Antenatal care is the care that you receive from healthcare professionals during your pregnancy. You will be offered a series of appointments with a midwife, or sometimes with a doctor (an obstetrician). They will check that you and your baby are well, give you useful information about being pregnant and what to expect as well as answering any questions you may have.

As soon as you know you are pregnant, you should get in touch with a midwife or your GP to organise your antenatal care. It’s best to see them as early as possible. Let your midwife know if you have a disability that means you have special requirements for your antenatal appointments or labour. If you don’t speak English, let your midwife know and arrangements will be made for an interpreter.

It is important to tell your midwife or doctor if:

•therewereanycomplicationsorinfectionsinapreviouspregnancyordelivery,suchaspre-eclampsiaorprematurebirth

•youarebeingtreatedforachronicdiseasesuchasdiabetesorhighbloodpressure

•youoranyoneinyourfamilyhaspreviouslyhadababywithanabnormality,forexamplespinabifida

•thereisafamilyhistoryofaninheriteddisease,forexamplesicklecellorcysticfibrosis.

Antenatal appointments 41Early antenatal appointments 44Regular checks at every antenatal appointment 45Appointments in later pregnancy 46Blood tests 46Ultrasound scans 48Tests to detect abnormalities 49

Tests for Down’s syndrome and other genetic disorders 50 Diagnostic tests for Down’s syndrome and other genetic disorders 51 If a test detects an abnormality 51Making the most of antenatal care 52Your antenatal team 54Antenatal education 56

If you are working, you have the right to paid time off for your antenatal care (see page 170).

AntenAtAl cAre

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Help and support

Ifyouhaveanyquestionsorworries,talktoyourmidwifeordoctor.Talkingisasmuchapartofantenatalcareastestsandexaminations.

AntenAtAl AppoIntmentsIfyouareexpectingyourfirstchild,youarelikelytohaveupto10appointments.Ifyouhavehadababybefore,youshouldhavearoundsevenappointments.Incertaincircumstances,forexampleifyouhaveordevelopamedicalcondition,youmayhavemoreappointments.

Yourappointmentsmaytakeplaceatyourhome,inyourGP’ssurgeryorinhospital.Youmaybeaskedtogotohospitalforyourscans.

Yourantenatalappointmentsshouldtakeplaceinasettingwhereyoufeelabletodiscusssensitiveproblemsthatmayaffectyou(suchasdomesticviolence,sexualabuse,mentalillnessorrecreationaldruguse).

Earlyinyourpregnancyyourmidwifeordoctorshouldgiveyouinformationabouthowmanyappointmentsyouarelikelytohaveandwhentheywillhappen.Youshouldhaveachancetodiscusstheschedulewiththem.Thetableonpages42–43givesabriefguidetowhatusuallyhappensateachantenatalappointment.

Ifyoucannotkeepanantenatalappointment,pleaselettheclinicormidwifeknowandmakeanotherappointment.

What should happen at the appointmentsTheaimistocheckonyouandyourbaby’sprogressandtoprovideclearinformationandexplanationsaboutyourcare.Ateachappointmentyoushouldhavethechancetoaskquestionsanddiscussanyconcernsorissueswithyourmidwifeordoctor.

Eachappointmentshouldhaveaspecificpurpose.Youwillneedlongerappointmentsearlyinpregnancytoallowplentyoftimeforyourmidwifeordoctortoassessyou,discussyourcareandgiveyouinformation.Whereverpossible,theappointmentsshouldincludeanyroutinetests.

Information

Animportantpartofantenatalcareisgettinginformationthatwillhelpyoutomakeinformedchoicesaboutyourpregnancy.Yourmidwifeordoctorshouldgiveyouinformationinwritingorsomeotherformthatyoucaneasilyuseandunderstand.Yourmidwifeordoctorshouldprovideyouwithinformationinanappropriateformatifyou:

•haveaphysical,learningorsensorydisability

•donotspeakorreadEnglish.

Youmayhavelotsofthingsyouwanttoaskthemidwife.It’sagoodideatowriteyourquestionsdown,soyoudon’tforget.

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Antenatal appointments schedule

Appointment What should happen

First contact with your midwife or doctor

Thisistheappointmentwhenyoutellyourmidwifeordoctorthatyouarepregnant.Theyshouldgiveyouinformationabout:•folicacidandvitaminDsupplements•nutrition,dietandfoodhygiene•lifestylefactors,suchassmoking,drinkingandrecreationaldruguse•antenatalscreeningtests.

Itisimportanttotellyourmidwifeordoctorif:•therewereanycomplicationsorinfectionsinapreviouspregnancy

ordelivery,suchaspre-eclampsiaorprematurebirth•youarebeingtreatedforachronicdiseasesuchasdiabetesorhighbloodpressure•youoranyoneinyourfamilyhaspreviouslyhadababywithanabnormality,

forexamplespinabifida•thereisafamilyhistoryofaninheriteddisease,forexamplesicklecellorcysticfibrosis.

Booking appointment (8–12 weeks)

8–14 weeks (dating scan)

Ultrasoundscantoestimatewhenyourbabyisdue,checkthephysicaldevelopmentofyourbabyandscreenforpossibleabnormalities.

16 weeks Yourmidwifeordoctorshouldgiveyouinformationabouttheultrasoundscanyouwillbeofferedat18to20weeksandhelpwithanyconcernsorquestionsyouhave.Yourmidwifeordoctorshould:•review,discussandrecordtheresultsofanyscreeningtests•measureyourbloodpressureandtestyoururineforprotein•consideranironsupplementifyouareanaemic.

18–20 weeks (anomaly scan)

Ultrasoundscantocheckthephysicaldevelopmentofyourbaby.(Remember,themainpurposeofthisscanistocheckthattherearenostructuralabnormalities.)

are pregnant.

blood pressure

Yourmidwifeordoctorshouldgiveyouinformationabout:•howthebabydevelops

duringpregnancy•nutritionanddiet•exerciseand

pelvicfloorexercises•antenatalscreening

tests•yourantenatalcare•breastfeeding,including

workshops•antenataleducation•maternitybenefits•planningyourlabour•youroptionsforwhere

tohaveyourbaby.

