As soon as you find out the wonderful news that you are pregnant, first thing’s first (after some of the excitement has slightly subsided) you will need to let your GP know. So, get yourself booked in with your doctor as they can then refer you to a midwife for your ‘booking appointment’ and first scan at around 12 weeks. There can often be a bit of a waiting list so it is best to get this arranged as soon as you can.
From what might feel quite early on in your pregnancy you will be offered a number of antenatal appointments and tests with a midwife or on occasion a doctor specialising in pregnancy, also known as an obstetrician. These appointments are not only fantastic in putting your mind at ease but will also help to ensure that you have a healthy pregnancy as they will be keeping a check on the health of both you and your baby-to-be. These sessions provide lots of opportunity to ask questions (and questions you will have a plenty!). You will also be given lots of useful information and advice during this exciting time. And, if it’s your first baby then you will have slightly more antenatal appointments, on average about 10 in the run up to your due date.
It will always be down to you as to whether you say ‘yes’ to particular tests offered to you, however, remember that these tests are offered for a reason. Many will provide your midwife and / or doctor with key information so that they are able to provide you and your baby with the best possible care during your pregnancy. Some test results may even help you to make certain choices during pregnancy.
Don’t forget that if you are in employment then your employee must legally offer you paid time off work to attend your antenatal appointments and classes. Lots of antenatal classes tend to run of an evening, so make sure you take someone along with you for support.
The ‘booking appointment’ is your first appointment and the perfect opportunity to ask questions, and I’m sure you have many, so ask away! Your midwife will start by asking you about previous smear tests and make a note of your pregnancy history to help anticipate if you might need additional care and specific support through your pregnancy. They will also take routine urine tests (to test for protein) as well as blood tests which include HIV testing, blood group and rhesus D testing amongst others. They will measure your height, weight and blood pressure and they will also discuss screening tests and ultrasound scans with you. Most importantly, you will be given lots of pregnancy advice and leaflets including step-by-step pregnancy guides, exercise and nutrition info, tools to write your birth plan, your rights to maternity benefits and lots more.
Between 8 – 14 weeks you will be offered a dating scan which is an ultrasound to help estimate when your due date will be. The scan also measures the length of your baby as well as their physical development. You will also be given the option of having a screen for any possible abnormalities such as Down’s Syndrome.
You will discuss your blood results and screening result from your previous booking appointment, and you will now be offered information on an ultrasound scan called an anomaly scan that is available to you between 18-20 weeks, should you want this. This scan is to check your baby’s physical development and screen for possible abnormalities. It gives you a chance to ask questions about this and decide if you would like to go ahead at your next appointment. Your blood pressure will be taken and urine checked again. Your urine is checked for protein as whilst a small amount of protein in your urine is completely normal, particularly during pregnancy, protein could also show that you are fighting an infection. It can also be a sign that you’re developing pre-eclampsia which is a potentially serious condition so this is why your midwife will be hot on the case with these tests.
If you have decided to go ahead with the anomaly scan then now is the time that this will take place. This looks at any structural abnormalities and measures various growth parameters too. If you opted not to have tests for HIV, syphilis and hepatitis B the first time round at your booking appointment, then you will be offered these tests again. Of course it is entirely up to you but it is recommended that you go ahead with these tests as they can significantly reduce the risk of passing any potential infection onto your baby.
Your midwife will check your blood pressure and your urine as usual. At this stage they will also measure your symphysis-fundal height (also known as SFH), which goes from your pubic bone to the top of your womb. This length in centimetres should equal your gestation in weeks, give or take 1cm, e.g. you should measure 23-25cms when you are 24 weeks pregnant. These three checks (SFH, BP and urine) will be done at each appointment so get used to providing a urine sample!
You will have a blood test to check for anemia and some hospitals will also check for gestational diabetes. If you are Rhesus negative then you should be offered an anti-D injection. And, if you are working, you should have been given your MatB1 form by now to pass to your employer for maternity benefits. It will all be starting to feel very real right about now!
You will have the standard three checks and the blood results from your 28 week appointment will be discussed as well as any other screening test results you might have had in your previous appointments.
Now is the time that your doctor or midwife will start to discuss how to prepare for the big day ahead which is edging closer and closer. You will be offered information and guidance on how to write your birth plan and talked through how to spot those all-important signs that you might be going into labour, as well as a little on pain management and pain relief options during this time.
The standard three checks are done and if you are Rhesus negative, you will be offered the second dose of Anti-D.
At this stage your midwife or doctor will measure the size of your uterus and check the position of your baby and the reason for this is because 36 weeks signifies the final position of your baby for birth. Your baby can no longer move around so if at this stage your baby is breech (upside-down) you will be offered the opportunity to try and turn the baby from the outside which is known as external cephalic version or ECV. This is when the obstetrician will apply pressure to your abdomen to try to turn the baby into a head down position.
If it isn’t possible to naturally turn the baby then your healthcare team will discuss next steps with you. You might be advised to have a caesarean if your baby is still determined to come out upside down.
You’ll also receive more information on the likes of breastfeeding, caring for your new baby, and also caring for yourself which is just as important.
You guessed it – blood pressure, urine and SFH are checked and now is the time to ask any last-minute questions or share any concerns. Your doctor or midwife will also discuss your options and the process if your baby decides to arrive fashionably late!
An appointment is made just in case you haven’t had the baby yet. Often you will be booked in for an extra appointment at 41 weeks during this appointment so that should you not have given birth by then, they can discuss how to induce labour medically should you want this. But, rest assured most of you won’t make it to this Week 40 appointment and instead you will be welcoming a new arrival into the family!