What happens at each antenatal appointment?
This is part of a series of blogs looking at what to expect throughout your pregnancy. The previous blog was on the schedule of antenatal care.
This blog looks at what happens at every antenatal appointment and the things your health professionals are looking out for.
Your physical health and well-being – Your health professional (midwife, obstetrician or GP) will ask how you are feeling and how the pregnancy is going so far. They can answer questions on any health issues you may be experiencing. You can experience some unusual symptoms in pregnancy – see my blog on them!
Your mental health – If you are feeling low, it’s really important that you tell your midwife. Antenatal depression and anxiety is common. This is an exciting but anxious time and it’s normal to feel these emotions, but if it’s more than that and you would like some help with your feelings, your midwife can refer you to a counsellor or psychologist. There are lots of charities that can offer support too. One of them is Mind.
Baby’s movements – This is the most accurate way of knowing that everything is well with your baby. Most women will feel their baby move between 16 and 24 weeks. After that, your baby will develop its own pattern of movements, which is unique to this baby. If this pattern of movement ever changes, so increases, decreases or feel different, you must call your midwife or hospital urgently. A ‘quiet’ baby maybe having a rest but it could be a sign of fetal distress and must be taken seriously. Old advice such as ‘lie down’ or ‘drink cold water’ are no longer appropriate for changes in fetal movements. For more information on fetal movements, see Kicks Count.
Blood pressure – Your blood pressure will be taken at every visit. Blood pressure can go up in pregnancy for several reasons. One reason is a condition called ‘pregnancy induced hypertension’. This can be treated with blood pressure (anti-hypertensive) medication if necessary. Another cause could be pre-eclampsia.
Pre-eclampsia – This is a more serious problem. Pre-eclampsia may present with other symptoms such as protein in your urine (see below), headaches, blurred vision, pain under your right breast and swelling of your hands, feet and face. Some swelling (oedema) can be a normal part of pregnancy. Pre-eclampsia is diagnosed by taking a blood sample and a urine sample. If you develop pre-eclampsia, your obstetric team will monitor you very closely to ensure you and your baby are well. The only treatment for pre-eclampsia is to deliver the baby as it’s thought to be related to hormones that the placenta emits. However, the individual symptoms, such as high blood pressure can be treated. Your team will make a plan for delivery that is best for baby and for you.
Urine – Your urine will be ‘dipsticked’ and tested for several things at every appointment. One of these is glucose which may indicate you have gestational diabetes. The presence of protein can mean a couple of things. It can be a sign of pre-eclampsia (see above) or of a urine infection. Leucocyte’s (white cells) in your urine can also indicate a urine infection. Urine infections can be a worry in pregnancy. They can often be the reason for premature labour. This is because if your bladder is irritated by an infection, it can irritate your womb to start contracting. Women can have urinary tract infections in pregnancy without any symptoms. It is important that you produce a good urine sample every time as false negatives can occur from small samples or samples that are collected incorrectly.
Palpation of your tummy – This is where the midwife (or obstetrician) will touch your bump. Your bump will be measured to see if it is growing in line with how many weeks you are. If it is bigger or smaller than expected, you will be referred for a growth scan. If you are having serial scans in your pregnancy and/or your unit is following the GAP/Grow programme, then your bump won’t be measured.
The midwife will then ‘palpate’ (feel) your bump. This is to try and find out how your baby is lying, whether the head is down, and from 37 weeks, if the head is engaged into the pelvis. If this is not your first pregnancy, then the head won’t usually engage until you go into labour.
Listen to your baby’s heartbeat! This is usually the highlight of your antenatal appointment! Once your midwife has identified the position of your baby, it makes it easier to locate his or hers heartbeat and you can listen to that reassuring, rhythmical beat!
Antenatal discussions – Midwives have lots of things that they need to discuss with women antenatally and these will take place at different stages in your pregnancy. Earlier on, the focus will be on the schedule of care and thinking about your place of birth. From 26 weeks, your midwife will discuss fetal movements in more details. From 28 weeks, infant feeding will be discussed.
If your midwife identifies any health issues in your antenatal appointment, they may refer you for scans, blood tests or to see an obstetrician.
Follow up – All antenatal appointments should end with details of your next appointment. If you require any further tests in the meantime, you will be told details of when and where they will happen. You will always be given advice of when you need to call the midwife and symptoms to look out for.
The next blog will be when to call the midwife.