Yourmidwifeordoctorshould:•giveyouyourhand-heldnotesandplanofcare•seeifyoumayneedadditionalcareorsupport•planthecareyouwillgetthroughoutyourpregnancy•identifyanypotentialrisksassociatedwithanyworkyou

maydo•measureyourheightandweightandcalculateyour

bodymassindex•measureyourbloodpressureandtestyoururine

forprotein•findoutwhetheryouareatincreasedriskofgestational

diabetesorpre-eclampsia•offeryouscreeningtestsandmakesureyouunderstand

whatisinvolvedbeforeyoudecidetohaveanyofthem•offeryouanultrasoundscanateightto14weeksto

estimatewhenyourbabyisdue•offeryouanultrasoundscanat18to20weeksto

checkthephysicaldevelopmentofyourbabyandscreenforpossibleabnormalities.

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25 weeks* Yourmidwifeordoctorshould:•checkthesizeofyouruterus•measureyourbloodpressureandtestyoururineforprotein.

28 weeks Yourmidwifeordoctorshould:•useatapetomeasurethesizeofyouruterus•measureyourbloodpressureandtestyoururineforprotein•offermorescreeningtests.

30 weeks Yourmidwifeordoctorshould:•offeryouranti-Dtreatmentifyouarerhesusnegative.

31 weeks* Yourmidwifeordoctorshould:•review,discussandrecordtheresultsofanyscreeningtestsfromthelastappointment•useatapetomeasurethesizeofyouruterus•measureyourbloodpressureandtestyoururineforprotein.

34 weeks Yourmidwifeordoctorshouldgiveyouinformationaboutpreparingforlabourandbirth,includinghowtorecogniseactivelabour,waysofcopingwithpaininlabourandyourbirthplan.Yourmidwifeordoctorshould:•review,discussandrecordtheresultsofanyscreeningtestsfromthelastappointment•useatapetomeasurethesizeofyouruterus•measureyourbloodpressureandtestyoururineforprotein.

36 weeks Yourmidwifeordoctorshouldgiveyouinformationabout:•feedingyourbaby•caringforyournewbornbaby•vitaminKandscreeningtestsforyournewbornbaby•yourownhealthafteryourbabyisborn•the‘babyblues’andpostnataldepression.

Yourmidwifeordoctorshould:•useatapetomeasurethesizeofyouruterus•checkthepositionofyourbaby•measureyourbloodpressureandtestyoururineforprotein.

38 weeks Yourmidwifeordoctorwilldiscusstheoptionsandchoicesaboutwhathappensifyourpregnancylastslongerthan41weeks.Yourmidwifeordoctorshould:•useatapetomeasurethesizeofyouruterus•measureyourbloodpressureandtestyoururineforprotein.

40 weeks* Yourmidwifeordoctorshouldgiveyoumoreinformationaboutwhathappensifyourpregnancylastslongerthan41weeks.Yourmidwifeordoctorshould:•useatapetomeasurethesizeofyouruterus•measureyourbloodpressureandtestyoururineforprotein.

41 weeks Yourmidwifeordoctorshould:•useatapetomeasurethesizeofyouruterus•measureyourbloodpressureandtestyoururineforprotein•offeramembranesweep•discusstheoptionsandchoicesforinductionoflabour.

* Extra appointment if this is your first baby

otein.

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eArlY AntenAtAl AppoIntmentsInearlypregnancy(upuntil20–24weeks),yourantenatalappointmentswilltakelongerthanthoseinmid-pregnancy.Thisisbecauseyourmidwifeordoctorwillneedtimetoassessyouandyourbaby,discussyourcareandgiveyouinformation.Ateachappointmentyoushouldhavethechancetoaskquestionsanddiscussanyconcernsorissues.

Your first appointment with your midwife or GpAssoonasyouthinkyouarepregnant,youshouldmakeanappointmenttoseeyourmidwife

orGP.Theearlieryoudothis,thebetter.Atthis

appointmentyouwillbegiveninformationabout:

•folicacidandvitaminDsupplements

•nutritionanddiet

• foodhygiene

•lifestylefactorsthatmayaffectyourhealthorthehealthofyourbaby,suchassmoking,recreationaldruguseandalcoholconsumption

•antenatalscreeningtests(seepage49formoreaboutthesetests).

Your booking appointment Mostwomenhavetheir‘bookingappointment’betweenthe8thand12thweekofpregnancy.Thiscantakeacoupleofhours.Youwillseeamidwifeandsometimesadoctor.Youshouldalsobeofferedanultrasoundscan.

Youshouldbegiveninformationabout:

•howthebabydevelopsduringpregnancy

•nutritionanddiet

•exerciseandpelvicfloorexercises

•antenatalscreeningtests

•yourantenatalcare

•breastfeeding,includingworkshops

•antenataleducation

•maternitybenefits

•planningyourlabour

•youroptionsforwheretohaveyourbaby.

Weight and heightYouwillbeweighedatthebookingappointment,butyouprobablywillnotbeweighedregularlyduringyourpregnancy.YourheightwillbemeasuredalongwithyourweightsothatyourmidwifecancalculateyourBMI(bodymassindex).Mostwomenputonbetween10and12.5kg(22–28lbs)inpregnancy,mostofitafterthe20thweek.Muchoftheextraweightisduetothebabygrowing,butyourbodywillalsobestoringfatreadytomakebreastmilkafterthebirth.Eatingsensiblyandtakingregularexercisecanhelp.SeeChapter3forwhatyoushouldeatandforadviceaboutexercise.

Insomeareas,height,weightandBMIareusedtoproduceapersonalisedgrowthchartforyourbaby’sdevelopment.However,otherareaswilluseanaveragegrowthchartinstead.

your antenatal careInanpebaarch

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reGulAr checks At eVerY AntenAtAl AppoIntmentYoururineandbloodpressurewillbecheckedateveryantenatalappointment.

urineYoururineischeckedforanumberofthings,includingproteinor‘albumin’.Ifthisisinyoururine,itmaymeanthatyouhaveaninfectionthatneedstobetreated.Itmayalsobeasignofpre-eclampsia(see‘Highbloodpressureandpre-eclampsia’onpage67).

