Antenatal appointments

There are many health professionals who can help provide you with antenatal care. One of the main ways you will get support during your pregnancy is through your antenatal appointments and check-ups. During these appointments, your midwife or GP will be able to carefully monitor the development of your baby, and will also be able to check your own health. You will be offered a series of tests that can help to detect any illnesses or conditions that may cause complications for you or your baby. These tests will help to ensure that any necessary treatment can be provided promptly and efficiently.

 

Antenatal notes

A record of your antenatal care and appointments will be made, and these are known as your antenatal notes. It will usually be your own responsibility to look after these notes, and you should bring them with you to each of your appointments. You should also carry them with you throughout your pregnancy, so if you fall ill while you are away from home, you will have all your up-to-date medical information with you.

Pregnancy can sometimes be a scary and daunting prospect, and it may feel like there is a lot of information that you need to take on board. Your antenatal appointments will provide you with an opportunity to talk through any of your worries, concerns or queries, and will also allow you to get all of the necessary tips, guidance and advice that you will need through every stage of your pregnancy.

 

Recommendations

Diet

A healthy diet and lifestyle during pregnancy is very important for the development of your baby, and may have long-term beneficial effects for both you and your child.

The average weight gain in pregnancy is 10kg to 12.5kg (22lb to 28lb). This is not a time to try to lose weight, or prevent weight gain. However, the old adage of eating for two no longer holds true - the calorie requirements of a pregnant woman should only increase by around 300 calories per day. It is quality, rather than quantity, that matters.

Try to follow a healthy, balanced diet based around the four main food groups, as outlined below.

·       Carbohydrates - such as rice, pasta, cereals, bread and potatoes. You should aim to have four to six portions daily.

·       Fruit and vegetables - you should have at least five portions a day.

·       Protein - such as meat, poultry, fish, pulses and eggs. You need approximately three portions a day.

·       Dairy products - such as milk, cheese and yoghurt. You should have at least one portion a day.

Try to drink plenty of fluids, such as water and fruit juices, at least 1.2 litres (six to eight glasses) every day (or more when you are exercising, or if it is hot). This helps the body to get rid of toxins and waste products, and can also help to prevent constipation and nausea.

Folic acid

During pregnancy you should increase your intake of folic acid (vitamin B9). Folic acid can help reduce the risk of problems developing with your baby's spine and brain, such as spina bifida (when the baby's spine does not form properly).

The Department of Health recommends that all women who are trying to get pregnant should take a daily supplement of 0.4mg of folic acid. You should also take this supplement for the first 12 weeks of pregnancy, when your baby's spine is developing.

You can get folic acid tablets from pharmacies, large supermarkets, health food stores, and on prescription. Natural sources of folic acid include green leafy vegetables, breakfast cereals and bread. If you are on medication for a condition such as epilepsy, it is important to check with your GP before taking folic acid. This is because some types of medication work against folic acid supplements.

  mould-ripened cheeses (such as brie and stilton),

  soft boiled eggs,

  unpasteurised dairy food,

  pâté,

  ready-washed salads, and

  cold, prepared meats.

Pasteurised foods, such as hard cheeses, yoghurts and commercial mayonnaise, made with pasteurised egg, are all safe to eat during pregnancy. You should try and avoid handling and eating raw meat, and should make sure that any fruit and vegetables are washed before you eat them.

If you are pregnant, it is recommended that you do not eat liver or liver products because they contain high levels of vitamin A. There are two kinds of vitamin A. The type that is found in liver is known as retinol and can be harmful to your developing baby. If you want to take a multi-vitamin supplement, look for one that is specially formulated for pregnant women.

Eating fish is good for your health and that of your baby. You should try and have two portions of fish a week, at least one of which should be oily fish. Oily fish includes mackerel, sardines, trout and fresh tuna (not tinned tuna). However, it is important to note that you should limit your intake of oily fish to no more than two portions a week. You should also avoid eating shark, swordfish and marlin because these fish can contain high levels of mercury, which can affect your baby's nervous system. Limit your weekly intake of tuna to two tuna steaks, or four medium-sized cans of tuna.

Allergies

You may have heard that some women, in the past, have chosen not to eat peanuts when they are pregnant. This is because the Government previously advised women that they may wish to avoid eating peanuts during pregnancy if there was a history of allergy, such as asthma, eczema, hayfever, food or other allergy, in their child’s immediate family.

