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Key takeaways

• Antenatal monitoring checks your and your baby's health during pregnancy.
• It helps to spot potential issues early and offer support.
• Extra monitoring may be recommended for certain health conditions.
• Your care team will discuss results and help plan your care.

What is antenatal monitoring?

Antenatal monitoring is the healthcare and support you receive from your maternity team during pregnancy. It is sometimes called pregnancy care or maternity care. This care helps to keep you and your baby well and ready for birth.

Your midwife or doctor will check your and your baby's health. They will give you useful information for a healthy pregnancy, such as advice on eating well and exercise. They will also discuss your care options and answer any questions you may have.

Regular antenatal appointments are important to monitor your baby's growth. They also check how you are feeling and offer support.

These appointments can help pick up conditions like a type of high blood pressure in pregnancy (pre-eclampsia) or an infection in your wee (urinary tract infection, or UTI) early. Blood pressure checks and urine tests can detect issues even if you do not have early symptoms.

Common types of monitoring and what to expect

Blood pressure monitoring

Your midwife will check your blood pressure at each antenatal appointment. They use a cuff wrapped around your upper arm. Ideally, blood pressure checks should be done on the same arm every time.

Your first reading helps your antenatal team understand your normal blood pressure. They can then see if your readings change during pregnancy.

Raised blood pressure can affect your baby's growth. It can also be a warning sign of pre-eclampsia.

You might also monitor your blood pressure at home. To do this:

1. Tighten the cuff around your arm and secure it.
2. Rest your arm on a table or across your lap with your hand slightly open and palm facing upward.
3. Press the start button, relax, and do not talk or move your arm muscles until the measurement is complete.

Measure your blood pressure twice, with at least one minute between measurements. Record two readings each time.

These are the top number (systolic, or SYS) and the bottom number (diastolic, or DIA). You do not need to record the pulse (PUL) number.

Ultrasound scans

An ultrasound scan is a way to look at your baby in the womb. These scans are painless and use sound waves to show your baby on a screen. They do not cause any harm to you or your baby.

Scans check your baby's size and growth. They can also show if you are having more than one baby.

You will be offered two ultrasound scans as part of your antenatal care. These are usually between 11-14 weeks and 18-21 weeks.

Some hospitals offer extra scans, for example, to check your baby's growth.

What happens during a scan?

During the scan, you will be asked to lie back on a couch. The person doing the scan (a sonographer) will spread a gel over your tummy. Then, they will roll a small scanning device over the gel to send pictures of your baby to a computer screen.

You can bring a partner, friend, or family member to your scans.

Doppler flow studies

An umbilical artery Doppler scan is another type of ultrasound scan. It measures the flow of blood through the umbilical cord.

This scan helps your team check that your baby is getting all the oxygen and nutrients they need through the umbilical cord. It can also help them decide if an earlier birth might be a safer option for your baby.

Additional Doppler scans may check the blood flow in your baby's brain and abdomen.

Cardiotocography (CTG)

A trace of your baby's heart rate and movements (cardiotocography, or CTG) is a way to check on their wellbeing during the third trimester.

Sometimes, your team may need to continuously monitor your baby's heartbeat and your contractions. This continuous monitoring is known as electronic fetal monitoring (EFM). To do this, two small plastic pads are held on your bump with soft elastic straps.

Why and when is extra monitoring recommended?

Extra monitoring may be recommended for several reasons. Your antenatal appointments may become more frequent from around 24 weeks of pregnancy. You may not be seen as often if your pregnancy is uncomplicated and you are healthy.

Reasons for extra monitoring

You should tell your midwife or doctor if:

• There were complications or infections in a previous pregnancy or delivery, such as pre-eclampsia or premature birth.
• You are being treated for a long-term condition, such as diabetes or high blood pressure.
• You or anyone in your family has previously had a baby with a health condition.
• There is a family history of an inherited condition.
• You know you are a genetic carrier of an inherited condition.
• The baby's other biological parent (their father or a sperm donor) is a known carrier of an inherited condition.
• You have had fertility treatment using a donor egg or donor sperm.

Your midwife or doctor will assess if you need additional care or support. They will plan your care with you throughout your pregnancy and check for anything that needs extra attention. They will also find out if you are at increased risk of gestational diabetes or pre-eclampsia.

Monitoring for specific conditions

If you had diabetes with poor blood sugar control in the first trimester, you might be offered a scan from around 16 weeks of pregnancy. If you have type 2 or gestational diabetes, you are more likely to have a larger than average baby. So, extra monitoring of your baby's growth will be offered.

Monitoring fetal movements

It's helpful to get to know your baby's usual pattern of movements.

If you have not felt any movement by 24 weeks, contact your midwife to check your baby's heartbeat.

After 24 weeks, contact your midwife or doctor immediately if your baby's movements change. This includes if they become less frequent, slow down, or stop. Do not wait until the next day.

They will check you and your baby.

Electronic fetal monitoring in labour

Your midwife might offer electronic fetal monitoring during labour if you have complications. These can include gestational diabetes or high blood pressure.

It may also be offered if your baby is small for their dates or if you have had a caesarean birth in the past. Your midwife or doctor will also suggest electronic fetal monitoring during labour if you have an epidural or an oxytocin drip. Other reasons for EFM include:

• If there is some of your baby's first poo (meconium) in the amniotic fluid.
• If you develop high blood pressure.
• If you start bleeding in labour.
• If your labour is not progressing.
• If there are concerns about your baby's heartbeat, position, or movements.

Understanding your screening results and making a plan

Discussing your results

A specialist doctor (obstetrician) or midwife will explain what your screening results mean. They will discuss your options with you.

You can ask questions about what any findings mean for your baby. You can also ask if special care or treatment is needed before birth.

They will advise if you need medication or further tests to keep you and your baby safe.

If you already take medication, they will advise if changes are needed. Most people with higher-chance screening results will have a baby without any conditions. You will be offered an appointment with a health professional to discuss the results.

They will explain what they mean and what condition your baby may have. They will also discuss your choices and answer any questions.

Options after a higher-chance result

If you get a higher-chance result, you have several options.

You can choose to have a more accurate screening blood test, called non-invasive prenatal testing (NIPT).

You may also choose a diagnostic test to confirm if your baby definitely has the condition. These tests involve taking a small sample of the placenta (chorionic villus sampling, or CVS) or the fluid around your baby (amniocentesis). Your care team will explain that these tests carry a very small risk of miscarriage. They will help you weigh up your options and make the decision that is right for you.

You can also choose to have no further tests. Your maternity team will support you with whatever decision you make.

If there are concerns, more scans and diagnostic tests might be offered. Depending on the results, your care team will talk with you about what this might mean for your birth plan.

We know this can be a lot to take in, and your team is there to support you in making any decisions. It is always your choice whether to have screening tests, and your team will support you whatever you decide.