Blood pressure

Ariseinbloodpressurelaterinpregnancycouldbeasignofpre-eclampsia(seepage67).Itisverycommonforyourbloodpressuretobelowerinthemiddleofyourpregnancythanatothertimes.Thisisnotaproblem,butmaymakeyoufeellight-headedifyougetupquickly.Talktoyourmidwifeifyouareconcerned.

If you are going to have your baby with midwifery care in a midwifery unit, in hospital or at home

Youwillprobablyseeyourownmidwifeformostofyourantenatalcare.Youmaybeofferedavisitatthehospitalforaninitialassessmentandperhapsforanultrasoundscanorforspecialtests.Sometimesyourmidwifemayvisityouathome.

If you are going to have your baby in hospital

Antenatalcarevariesaroundthecountry.Insomeareas,thebookingappointmentisatthehospital,thenallormostoftheremainingappointmentsarewithamidwifeorGP.However,iftherearecomplications,allappointmentswillbeatthehospital.Inotherareas,allcareisgivenbyamidwifeorGPunlesstherearecomplications,whichmeanareferraltothehospitalantenatalclinic.

Questions at the booking appointment

Youwillbeaskedalotofquestionstobuildupapictureofyouandyourpregnancy.Thisissothatyouaregiventhesupportyouneedandanyrisksarespottedearly.Youwillprobablywanttoaskalotofquestionsyourself.

Youmaybeaskedabout:

•thedateofthefirstdayofyourlastperiod,tohelpworkoutwhenyourbabyisdue

•yourhealth

•anypreviousillnessesandoperations

•anypreviouspregnanciesormiscarriages

•yourandyourbaby’sfather’sorigins.Thisistofindoutifyourbabyisatriskofcertaininheritedconditions,orifthereareotherfactors,suchasahistoryoftwins

•yourworkoryourpartner’sworkandwhatkindofaccommodationyoulivein,toseeifthereisanythingaboutyourcircumstancesthatmightaffectyourpregnancy

•howyouarefeelingandifyouhavebeenfeelingdepressed.

Attheendofyourbookingappointment,youshouldunderstandtheplanofcareforyourpregnancyandhaveyourhand-heldnotestocarrywithyouatalltimes.

Yourbookingappointmentisanopportunitytotellyourmidwifeordoctorifyouareinavulnerablesituationorifyouneedextrasupport.Thiscouldbebecauseofdomesticviolence,sexualabuseorfemalegenitalmutilation.

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AppoIntments In lAter preGnAncY From20–24weeks,yourantenatalappointmentswillbecomemorefrequent.Ifyourpregnancyisuncomplicatedandyouarewell,youmaynotbeseenasoften.

Yourlaterappointmentsareusuallyquiteshort.Yourmidwifeordoctorwill:

•checkyoururine,bloodpressure,andsometimesyourweight

•feelyouruterustocheckyourbaby’sposition

•measureyouruterustocheckyourbaby’sgrowth

•listentoyourbaby’sheartbeatifyouwantthemto.

Youcanalsoaskquestionsortalkaboutanythingthatisworryingyou.Youshouldbegiveninformationabout:

•yourplanofbirth

•howtoprepareforlabourandbirth

•howtotellifyouareinactivelabour

•inductionoflabourifyourbabyislate

•the‘babyblues’andpostnataldepression

•feedingyourbaby

•screeningtestsfornewbornbabies

•lookingafteryourselfandyournewbaby.

checking your baby’s development and well-beingAteachantenatalappointmentfrom24weeks,yourmidwifeordoctorshouldcheckyourbaby’sgrowth.Todothis,theywillmeasurethedistancefromthetopofyouruterustoyourpubicbone.Themeasurementwillberecordedinyournotes.

Inthelastweeksofpregnancy,youmayalsobeaskedtokeeptrackofyourbaby’smovements.Ifyourbaby’smovementsbecomelessfrequent,slowdownorstop,contactyourmidwifeordoctorimmediately.

Youwillbeofferedanultrasoundscanifyourmidwifeordoctorhasanyconcernsaboutyourbaby’sgrowth.

BlooD testsAspartofyourantenatalcare,youwillbeofferedanumberofbloodtests.Someareofferedtoallwomenandsomeareonlyofferedifitisthoughtthatyouareatriskofaparticularinfectionorinheritedcondition.Allofthetestsaredonetohelpmakeyourpregnancysaferortocheckthatyourbabyishealthy.Talktoyourmidwifeordoctorsothatyouunderstandwhythebloodtestsarebeingofferedandsothatyoucanmakeaninformedchoiceaboutwhetherornotyouwantthem.Yourmidwifeordoctorshouldalsogiveyouinformationaboutthetests.Belowisanoutlineofalltheteststhatcanbeoffered.

Your blood group and rhesus factorYourbloodwillbetestedtocheckyourbloodgroupandtoseewhetheryouarerhesusnegativeorpositive.Somewomenarerhesusnegative.Thisisusuallynotaworryforafirstpregnancybutitmayaffectthenextchild.

PeoplewhoarerhesuspositivehaveasubstanceknownasDantigenonthesurfaceoftheirredbloodcells.Rhesusnegativepeopledonot.Awomanwhoisrhesusnegativecancarryababywhoisrhesuspositiveifthebaby’sfatherisrhesuspositive.Duringpregnancyorbirth,smallamountsofthebaby’sbloodcanenterthemother’sbloodstream.Thiscancausethemothertoproduceantibodies.Thisusuallydoesn’taffecttheexistingpregnancy,butthewomanbecomes‘sensitised’.Thismeansthatifshegetspregnantwithanotherrhesuspositivebaby,theimmuneresponsewillbequickerandmuchgreater.Theantibodiesproducedbythe

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mothercancrosstheplacentaandattachtotheDantigenonherbaby’sredbloodcells.Thiscanbeharmfultothebabyasitmayresultinaconditioncalledhaemolyticdiseaseofthenewborn,whichcanleadtoanaemiaandjaundice.

prevention of rhesus disease

Anti-Dinjectionspreventrhesusnegativewomenproducingantibodiesagainstthebabyandreducetheriskofarhesusnegativewomanbecomingsensitised.

Rhesusnegativemotherswhoarenotsensitisedareofferedananti-Dinjectionat30weeksaswellasafterthebirthoftheirbaby.Thisisquitesafeforboththemotherandherbaby.

