Antenatal care

Expert reviewer, Dr Samantha Wild, General Practitioner, Bupa UK
Next review due March 2022

Antenatal care is the care you get from healthcare professionals to ensure you have a healthy pregnancy. It includes information on services and support to make choices right for you. Antenatal care will include 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

About antenatal care

If you’re healthy, and it’s your first pregnancy, you’ll usually have 10 antenatal appointments. If you’ve already had a healthy pregnancy, you might have fewer.

If you’re fit and healthy and you’re expected to have a pregnancy without any major problems, a small team of people will look after you. 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.

There are hospital and community midwives.

  • Hospital midwives are based in a birth centre, midwife-led unit, hospital obstetric or consultant unit. They’ll support you through labour, your delivery 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.

Other health professionals who may provide care, include:

  • a sonographer who does your ultrasound scans
  • a perinatologist or feto-maternal medicine specialist – an obstetrician who can offer more specialised care if you have a complicated pregnancy or a medical condition

Your antenatal appointments may be at a hospital maternity unit, your GP surgery, a local health centre, or at home. Health professionals will check the progress of you and your baby and give you information to help you have a healthy pregnancy and birth. Other goals of antenatal care are to give you information to help you take care of your new baby.

First contact with your GP surgery and midwife

When you find out you're pregnant, contact your GP surgery – they’ll put you in touch with an NHS midwife. If you would like to access private antenatal care, you may be able to find a private midwife through the Independent Midwives website. See Other helpful websites for details.

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

  • the date of the first day of your last period
  • your general health, including your mental health
  • any previous pregnancies, and how those were
  • any medical conditions you, or your family have
  • any medicines you’re taking

You’ll also be given advice about how to have a healthy pregnancy, which may include the following.

  • Folic acid. If you’re not already taking folic acid, 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 (5mg) if you’re very overweight, take anti-epileptic medicines for epilepsy, or have another health condition, such as diabetes. You might also need a higher dose 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.
  • Your lifestyle. Your midwife will give you information about what foods to avoid and suitable types of exercise you can do while pregnant. They’ll also give you help and support to stop smoking if you smoke, and give you information about the risks of 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.

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

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.

At the end of your booking appointment, your midwife may give you your maternity notes to look after. These contain all the information about your health and care, and you need to take them with you to every appointment. Some hospitals are changing from paper notes to digital notes. Your midwife will advise you which system your hospital uses.

At your booking appointment, your midwife will talk to you about taking vitamin D supplements. You will normally take 10 micrograms (10µg) of vitamin D every day throughout your pregnancy to keep your bones strong.

Being pregnant can affect the sugar levels in your body in all kinds of ways, and this can sometimes lead to a condition called gestational diabetes. At your booking appointment, your midwife will check to see whether you’re more likely to develop diabetes than other women. .

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

Blood tests

Your midwife will offer you 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. Around one in four women develop anaemia when they’re pregnant. If you develop it, you may need to take iron tablets.
  • Infections, such as hepatitis B, human immunodeficiency virus (HIV) and syphilis. These may affect your pregnancy, but it’s your choice if you would like to be checked for them.
  • Blood disorders, such as sickle-cell disease and thalassaemia. If you’re at risk of carrying the genes for these conditions and may pass them on to your baby, you’ll be offered this test. 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. For more information, see Frequently asked questions below.

Blood pressure, urine and other checks

Your midwife will measure your blood pressure and your urine at every appointment to check for pre-eclampsia. Pre-eclampsia is a type of high blood pressure that can develop when you’re pregnant.

If you have any risk factors for pre-eclampsia, such as type 1 or type 2 diabetes, high blood pressure (before you were pregnant), or kidney disease, your midwife may offer you aspirin. This will be a low dose (75mg) that you take each day from 12 weeks of your pregnancy. This will help to reduce your risk of developing pre-eclampsia, but it can’t take away the risk completely. You can read more about the risk factors in our information on pre-eclampsia.

Your midwife will measure your height and weight to work out your body mass index (BMI). 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.

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, and 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 some conditions can be difficult to see and diagnose. Other factors, such as the way your baby is lying during the scan, can affect how much you can see.

You’ll usually have your first scan, called a dating scan, when you’re between 10 and 14 weeks pregnant. It's used to work out when your baby is due and to see if you’re having more than one baby.

You’ll have your second scan when you’re between 18 and 21 weeks pregnant. This scan will check that your baby is healthy and developing as it should be. The ultrasound images should show your baby clearly, including their main organs. 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’ll 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, later in your pregnancy.

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. 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.

If you’re between 10 and 14 weeks pregnant, you can have what’s known as the ‘combined test’. There are two parts to this screening test.

  • Nuchal translucency screening. This is done at your first ultrasound scan. Your sonographer uses images from the scan to measure the fluid at the back of your baby’s neck.
  • A blood test which measures specific proteins in your blood. This can be done alongside the nuchal translucency scan when you’re in your first trimester.

If your first scan is later than 14 weeks or you’re further on in your pregnancy than you realised, the combined test can’t be done. Instead, you can have a blood test called the ‘quadruple test’. This can be done up to 20 weeks of pregnancy, but is less accurate than the combined test.

Using the results of these tests, plus other factors such as your age, 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 further tests 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 surrounds your baby (amniotic fluid) for testing. 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.


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. NIPT is gradually being rolled out across the country as an additional option for women who have a higher chance of having a baby with Down’s syndrome or other conditions caused by abnormal chromosomes. For the latest information about NIPT and its availability in your area, speak to your midwife.

Antenatal appointments in later pregnancy

For the first 28 weeks of your pregnancy you’ll usually have an antenatal appointment about every four weeks. Between 28 and 36 weeks, you’ll have one every two to three weeks, and after 36 weeks you’ll be seen every week. This can vary so ask your midwife. 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

Week 34 and 36

At these appointments, your midwife or doctor will give you information about labour, birth, breastfeeding and preparing to look after a newborn baby.

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. 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 4

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 may be offered a membrane sweep. This involves your midwife massaging your cervix or passing a finger through your cervix. This is to gently separate the membranes of the amniotic sac your baby is in, from your cervix. This can help release hormones to start labour naturally.

After 41 weeks

At your 41-week appointment, you’ll be offered induction, which means starting your labour artificially. Your midwife or doctor will talk to you about the different ways of doing this.

Frequently asked questions

  • Antenatal classes can help you and your partner to learn more about your pregnancy, birth and how to care for your new baby. There are different types of class available, so choose one that you feel comfortable with.

    Most classes include information about:

    • exercises to keep you fit during pregnancy and help you in labour
    • what happens during labour and when you give birth
    • coping with labour, and information about different types of pain relief
    • making your birth choices
    • caring for your baby, including feeding them
    • your emotions during pregnancy, birth and after your baby is born

  • One blood test you have at 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. 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’ll be offered specialist care in this situation.

    To prevent rhesus disease if you are rhesus-negative, your midwife or doctor will offer you one or two injections of anti-D in your third trimester. These are given either as a single dose at 28 weeks, or as two doses at 28 and 34 weeks. These will reduce the risk of your body producing the antibodies and help prevent problems if you have another baby in the future.

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, March 2019
    Expert reviewer Dr Samantha Wild, General Practitioner, Bupa UK
    Next review due March 2022