Antenatal care is the care and support you receive during pregnancy from your maternity team.
For most people, this will mainly be provided by a midwife. You may also see an obstetrician or other specialist if you have a medical condition, develop a pregnancy complication or need additional monitoring.
Your appointments are there to check how you and your baby are doing, pick up any concerns early and give you time to talk about your pregnancy, birth and the weeks after your baby arrives.
If this is your first baby, you will usually be offered at least 10 antenatal appointments, as well as your ultrasound scans. If you have given birth before, you will usually be offered at least 7 appointments.
Some people will need more appointments than this, depending on their health, previous pregnancies or how their current pregnancy progresses.
The exact timing can also vary slightly between maternity services, so use the schedule below as a guide rather than worrying if your local appointments look a little different.
Starting Your Antenatal Care
You can contact maternity services as soon as you know you are pregnant.
In many areas of the UK you can refer yourself directly to your local maternity service online without needing to see your GP first.
It’s worth doing this early so that your booking appointment and screening can be arranged in good time.
You can usually choose which maternity service you would like to receive care from. When you’re deciding, you may want to think about location, travel time, the type of birth facilities available and any specialist services you might need.
Your Booking Appointment
Your first main appointment with a midwife is usually called your booking appointment.
This should ideally happen by around 10 weeks of pregnancy.
It is often one of your longer appointments because your midwife will spend time getting to know you and planning your care.
They will usually ask about:
- your general health and any medical conditions
- medications you take
- previous pregnancies and births
- your mental and emotional wellbeing
- your family medical history
- your baby’s other biological parent’s medical history where relevant
- smoking, alcohol and substance use
- your home and support network
- work and occupation
- your ethnic and cultural background
- any social or financial circumstances that may affect your pregnancy.
Some questions can feel quite personal, but they help your midwife work out whether there is any additional care or support that may be useful.
If you don’t understand why something is being asked, it is fine to ask.
What checks happen at booking?
You will usually have:
- your blood pressure checked
- your height and weight measured
- a urine test
- blood tests.
Booking blood tests usually include:
- a full blood count to check, among other things, for anaemia
- your blood group
- your RhD blood type
- screening for red-cell antibodies
- HIV
- hepatitis B
- syphilis
- sickle cell and thalassaemia screening as part of the national screening pathway.
Vitamin D is important in pregnancy, but it is not routinely checked with a blood test for everyone.
Your midwife will also talk to you about folic acid, vitamin D supplements, healthy eating, vaccines, screening tests and anything else that is relevant to your pregnancy.
You will usually receive access to your maternity notes, either electronically or on paper, together with important contact numbers for your maternity service.
Around 11 to 14 Weeks
You will usually be offered your first ultrasound scan between around 11 weeks and 14 weeks.
This is often called the dating scan because it helps estimate your baby’s due date.
If you choose screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome, the combined screening test may also take place around this time. This uses information from a blood test together with measurements from your scan.
Your screening team will explain the tests being offered and what the results may mean.
Screening is your choice.
Around 16 Weeks
At your 16-week appointment, your midwife will usually:
- review the results of your booking blood tests
- make sure you have received and understood any screening results
- check your blood pressure
- test your urine if needed
- ask how you are feeling physically and emotionally
- discuss any concerns you have
- check that your mid-pregnancy ultrasound scan has been arranged.
You may also start talking about your baby’s movements and when you might expect to notice them.
The whooping cough vaccination can be given from 16 weeks. It is usually offered around the time of the mid-pregnancy scan, often at about 20 weeks, and having it before 32 weeks gives your baby the best protection after birth.
Around 18 to 21 Weeks
You will usually be offered your second routine ultrasound scan between around 18 and 21 weeks.
This is sometimes called the anomaly scan or 20-week scan.
It looks closely at your baby’s development and growth and checks the position of the placenta.
Your sonographer will talk you through what they are looking at and will explain if any further scans or appointments are needed.
Depending on your maternity service, you may have a separate appointment with your midwife around this time or discuss the results at your next routine visit.
