20th July 2021
In general, as long as you’re healthy and your pregnancy is progressing as expected, you’ll have most or all your appointments with a midwife (or team of midwives).
However, depending on where you live, some of your antenatal appointments may be with your GP, and if you’re at higher risk of pregnancy complications you may see a consultant who specialises in pregnancy and birth.
The appointments can take place in different locations, including your GP surgery, children’s centre or your own home. If you have requests about where you want to be seen, you can ask your midwife or doctor for your local options.
At every appointment, your midwife or doctor will do a number of routine checks to make sure that you’re healthy and your baby is developing well. Your midwife will:
From your 28-week appointment onwards, your midwife or doctor will also:
In general, as long as you’re healthy and your pregnancy is progressing as expected, you’ll see your midwife (or team of midwives) around 10 times if it’s your first baby, and seven times if you’ve given birth before.
Here's a week-by-week breakdown of antenatal appointments and scans:
Midwives are experts in straightforward pregnancies and births, so they are a great first port of call for questions about random symptoms you’re experiencing or anything that’s worrying you.
For example, your midwife can:
Sometimes, the most difficult conversations are also the most important. During appointments with your midwife, you should feel able to bring up any problems that you’re having. This might include:
You may have heard of postnatal depression, but feelings of anxiety or depression are also common when you’re pregnant, especially if you have suffered from mental illness earlier in your life. Talking to your midwife about your feelings can get you the help you need.
One in four women experience domestic violence during their lifetime and the threat is higher during pregnancy. So, if this is happening to you, first of all know that you’re far from alone. Your midwife can refer you to specialist services and suggest options to keep you safe.
You’re probably aware that smoking, drinking alcohol or using drugs during pregnancy can have a negative effect on your baby, but that doesn’t necessarily make it any easier to stop. By talking to your midwife you can be referred to services that can help you give up, and plan for the safe birth of your baby.
Midwives are there to support you throughout pregnancy and to help you and your baby get the best start in life together. Your midwife will do their best to help you, or refer you to someone who is better placed to do so.
Remember, there are no stupid questions. Your midwife is likely to have heard it all before and would much rather you ask too many questions than too few.
When you’re pregnant, you have a legal right to paid time off work for every antenatal appointment that your midwife or doctor recommends. You should also be paid for the travel time.
Your partner has the right to take unpaid time off work to come with you to two appointments, although some employers may allow the time off with pay.
At the front of your maternity notes, your midwife or doctor will write down contact information for your midwifery team as well as triage at your local hospital, so you always have a way of getting advice when you need it.
If you have any concerns, it’s always better to speak to someone and put your mind at rest rather than waiting weeks until your next appointment.
Every time you have an antenatal appointment or receive maternity care at a hospital, records of your and your baby’s health will be written down in your notes.
As well as bringing the notes with you to every antenatal appointment and visit to the maternity unit, you’re also encouraged to carry the booklet with you day-to-day as well as if you go away on holiday, in case you need emergency care at any time.
When you have your antenatal appointments, your midwife or doctor will often write details about your health or observations about your baby as abbreviations in your maternity notes. These can seem a little cryptic if you haven’t seen them before. Here’s a quick run-through of some of the codes you may come across as you look through your notes.
When your baby’s due and whether you’ve been pregnant or given birth before can all impact your maternity care needs.
EDD - Expected due date.
How many weeks pregnant you are - For example, 16+4 (16 weeks and four days pregnant).
Gravida, or G - Whether you’ve been pregnant before.
Primigravida - Pregnant for the first time.
Multigravida - You’ve been pregnant before.
Parity, or P - How many times you’ve given birth before.
Nulliparous - Never given birth before.
Primipara or primip - Have given birth to one baby before.
Multipara or multip - Have had two or more babies before.
Your blood pressure and urine samples will be tested throughout your pregnancy, and other tests like blood checks will also be done occasionally to make sure the pregnancy’s progressing as expected.
NAD - No abnormality detected (your urine test was normal).
Tr (trace) - Small amount of protein or glucose was found in your urine.
+, ++, +++ - Greater amounts of protein or glucose have been found in your urine. This can be a symptom of pre-eclampsia or gestational diabetes.
