sampling. In this test, your doctor takes a sample of cells from your placenta for testing. This is done during an ultrasound.
    • Amniocentesis. Your doctor takes a sample of the fluid that’s around your baby (amniotic fluid) and this is tested. This is also done during an ultrasound.

    Both of these tests can cause a miscarriage, so it’s important to understand the risks as well as the benefits of having them. For more information, talk to your midwife or doctor.

    NIPT

    There is another less invasive test available for detecting babies with Down’s syndrome and other chromosomal problems. This is called a non-invasive prenatal test, or NIPT for short. This test is a simple blood test and looks for your baby’s DNA that has ‘leaked’ into your circulation. It’s very accurate for detecting Down’s and other syndromes. However, at the moment, this test is only available privately.

  • Appointments in later pregnancy Antenatal appointments in later pregnancy

    For the first 28 weeks of your pregnancy you’ll have an antenatal appointment about every four weeks. Between 28 and 36 weeks, you’ll be seen every two to three weeks, and after 36 weeks you’ll be seen every week. At each appointment your midwife or doctor will:

    • talk to you about how you’re feeling and how your general health is
    • measure the size of your womb and your baby
    • check your blood pressure
    • test your urine for protein

    Your midwife or doctor won’t usually listen to your baby’s heart. But if you’d like to hear it, or if you’re worried your baby isn’t moving well, ask for this to be checked.

    Week 34 and 36

    At these appointments, you’ll be given information about labour, birth, breastfeeding and preparing to look after a newborn baby.

    The position of your baby will be checked too. If your baby is in the bottom downwards position (breech), your midwife or doctor will discuss the options available to you. You might be offered a procedure called external cephalic version (ECV),which tries to turn your baby around from the outside of your abdomen (tummy).

    Weeks 38 to 41

    At your 39- and 40-week appointments, you’ll be able to talk about your options and choices if your pregnancy lasts longer than 42 weeks.

    If your pregnancy lasts 40 weeks, you’ll have another antenatal appointment at which you’ll be offered a membrane sweep. This is where your midwife massages your cervix or passes a finger through your cervix to gently stretch it. This can help release hormones to start labour naturally.

    After 41 weeks

    At your 41-week appointment, you’ll be offered induction, usually between 10 and 14 days past your due date if you and your baby are healthy. This means starting your labour artificially. Your midwife or doctor will talk to you about the different ways of doing this.

  • FAQ: Who will look after me? Who will look after me during my pregnancy?

    If you’re healthy and well, and you’re having an uncomplicated pregnancy, you’re likely to be looked after by a midwife. Your midwife will work together with your GP and an obstetrician if you need more specialised care.

    There are hospital and community midwives. Hospital midwives are based in a birth centre, midwife-led unit, hospital obstetric or consultant unit. They will support you as you labour, deliver and in the postnatal period. Community midwives often work in teams, which means you’re likely to see the same small group of people. When you go into labour, they can support you with a home birth, or rarely they may come into the labour ward in the hospital to be with you.

    You may also have care from other health professionals, including:

    • an obstetrician, who is a doctor who specialises in pregnancy and childbirth
    • a radiographer or sonographer who does your ultrasound scans
    • a perinatologist or feto-maternal medicine specialist, who is an obstetrician who can offer more specialised care if you have a complicated pregnancy or a medical condition
  • FAQ: Blood sugar checks Why is my blood sugar being checked?

    Being pregnant can affect the sugar (glucose) levels in your body in all kinds of ways, and this can sometimes lead to diabetes. Around four in every 100 women develop diabetes while they’re pregnant. This is called gestational diabetes and it begins during pregnancy and goes away after your baby is born.

    If it’s not treated and well managed, gestational diabetes can harm both you and your baby. So, at your booking appointment, your GP or midwife will check to see whether you’re more likely to develop diabetes than other women. You’re more likely to develop gestational diabetes if you:

    • are obese (your body mass index is over 30)
    • have previously had a large baby weighing 4.5kg or more
    • had gestational diabetes in a previous pregnancy
    • have a family history of diabetes (your parent, brother or sister has it)
    • come from an ethnic group which increases your risk, such as South Asian

    If there is a high chance you might develop gestational diabetes, your midwife or GP will measure your blood sugar level early in your pregnancy and again between weeks 24 and 28.

  • FAQ: Antenatal classes What will I learn at antenatal classes?

    Antenatal classes can help you and your partner to learn more about your pregnancy, birth and caring for your new baby. There are different types of class available, so choose one that you feel comfortable with. Most antenatal classes are aimed at helping women and partners having their first baby. However, if you’ve already had a baby, you can still go again.

