Antenatal appointments and scans
The pregnancy test was positive and you've already started making shortlists of baby names. This means it's time to make it official and enter the world of antenatal appointments. We answer some of your key questions
Will I get paid time off for antenatal appointments?
Yes, all pregnant women are entitled to paid time off for antenatal care. Your employer can ask you to reschedule if there is a particular business need for it, but your right to attend your appointments at the right stage of your pregnancy is protected.
Where will I have my antenatal appointments?
Initially, most women go to their GP to tell them they are pregnant though in some areas you can simply book yourself in directly with your local hospital or refer yourself to a midwifery service. Sometimes you can actually 'book in' with your GP and have your antenatal care done through your GP surgery, too.
Either way, your doctor will be able to run through your options for where to give birth as well as where to have your antenatal care and should be able to answer any questions you have.
If you're considering having a home birth you may be able to get a referral to midwives who specialise in home birth if this is an option in your area.
From then on, you may have your appointments with your GP, a hospital-based midwife, a midwife attached to your GP's surgery or with a community midwife in your home. Or it can be a mixture of any of those. It depends on what's on offer locally. You may see the same midwife all the way through or it may be one of several people from a team of midwives that you see.
Can my partner come to my antenatal appointments?
Your partner is usually welcome at appointments and it's lovely to have them at the scans; it's an extra opportunity to bond with the baby for them, too.
Sometimes your midwife or doctor may want to have a word with you alone but otherwise partners are almost always welcome.
Unlike mothers, fathers and birth partners don't have an automatic right to paid time off for these appointments (though many companies will offer it and the government states that this is 'best practice'). However, since 2014, partners and fathers do have had the right to time off (unpaid) to attend up to two antenatal appointments. Most partners use this to attend the dating and anomaly scans.
What happens at my first midwife appointment?
Your first official appointment is your 'booking in' between week 8 and week 10, where you sign up for maternity care with either your GP or a midwife (or sometimes 'shared care', where you'll continue to see your GP from time to time as well as a midwife).
They'll have lots of questions and information they need to take from you:
Questions about lifestyle
You will be asked lots of questions about your general health and lifestyle, such as whether you smoke, drink alcohol, or take drugs.
You may be weighed and measured to calculate your BMI (body mass index) and give them a 'baseline' for your pregnancy. Your weight is likely to change drastically (at least, one would hope) – but they will monitor your pregnancy weight gain.
They may also ask you how you plan to feed your baby. Don't worry too much about it at this stage though – it's simply a note of what you're hoping for, no one is going to hold you to it!
All this information will be put into your maternity notes.
Questions about previous pregnancies
They will also ask about any previous births, miscarriages or terminations, and whether you have a family history of genetic disorders.
You will be asked about the date of your last period so a due-date calculation can be worked out, although this might change after your first scan, which gives a more accurate gestation.
Questions about how you are coping emotionally and at home
You'll probably also be asked how you're feeling in yourself. Medical experts know that some women who have suffered with mental health problems in the past may have a flare-up at this time. During pregnancy and just after birth we are all more vulnerable to depression and other mental health issues. There's lots of help and support available so if you've suffered from depression in the past or think you may be now, don't be afraid to speak up. Your midwives should ask you about how you're feeling emotionally both during pregnancy and after the birth and they'll be only to happy to offer help and support.
You can take the opportunity at this appointment to tell your midwife about anything that makes you particularly vulnerable – if you're experiencing domestic abuse (emotional, physical or sexual), for example, or if you have been a victim of female genital mutilation (FGM). This can have serious repercussions during labour and birth for both mother and baby, so it's important to tell your caregivers about it. Any GP, midwife, health visitor or obstetrician you tell about abuse will be able to refer you to the right services to ensure you get the help you need to keep you and your baby safe. They will not share this information with any other agencies unless there is a concern that your unborn child or other children involved are at risk.
Tests at your first midwife appointment
Blood tests will be taken to check for:
- Your rhesus status and blood type
- Rubella immunity
- HIV and STIs
You'll also have your blood pressure taken to establish whether you have high blood pressure, and a urine test to check for:
- Protein being present, which can later be a sign of pre-eclampsia
- Kidney problems
During this appointment your screening scans (see below) should be arranged. You're under no obligation to have these but many women want to know how their baby is doing in there. And you may be offered further blood tests for sickle cell anaemia, Tays-Sachs disease or thalassemia, depending on whether or not you are in a high-risk group.
If you are over 40 and pregnant you may also be offered additional appointments and screening.
Advice given at your first midwife appointment
When will all my antenatal appointments be?
This varies slightly from one area to another but here's a schedule of what you can expect.
Following your booking-in appointment (above) and dating scan, you should have appointments at the following stages (this may look slightly different if you're expecting twins or more).
Your antenatal appointments schedule
You'll be given a blood pressure check and urine test and the midwife will discuss the results of any earlier tests with you. You'll be told about your anomaly scan that is coming up and they may discuss taking an iron supplement with you if previous blood tests have shown you are anaemic.
