Antenatal care: What to expect

Antenatal care is the care you receive from health professionals during your pregnancy to ensure you and your baby are as well as possible.

You should begin your antenatal care as soon as you know you’re expecting. You can do this by contacting your GP or a midwife or referring yourself directly to maternity services near you. This is usually via an online form on your local hospital or NHS trust website. If not, your GP will have a referral form.

What antenatal care can I expect from my midwife or doctor?

Your first midwife appointment should happen before you’re 10 weeks pregnant. (If you’re more than 10 weeks pregnant and haven’t seen a midwife or GP, make an appointment as soon as possible so you can start your antenatal care.)

The NHS in England will offer you:

• 10 pregnancy appointments (seven if you’ve had a child before) to check the health and development of you and your baby.
• Screening for inherited blood disorders (sickle cell and thalassaemia).
• Screening tests to find out the chance of your baby having certain conditions, such as Down’s syndrome.¹
• Blood tests to check for syphilis, HIV and hepatitis B.

If you or your baby need them, you’ll be offered additional appointments. Depending on your health and where you live, you may see a midwife for all your appointments, or a midwife for some appointments and a GP for others.

What can I expect during my first midwife appointment?

Several questions are asked to ensure you get the care that’s right for you. Your midwife will ask you about:

• Where you live and who you live with.
• Your physical and mental health, and any issues or treatment you’ve had in the past.
• Any health issues in your family.
• Any other pregnancies or children.
• Your partner if they’re in the picture.
• The baby’s biological father’s medical history.
• Whether you’ve had fertility treatment.

The NHS website dives into more detail here.

Tests at your first appointment include:

• Measuring your height and weight and working out your body mass index (BMI).
• Measuring your blood pressure and testing your urine for signs of pre-eclampsia.
• Also testing your urine for signs of a urinary tract infection and diabetes.
• Blood tests to check your general health and blood group, and to see if you have HIV, syphilis, or hepatitis B.
• You’ll also be offered a blood test for sickle cell and thalassaemia (blood disorders that can be passed onto your baby).²

Your midwife may discuss with you:

• how your baby develops,
• diets and foods to avoid,
• exercise and pelvic floor exercises,
• your NHS antenatal care,
• breastfeeding,
• antenatal classes,
• benefits such as free prescriptions and free dental care,
• your options for where to have your baby,
• tests and scans you'll be offered.

Maternity notes

Your midwife will give you your maternity notes, which may be digital in an app, via a website or written down in a book or folder. These notes are a record of your health, appointments, and test results in pregnancy.

They include useful phone numbers, such as your maternity unit or midwife team. You should have these notes with you all the time until you have your baby. This is so healthcare staff can read about your pregnancy health if you need urgent medical care.

How many ultrasound scans can I expect through the NHS?

Hospitals in England offer at least 2 ultrasound scans during pregnancy:

• around 11 to 14 weeks
• between 18 and 21 weeks.

The first scan is called the 12-week scan, also called the dating scan. The sonographer estimates when your baby is due – the estimated date of delivery (EDD) – based on your baby's measurements.

The dating scan can include a nuchal translucency (NT) scan, which is part of the combined screening test for Down's syndrome, if you choose to have this screening.

The scan will also confirm whether you’re expecting more than one baby, that your baby is growing in the right place, as well as your baby’s development. It can also detect some health conditions, such as spina bifida.³

The second scan is the 20-week screening scan and is sometimes called the anomaly scan or mid-pregnancy scan. This scan checks if your baby could have a condition that affects their health and development. It checks for signs of 11 conditions:

• anencephaly
• open spina bifida
• cleft lip and palate
• diaphragmatic hernia
• gastroschisis
• exomphalos
• serious cardiac abnormalities
• bilateral renal agenesis
• severe skeletal dysplasia
• Edwards' syndrome (trisomy 18)
• Patau's syndrome (trisomy 13).⁴

Some conditions can be seen more clearly than others, so the scan might not find everything. But screening is the best way to find any conditions and helps you and your doctors to make the best decisions for you and your baby.⁴

Your sonographer will be able to tell you the results of your scan at the time. You may be offered more than 2 scans, depending on your health and the pregnancy.

Further information on what to expect during your scans can be found on the NHS website.

Additional needs

If you have special health needs, your midwife, GP, or obstetrician may take shared responsibility for your maternity care.

Let your midwife know if you have a disability that means you have special requirements for your antenatal appointments or for labour.

If you don’t speak English, flag this with your midwife also.