AnaemiaAnaemiamakesyoutiredand

lessabletocopewithanylossofbloodwhenyougivebirth.Iftestsshowyouareanaemic,youwillprobablybegivenironandfolicacid.

Immunity to rubella (German measles)Ifyougetrubellainearlypregnancy,itcanseriouslydamageyourunbornbaby.Yourmidwifeordoctorwilltalktoyouaboutwhathappensifyourtestresultsshowlowornoimmunity.Youwillbeofferedarubellaimmunisationafteryourbabyisborn.Formoreinformationaboutrubella,visitwww.immunisation.nhs.uk

syphilisYouwillbetestedforthissexuallytransmittedinfectionbecauseifleftuntreated,itcanleadtomiscarriageandstillbirth.

hepatitis BThisisavirusthatcancauseseriousliverdisease.Ifyouhavethevirusorareinfectedduringpregnancy,itmayinfectyourbaby(seepage37).Yourbabywillnotusuallybeillbuthasahighchanceofdevelopinglong-terminfectionandseriousliverdiseaselaterinlife.Yourbabycanstartacourseofimmunisationatbirthtohelppreventinfection.IfyouhavehepatitisB,youwillbereferredtoaspecialist.

hepatitis cThisviruscancauseseriousliverdiseaseandthereisasmallriskthatitmaybepassedtoyourbabyifyouareinfected.Thiscannotbepreventedatpresent.TestsforhepatitisCarenotusuallyofferedroutinelyaspartofantenatalcare.Ifyouthinkyoumaybeatrisk(seepage37),talktoyourmidwifeorGP.Theycanarrangeatest.Ifyouareinfected,yourbabycanbetestedwithinafewdaysofbirth.IfyouhavehepatitisC,youwillbereferredtoaspecialist.

hIV ThisisthevirusthatcausesAIDS.Ifyouareinfectedyoucanpasstheinfectiontoyourbabyduringpregnancy,atdelivery,orafterbirthbybreastfeeding.Aspartofyourroutineantenatalcare,youwillbeofferedaconfidentialtestforHIVinfection.IfyouareHIVpositive,bothyouandyourbabycanhavetreatmentandcarethatreducetheriskofyourbabybecominginfected.Ifyourtestresultisnegative,thefactthatyouhadthetestaspartofyourantenatalcareshouldnotaffectyourabilitytogetinsurance.

If you are hIV positive

IfyouareHIVpositive,yourdoctorwillneedtodiscussthemanagementofyourpregnancyanddeliverywithyou.

•Thereisaoneinfourchanceofyourbabybeinginfectedifyouandyourbabydon’thavetreatment.

•TreatmentcansignificantlyreducetheriskoftransmittingHIVfromyoutoyourbaby.20%ofHIV-infectedbabiesdevelopAIDSordiewithinthefirstyearoflife,soit’simportanttoreducetheriskoftransmission.

•Yourlabourwillbemanagedtoreducetheriskofinfectiontoyourbaby.Thismayincludeanelectivecaesareandelivery(seepage98).

•YourbabywillbetestedforHIVatbirthandatintervalsforuptotwoyears.IfyourbabyisfoundtobeinfectedwithHIV,paediatricianswillbeabletoanticipatecertainillnessesthatoccurininfectedbabies,andtreatthemearly.AllbabiesborntoHIVpositivemotherswillappeartobeHIVpositiveatbirth,becausetheyhaveantibodiesfromtheirmother’sinfection.Ifthebabyisnotaffected,thetestwilllaterbecomenegativebecausetheantibodieswilldisappear.

•YouwillbeadvisednottobreastfeedbecauseHIVcanbetransmittedtoyourbabyinthisway.

Help and support

IfyouthinkthatyouareatriskofgettingHIVorknowyouareHIVpositive,talktoyourmidwifeordoctoraboutHIVtestingandcounselling.YoucanalsogetfreeconfidentialadvicefromtheNationalAIDSHelplineon0800567123.

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cystic fibrosisCysticfibrosisisaninheriteddiseasethataffectsvitalorgansinthebody,especiallythelungsanddigestivesystem,bycloggingthemwiththickstickymucus.Thesweatglandsareusuallyalsoaffected.Thediseaseisinheritedandbothparentsmustbecarriersofthegenevariationfortheirbabytobebornwithcysticfibrosis.Testingisofferedifthereisafamilyhistoryofcysticfibrosis.

cervical cancerCervicalsmearsdetectearlychangesinthecervix(theneckoftheuterus),whichcouldlaterleadtocancerifleftuntreated.Routinesmearsareonlyofferedtowomenover25.Ifyouareduetohaveacervicalsmear(ifyouhavenothadoneinthelastthreeyears),youwillprobablybetoldtowaituntilthreemonthsafteryourbabyisbornunlessyouhaveahistoryofabnormalsmears.ThisisbasedonguidancebytheHSCcervicalscreeningprogramme.Formoreinformation,gotowww.cancerscreening.hscni.net

herpesIfyou,oryourpartner,haveeverhadgenitalherpes,oryougetyourfirstattackofgenitalblistersorulcersduringyourpregnancy,letyourmidwifeordoctorknow.Herpescanbedangerousforyournewbornbabyanditmayneedtreatment.

ultrAsounD scAnsMosthospitalswillofferwomenatleasttwoultrasoundscansduringtheirpregnancy.Thefirstisusuallyaroundeightto14weeksandissometimescalledthedatingscanbecauseitcanhelptodeterminewhenthebabyisdue.Thesecondscanusuallytakesplacebetween18and20weeksandiscalledtheanomalyscanbecauseitchecksforstructuralabnormalities.

Ultrasoundscansusesoundwavestobuildupapictureofyourbabyinyouruterus.Theyarecompletelypainless,havenoknownserioussideeffectsonmothersortheirbabies,andmaybecarriedoutformedicalneedatanystageofpregnancy.Ifyouhaveanyconcernsabouthavingascan,talkitoverwithyourmidwife,GPorobstetrician.

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What do scans tell us?•Checkyourbaby’smeasurements.