If you have not yet been offered your whooping cough vaccine, ask your midwife or GP about it.
Around 25 Weeks
If this is your first baby, you will usually be offered an additional appointment at around 25 weeks.
Your midwife will usually:
- ask how you are feeling
- check your blood pressure
- check your urine where appropriate
- talk about your baby’s movements
- measure your uterus to monitor your baby’s growth.
From around this stage, your baby’s growth will usually be monitored by measuring the size of your uterus with a tape measure, unless you are already having growth scans for another reason.
Around 28 Weeks
At your 28-week appointment, your midwife will repeat many of the usual pregnancy checks.
This will normally include:
- checking your blood pressure
- discussing your baby’s movements
- measuring your baby’s growth
- reviewing how you are feeling physically and emotionally
- repeat blood tests.
You will usually have another full blood count to check for anaemia and repeat testing for red-cell antibodies.
If you are RhD negative, your maternity team will discuss whether you need anti-D immunoglobulin. The exact timing and number of doses can vary depending on your local maternity service and whether fetal RHD testing has been used.
RSV vaccination
You should also be offered the RSV vaccine from 28 weeks of pregnancy.
RSV can cause serious chest infections such as bronchiolitis and pneumonia in young babies. Vaccination during pregnancy allows antibodies to pass to your baby and helps protect them during the first months after birth.
The NHS recommends having it as soon as possible from 28 weeks for the best protection, although it can still be given later in pregnancy.
Around 31 Weeks
If this is your first baby, you will usually be offered another appointment at around 31 weeks.
Routine checks will be carried out and your midwife will usually discuss the results of your 28-week blood tests.
It is also a good opportunity to ask about anything that has changed since your last appointment.
Around 34 Weeks
At around 34 weeks, your midwife will usually repeat the routine checks and start having more detailed conversations with you about labour and birth.
This may include:
- where you are planning to give birth
- birth preferences
- pain relief options
- what to expect during labour
- when to contact your maternity unit
- your baby’s movements
- feeding and the early postnatal period.
This is not about fixing a rigid birth plan. It is a chance to talk through what matters to you, your options and any questions you have.
Around 36 Weeks
Your usual checks will be carried out again.
Your midwife will also check your baby’s position by feeling your abdomen.
If your baby appears to be breech, meaning bottom or feet first, you may be offered an ultrasound scan to confirm their position and a discussion about your options.
You may also talk about:
- breastfeeding and infant feeding
- skin-to-skin contact
- caring for your baby after birth
- safe sleeping
- vitamin K for your baby
- your postnatal care
- recognising when you or your baby may need help.
Around 38 Weeks
Routine checks will continue, including your baby’s growth, movements and your blood pressure.
Your midwife will also begin talking with you about what happens if your pregnancy continues beyond your due date.
You should have the opportunity to discuss induction of labour, the reasons it may be offered and your choices.
Around 40 Weeks
If this is your first baby, you will usually have an appointment at around 40 weeks.
Routine checks will continue.
Your midwife may discuss a membrane sweep, including what it involves and whether you would like one.
A membrane sweep is optional and should only be carried out with your consent.
Around 41 Weeks
If you have not yet had your baby, you will usually be offered another appointment at around 41 weeks.
Your midwife will:
- check your blood pressure
- monitor your baby’s growth and movements
- discuss how you are feeling
- offer a membrane sweep if appropriate
- talk with you about induction of labour.
Current guidance recommends discussing induction from 41 weeks, because some risks gradually increase as pregnancy continues beyond this point.
Your maternity team should explain the benefits, risks and alternatives so you can make an informed decision about your care.
What If I Choose Not to Have an Induction?
If you decide not to have an induction at the time it is offered, your maternity team should continue to support you.
They will discuss your individual circumstances, what monitoring may be offered and when they would like to review you again.
Additional monitoring can provide information about how your baby is doing at that point in time, but it cannot predict every problem or remove all the risks associated with a pregnancy continuing beyond 41 to 42 weeks.
Your preferences should remain part of the discussion throughout.
What Happens at Routine Antenatal Appointments?