Some important things to know during pregnancy

• Scans can’t pick up all health conditions.⁵ If you’re worried something isn’t right, speak to your doctor or midwife.
• The NHS doesn’t offer routine blood tests or scans to confirm pregnancy.
• Your pregnancy is first calculated using your last menstrual period, but this is later corrected with scan measurements to give you an estimated delivery date = 40 weeks of pregnancy.
• It’s considered normal to deliver within two weeks of your estimated delivery date – 38 weeks or 42 weeks' gestation. But you’ll be offered an induction of labour at 41 weeks and 3 days, as there is evidence of reduced placenta sufficiency after 40 weeks' gestation.
• Every woman has a minimum of two antenatal scans and up to 10 antenatal appointments during pregnancy. You’ll be offered more investigations or monitoring to keep track of the growth and wellbeing of yourself and your baby if necessary.
• You’ll have regular bloods and urine tests during pregnancy. Always take a urine sample to your midwife visit.
• You’re required to give your Mat B form to your employer, so they can process your maternity pay if applicable.
• You may be low risk at the start of your pregnancy, but this may change as your pregnancy progresses, or during labour. Should your risk change, you’ll be transferred to the appropriate birthing unit for the safety of yourself and your unborn baby.
• Discuss all your travel plans with your GP / midwife to make sure it’s safe for you to travel.
• In the UK, a woman has the right to choose where she’d like to give birth, if it’s a safe choice for her and the baby, and she can travel there herself during labour. Familiarise yourself with the hospitals with maternity units around you, to help with your decision on where you’d like to give birth, and what’s most suitable for you – including the pain relief they’re able to offer.
• Having a birth plan can mean you enter the delivery room with an idea of what you’d like to happen in an ideal world, rather than make decisions at the time. Include things like who your birth partner is, pain relief preferences, whether you’d like a water birth, these sort of things. Your midwife can advise you of your options. If you attend any NCT classes in the run-up, the person leading your classes can also provide more information.
• Try and view your birth ‘plan’ as a birth ‘wish list’. Birth isn’t something that can be controlled by a plan, but it’s useful to know your preferences should they be an option at the time. This also avoids disappointment should your birth experience not go to ‘plan’.
• Think about how you’d like to feed your baby. For example, antenatal colostrum harvesting if you’re breastfeeding.
• Your GP and maternity team will help identify what risk you are, following thorough health assessments. Though most women may fall within the low-risk category at the beginning of pregnancy, this can change at any point in pregnancy, should complications develop.
• Think about how pregnancy will impact your finances. How long will your maternity leave be? How much paternity leave will your partner receive? Do you have support during and after your pregnancy from family and friends?
• Find out what your health insurance covers in pregnancy, as most policies don’t cover pregnancy.
• Your midwife can point you in the direction of antenatal classes and breastfeeding workshops in your area. These classes can help you prepare for your baby’s birthday, give you confidence and information from how to look after and feed your baby, stay healthy during pregnancy and guidance on making a birth plan.
• These classes are also a great way to make friends with other parents who are expecting babies around the same time as you. Most classes begin around 8-10 weeks before your baby is due, when you’re around 30-32 weeks pregnant. If you’re expecting twins, start your classes when you’re around 24 weeks pregnant, as your babies are more likely to be born early. Some units offer special antenatal classes if you’re expecting multiples. Your midwife can point you in the right direction for more information.⁶
• Children’s Centres also support families with children under the age of five. They can provide easy access to antenatal care, health services, parenting and family support, drop-in sessions, and more.⁶
• You can bring someone to your antenatal scans, but most hospitals don’t allow children. Check with the clinic or hospital before your appointment.

Partners

Although you’re not physically carrying your baby, your health and wellbeing is still extremely important. If you don’t take care of yourself, you won’t be able to provide the support you want to, or the support your partner needs.

Alongside the usual health and wellbeing and diet and exercise recommendations, don’t forget to check in with how you’re feeling emotionally and keep communicating with your partner.

Find time for activities that bring you joy, prioritise rest and sleep (as sleepless nights lie ahead!), and read up on parenthood to build confidence in your capabilities.

Useful websites for additional information and support

• NCT – A charity that supports people as they become parents, including antenatal courses, local activities and meet-ups. Find your local antenatal course here.
• Antenatal Results and Choices (ARC) – Has information about screening tests and how you might feel if you're told your baby has, or might have, a condition. Their helpline is open Monday to Friday 10am to 5.30pm or call 020 7713 7486.
• Tommy’s – A pregnancy and baby charity.
• Patient.info – Healthcare information and symptom checker for patients and professionals.
• National Institute for Health and Care Excellence – Including guidelines on the antenatal care that women and their babies should receive.
• SANDS – Supporting anyone affected by pregnancy loss and the death of a baby.
• Miscarriage Association – A charity that provides information and support for anyone affected by miscarriage.
• The Ectopic Pregnancy Trust – A charity focusing on ectopic pregnancy, providing information and support.
• Group B Strep Support – A charity working to stop group B Strep infection in babies.
• Petals – A baby loss counselling charity.
• 4Louis – A charity supporting families with child loss.
• Mind – A mental health charity providing support and services including online peer support.
• Samaritans – A charity providing emotional support to anyone who is struggling to cope.
• Association for Post Natal Illness (APNI) – A countrywide network of phone and email volunteers, who have had, and recovered from post-natal illness. APNI also provides support, education and information on post-natal illness.
• PND Awareness & Support (PANDAS) – A charity supporting families and their networks who may be suffering with postnatal depression.
• Rethink Mental Illness – Improving the lives of people severely affected by mental illness through their networks, local groups and services, information and campaigns.

Further antenatal information can be found on the NHS website.

References

1. Your antenatal care – NHS
2. Your first midwife appointment – NHS
3. 12-week scan – NHS
4. 20-week screening scan – NHS
5. Ultrasound scans in pregnancy – NHS
6. Antenatal classes – NHS