Thisgivesabetterideaofwhenyourbabywasconceivedandwhenitislikelytobeborn.Thiscanbeusefulifyouareunsureaboutthedateofyourlastperiodorifyourmenstrualcycleislong,shortorirregular.Yourduedatemaybeadjusteddependingontheultrasoundmeasurements.

•Checkwhetheryouarecarryingmorethanonebaby.

•Detectsomeabnormalities,particularlyinyourbaby’sheadorspine.

•Showthepositionofyourbabyandyourplacenta.Sometimesacaesareansectionisrecommended–forexampleifyourplacentaislowlyinginlatepregnancy.

•Checkthatyourbabyisgrowinganddevelopingasexpected(thisisparticularlyimportantifyouarecarryingtwinsormore).

At the scanYoumaybeaskedtodrinkalotoffluidbeforeyouhavethescan.Afullbladderpushesyouruterusupandthisgivesabetterpicture.Youthenlieonyourbackandsomejellyisputonyourabdomen.Aninstrumentispassedbackwardsandforwardsoveryourskinandhigh-frequencysoundisbeamedthroughyourabdomentotheuterusandpelvis.

Thesoundisreflectedbackandcreatesapicturethatisshownonascreen.Itcanbeveryexcitingtoseeapictureofyourownbabymovingaboutinsideyou.

Askforthepicturetobeexplainedtoyouifyoucannotmakeitout.Itshouldbepossibleforyourpartnertocomewithyouandseethescan.Althoughscansaremedicalprocedures,manycouplesfeelthattheyhelptomakethebabyrealforthemboth.Askifit’spossibletohaveacopyofthepicture.Theremaybeasmallchargeforthis.

Fetal movementYouwillusuallystartfeelingsomemovementsbetween16and22weeks.Laterinpregnancyyourbabywilldevelopitsownpatternofmovements–whichyouwillsoongettoknow.

Thesemovementswillrangefromkicksandjerkstorollsandripplesandyoushouldfeelthemeveryday.Ateachantenatalappointment,yourmidwifewilltalktoyouaboutthepatternofmovements.Achange,especiallyareductioninmovements,maybeawarningsignthatyourbabyneedsfurthertests.Trytobecomefamiliarwithyourbaby’stypicaldailypatternandcontactyourmidwifeormaternityunitimmediatelyifyoufeelthatthemovementshavechanged.

tests to Detect ABnormAlItIes Youmaybeofferedteststhatcandetectstructuralabnormalitieslikespinabifida,whichisadefectinthedevelopmentofthespine,orsomechromosomaldisorderslikeDown’ssyndrome,whichiscausedbyanabnormalnumberofchromosomes.Discussthetestsandwhattheymeanwithyourmidwife.

Screeningtestscan:

•reassureyouthatyourbabyhasnodetectedstructuralabnormalities

•provideyouwithanopportunitytoseeyourbabyduringthescan

•giveyoutimetoprepareforthearrivalofababywithspecialneeds.

Testscanalsoprovidevaluableinformationforyourcareduringthepregnancy.However,notestcanguaranteethatyourbabywillbebornwithoutanabnormality.Notestis100%accurateandsomeabnormalitiesmayremainundetected.

Ifyoudohaveascreeningtestanditsuggestsanincreasedchanceofachromosomalabnormality,youwillbeoffereddiagnostictests,whichwillgiveamoredefinitediagnosis.Thesediagnostictestscarryasmallriskofmiscarriage,soyoumaydecidenottohavethem.Discussingtheissueswithyourpartner,midwife,doctorandfriendsmayhelpyouindecidingwhatisrightforyou.

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haemophilia and muscular dystrophy

Somedisorders,suchashaemophiliaandmusculardystrophy,areonlyfoundinboys(althoughgirlsmaycarrythedisorderintheirchromosomesandpassitontotheirsons).Tellyourmidwifeordoctoriftheseorothergeneticdisordersruninyourfamily,asitmaythenbeimportanttoknowyourbaby’ssex.

testInG For DoWn’s sYnDrome AnD other GenetIc DIsorDersTestsmaybeofferedtopregnantwomen.Serumscreeningisa

bloodtestthatscreensforDown’ssyndrome,usuallyatabout16weeksintoyourpregnancy.Itmeasuresthreeorfourpregnancy-associatedbloodchemicalstogiveyourindividualstatisticalchanceofhavingababywithDown’ssyndrome.Serumscreeningonitsownisnotrecommendedfortwinandothermultiplepregnancies.

screening resultsSomematernityservicesgivetheresultas‘lowerrisk/screennegative’or‘higherrisk/screenpositive’.IfthescreeningtestshowstheriskofthebabyhavingDown’ssyndromeislowerthantherecommendednationalcut-off,thisisknownashavinga‘low-risk’result.Alow-riskresultmeansthatyouareatalow-riskofhavingababywithDown’ssyndrome,butitdoesnotmeanthereisnorisk.

IftheresultshowstheriskofthebabyhavingDown’ssyndromeisgreaterthantherecommendednationalcut-off,thisisknownasan‘increasedrisk’or‘higherrisk’result.Anincreasedriskmeansyouwillbeoffereddiagnostictestbutitdoesnotmeanthatyourbabydefinitelyhasthecondition.Thediagnosticprocedureyouwillbeofferediseitherchorionicvillussampling(CVS)(seenextpage)oramniocentesistogiveyouadefiniteansweraboutDown’ssyndrome.Yourmidwifeordoctorwillexplaintheresulttoyouandhelpyoudecidedwhetheryouwanttohavefurthertests.

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DIAGnostIc tests For DoWn’s sYnDrome AnD other GenetIc DIsorDersThesetestswillgiveyouadefinitediagnosisofDown’ssyndromeandsometimesotherabnormalities.

Yourmidwifeordoctorwillexplainwhatisinvolvedandyouwillusuallybeofferedcounselling.

chorionic villus sampling (cVs)CVScanbecarriedoutataround11weeks.Itcangiveyouanearlierdiagnosisifyouareatriskofhavingachildwithaninheriteddisorder,suchascysticfibrosis,sicklecelldisorder,thalassaemiaormusculardystrophy.

What happens?

Thetesttakes10to20minutesandmaybealittleuncomfortable.Usingultrasoundasaguide,afineneedleispassedthroughtheabdomenintotheuterus.

