PLEASE help explain OB care in the UK to this American

[aleigh1]

HELP!!!

I am new to the UK from the US. I had my two other children in the US and am now pregnant with my third in the UK. Will someone please give me a timeline and breakdown of prenatal care in the UK. I have made phone calls to OB and GP and it seems I keep getting passed off.

Explain it to me like I'm 5. I won't be insulted! PLEASE help me understand! I'm so worried that crucial scans/blood work will be missed.

Any other American Moms out there been through this?

Thanks in advance.

You go to your GP and say you're pregnant. They refer you to the midwife who books you in between 8-10 weeks. You will have a blood test and be offered screening tests with your dating scan around 12 weeks.

You will then see your midwife regularly (depending on your health and history) throughout your pregnancy, and you have an anomaly scan around 20 weeks.

The remainder of your care will depend on how your pregnancy progresses.

And your care will be provided by a midwife, not an obstetrician, unless you have complications.

If you do, you will be 'consultant-led' meaning that a consultant oversees your care, but it is in the main still provided by midwives.

Okay you normally start by making an appointment with either your GP or a midwife at your GPs practice. They will explain what is next.
You will probably find you have far less interaction with your OBs. At about 10 weeks you will probably get your first scan at a local hospital. And another one at 16 weeks. Most of your care will probably be carried out by a midwife.
You will have choices over whether to have a home birth, maybe a midwifery unit or hospital.
Most appointments seem to involve a wee sample and sometimes a blood test.

Congratulations!

As soon as you find out your pregnant, go see your GP. They'll do a basic assessment (calculating your dates based on your period, check weight and blood pressure, give vitamins and prescription exemption form). They'll discuss which hospital you'd like to deliver at/have your care based at and will refer accordingly. If you already know where you want to go you can bypass this appointment and refer yourself directly to the hospital via their website.

First appointment at the hospital is with a midwife between 8-12 weeks (called a booking appointment). Essentially same as GP, probably with a bit more about your obstetric history and blood tests. All scans and appointments are then organised through here. You're normally under midwife led care unless there is a complication/history etc that warrants seeing an Obstetrician. Routine antenatal appointments xan be with a midwife in the hospital, in a community clinic, or in your GP surgery (by a midwife or GP).

Dating scan at 10-14 week
Anomaly scan at 18-20

Routine appointments are at 16, 28, 34,36,38 and 40 weeks (and extra if you go overdue). If it's your first baby you are usually seen at 25 and 31 weeks to.

Hope that helps. The nhs.uk website has a good summary of care in pregnancy

I'm American and living in the UK. This is my 3rd pregnancy (2nd healthy pregnancy and then I also had a mc at 11 weeks in between). Antenatal care here isn't usually through an OB and in many places you don't necessarily even go through your GP, so that might be why you aren't getting anywhere. In our area, you self-refer to the midwives. I've not even seen or spoken to my GP this pregnancy and didn't at all for either of my other two pregnancies. Also, never seen an OB either. Unless you're high risk for some reason, your care is all through midwives. It's so much nicer and more personal that the U.S. (and actually one of the reasons we chose to live here rather than there when we were deciding where to settle).

Different areas may be a bit different, but in our area, you self-refer by just calling the midwives at the hospital. Your GP receptionist should be able to give you the number or just google it for your local hospital or call the hospital switchboard and ask to be transferred to the maternity ward and speak to the receptionist. I know here though, the numbers are very prominently posted in the GP reception area and our local team has a website, so I just googled them and got the number. I'm with the home birth team so it's a little bit different (for example, all my midwife appts are at home, they come to me, usually two of them to do all my appts with the exception of ultrasound scans, which are done at the hospital). But in most teams, your first appt (your booking appt) is done at home to start all your notes, take urine samples, blood samples, check your blood pressure, etc. and then all future appts are with the midwives but in a room at the GP surgery.

Your first appt (booking appt) is usually around 7-10 weeks. Mine have been at 7, 8 and 9 weeks for my 3 pregnancies. Your first scan is 12 weeks unless you have a medical need for an earlier one. Then for 2nd+ pregnancies, your further appts are usually at roughly 16 weeks, 28 weeks, 34 weeks, 36 weeks, 38 weeks, 40 weeks, 41 weeks, after which most have had their babies, but you can carry on and they'll see you as and when for monitoring. You have your 20 week scan at 20 weeks, but that's with a sonographer, not a midwife. And that's if you're low risk. If you're higher risk, they'll see you a bit more and you may also have shared care with an OB consultant who will see you for some appts as well (in place of or in addition to the midwife). I've always only had care with the midwife team (both home births) though, so not sure exactly how much more they'd see you if you were shared or consultant-led.