This advice has now been changed because the latest research shows there is no clear evidence to say if eating or not eating peanuts during pregnancy affects the chances of your baby developing a peanut allergy.

If you would like to eat peanuts or foods containing peanuts (such as peanut butter) during pregnancy, you can choose to do so as part of a healthy balanced diet, unless you yourself are allergic to them or unless your health professional advises you not to.

 Facts

Employers have a responsibility to protect the health and safety of their employees, and this involves assessing any potential risks to employees during pregnancy, and upon their return to work. Your employer must carry out an assessment to ensure that you and your baby are not exposed to any risks posed by chemicals, processes, or conditions in the workplace.

You are entitled to paid time off work to attend antenatal appointments that have been made on the advice of your healthcare providers, which include relaxation and parenting classes, as well as scans and medical check-ups. Your employer may ask to see the certificate from your midwife, or GP, confirming your pregnancy, and an appointment card showing that an antenatal appointment has been made.

Maternity leave

As a female employee, you are entitled to 52 weeks maternity leave, regardless of how long you have worked for your employer, or how many hours you work. You can start your maternity leave 11 weeks from your expected week of birth. However, you must make sure that you inform your employer of your wish to take maternity leave at least 15 weeks before the week the baby is due.

Statutory Maternity Pay (SMP)

If you have worked for the same employer for at least 26 weeks before the end of the 15th week your baby is due, you may be entitled to Statutory Maternity Pay (SMP). SMP is paid for up to 39 weeks. For the first six weeks you will receive 90% of your average weekly earnings. For the remaining 33 weeks, you will receive £112.75 a week. You must be earning an average of £87, or more, a week to qualify for SMP.

If you wish to return to work at the end of your maternity leave, you should expect to return to the same job offering the same terms and conditions of employment (as if you had not been absent), and to benefit from any general improvements to pay, or other conditions, that have arisen during your leave. There are some exceptions and additions to these entitlements. For more details, you can visit the government's TIGER (Tailored Interactive Guidance on Employment Rights) website, which also provides information about paternity rights.

 

Treament

During your pregnancy, you may be referred for a variety of tests and checks. Some tests, such as urine and blood type, are recommended for all pregnant women and are used to check your health and that of your baby. Others, such as amniocentesis and chorionic villus sampling, are for women who may be at a higher risk of developing particular conditions, or health problems. Your midwife, or GP, can help you and your partner decide what is best for you and your baby, and they will also be able to help you to understand the purpose, risks, and benefits of each test.

You can decline to have these tests, but they can provide information that will help ensure that you deliver a healthy baby.

The tests may be done at your GP surgery, the local clinic, or at the hospital antenatal department. Some of the tests that you may have while you are pregnant are outlined below.

·       Blood type test - this is to check to see if you have a blood type known as rhesus negative. If you are rhesus negative, and your baby has inherited a rhesus positive blood type from the father, the mismatch of blood types can sometimes cause your body to produce antibodies (proteins which fight infection) which attack the baby's red blood cells. This condition can be treated with an anti-D injection straight after birth.

·       Hepatitis B - this is a virus which can cause liver disease, and may infect your baby if you are carrying the virus. Your baby can be immunised straight after birth to stop it from developing the condition.

·       HIV testing - this is the virus that causes AIDS. If you are HIV positive, you can pass the infection on to your baby during pregnancy, delivery, or breastfeeding. If your test shows you are HIV positive, you and your baby can have treatment to help minimise the risk of your child developing the condition.

·       Anaemia - this is a condition caused by a lack of iron in your blood. It means that you produce fewer red blood cells, leaving you weak, tired and lethargic. If your test shows that you have anaemia, you may have to take iron supplements.

·       Syphilis - this is a sexually transmitted infection (STI). If you test positive for syphilis, you must receive treatment as soon as possible because, if left untreated, this infection can cause miscarriage and stillbirth.

·       Rubella - also known as German measles, rubella can seriously harm your unborn baby. Most women are immune to the condition because they have been vaccinated as a child. If your test shows that you do not have the antibodies to fight the disease, it is important that you avoid contact with anyone who has rubella. If you have rubella, you and your baby will require treatment to try and prevent any complications.

·       Urine tests - the sugar levels in your urine will be tested because some women develop diabetes during pregnancy. Your urine will also be tested for protein, as its presence may indicate that you have an infection.