Sometimesafinetubeispassedthroughthevaginaandcervixintotheuterusinstead.Atinypieceofthedevelopingplacenta,knownaschorionictissue,istaken.Thechromosomesinthecellsofthistissueareexamined.Aswithamniocentesis,arapidresultcanbeobtained,butifallthechromosomesaregoingtobecheckedtheresultsmaytakeuptotwoweeks.

the risks

CVShasa1–2%riskofmiscarriage.Thisisslightlyhigherthanamniocentesis.

IF A test Detects An ABnormAlItYItisalwaysdifficultwhenyouaretoldthereissomethingwrongwithyourbaby.Yourmidwifeordoctorwillmakesureyouseetheappropriatehealthprofessionalstohelpyougetalltheinformationandsupportyouneedsoyoucanmakethechoicesthatarerightforyouandyourfamily.

Help and support

AmniocentesisAmniocentesiscanbeofferedfrom15weeksofpregnancyif:

•youhaveapositiveorhigherriskDown’ssyndromescreeningresult

•anultrasoundscandetectsanabnormalitythatisassociatedwithageneticdisorder

•yourpasthistoryorfamilyhistorysuggeststhattheremaybeariskofyourbabyhavingageneticorchromosomaldisordersuchasDown’ssyndrome,sicklecelldisorderorthalassaemia.

What happens

Usingultrasoundasaguide,afineneedleispassedthroughthewalloftheabdomenintotheamnioticfluidthatsurroundsyourbaby.Withinthefluidarecellsthatcontainthesamechromosomesasyourbaby.Asmallsampleofthisfluidisdrawnoffandsenttoalaboratoryfortesting.Mostwomenfeelonlymilddiscomfort.

Usually,thefluidwillbetestedforDown’ssyndromeandotherserioussyndromes.Theresultsshouldbeavailablewithinthreeworkingdays.Ifallthechromosomeshavetobelookedat,itcantakeuptothreeweeks.Thistestwillrevealyourbaby’ssex,sotellyourmidwifeordoctorwhether,atthisstage,youwanttoknowifyourbabyisaboyoragirl.

the risks

Amniocentesishasa0.5–1%riskofmiscarriage.Atmost,onetestin100willresultinpregnancyloss.Whendecidingwhetherornottogoaheadwiththistest,trytobalancetheriskofmiscarriageagainstthevalueoftheresulttoyou.

AntenatalResultsandChoices(ARC)(seepage184)helpsparentswithallissuesassociatedwithantenataltestinganditsimplications.Theycangiveyoumoreinformationorputyouintouchwithparentswithapregnancyinwhichanabnormalityhadbeendetected.Gotowww.arc-uk.orgformoreinformation.Go to www.arc-uk.orgwww.arc-uk.orgww for more information.

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DAte WeeKS WeIGHt UrIne AlB SUGAr

BP HeIGHt FUnDUS

PreSentAtIOn relAtIOn OF PP tO

BrIM

FH OeDeMA Hb neXt SIGn. nOteS

15/6/09 13 58kg nil 110/60 15 – – – – 12.0 20/7 JS u/s arranged for 17/7 to check maturity

20/7/09 18 59.2kg nil 125/60 18–20 – – FMF – – 21/8 JS

21/8/09 22 61kg nil 135/65 20 – – – – 18/9 JS taking iron

18/9/09 26+ 64kg nil 125/75 24–26 – H – 11.2 28/10 JS Health in Pregnancy Grant

28/10/09 30 66kg nil 125/70 30 ceph 5/5 FHH – – 27/11 JS MAt B1 given, Hb taken

27/11/09 34 – nil 115/75 34 ceph 4/5 FHH – 11.0 15/12 JS

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Your hand-held antenatal notes

Atyourfirstantenatalvisit,yourmidwifewillenteryourdetailsinarecordbookandaddtothemateachvisit.Youshouldbeaskedtokeepyourmaternitynotesathomewithyouandtobringthemalongtoallyourantenatalappointments.Takeyournoteswithyouwhereveryougo.Then,ifyouneedmedicalattentionwhileyouareawayfromhome,youwillhavetheinformationthatisneededwithyou.

Thechartontherightgivesasampleoftheinformationyourcardornotesmaycontain,buteachclinichasitsownsystem.Alwaysaskyourmidwifeordoctortoexplainanythingtheywriteonyourcard.

Date.Thisisthedateofyourantenatalvisit.

Weeks.Thisreferstothelengthofyourpregnancyinweeksfromthedateofyourlastmenstrualperiod.

Weight. Thisisyourweight.

Urine.Thesearetheresultsofyoururinetestsforproteinandsugar.‘+’or‘Tr’meansaquantity(ortrace)hasbeenfound.‘Alb’standsfor‘albumin’,anameforoneoftheproteinsdetectedinurine.‘Nil’oratickor‘NAD’allmeanthesame:nothingabnormalhasbeendiscovered.‘Ketones’maybefoundifyouhavenoteatenrecentlyorhavebeenvomiting.

Blood pressure (BP). Thisshouldstayataboutthesamelevelthroughoutyourpregnancy.Ifitgoesupalotinthelasthalfofyourpregnancy,itmaybeasignofpre-eclampsia(seepage67).

mAkInG the most oF AntenAtAl cAre

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Havingregularantenatalcareisimportantforyourhealthandthehealthofyourbaby.Mostantenatalservicesarenowprovidedineasilyaccessiblecommunitysettings.Waitingtimesinclinicscanvary,andthiscanbeparticularlydifficultifyouhaveyoungchildrenwithyou.Trytoplanaheadtomakeyourvisitseasier.Herearesomesuggestions:

•Insomeclinicsyoucanbuyrefreshments.Ifnot,takeasnackwithyouifyouarelikelytogethungry.

•Writealistofquestionsyouwanttoaskandtakeitwithyoutoremindyou.Makesureyougetanswerstoyourquestionsortheopportunitytodiscussanyworries.

•Ifyourpartnerisfree,theymaybeabletogowithyou.Thiscanhelpthemfeelmoreinvolvedinthepregnancy.

