Our resident GP Dr Nicola Harrison explains everything you need to know about your antenatal appointments and tests.
The first thing you need to know about pregnancy is that everything is documented or discussed in weeks. Oddly, the first day of your last period before you got pregnant is termed Week 1 and your due date is at Week 40 – so yes, that’s actually 10 months of pregnancy!
For your first baby, there is on average 10 antenatal appointments throughout your pregnancy; initially spaced out, until every 2 weeks up to your due date.
You need to notify your GP as soon as you find out you are pregnant. Nothing physical needs to be checked by the GP at that stage but they need to refer you to the midwife for your ‘booking appointment’ and first scan at around 12 weeks, so the sooner this is arranged the better as there is often a waiting list.
The booking appointment is your chance to ask the midwife any questions you may have about pregnancy. I recommend you take your partner with you as you’d be surprised how many Dads have questions! They will ask you about previous smears tests and take a pregnancy history from you to anticipate which mother’s will need additional care and support throughout pregnancy. They will also take routine bloods which include HIV testing, blood group and rhesus D testing amongst other things. They will measure height, weight and blood pressure and discuss Down’s Syndrome screening with you. Most importantly they will give lots of pregnancy advice and leaflets.
Your first scan, known as the Dating scan, should be around the time of your booking appointment. This scan measures the baby’s length and can accurately predict your due date (particularly helpful if you have irregular periods). You will also be offered a combined test for Down’s Syndrome where your age; the thickness of the fluid area at the back of the baby’s neck (nuchal translucency/NT); and blood test results are all combined to give you a risk of Down’s Syndrome.
The following appointments are either conducted by a community midwife, GP or hospital Consultant/ Obstetrician depending on your circumstances;
Your blood results and down’s screening result are discussed again and documented in your self-held maternity records. Your blood pressure and urine will be checked again. Antenatal classes will be discussed.
You will have an anomaly scan that looks at any structural abnormalities and measures various growth parameters. Your scan report (to be stuck into your maternity records) will comment on the baby’s: head, brain, face, spine, neck, skin, chest, heart, abdomen, intestines, kidneys, bladder, limbs and skeleton. It will also tell you where in the womb the placenta has attached.
The midwife will measure your SFH (or symphysis-fundal height) 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. They will also check your blood pressure and your urine for any protein. These 3 checks (SFH, BP and urine) will be done at each appointment so get used to providing a urine sample!
You should have a blood test to check for anemia and some hospitals check for gestational diabetes. If you are Rhesus negative then you should be offered an anti-D injection. If you are working, you should have been given your MatB1 form by now to pass to your employer for maternity benefits.
You have the standard 3 checks and the blood results from the 28 week appointment will be discussed.
The standard 3 checks are done and if you are Rhesus negative that you will be offered the second dose of Anti-D.
This signifies the final position of the baby for birth as it can no longer move around. If at this stage your baby is breech (upside-down) you will be offered the chance to try and turn the baby from the outside, or you can opt for a caesarian. If your placenta was low down near the cervix at the 20 week scan, you will be offered another scan here to reassess its position.
The standard 3 checks are done and you should take the time to ask any last minute questions or concerns.
Appointment is made just in case you haven’t had the baby yet and in my experience a lot of women don’t make it to these appointments! 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.