    Different classes will cover different topics. However, most will include information about:

    • exercises to keep you fit during pregnancy and help you in labour
    • what happens during labour and at the birth of your baby
    • coping with labour and information about different types of pain relief
    • making your birth choices
    • caring for your baby, including breastfeeding
    • your emotions during pregnancy, birth and after your baby is born
  • FAQ: Rhesus D Why is my rhesus D antigen status checked during pregnancy?

    One of the blood tests you have, when you go to your booking appointment, is to check your rhesus D antigen status. Your blood is either rhesus D positive or negative, which means you have a protein called rhesus D on your blood cells, or you don’t.

    Your rhesus status only matters if you’re rhesus-negative and you’re carrying a rhesus-positive baby. Your baby will have inherited rhesus-positive status from their father.

    If some of your baby's blood enters your bloodstream, your immune system reacts to the D antigen in your baby's blood. It will be treated as a foreign invader, which means your body will produce antibodies against it. This is called being sensitised.

    If it’s your first pregnancy, this isn’t usually harmful to you or your baby. But it can cause problems if you have another rhesus-positive baby. The antibodies that your body made in your first pregnancy can cross the placenta and attack the blood cells of your baby. In this situation, your baby can become seriously unwell, even while still in the womb. You will be offered specialist care in this situation.

    To prevent rhesus disease, 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 and the risk that any future babies will be affected by rhesus sensitisation.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Antenatal care information for the public. National Institute for Health and Care Excellence (NICE), January 2017. www.nice.org.uk
    • Routine antenatal care. BMJ Best Practice. bestpractice.bmj.com, last updated September 2016
    • Antenatal care. PatientPlus. patient.info/patientplus, last checked December 2015
    • Antenatal care. National Institute for Health and Care Excellence (NICE), April 2016.
    • Map of medicine. Antenatal care. International View. London: Map of Medicine; 2016 (Issue 4)
    • All about antenatal care. Tommy’s. www.tommys.org, last reviewed April 2015
    • Antenatal care – uncomplicated pregnancies. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2016
    • Maternal and child nutrition. National Institute for Health and Care Excellence (NICE), November 2014.
    • Booking appointment. Tommy’s. www.tommys.org, last reviewed March 2015
    • Anaemia in pregnancy. PatientPlus. patient.info/patientplus, last checked February 2016
    • Antenatal infections and their consequences. PatientPlus. patient.info/patientplus, last checked January 2014
    • Anti-D (Rho) immunoglobulin. PatientPlus. patient.info/patientplus, last checked February 2016
    • Haemolytic disease of the fetus and newborn. PatientPlus. patient.info/patientplus, last checked June 2016
    • Pre-eclampsia. BMJ Best Practice. bestpractice.bmj.com, last updated January 2016
    • Diabetes in pregnancy: management from preconception to the postnatal period. National Institute for Health and Care Excellence (NICE), August 2015.
    • Routine antenatal care. BMJ Best Practice bestpractice.bmj.com, last updated September 2016
    • Ultrasonography. MSD Manuals. www.msdmanuals.com, last reviewed January 2015
    • Fetal anomaly screening programme. Public Health England. www.gov.uk, published January 2015
    • Chitty LS, Wright D, Hill M, et al. Uptake, outcomes, and costs of implementing non-invasive prenatal testing for Down’s syndrome into NHS maternity care: prospective cohort study in eight diverse maternity units. BMJ 2016; 354:i3426. doi: https://doi.org/10.1136/bmj.i3426
    • Placenta praevia. BMJ Best Practice. bestpractice.bmj.com, last updated June 2016
    • Prenatal screening for Down’s Syndrome. PatientPlus. patient.info/patientplus, checked October 2016
    • Breech presentation. BMJ best Practice. bestpractice.bmj.com, last updated May 2016
    • Inducing labour. National Institute for Health and Care Excellence (NICE), July 2008. www.nice.org.uk
    • Healthcare professionals in pregnancy and labour. National Childbirth Trust. www.nct.org.uk, last updated July 2014
    • Gestational Diabetes. PatientPlus. patient.info/patientplus, last checked March 2014
    • Diabetes in pregnancy: management from preconception to the postnatal period, National Institute for Health and Care Excellence (NICE), 2015. www.nice.org.uk
    • Antenatal classes. Tommy’s. www.tommys.org, last reviewed April 2015
    • 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
    • Rh incompatibility. Medscape. emedicine.medscape.com, updated February 2014
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    Reviewed by Alice Rossiter, Specialist Health Editor, February 2017.
    Expert reviewer: Dr Evelyn Ferguson, Obstetrician Gynaecologist.
    Next review due: February 2020.

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