Antenatal care is the care received from healthcare professionals during pregnancy. A series of appointments with a midwife, or sometimes with a doctor who specialises in pregnancy and birth are offered.
Book an appointment with your GP or directly with your midwife as soon as you know that you're pregnant. It's best to be seen as early as possible.
With a first pregnancy you'll have up to 10 appointments. If you've had a baby before, you'll have around seven appointments. Under certain circumstances, for example if you develop a medical condition, you may have more.
Your first visit appointment
At this first visit, you will be given information about:
· folic acid and vitamin D supplements
· nutrition, diet and food hygiene
· lifestyle factors that may affect your health or the health of your baby, such as smoking, recreational drug use and drinking alcohol
· antenatal screening tests
The midwife or doctor will ask about previous health or pregnancy issues. It's important to tell your midwife or doctor if:
· You've had any complications or infections in a previous pregnancy or delivery, such as pre-eclampsia or premature birth.
· You're being treated for a chronic disease, such as diabetes or high blood pressure.
· You or anyone in your family have previously had a baby with an abnormality, such as spina bifida.
· There's a family history of an inherited disease, such as sickle cell or cystic fibrosis.
The next appointment should happen at 8-12 weeks pregnancy - called the booking appointment.
Women will usually see a midwife and sometimes a doctor. An ultrasound scan may also be offered.
The midwife or doctor will ask questions building up a picture of the mother and pregnancy. This is to make sure the correct level of support is given, and so that any risks are spotted early.
Several antenatal screening tests are performed on a sample of blood which is usually taken at the booking appointment. In some cases, the baby's father may be asked to have a blood test to check for inherited conditions, such as sickle cell or thalassaemia.
The booking appointment is an opportunity to tell the midwife or doctor if extra support is needed. This could be due to domestic abuse or violence, sexual abuse or female genital mutilation.
· Eight to 14 weeks: dating scan
This is the ultrasound scan to estimate when the baby is due, check the physical development of the baby and screen for possible abnormalities.
· 18-20 weeks: anomaly scan
The main purpose of this scan is to check that there are no physical abnormalities.
From around 24 weeks, antenatal appointments will usually become more frequent. However, if the pregnancy is uncomplicated and the mother is in good health, appointments may not need to be too frequent.
Later visits are usually quite short. The midwife or doctor will usually:
· check urine and blood pressure
· feel the abdomen (tummy) to check the baby's position
· measure your uterus (womb) to check the baby's growth
· listen to the baby's heartbeat
Information should be provoided about:
· the birth plan
· preparing for labour and birth
· how to recognise signs of active labour
· induction of labour if the baby is overdue (after your expected date of delivery)
· the "baby blues" and postnatal depression
· feeding the baby
· vitamin K (which is given to prevent bleeding caused by vitamin K deficiency in the baby)
· screening tests for newborn babies
· self-care and care of the baby
In the last weeks of pregnancy, keeping track of your baby's movements is important. If the baby's movements become less frequent, slow down or stop, contact your midwife or doctor immediately. An ultrasound scan will be undertaken if there are any concerns about how the baby is growing and developing.
Antenatal checks and tests
During pregnancy a range of tests, including blood tests and ultrasound scans are offered. These tests are designed to help make pregnancy safer, check and assess the development and wellbeing of mother and baby, and screen for particular conditions.
· Weight and height
· Blood pressure
· Blood tests - including blood group and infection screening - see details below
The blood group test tells whether the mother’s blood group is rhesus negative or rhesus positive. Women who are rhesus negative may need extra care to reduce the risk of rhesus disease. A rhesus negative woman can carry a baby who is rhesus positive if the baby's father is rhesus positive. If a small amount of the baby's blood enters the mother's bloodstream during pregnancy or birth, the mother can produce antibodies against the rhesus positive cells (known as anti-D antibodies).
This usually doesn't affect the current pregnancy, but if the woman has another pregnancy with a rhesus positive baby, her immune reponse will be greater and she may produce a lot more antibodies. These antibodies can cross the placenta and destroy the baby's blood cells, leading to a condition called rhesus disease, or haemolytic disease of the newborn. This can lead to anaemia and jaundice in the baby.
