The first consultation
Obviously you see your midwife or doctor as soon as you suspect you are pregnant to start the referral process, but the first check-up should take place ideally by the twelfth week of pregnancy. It will be the longest appointment because your midwife will ask lots of questions and provide you with lots of information. Your midwife will calculate the date of conception and will ask questions about your health and medical history, as well as the medical history of your family that could affect your pregnancy (allergies, genetic conditions, etc). You will also have your weight, height and blood pressure measured.
You may also be offered an ultrasound scan there and then if your midwife is based at the local hospital. This scan measures the size of your baby and gives a more accurate estimate of your due date.
Several blood tests will be taken, allowing the midwife to check your:
- blood group and Rhesus status
- rubella or German measles status
- iron levels.
You will also be screened for HIV, syphilis and hepatitis B (unless you specifically opt not to) and you may be asked if you want your baby to be screened for Down’s syndrome, spina bifida, and hemoglobinopathies, for example sickle cell or thalassemia. Analysis of your urine will allow the midwife to check for the presence of albumin and sugar, and to detect any risk of diabetes, infections or kidney problems.
After your first appointment, you'll be seen every four to six weeks until it gets to near the end of your pregnancy, when you’ll be seen every week or so. If you’re expecting your first child you may have additional appointments (at 25, 31 and 40 weeks). Your midwife will explain when you need appointments.
During this appointment, your midwife will go over the results from the blood and urine tests from your first appointment. She’ll check your blood pressure and test your urine again (this will happen at every appointment). Use this opportunity to ask questions and talk about anything that’s worrying you. Ask the midwife about antenatal classes and where you can have your baby.
Along with the routine checks, if you’ve decided to have screening for anomalies, this is when it takes place. If the scan detects that your placenta is blocking the entrance to your cervix, you’ll have another scan at 36 weeks to check whether it has moved out of the way.
In addition to the routine checks, the midwife starts to measure your bump at each appointment so she can check your baby is growing properly. If you’re Rhesus negative, you will be offered an Anti-D injection which coats any fetal blood cells that may have leaked into your circulation. This will reduce the chances of your body producing antibodies that may attack fetal cells causing problems for your unborn baby.
Your midwife will also take bloods off you to check for antibodies and ensure that your iron levels are sufficient.
Along with the routine checks and bump measurements, your midwife will discuss with you the blood results that you had taken at 28 weeks. If your iron levels are low then you may need supplements to boost the levels before your baby's birth.
On top of the routine checks, the midwife will discuss the results from the scan taken to check the position of the placenta (if you had one). She will also check your baby’s position by feeling your bump with her hands. If your baby is breech (positioned feet first), the midwife may offer you a procedure called an external cephalic version (ECV) to try and turn the baby around manually. This will be performed by the consultant in the hospital, he or she will try and gently manipulate your baby into the head down position. If the anomalies scan you may have had at 18-20 weeks showed that your placenta was blocking the entrance to your cervix, you will have another scan now to check it’s moved out of the way.
If you have a birth plan, now is a good time to discuss it with your midwife. You may want to consider how you wish to feed your baby and whether or not you want your baby to have Vitamin K following birth.
At your final appointment before the big moment (unless you’re a first-timer), your midwife will check your blood pressure and urine, and once again will measure your bump. Although you may have a few weeks left, your midwife may discuss with you at this appointment options for induction of labor should your baby not arrive on time. The WHO do say that the normal gestation of a human infant is between 37-42 weeks of pregnancy.
Don’t forget that there’s nothing stopping you from speaking to a midwife in between appointments if you have a concern. If your midwife hasn’t already given you a 24-hour contact number, ask her for one.