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DAte WeeKS WeIGHt UrIne AlB SUGAr

BP HeIGHt FUnDUS

PreSentAtIOn relAtIOn OF PP tO

BrIM

FH OeDeMA Hb neXt SIGn. nOteS

15/6/09 13 58kg nil 110/60 15 – – – – 12.0 20/7 JS u/s arranged for 17/7 to check maturity

20/7/09 18 59.2kg nil 125/60 18–20 – – FMF – – 21/8 JS

21/8/09 22 61kg nil 135/65 20 – – – – 18/9 JS taking iron

18/9/09 26+ 64kg nil 125/75 24–26 – H – 11.2 28/10 JS Health in Pregnancy Grant

28/10/09 30 66kg nil 125/70 30 ceph 5/5 FHH – – 27/11 JS MAt B1 given, Hb taken

27/11/09 34 – nil 115/75 34 ceph 4/5 FHH – 11.0 15/12 JS

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Fetal heart (FH). ‘FHH’orjust‘H’means‘fetalheartheard’.‘FMF’means‘fetalmovementfelt’.

Oedema.Thisisanotherwordforswelling,oftenofthefeetandhands.Usuallyitisnothingtoworryabout,buttellyourmidwifeordoctorifitsuddenlygetsworseasthismaybeasignofpre-eclampsia(seepage67).

Hb.Thisstandsfor‘haemoglobin’.Itistestedinyourbloodsampletocheckifyouareanaemic.

Height of fundus. Bygentlypressingonyourabdomen,themidwifeordoctorcanfeelyouruterus.Earlyinpregnancythetopoftheuterus,or‘fundus’,canbefeltlowdown,belowyournavel.Towardstheenditiswellupaboveyournavel,justunderyourbreasts.Thefigureshouldberoughlythesameasthefigureinthe‘weeks’column.Ifthereisabigdifference(morethantwoweeks),askyourmidwifewhatactionisappropriate.

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2/5 felt

3/5 engaged

relation to brim. Attheendofpregnancy,yourbaby’shead(orbottom,orfeetiftheyareinthebreechposition)willstarttomoveintoyourpelvis.Professionals‘divide’thebaby’sheadinto‘fifths’anddescribehowfarithasmoveddownintothepelvisbyjudginghowmany‘fifths’oftheheadtheycanfeelabovethebrim(theboneatthefront).

Theymaysaythattheheadis‘engaged’–thisiswhen2/5orlessofyourbaby’sheadcanbefelt(‘palpated’)abovethebrim.Thismaynothappenuntilyouareinlabour.Ifallofyourbaby’sheadcanbefeltabovethebrim,thisisdescribedas‘free’or‘5/5palpable’.

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2/5 felt

3/5 engaged Presentation.Thisreferstowhichwayupyourbabyis.Uptoabout30weeks,yourbabymovesaboutalot.Thentheyusuallysettleintoahead-downwardposition,readytobebornheadfirst.Thisisrecordedas‘Vx’(vertex)or‘C’or‘ceph’(cephalic).Bothwordsmeanthetopofthehead.Ifyourbabystayswithitsbottomdownwards,thisisabreech(‘Br’)presentation.‘PP’meanspresentingpart,whichisthepart(headorbottom)ofyourbabythatiscomingfirst.‘Tr’(transverse)meansyourbabyislyingacrossyourabdomen.

Breech presentAtIon

cephAlIc presentAtIon

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Your AntenAtAl teAmWhileyouarepregnantyoushouldnormallyseeasmallnumberofhealthcareprofessionals,ledbyyourmidwifeordoctor,onaregularbasis.Theywanttomakeyoufeelhappywithallaspectsofthecareyoureceive,bothwhileyouarepregnantandwhenyouhaveyourbaby.

Manymotherswouldliketobeabletogettoknowthepeoplewhocareforthemduringpregnancyandthebirthoftheirbaby.TheHSCisworkingtoachievethisbutyoumaystillfindthatyouseeanumberofdifferentcarers.Theprofessionalsyouseeshouldintroducethemselves

andexplainwhotheyare,butiftheyforget,

don’thesitatetoask.Itmayhelp

tomakeanoteofwhoyou

haveseenandwhattheyhavesaid

incaseyouneedtodiscussanypoint

lateron.

the people you are most likely to meet are listed below

•Amidwifeisspeciallytrainedtocareformothersandbabiesthroughoutpregnancyandlabourandafterthebirth.Midwivesprovidecareforthemajorityofwomenathomeorinhospital.Increasingly,midwiveswillbeworkingbothinhospitalsandinthecommunity,sothatthesamemidwifecanprovideantenatalcareandbepresentatthebirth.Youshouldknowthenameofthemidwifewhoisresponsibleforyourcare.

Amidwifewilllookafteryouduringlabourand,ifeverythingisstraightforward,willdeliveryourbaby.Ifanycomplicationsdevelopduringyourpregnancyordelivery,youwillalsoseeadoctor.Youmayalsomeetstudentmidwivesandstudentdoctors.Afterthebirth,youandyourbabywillbecaredforbymidwivesandmaternitysupportworkers.

•An obstetricianisadoctorspecialisinginthecareofwomenduringpregnancyandlabourandafterthebirth.

YourmidwifeorGPwillreferyouforanappointmentwithanobstetricianiftheyhaveaparticularconcern,suchaspreviouscomplicationsinpregnancyorchronicillness.Youcanrequesttoseeanobstetricianifyouhaveanyparticularconcerns.

•An anaesthetist isadoctorwhospecialisesinprovidingpainreliefandanaesthesia.Ifyoudecidetohaveanepidural,itwillbesetupbyananaesthetist.

Ifyourequireacaesareansectionoraninstrumentaldelivery(e.g.usingforcepsorventouse),ananaesthetistwillprovidetheappropriateanaesthesia.Inmanyhospitalsyourmidwifecanarrangeforyoutotalktoananaesthetistaboutanalgesiaoranaesthesiaifyouhavemedicalorobstetricproblems.Beforeorduringlabouryouwillbeabletospeaktoyouranaesthetist.

care fromyour

midwife

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•An obstetric physiotherapist isspecially

trainedtohelpyoucopewithphysicalchangesduringpregnancy,childbirthandafterwards.Someprovideantenataleducationandteachantenatalexercises,relaxationandbreathing,activepositionsandotherwaysyoucankeepyourselffitandhealthyduringpregnancyandlabour.Afterthebirth,theyadviseonpostnatalexercisestotoneupyourmuscles.Yourmidwifecanhelpyouwiththeseexercises.