Anti-D injections can prevent rhesus negative women from producing antibodies against the baby. Rhesus negative mothers who haven't developed antibodies are therefore offered anti-D injections at 28 and 34 weeks of pregnancy, as well as after the birth of their baby. This is quite safe for both the mother and the baby.
Anaemia causes tiredness and being less able to cope with a loss of blood when giving birth. If tests show anaemia, iron and folic acid may be prescribed.
Tests are offered for:
· susceptibility to rubella (German measles)
Checks for abnormality
Most expectant parents worry at some time during pregnancy that there may be something wrong with their baby.
Of all the babies born in the UK, 97% are healthy and 1% will be born with abnormalities that can be partly or completely corrected. However, about 2% of babies will have a major abnormality that cannot be corrected. Screening tests help to pick up potential problems and allow appropriate action to be taken.
The screening tests offered during pregnancy are either ultrasound scans or blood tests, or a combination of both. Ultrasound scans may detect structural abnormalities, such as spina bifida. Blood tests and scans can help to detect chromosomal abnormalities, such as Down’s syndrome.
An anomaly scan is usually offered when around 18-20 weeks pregnant.
Some diseases or conditions are inherited from one or both parents. These include cystic fibrosis, haemophilia, muscular dystrophy, sickle cell disorders and thalassaemia. You may be able to have tests early in pregnancy to check whether your baby is at risk, or is affected. Ask your GP or midwife to refer you to a clinical geneticist (a specialist in inherited diseases) for advice. Ideally, you should do this before you get pregnant or in the early weeks of pregnancy.
Listen to our expert interview with Marcus Setchell, a senior Consultant Obstetrician and Gynaecologist who has worked in some of London’s largest Maternity departments, discusses the stages of pregnancy and the tests a pregnant woman can expect to undergo.
This Podcast was recorded in May 2009.
What would you say are the first actions you need to think about once you discover you are pregnant?
I think that is a jolly good question. Of course I would say, even before you’ve got pregnant you’d have given up smoking, taken a check on your weight, and looked after various health issues. Assuming you have done all that and as soon as you are pregnant, if you are, then stop smoking at once and reduce alcohol intake to a bare minimum. Begin to be a little bit careful about certain things that you eat, and certain activities you get on with.
Then the next stage is to start think about, where am I going to have this baby? What sort of antenatal care pattern do I want to use? And generally begin to prepare for the fact that at the end of this long nine-month period there is going to be a baby to be looked after.
Can you describe what the implications of pregnancy are for the mother’s health; both physical and emotional?
Most men would say during pregnancy women are very emotional, and certainly I think they maybe more emotionally sensitive, and that is rather important men do know and understand that.
Physically in the beginning of pregnancy nearly everybody feels awful and so when you were saying we wanted to concentrate on straightforward pregnancy, most people at the beginning of pregnancy think can this be normal? I feel so awful, so sick, so tired, so exhausted, and for them this isn’t normal at all, and they are bound to be worried if it actually is progressing normally.
Can you summarise the physical aspects of pregnancy?
Physical aspects: Almost everybody has read about pregnancy sickness, morning sickness, not everybody gets that, but almost everybody feels really tired and exhausted; they get home from work and want to go to bed; they don’t want to cook supper. The nausea again, sometimes it isn’t morning sickness at all, many people have the worst affects of nausea and sickness in the evening; and it can be at any time of the day. Some people get headaches, and it can be a quite severe symptom in the first few weeks of pregnancy.
There are more minor things like breast tenderness, but again for some people the breast tenderness and breast enlargement is extremely uncomfortable. Some people will notice they need to spend a penny more often. Others will get constipated even in the very early stages of pregnancy, and all those things are normal but when they get better is very variable, the textbook answer is that you’ll be feeling better by 3 months, but it is often longer, sometimes shorter.
Can you take us through the main phases of development, and what is to be expected at each phase?
Phases of development: Professionally we divide pregnancy in 3 so called trimesters, roughly 3 month periods. The first trimester is from the very beginning of conception to about 12 weeks or 3 months. That is the phase when the woman doesn’t feel well, not much to enjoy in those first 3 months other than the excitement that you are pregnant. Of course during those first 3 months you have very little to show for it, she is not feeling any movement, the tummy isn’t getting any bigger, you might put a few pounds of weight on.
