Articles

Key takeaways

• Antenatal care supports your and your baby's health.
• Regular appointments check you and your baby’s health and development and offer support.
• Screening tests estimate risks; diagnostic tests confirm conditions.
• You will have scans and tests throughout your pregnancy.

What is antenatal care?

Antenatal care 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 keep both you and your baby well and prepares you for birth.

Your midwife will check your and your baby's health. They will also look for any problems so you can get early support.

Your midwife offers support with your mental health and gives you information to help you make decisions. They will answer your questions and help you plan your baby's birth.

Why antenatal care is important

It is important to start your antenatal care as early as possible. The first appointment is known as the booking appointment – this usually happens before you are 10 weeks pregnant.

Some tests, like screening for sickle cell and thalassaemia, should be done before 10 weeks. You can refer yourself for NHS pregnancy care, often using an online form.

Regular antenatal appointments are important for several reasons. They keep an eye on how your baby is growing. They also check how you are feeling and offer any support you might need.

Appointments can pick up conditions like pre-eclampsia and urinary tract infections. These checks also help assess your baby's health through blood tests and ultrasound scans.

Your antenatal appointment schedule

You will have regular appointments with a midwife. Sometimes you may see an obstetrician, a doctor who specialises in pregnancy. If this is your first baby, you will usually have 10 antenatal appointments.

If you have already had a healthy pregnancy and baby, you will typically have 7 appointments. You may have more appointments if you have had previous complications or a medical condition.

You will also be offered two ultrasound scans. These are usually at 11–14 weeks and 18–21 weeks.

Your midwife or doctor will give you written information about your likely appointment schedule. Pregnant employees have the right to paid time off for antenatal care.

Your first trimester checks and scans

Your first main appointment is your booking appointment. This usually takes place with your midwife between 8 and 10 weeks of pregnancy.

The appointment can be held in various places, including your home, a GP surgery, or a hospital. This appointment usually lasts about an hour.

During this visit, your midwife will ask you questions to understand your needs. These questions may cover where you live, your family's health, and your physical and mental well-being. They will also ask about any previous pregnancies or children.

This is a chance to tell your midwife if you are worried about anything, such as domestic abuse or female genital mutilation (FGM). It's important to talk about FGM. It can sometimes lead to difficulties during labour and birth, and your team can give you extra support and help you plan.

Initial checks and blood tests

At your booking appointment, your midwife will carry out some physical checks. They will measure your height and weight, and check if you are a healthy weight for your height (your body mass index, or BMI).

Your blood pressure will be measured, and you will be asked to give a urine sample. These will be checked again at every antenatal appointment.

You will also be offered blood tests to check several things:

• Blood group and rhesus status – this identifies your blood type and whether you have a specific protein.
• Infections – These tests check for infections like HIV, hepatitis B, or syphilis. HIV is the virus that can lead to AIDS.
• Iron-deficiency anaemia – this checks if you have enough iron in your blood.
• Sickle cell anaemia or thalassaemia – these are blood disorders that can be passed on to your baby. These tests are offered if there is a high chance you might have them.

All blood tests are optional. Your midwife will also tell you about available screening tests and vaccines.

Early screening for genetic conditions

You will be offered screening tests to find out how likely it is that your baby has a health condition. These tests cannot tell you for certain if your baby has a condition. You can choose whether or not to have these screening tests.

The combined test screens for three genetic conditions: Down's syndrome, Edwards' syndrome, and Patau's syndrome. This test is not harmful to you or your baby. It involves:

• A blood sample taken from your arm between 10 and 14 weeks of pregnancy checks the levels of certain substances made during pregnancy. These include pregnancy-associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotrophin (Free beta hCG).
• A nuchal translucency scan is an ultrasound scan performed between 11 and 14 weeks. During this scan, the sonographer looks at the fluid at the back of your baby's neck; babies with certain conditions often have more fluid here.

Your antenatal team uses the results of your blood test, the scan, and your age to work out the chance of your baby having one of these conditions. If your dating scan happens after 14 weeks, you will not be offered the combined test as it is not possible to do this test after 14 weeks.

Instead, you will be offered another blood test between 14 and 20 weeks, called the quadruple test, which is less accurate. Most screening results (around 97%) show a lower chance of these conditions.

Mid-pregnancy: second trimester tests

The 20-week anomaly scan

You will be offered an ultrasound scan between 18 and 21 weeks of pregnancy. This is known as the 20-week scan or foetal anomaly scan. This scan checks how your baby is growing and the health and position of your placenta (the organ that feeds your baby).

It also looks for any visible problems with your baby's development. Most scans show that the baby is developing normally.

The sonographer will check your baby for signs of 11 different conditions. These include:

• Anencephaly – a serious condition affecting the development of the baby's brain and skull.
• Open spina bifida – a condition where the spine and spinal cord do not form properly.
• Cleft lip and palate – a split in the lip or roof of the mouth.
• Diaphragmatic hernia – a hole in the diaphragm. This is the muscle that separates the chest from the abdomen.
• Gastroschisis – a condition where the baby's tummy wall has an opening, and some of the intestines are on the outside.
• Exomphalos – a condition where some of the baby's organs are on the outside of the tummy, contained in a protective sac.
• Serious cardiac abnormalities – problems with the baby's heart.
• Bilateral renal agenesis – a serious condition where the baby's kidneys do not develop.
• Severe skeletal dysplasia – severe problems with bone growth.
• Edwards' syndrome (trisomy 18) – a genetic condition causing severe developmental delays.
• Patau's syndrome (trisomy 13) – a genetic condition causing severe developmental problems.