•health visitorsarespeciallytrainednurseswhoofferhelpandsupportwiththehealthofthewholefamily.Youmaymeetyourhealthvisitorbeforethebirthofyourbabyandyouwillbevisitedbyamemberoftheteaminthefirstfewweeksafteryourbabyisborn.Youmaycontinuetoseeyourhealthvisitororamemberofthehealthvisitingteamathomeoratyourchildhealthclinic,healthcentreorGP’ssurgery.

•Dieticiansmaybeavailabletoadviseyouabouthealthyeatingorspecialdiets,forexampleifyoudevelopgestationaldiabetes.

research

Youmaybeaskedtoparticipateinaresearchprojectduringyourantenatalcareorlabourorafteryouhavegivenbirth.Thismaybetotestanewtreatmentortofindoutyouropinionsonanaspectofyourcare.Suchprojectsarevitalifprofessionalsaretoimprovematernitycare.Theprojectshouldbefullyexplainedtoyouandyouarefreetosayno.

students

Someofthehealthprofessionalsyouseewillhavestudentswiththem.Thestudentswillbeatvariousstagesoftheirtrainingbutwillalwaysbesupervised.Youcansayno,butifyouletastudentbepresentitwillhelptheireducationandmayevenaddtoyourexperienceofpregnancyandlabour.

•A paediatricianisadoctorspecialisinginthecareofbabiesandchildren.Apaediatricianmaycheckyourbabyafterthebirthtomakesurealliswellandwillbepresentwhenyourbabyisbornifyouhavehadadifficultlabour.Ifyourbabyhasanyproblems,youwillbeabletotalkthisoverwiththepaediatrician.Ifyourbabyisbornathomeoryourstayinhospitalisshort,youmaynotseeapaediatricianatall.YourmidwifeorGPwillcheckthatalliswellwithyouandyourbaby.

•A sonographerisspeciallytrainedtocarryoutultrasoundscans.Asonographerwillperformyourdatingand nuchaltranslucencyoranomalyscan.Somewomenarescannedatotherpointsintheirpregnancy.

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AntenAtAl eDucAtIonAntenataleducation(sometimescalledantenatalclasses)canhelptoprepareyouforyourbaby’sbirthaswellasforlookingafterandfeedingyourbaby.Itcanhelpyoutokeepyourselffitandwellduringpregnancyandgiveyouconfidenceaswellasinformation.Youcanfindoutaboutarrangementsforlabourandbirthandthesortsofchoicesavailabletoyou(seepage74forinformationaboutbirthplans).Youmayalsomeetsomeofthepeoplewhowilllookafteryouduringlabour.

Youwillbeabletotalkoveranyworriesanddiscussyourplans,notjustwithprofessionalsbutwithotherwomenandtheirpartnersaswell.Classesarealsoareallygoodwaytomakefriendswithotherparentsexpectingbabiesataroundthesametimeasyou.Thesefriendshipsoftenhelpyouthroughthefirstfewmonthswithababy.Classesareusuallyinformalandfun.

choosing an antenatal classThinkaboutwhatyouhopetogainfromantenatalclassessothatyoucanfindthesortofclassthatsuitsyoubest.Youneedtostartmakingenquiriesearlyinpregnancysothatyoucanbesureofgettingaplaceintheclassyouchoose.Youcangotomorethanoneclass.Askyourmidwife,healthvisitororGPaboutwhatisavailableinyourarea,orcontacttheNCT(seenextpage).Speaktoyourcommunitymidwifeifyoucannotgotoclasses.ThemidwifemayhaveDVDstolendyou,oryoumaybeabletohireorbuyone.

the classesDuringpregnancy,youmaybeabletogotosomeintroductoryclassesonbabycare.Moststartabouteightto10weeksbeforeyourbabyisdue.Ifyouareexpectingamultiplepregnancy,trytostartyourclassesataround24weeks,becauseyourbabiesaremorelikelytobebornearlier.

Classesarenormallyheldonceaweek,eitherduringthedayorintheevening,forabouttwohours.Someclassesareforpregnantwomenonly.Otherswillwelcomepartnersorfriends,eithertoallthesessionsortosomeofthem.InsomeareasthereareclassesforwomenwhosefirstlanguageisnotEnglish,classesforsinglemothersandclassesforteenagers.Thekindsoftopicscoveredinantenataleducationare:

•healthinpregnancy

•exercisestokeepyoufitduringpregnancyandhelpyouinlabour

•whathappensduringlabourandbirth

•copingwithlabourandinformation about different typesofpainrelief

•howtohelpyourselfduringlabourandbirth

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•relaxationtechniques

•howtogivebirthwithoutanyintervention,ifthatiswhatyouwant

•informationondifferentkindsofbirthandintervention

•caringforyourbaby,includingfeeding

•yourhealthafterthebirth

•‘refresherclasses’forthosewhohavealreadyhadababy

•emotionsduringpregnancy,birthandtheearlypostnatalperiod.

Someclasseswilltrytocoverallofthesetopics.Otherswillconcentrateoncertainaspects,suchasexercisesandrelaxationorcaringforyourbaby.

Thenumberofdifferentantenatalclassesavailablevariesfromplacetoplace.

the nct

TheNCT(alsoknownastheNationalChildbirthTrust)runsarangeofclasses.Thegroupstendtobesmallerandmaygointomoredepth,oftenallowingtimefordiscussionandforpractisingphysicalskills.Fordetailsofantenatalcourses,alongwithinformationonlocalsupportgroups,visitwww.nct.org.uk

sure start centres

SureStartCentresalsosupportfamilieswithchildrenundertheageoffive.Theycanprovide:

•easyaccesstoantenatalcare

•healthservices

•parentingandfamilysupport

•drop-insessions

•outreachservices

•earlyeducationandchildcare,and

•linkstotrainingandemploymentopportunities.

FormoreinformationonSureStartCentres,includingfindingcentresinyourarea,visitwww.surestart.gov.uk

parents-to-be

meetother

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