Then the 2nd trimester from 3 months to 6 months, her tummy will begin to show not necessarily until 4-5 months, she may not show very much until 6-7months, but certainly most people by 20 weeks, 4-5months it will show that they are pregnant. Then about 20 weeks she will feel the baby move, which is a very exciting time. And then 3rd phase, it is the big growing phase, when it is obvious to everybody that she is pregnant. She may begin to feel physically uncomfortable simply from the increased size and the increased weight to carry around. Of course what is happening in that first 3 months is the baby is developing from a fertilised egg, developing its organs. In the first 3 months all those organs are virtually fully developed by 3 months, but the foetus is still very small indeed measuring only an inch/inch and a half. In the 2nd phase the organs are all developed, the baby is growing and the growing organs are perhaps particularly sensitive to nutrition and diet but not quite so sensitive to things like medications, and then the 3rd phase, really is the fattening up phase.
Could you talk about some of the discomforts that might be normal at the various stages of pregnancy?
As I said in the 1st trimester, sickness, tiredness, nauseas, perhaps headaches, are the main discomforts the woman will feel.
The 2nd trimester is often the glowing phase from 12 weeks till about 26-28 weeks, and people feel very well. Those minor problems of the first phase are over and they are not so large as to be experiencing discomfort from being very heavy; not uncommonly they get some stretching feelings in the abdomen, which may be a bit uncomfortable but by and large nothing very much. As you get to the end of 2nd trimester and enter in the 3rd final phase, when the baby is really growing quite big and quite rapidly, there are some other symptoms that the woman may experience which are uncomfortable and make her feel something is not quite right. She will often get heartburn and indigestion, and it can be really quite bad, enough that she would want to take medicine for it, to relieve it.
Some people will get quite badly breathless, and can’t do one flight of stairs without having to stop to catch their breath. They worry that there may be something wrong, but it is actually very normal. Because what is happening at the end of pregnancy is the diaphragm is pushed up so far, there is far less breathing reserve, so people feel short of breath.
Is there any advice you would give to women in terms of the symptoms?
The breathlessness, there isn’t much we can do other than reassure them. Heartburn you can certainly encourage women to perfectly safely, to take antacids.
Perhaps it would also be useful to talk about the development of the baby, particularly in the final phase?
Yes, the first phase is very much the development from a blob of tissue to that blob of tissue separating out and developing into the parts that you and I all recognise of the body; developing limbs, developing a heart. That really all happens at a very early stage of the pregnancy. By 10 or 11 weeks, and when people have an early scan, they are fascinated to see that it already looks like a baby. Certainly by 12 weeks the organs have developed, but of course they are not mature, and couldn’t begin to function and provide all the things to the body it needs. The heart its there, and pumping the blood around, but the mothers circulation is pumping all the blood into the baby. As the development occurs in the second phase, those organs begin to mature more so they are still delicate and sensitive. The brain development can be impaired if things go really wrong in what the woman is eating, particularly things like drugs, and even at that stage development and growth can be affected by smoking. Then by the third phase the organs are all there, but they are undergoing maturation ready for birth. There is quite a variation as to what organs mature at what stage, and of course the most important things for birth for independent life after birth, are the lungs and the heart. The lungs don’t get fully developed until around 36 weeks, that’s why babies born as early as 28 weeks, will almost all require some sort of assistance with their breathing. Their hearts will work pretty well even at 26 weeks.
What about the tests that are carried out during pregnancy?
The very first thing most women will do when they are late with their period, is do a pregnancy test, and of course nowadays most of those will do a home-pregnancy test, rather than going to the doctor, and they are very very reliable. Then most of the other tests do require some sort of professional assistance, and they will include a range of blood tests and mostly the range of first blood tests are done at around 10-12 weeks. These are all important things like the blood group, the blood sugar level, tests to screen for various infections, to make sure she is immune to Rubella, German measles, hopefully most people will know that long before they are pregnant. Hepatitis tests are done on everybody nowadays, and for ever and ever syphilis test has been done, syphilis is very rare nowadays, but it its very important in pregnancy. It is something you can actually do something about. Most pregnant women nowadays, well all pregnant women are offered an HIV test, and most of them actually do agree to have them done. Of course the test that is really exciting for her is her first ultra sound scan. That is universally offered at about 12 weeks, in certain circumstances people are offered the scan earlier, perhaps if they have had previous miscarriages or that sort of problem. The 12 weeks scan will show that it is a properly developing foetus, a properly developing small baby. You won’t be able to tell everything about it, you certainly can’t tell the sex on a 12-week scan. But you can tell whether it’s growing at a proper rate, whether its size is consistent with when has been worked out with the periods, as to when the baby is due. Many hospitals now at 12 weeks do a special scan test that predicts whether the woman is at high risk of Downs syndrome chromosomal abnormality, or not. Then at 20 weeks everybody is offered a much more detailed scan, by then at 20 weeks it is possible to visualise on a scan the brain and its ventricles, the heart and its structure, the liver, the kidneys, and all the organs. It’s a very important scan, and people will enjoy it, they may have slight anxieties as they are waiting to have it done, are they going to find something wrong? It is important that women are aware that the scan is being done to look for things that are wrong.