If you are 5/6 weeks though, I'd be pushing to get your booking appt set up. You may need to self-refer though. I would ask locally in your area what the procedure. I've always just called the midwife and made my first appt there and then on the phone with her. Then they usually book you in for your next appt at the end of the one before.

Antenatal appointment schedule on the NHS website.

IME (which is basically comparing what happened during my pregnancies to what happened during those of my friend who moved to the US), there are fewer appointments, fewer scans, a more hands off approach to low risk pregnancies and a later start to antenatal care in the UK. And as pp have said, unless there are specific risks, you are cared for by midwives, not a consultant obstetrician.

Congratulations!

Right. So you go to your GP. They will refer you to a midwife. The midwife/midwives will be in charge of your pregnancy unless you absolutely need an OBnat which point they will refer you. They will send you to hospital for ultrasounds/tests and devise a birth plan home/maternity unit/hospital with you where you will then go to give birth. Unless you are paying for your treatment yourself in which case you can go to a birth clinic. These clinics usually provide OB, midwifery and one off scans and testing services. I used the birth company on Harley street and would reccomend them.

If you are deemed low risk you will never see any kind of doctor during your pregnancy, at all.

If you are deemed higher risk (you'll probably know the reasons, but if you are over 35, higher BMI, previous c-sections or difficult pregnancies/ deliveries, history of late losses, if this is going to be twins/multiple birth etc) then you will see an OB/gyne, but the midwife will still be your gate keeper initially and you won't have the frequency of appointments or the consistency of care you might be used to (by which I mean you might very well see a different doctor every time).

Nothing usually happens before about 8 or 9 weeks pregnant, when you will be "booked in" by the midwife, she will take your history and tell you what to expect. In most areas you get a viability scan at 12 weeks and an anomaly scan at 20 weeks, but you do not get the 30 week placental scan. TBH the 30 week placental scan is the one I'd pay for privately - it's not a sentimental "look at your baby" as you can't really make them out by then, but my doctor here was most shocked at the lack of a 30 week placental scan because so many avoidable late losses are due to issues with the placenta developing in the final trimester.

I've had babies in the UK and Germany (not the US) but Germany is doctor led like the US. There are pros and cons, but if you've had two easy pregnancies and births the midwife led approach can be nicer. If you're high risk I wouldn't pick the UK. When I was expecting DC2 I was child minding so had 3 very small children with me all day, and my midwife came out to me to do my blood work and check ups in my living room -watched by 3 toddlers - that was service :o Despite doubtless costing an awful a lot less than the doctor led care I had once we moved to Germany.

Congratulations and good luck!

www.nhs.uk/conditions/pregnancy-and-baby/pages/antenatal-midwife-care-pregnant.aspx

I only saw the OB once during my pregnancy. He examinded me, said everything was fine and that was it. All the other care was done by the midwives.

Unlike in the US where midwives can have different qualifications, midwives in the UK are all well trained to a similar standard.
A low risk pregnancy can mean that you don't see a doctor at all. A normal vaginal delivery will not be attended by doctors, but by midwives.
However a C section/forceps/baby being naughty on the monitor will get an obstetrican in the room delivering.
If you are high risk, you'll get a named consultant. If you have an elective lscs you may get a named consultant delivering your baby. Otherwise, any doctors you see will be the oncall team in your local hospital.
Officially you get two scans - a dating scan at 10-12 weeks, and an anomaly scan at 20ish weeks. Unofficially its impressive to only have these two scans, and any concerns will get you extra especially as your pregnancy progresses. At other midwife appointments, they'll measure your uterus, and listen to the heart, plus check urine and blood pressure and things.

It's self referral in my area too. At the booking appointment the midwife gave me a massive folder 'my notes' that you take to all appointments. On one of the first pages it runs through the schedule of appointments so you have it to hand.

Depends where you live. Where I live you self refer online to the midwives - don't see the GP at all. I would do a search online for your local hospital and 'midwifery', it should tell you there.

As a first time mum I just basically rang up and said ‘I’m pregnant what do I need to do?’ :) and my practice were really helpful.

