If you are booked for NHS midwifery care (i.e. you are classed as ‘low risk’) your schedule of antenatal appointments is likely to follow the National Institute for Clinical Excellence (otherwise known as NICE) guidelines. If you have additional medical needs during pregnancy and require consultant care, you may have extra appointments and care than those described below.
If this is the first time you have been pregnant you are known as a “Primigravida” or “Primip”. Mums who have had babies before are often referred to as “multigravida” or “Multips”. Multips who have had a healthy pregnancy and birth previously tend to require fewer antenatal appointment as you will see from the outline appointment schedule shown below. If at any time during the pregnancy a woman needs referral to a consultant or develops complications with her pregnancy, then extra appointments and treatment may be given.
If you are accepting antenatal screening, this is the time when a second lot of blood tests are taken, although much less than is taken for booking! If you are a rhesus negative blood group, then it is also at this time that you will be offered “Routine Antenatal Anti-D Prophylaxis”(RAADP). For more information of rhesus negative blood group and RAADP, see our article here.
In addition to the blood screening, you will also be offered a Midwife appointment to check your blood pressure, urine and to perform an abdominal palpation. The Midwife will also start to measure your abdomen from this point in pregnancy. The Symphysis fundal height is a measurement taken in cm from your pubic bone to the top of your womb and is approximately 1cm for each week of pregnancy (ie 28 weeks pregnant = 28cm). There is a leeway of 2-3cm more or less, and it is partly the consistent increase in measurement that is important, not just the actual numbers themselves.
The Midwife will also ask you to keep an eye on your baby’s individual pattern of movements. Any change in movement pattern can indicate that the baby is not entirely happy about something and you should contact your midwife immediately if you have any concerns.
This is another routine appointment that only first time mums, or mums at higher risk in pregnancy will be offered. Again, if you would like to be seen even though you are a ‘low risk multip’ (i.e: this is not your first pregnancy), do make an appointment.
Blood pressure, urine testing and abdominal palpation will be offered at this appointment and the Midwife will ensure that any blood screening you had at 28 weeks is documented in your hand held notes.
A routine antenatal appointment is offered to all women at this gestation. As well as the usual blood pressure, urine and abdominal palpation, you might also like to ask your Midwife about your birth plan at this time. This is also about the time when NHS antenatal classes are held, though this varies from trust to trust.
If your placenta has been found to be low lying at a previous screening ultrasound scan, then you will be offered a further scan at this gestation to see if your placenta has ‘moved’ a sufficient distance from your cervix to enable a vaginal birth (see our low lying placenta article for more information). A routine antenatal check is offered and you may also be referred for a further ultrasound scan if your Midwfie suspects your baby is presenting breech.
By Lorraine Berry – Midwife