And ordinarily you would be able to tell the sex of the baby at that point?
You would be able to tell the sex.
Are there any particular health issues that arise for specific groups? For example for older women, giving the increasing phenomenon of older mothers?
By and large if an older mother is healthy, the problems of pregnancy are not enormous. Of course there is the very well recognised risk that the chances of having a baby with Downs syndrome do go up very considerably with age. By 45 they are probably as high as 1 in 10, 48 I think I have heard quoted as high as 1 in 4. That is a very important thing; nowadays people can have pre-natal diagnostic tests for Downs syndrome. Providing they are happy to take action on what is found, it doesn’t become such an important thing. On the whole older mothers are more careful about their health. More conscientious about stopping smoking, reducing alcohol, making sure their diet is healthy and varied, not living on fast foods. I’m a great believer that rather than people taking vitamin supplements, they should be given advice on diet, because if you eat a sensible balanced diet, with some protein whether that’s from meat or fish or eggs, and some carbohydrate from pasta and so on, and lots of vegetables, salads, fruit, which will provide all the vitamins anyone needs. I’m not a vitamin tablet enthusiast at all, other than in the very early weeks in pregnancy, where it is worth taking folic acid.
So there are no specific issues or health advice that you would give to older mothers?
The other point I should make is miscarriage is commoner, as the mother gets older. Perhaps that isn’t particularly well recognised. I sometimes hear people saying ‘Oh I’m only 39 I’ll put of getting pregnant for another few years’ they are not aware that over 40, something like a quarter of pregnancies will end in a spontaneous miscarriage, so that is important. There is statistically, pregnancy is slightly more dangerous for older mothers, but that is because some older mothers are actually people who have hard a large number of babies, they actually don’t go for antenatal visits or have their blood pressure checked. Its important for all pregnant women to have those thing checked and tested.
There are numerous advances that have been made in antenatal care in the last 50 years or so. But from your personal perspective, is there a particular development that can you single out, that you feel has revolutionised antenatal care?
There are all sorts of advances that have happened, some of which are not medical advances at all, but to do with the fact that nutrition is generally better in the population today than it was 50 years ago. If you are looking for technical advances, then I think ultra sound scanning must be the most important thing. It has really, really opened a window on the baby, that you can see things as they are developing, check that things are going right, you can use ultra sound as a diagnostic tool.
Where do you see improvements in care being made going forward, and what role do you feel that research plays in this area?
Certainly things like ultra sound, the research in ultra sound, has improved the technical qualities of the images you get hugely, and I’m sure they will go on improving. For many years obstetricians and midwives have been conscious that we can try and help identify who is at risk of developing problems with pregnancy, such as premature birth pregnancy, blood pressure, toxaemia, pre-eclampsia. But actually were not very good at identifying people who are at risk of those things, despite a lot of research that has been done. But we are beginning to be able to identify markers in the blood, substances in the blood that are different in people who have got premature labours, pre-eclampsia, babies who are not growing well. Once we can develop those tests more fully, it may be that by doing them routinely on all pregnant women at various points of the pregnancy, we will really be able to identify those who are at risk of these things. Then apply preventative measures to try and prevent that risk form developing, and even therapeutic measures, i.e treatments before the disorder has really become full blown.
That is particularly pertinent to Wellbeing of Women. Since we announced the launch of the unique data bank The Baby Bio Bank in March, which is set to revolutionise research into pregnancy complications based upon investigating how far these are inherited, which I think underlines the importance of research.
Thank you very much for your time
Page last updated March 2013