NhS care is basically the same but different healthcare trusts may vary slightly in how they administer it. I can tell you how it happens where I live.

First I had to register at a doctors near me because I was still registered at my old Practice.

The I rang up my doctors and said ‘I’m pregnant, do you refer me to the midwife team or do I contact them directly?’. They booked in my first appointment with the community midwife team. As other posters have said, if your pregnancy is fairly straightforward you will be under care of midwives rather than a consultant. I have actually not seen a doctor during my pregnancy at all.

Then you have a booking in appointment. Depending on where you are, this is in between 8-10 weeks. This first appointment is an hour long and is basically 120 questions about your health history. Risk assessment. You’ll get booked in for the first scan which is around 12 weeks. You want to get it done by 14 weeks.

The ‘12 week scan’ is in part where if you give consent they will do part of the combined test to check risk of child having downs, Edwards, patau syndrome. You get a letter giving you risk, and if you come up as higher risk (more than 1 in 150) then they will follow up with further appointments.

I had another scan at 20 weeks, which is the anomaly scan and where you can find the sex of your child if you choose. I didn’t have one at 16 weeks.

At the booking in appointment they give you a big folder of notes and information. You take this with you to each appointment and they keep your notes in there. Mine has a really useful couple of pages that tell you what gets covered at each appointment.

You should also get a list of contact numbers in your notes, and the midwife will make sure you know who to call if there are particular issues (bleeding in early pregnancy for example). You will want to call the number given rather than your doctor.

At each appointment we covered various bits of ‘need to know’ and did pee, blood pressure and blood tests quite often until I got to about 28 weeks. This is mostly checking for things like pre eclampsia.

The midwife team will refer you on to other services if there is need. For example the health visitor team will contact you separately from the community midwifery team. Depending on where you choose to give birth, you may transfer from community midwifery team to the hospital or home birth team. For example at 36 weeks I will transfer to the home birth team. If you are consultant led you’ll be in that team.

You might also find your local maternity services page useful to find local services etc. I also use the app babybuddy which directs to local nhs resources too. The app might be a bit teaching you to suck eggs with the pregnancy info, but it’s all inline with current nhs guidance so gives you some idea of how practices might differ.

You don't even need to see your GP in many surgeries. I just rang the surgery and asked for a midwife appointment as all the GP will do is say congrats and refer you to them (here at least). I didn't see a doctor once until 34 weeks when I developed pre eclampsia. It was all midwife care before that.

Midwifes will see you to book you into their system and arrange a dating scan, but the main 'booking in' appointment here, with bloods taken, BP checks, previous history gone through etc. isn't done until 12 weeks after the dating scan here.

If it's not a first child and you don't have any risk factors, you won't see the midwife often at all until much later on, unless anything arises.

You will not miss anything crucial in terms of scans/blood tests. NHS antenatal care (as with all care in the NHS) should follow nice guidance which is formulated through constant reviews of the best evidence and designed to give the best care.

See the schedule posted above re how often you can expect to be seen.

You can also have a mooch through the NICE guidelines for antenatal care in uncomplicated pregnancies here.

Oh and btw maternal age alone doesn’t make you high risk. I turned 37 this year and as have no other risk factors have remained under midwifery team.

E.g. the following is what the guidance says re why antenatal care is midwife led;

“Midwife‑ and GP‑led models of care should be offered to women with an uncomplicated pregnancy. Routine involvement of obstetricians in the care of women with an uncomplicated pregnancy at scheduled times does not appear to improve perinatal outcomes compared with involving obstetricians when complications arise.”

Meghan is that you? LOL just kidding!
Congratulations! People have been having babies in Britain for a very long time and I am sure you will be fine

It depends on the area that you live in whether you self refer or go through a gp. Go to your doctors surgery and just ask at the reception. They will either tell you to make a GP appointment or they will get you a booking in appointment with the midwife. Booking in appointments take just over an hour usually but after that appointments with midwife will be half an hour long. You wont see a doctor unless the midwife feels there are any complications or factors that would lead you to need extra care. So you basically just give all your info to the midwife and talk it through with her. If everything is normal you have a dating scan at around 12 weeks which the midwife will book you in for and then you have another scan at 20 weeks which checks development. The midwife will also offer you some screening tests and give you information to help you decide which ones to have. Some are advised by the NHS to all mothers and some are for specific situations.