Ultrasound

An ultrasound scan uses high-frequency sound waves to provide an image of your baby. The scan is completely painless, and there are no known serious side effects to you or your baby. You may have to have several scans during the course of your pregnancy, depending on how your baby is developing. An ultrasound scan may be used to:

  determine the size and age of the baby,

  check the position of the baby and placenta,

  check for physical problems in the baby, or placenta, and

  determine a multiple birth.

You will normally be asked to drink plenty of fluids before the scan. This is because a full bladder pushes the womb up, and provides a better picture. A special jelly is put on to your stomach, and the ultrasound instrument is moved back and forward over your skin.

Alpha-fetoprotein test

An alpha-fetoprotein test is usually performed at around 15-20 weeks of your pregnancy to check for the amount of alpha-fetoprotein (AFP) in your blood. If you have a high level of AFP, it could be an indication that your baby has spina bifida (where the baby's spine does not develop properly). If you have abnormally low levels of AFP, it could be a sign that your baby has Down's syndrome. If your AFP levels are abnormal, further testing may be required.

Amniocentesis

Amniocentesis is a test that is offered to some women after 14 weeks of pregnancy to check for any possible genetic disorders. If you are at increased risk of having a baby with Down's syndrome, for example, you have had a low AFP test result, or if your ultrasound showed that your baby has a genetic-related abnormality, then you will have this test.

During the amniocentesis test, a fine needle is passed through your abdomen and into the amniotic fluid (the fluid which surrounds and protects your baby). A small sample of the fluid is taken for testing, and is analysed to check for genetic disorders. The procedure usually only causes mild discomfort, although there is a 0.5-1% risk of miscarriage. Results can take up to three weeks to come back.

Chorionic villus sampling (CVS)

Chorionic villus sampling (CVS) is also offered to some women to test for genetic disorders. It is usually performed at 11 weeks of pregnancy, and can detect conditions such as cystic fibrosis (a condition that causes a build-up of mucus in the lungs) and muscular dystrophy (where the muscles slowly, progressively waste away). A needle is inserted through the abdomen, and a small sample of placenta is taken. The risk of miscarriage is slightly higher than it is for an amniocentesis test, at 1-2%.

 

 

Advice and support

If you suspect that you are pregnant, or have taken a home pregnancy test which confirms that you are pregnant, you should arrange to see your GP or midwife straight away. This is to ensure that you receive all the necessary advice and support that you need as early as possible. Midwives may be based at your GP surgery, a local hospital, or at a specialist midwife unit.

Antenatal appointments

During your pregnancy, you will be offered a series of appointments to check on your health and the health of your baby.

The number of appointments you have depends on your individual situation. For example, if it is your first child, you may have up to 10 appointments, or around seven if you have had children before. Some appointments can take place at your home, if necessary.

Your first antenatal appointment will ideally take place by the tenth week of your pregnancy. This appointment will be the longest. It will probably last at least an hour because your midwife will ask you lots of questions and give you lots of information.

After your first appointment, all pregnant women will usually have appointments at:

·       16 weeks,

·       18-20 weeks,

·       28 weeks,

·       34 weeks,

·       36 weeks, and

·       38 weeks.

Pregnant women who are having their first child should also have additional appointments at:

·       25 weeks,

·       31 weeks, and

·       40 weeks.

Your midwife will advise you about how and when you should be making your appointments.

Urine sample

At your first appointment, you will usually be asked to bring a urine sample, which will be tested for the presence of protein.

It is best if you can bring a mid-stream urine sample. A mid-stream urine sample is when you collect the sample a few seconds after you first start to pass urine. The aim is to get a sample from the middle of your bladder. This is because the first bit of urine you pass can sometimes be contaminated with bacteria from the skin.

You must make sure that your urine sample is stored in a sterile container. Do not open the container until you are ready to take the sample. You should also try not to touch the rim of the container because this may also contaminate the sample. Your midwife or GP will be able to give you further advice about the best way to take a urine sample.

Your blood pressure will be taken, and your weight and height measured. Other antenatal appointments should be determined by your specific health needs. However, at appointment, your baby's development and growth should be checked, as well as your blood pressure and urine.

If you are expecting more than one baby, or if you have an existing or pregnancy-related medical condition, such as diabetes, you will be offered extra antenatal care.