Although the focus changes as your pregnancy progresses, appointments later in pregnancy will usually include several familiar checks.
Your midwife may:
- ask how you are feeling physically
- ask about your emotional wellbeing
- check your blood pressure
- test your urine where clinically needed
- measure your baby’s growth
- ask about your baby’s movements
- assess your baby’s position later in pregnancy
- review test and scan results
- give you information about upcoming appointments and choices.
Appointments should also give you time to ask questions and raise anything that is worrying you.
If there is something you want to discuss, you don’t need to wait for your midwife to bring it up.
What Vaccinations Are Offered During Pregnancy?
Several vaccines are recommended during pregnancy.
Whooping cough
Usually offered at around 20 weeks, although it can be given from 16 weeks. Having it before 32 weeks gives your baby the best protection after birth.
RSV
Offered from 28 weeks during every pregnancy.
Flu
The flu vaccine is recommended during pregnancy during the flu vaccination season and can be given at any stage of pregnancy.
You do not need to wait and have your vaccines together. It is better to have each one when it is offered.
Will Everyone Have the Same Appointment Schedule?
No.
This schedule is designed for an uncomplicated pregnancy.
You may be offered additional appointments or scans if, for example:
- you have high blood pressure or another medical condition
- you develop gestational diabetes
- your baby needs additional growth monitoring
- you are expecting twins or more
- you have had complications in a previous pregnancy
- there are concerns about your baby’s movements or growth
- you need specialist maternity care.
Additional appointments do not necessarily mean that something is wrong. Sometimes they are simply the safest way to keep a closer eye on you or your baby.
Where Will My Antenatal Appointments Take Place?
This varies between areas.
You may have appointments at:
- your maternity hospital
- a community maternity clinic
- your GP surgery
- a children’s or family centre
- another local NHS clinic.
Some conversations may occasionally take place by phone or video, although important physical assessments still need to be carried out face to face.
Can I Take Time Off Work for Antenatal Appointments?
If you are an employee, you are entitled to reasonable paid time off for antenatal care, including the time needed to travel to and attend your appointments.
This can also include antenatal classes if they have been recommended by a registered doctor, midwife or health visitor as part of your care.
You do not need to have worked for your employer for a minimum length of time to qualify for this right.
Agency workers have different rules. After completing 12 weeks in the same placement, eligible agency workers are also entitled to reasonable paid time off for antenatal appointments.
Partners who are employees usually have the right to unpaid time off to attend up to two antenatal appointments, although some employers offer more generous arrangements.
Don’t Wait for Your Next Appointment If You’re Worried
Your planned appointments are for routine antenatal care.
You should not wait until your next appointment if you:
- notice your baby moving less than usual or their usual pattern changes
- have vaginal bleeding
- think your waters have broken
- have severe abdominal pain
- have symptoms that could suggest pre-eclampsia, such as severe headache, visual changes or sudden swelling
- feel unwell
- are concerned about your pregnancy for any reason.
Use the maternity contact numbers given to you by your service and ask for advice.
Getting Ready for Your Appointments
It can help to write down any questions before you go.
You may also want to bring your partner, birth partner or another person you trust to appointments where this is possible.
Your antenatal appointments aren’t just about having your blood pressure checked and your bump measured. They are also your opportunity to understand your care and be involved in decisions about your pregnancy and birth.
Our Complete Antenatal Course can help you prepare for these conversations, as well as covering pregnancy, labour and birth, feeding and caring for your new baby.The course is self-directed, so you can work through it at your own pace.
References
- NICE Guideline NG201. Antenatal care.
- NICE. Schedule of antenatal appointments.
- NHS. Antenatal care and appointments.
- NHS. Antenatal checks and tests.
- NHS. Vaccinations in pregnancy.
- NHS. Whooping cough vaccination in pregnancy.
- NHS. RSV vaccine.
- NHS. Flu vaccination in pregnancy.
- NICE Guideline NG207. Inducing labour.
- Maternity Action. Time off for antenatal care.
- PIF TICK. Criteria for trustworthy health information.