BP - Blood pressure. If your blood pressure’s higher than usual it could be a sign of pre-eclampsia or pregnancy-induced hypertension.
Oed - Swelling (oedema) can also be a symptom of pre-eclampsia.
Hb - Haemoglobin - if your iron levels are too low you might need treatment for anaemia.
VE - Vaginal examination - sometimes done in pregnancy to check whether your cervix has started to efface and dilate.
A doppler or stethoscope will be used to record and measure your baby’s heart rate, and your midwife or doctor will ask you whether you’re feeling any movements.
FHH, or H - Foetal heart rate heard. This will be accompanied with beats per minutes (BPM).
FHNH, or NH - Foetal heart rate not heard. This isn’t unusual in the first and sometimes second trimester, but your midwife may like you to come for an extra check-up.
FMNF - Foetal movements not felt. Many women don’t start to feel movements until 20 to 24 weeks.
The midwife or doctor will also check how much of the baby’s head is in your pelvis (how engaged they are) when you’re in the later stages of your pregnancy.
5/5, NE, NEng, Not Eng or 'free' - Your baby’s head is above your pelvis.
4/5 - Your baby’s head is above your pelvis.
3/5 - The head is lower but still mostly above the brim.
2/5 - Your baby’s engaged and mostly below the brim.
1/5 or 0/5 - Your baby’s head is deeply engaged and hardly palpable from above.
Your midwife will palpate (feel) your tummy to see which position your baby’s in throughout pregnancy and ahead of the birth.
Ceph, C or Vx - Cephalic (head down).
B or Br - Breech (head up with their bottom or feet in your pelvis).
R or Tr - Transverse (lying across your belly).
L or Long - Vertical.
O or Obl - Oblique or diagonally.
OA - Occiput Anterior (head down, facing your back).
OP - Occiput Posterior (head down, facing your front).
OL - Occiput Lateral (head down, facing your side).
Routine antenatal care is essential for detecting common complications of pregnancy such as pre-eclampsia, gestational diabetes and urine infections that don’t present symptoms, and there's a potential risk of harm if you don't attend appointments - even in the context of coronavirus.
Gill Walton, CEO of the Royal College of Midwives (RCM), says, ‘If you are pregnant, with no coronavirus symptoms, you should continue to go to your antenatal appointments as usual, while following the social distancing guidance of keeping a two-metre distance from others and using private transport if possible. Even if you have symptoms, contact your midwife and they will work with you to ensure you continue to get the care and support you and your baby need.’
The RCM and the Royal College of Obstetricians and Gynaecologists (RCOG) say that a minimum of six face-to-face antenatal consultations should take place during the coronavirus pandemic.
Virtual consultations will be offered where appropriate, ensuring that women are seen in one-stop clinics that cover all medical and obstetric needs in the same visit, and making use of home monitoring of blood pressure where it’s safe to do so. This is to enable greater compliance with social distancing measures and to avoid unnecessary hospital admissions.
However, risk assessment will be carried out to ensure that women who need it are prioritised for face-to-face care where available.
The RCOG says: 'The NICE recommended schedule of antenatal care should be offered in full wherever possible. Ideally and where safe, these appointments should be offered in-person, particularly to those from BAME communities, those with communication difficulties or those living with medical, social or psychological conditions that put them at higher risk of complications, or adverse outcomes, during pregnancy.'
Your birth partner should be allowed to be present at antenatal appointments, whether virtual or face-to-face, but check with your maternity team to see if this is the case.
If you are in self-isolation and have an antenatal appointment coming up, you should contact your midwife or antenatal clinic to inform them of your situation. It’s likely that your routine appointments will be delayed until your isolation period ends. If your maternity team advise you that your appointment can’t wait, the necessary arrangements will be made for you to be seen.
If you have suspected or confirmed COVID-19, you should also contact your maternity team and they’ll arrange the right place and time for you to attend your appointments: you should not attend a routine clinic.
If you have any concerns about the wellbeing or yourself or your unborn baby during your self-isolation period, contact your midwife or, out of hours, your maternity team for further advice on whether you need to attend hospital or not.