The sonographer will look carefully at your baby from head to toe. They will check the spine and major organs.

Sometimes, the scan may show a variant. This is a feature picked up by the ultrasound that is not harmful itself. However, it can sometimes suggest a chromosomal or genetic condition.

If a variant is found, you might be offered an amniocentesis (a diagnostic test). You will also be offered an appointment with a consultant to discuss the findings.

Screening for gestational diabetes

If your healthcare team thinks it is important to test you for gestational diabetes, you will usually be tested between 24 and 28 weeks. Gestational diabetes is a type of diabetes that can develop during pregnancy. You might be tested earlier if you are at higher risk or have had it before.

The main test for gestational diabetes is a test to check how your body processes sugar, called the oral glucose tolerance test (OGTT). This is a simple test that does not harm you or your baby. Your healthcare team will explain your results to you. If your blood sugar levels are higher than normal, you will be diagnosed with gestational diabetes and your team will discuss the next steps with you.

Checks in the third trimester

In your third trimester, your antenatal appointments will usually become more frequent. First-time mothers typically have appointments at weeks 31, 34, and 36.

Additional appointments are scheduled for weeks 38, 40, and 41. Later visits are usually quite short, lasting 20 to 30 minutes.

At these appointments, your midwife or doctor will:

• Check your urine and blood pressure.
• Feel your tummy (abdomen) to check your baby's position.
• Measure your womb (uterus) to check your baby's growth.
• Ask about your baby's movements.
• Listen to your baby's heartbeat, if you wish.

Monitoring for pre-eclampsia

Checking your blood pressure and urine at each appointment is very important. These checks are looking for signs of a serious pregnancy condition that involves high blood pressure and protein in the urine (pre-eclampsia). This is a serious condition that needs to be monitored closely, as it can affect both you and your baby.

That's why regular checks are so important. Your team can then spot any signs early and give you the right care. Monitoring helps your maternity team know if you need treatment quickly.

Assessing your baby's growth and position

From around 24 weeks, your midwife or doctor will check your baby's growth. They do this by measuring the distance from the top of your womb to your pubic bone. This measurement will be recorded in your notes.

Your midwife will also gently feel your tummy to work out which way up your baby is positioned. The position that your baby is in becomes more important as you near your due date. Some babies will be head down, ready for birth.

If your baby is still in a head-up position (known as a breech position) by about 36 to 37 weeks, they may not turn by themselves. Your obstetrician may offer to try turning your baby by applying gentle pressure on your tummy. This procedure is called an external cephalic version (ECV).

Group B strep (GBS)

Your team may discuss a common type of bacteria called Group B Strep (GBS). It is found in the gut, vagina, and bottom and is normally harmless.

However, if you have GBS during pregnancy, there is a small risk it could spread to your baby during labour and make them ill. Although it is very rare, this infection can be very serious for a newborn baby.

Screening for GBS is not routinely offered to everyone in the UK. This is because the bacteria is very common and usually harmless.

Therefore, a positive test does not mean your baby will become ill. Also, tests are not always accurate, and it's hard to predict which babies will be affected.

You can pay for a private GBS test if you wish. You will give a urine sample at each antenatal appointment, which checks for signs of possible infection (and protein in your urine), but not specifically for GBS.

If you had GBS in a previous pregnancy, you will be offered a swab test at 35 to 37 weeks. This helps you decide whether to have antibiotics during labour.

Making sense of your test results

It is important to understand the difference between screening and diagnostic tests. Screening tests tell you how likely it is that your baby has a health condition. They cannot tell you for certain if your baby has the condition.

Diagnostic tests, however, can tell you for certain if your baby has the condition.

The combined testis a screening test. Most of the combined test results (around 97%) will show a lower chance of a condition. This means it is unlikely your baby has one of these conditions, but it is still possible.

If you receive a higher chance result, it does not mean your baby definitely has a condition, but it is more likely. About 3% of screening test results are higher chance.

Most people with a higher-chance result will have a baby without any of the conditions. Receiving a higher-chance result can cause anxiety, and your antenatal team will give you support and information to help you decide what to do next.

Next steps after a higher-chance result

If combined testscreening shows your baby has a higher chance of a health condition, you will be offered a diagnostic test. You may choose to:

• Not have any further tests.
• Have another very accurate screening test.
• Have a diagnostic test.

Your team will discuss the options with you, which are chorionic villus sampling (CVS) and amniocentesis. Both tests involve using a fine needle to take a sample.

This carries a small risk of miscarriage (about 1 in 200). Your team will help you weigh the risks and benefits.

• Chorionic villus sampling (CVS) – This test takes a tiny sample of tissue from the placenta (the organ that feeds your baby). It is usually done between 11 and 14 weeks.
• Amniocentesis – This test takes a small sample of the fluid from around your baby in the womb (amniotic fluid). It is usually done between 16 and 22 weeks.

Your maternity team will support you with whatever decision you make. Organisations like the national charity Antenatal Results and Choices (ARC) also offer impartial support and information.