25 weeks (for mums of first babies)
Standard blood pressure and urine checks are done and the midwife should measure your bump, too.
The blood pressure and urine tests are repeated and your bump measured again. You should also be offered blood tests at this appointment to check for anaemia and red-blood-cell antibodies, which can indicate foetal anaemia among other things. If you're Rhesus negative you'll be given the first of two Anti-D injections this week.
31 weeks (for mums of first babies)
Blood pressure and urine checks are done again. The results of any tests done at your last appointment will be discussed with you.
If you're Rhesus negative you'll be offered the second of your Anti-D injections. At this appointment your care-giver should also discuss labour and birth – including ways to spot the early signs of labour when it comes. They might also discuss Caesarean sections and the risks and benefits of those. The blood pressure, urine checks and bump-measuring you've become used to now will also be done.
At this appointment, as well as all the usual checks, your midwife will also check the position of your baby and establish whether he or she is breech (with the feet or bottom rather than head pointing down at the exit). If the answer's yes, you may be offered ECV (External Cephalic Version), which is a way of manually turning a baby in the womb (from outside, you'll be relieved to hear) by gently pushing and rolling the baby into the head-down position.
You'll also be give information about breastfeeding, caring for a newborn and the Vitamin K injection (which helps newborns' blood to clot) as well as the screening tests your newborn will be offered. They'll also talk to you about looking after your own health after the birth and how to spot the signs of postnatal depression.
As well as the usual checks, there will be a discussion about how to proceed if your pregnancy goes beyond 41 weeks. Sometimes you will be offered a date for a sweep or induction.
40 weeks (for mums of first babies)
This pretty much is a repeat of the last appointment. Expect more of the standard urine and blood pressure checks and a bit of a chat about what will happen if you go overdue.
You might be offered a membrane sweep if you've got this far. The standard checks will be done again – bump measurement, urine test and blood pressure. Hopefully for the last time!
Will I have any additional appointments?
You might be given extra appointments if any of the following apply:
- You're pregnant with twins or more.
- You're having consultant care for any reason.
- You have a pre-existing medical condition or had difficulties in a previous pregnancy which means you need more careful monitoring.
- You need additional scans to check on growth – for example, if you have a high BMI you may be given a late growth scan at around 34 weeks.
- You're an older mother
What scans and screening tests will I have?
Most women just have two or three scans during their pregnancy, but if your pregnancy is considered to be high risk for any reason, you may have more.
Done between week 10 and when you are 13 weeks plus six days, this scan (often referred to as the 12-week scan) is to confirm your due date and also to check that there is just the one baby in there. Erk! Sometimes the nuchal scan is also done at this stage, if you are having that test.
Between week 11 and when you are 13 weeks plus six days, you should be offered the combined test (though this isn't used in every area) which is a nuchal translucency scan combined with some blood tests. The results of both are put together to give you a 'risk factor' for several genetic disorders or conditions, including Down's Syndrome.
If your risk factor is high, you may be offered diagnostic testing such as amniocentesis or CVS.
If the combined test isn't available where you are, or you booked in after 14 weeks, you may be offered triple or quadruple blood-screening tests between week 15 and week 20.
Also known as the 20-week scan, this is carried out between week 18 and week 20. It's a longer scan than the dating scan as the sonographer will be looking at your baby's growth and development in some detail. At this scan you may also be able to find out the sex of your baby.
If you have concerns in the first few weeks of pregnancy (perhaps because you have bleeding), experienced unusual pain or have suffered pregnancy losses previously, you might be able to have an early scan at an Early Pregnancy Assessment Unit (EPAU). Some of these are walk-in, but others need you to have an appointment (arranged through your doctor or midwife).
You may be offered a trans-vaginal ultrasound where a camera is inserted into the vagina, because it might be too early to see the baby via an abdominal scan. It's sometimes possible to see a heartbeat on a scan at as early as 5 or 6 weeks, but the later you go the better the chances are of seeing the tiny heartbeat that will set your mind at ease.
Will I hear my baby's heartbeat at any of my antenatal appointments?
It's hard to hear your baby's heartbeat during the first trimester though you may well hear it at your dating scan. Usually the first time your midwife will try to find the heartbeat (often with a handheld doppler) is at your 16-week appointment. It will sound somewhere between the noise of a train and horses galloping, and is much faster than your own heartbeat.
Don't be alarmed if they can't hear the heartbeat at this appointment. It doesn't mean anything is wrong – just that it was tricky to pick up this time. They will probably ask you to come back and see if they can hear it again at a later date.
Can I have extra antenatal appointments if I'm worried?
Yes. Never wait until your next appointment if you have concerns, particularly if you're concerned about your baby's movements. Your maternity notes will include a number to call if you're worried, and it's always worth giving your midwife team a ring. They'll be pleased to be able to reassure you, and if it does turn out there is a problem they'll be glad you called immediately.
You might be asked to come in to see the midwives or, if your pregnancy is pretty advanced, you may be asked to go to the Day Assessment Unit where midwives and doctors can monitor both you and the baby, and arrange scans if needs be.