Throughout your pregnancy you will have regular care, either at a hospital antenatal clinic or with your own GP or community midwife. This is to check that you and the baby are well and so that any problems can be picked up as early as possible. This is the time to get answers to any questions or worries and to discuss plans for your baby's birth.

The first visit

Most women have their first, and longest, antenatal check-up around the 8th to 12th week of pregnancy. The earlier you go the better. You should allow plenty of time as you will probably see a midwife and a doctor, and may be offered an ultrasound scan.

Questions

You can expect a lot of questions on your health, on any illnesses and operations you have had, and on any previous pregnancies or miscarriages. You will be asked for any information you have on your own family and your partner's family (whether there aretwins on your side or any inherited illness, for example). You will also be asked about your ethnic origin. This is because certain inherited conditions that need attention in early pregnancy are more common in some ethnic groups.

There may also be questions about your work or your partner's work and what kind of accommodation you live in, to see if there is anything about your circumstances that might affect your pregnancy.

All this information will help to build up a picture of you and your pregnancy so that any special risks can be spotted and support provided.

The midwife or doctor will want to know the date of the first day of your last period, to work out when the baby is due. You will probably want to ask a lot of questions yourself. This is a good opportunity and it often helps if you can write down what you want to say in advance, as it's easy to forget once you are there. It's important to find out what you want to know and to express your own feelings and preferences.

Remember that, if you're working, you have the right to paid time off for your antenatal care

If you don't speak English, ask a friend who does to come with you and interpret, or telephone your clinic so that an interpreter can be arranged for when you have an appointment.

Let your midwife or doctor know if:

• there were any complications in a previous pregnancy or delivery, such as pre-eclampsia or premature delivery;
• you are being treated for a chronic disease such as diabetes or high blood pressure;
• you, or anyone in your family, have previously had a baby with an abnormality, for example spina bifida, or there is a family history of an inherited disease such as thalassaemia or
  cystic fibrosis.

If you're going to have your baby in hospital, your GP or midwife will send or give you a letter for the hospital. Antenatal care varies around the country.

In some areas, the first (booking) appointment is at the hospital then all or most subsequent appointments are with the GP or community midwife unless the pregnancy is complicated, when all appointments are at the hospital. In other areas, all care is given by the GP and/or midwife unless there is a reason for referral to the hospital antenatal clinic.

If you're going to have your baby in a GP or midwife unit or at home, then you will probably go to your own GP and community midwife for most of your antenatal care. You may need to visit the hospital for an initial assessment and perhaps for an ultrasound scan or for special tests. Sometimes your midwife may visit you at home.

Weight

You'll be weighed. From now on, your weight gain will probably be checked regularly, although this is not done everywhere. Most women put on between 10 and 12.5 kg (22-28 lbs) in pregnancy, most of it after the 20th week. Read this section on what to eat in pregnancy, and take regular exercise. Much of the extra weight is due to the baby growing, but your body will also be storing fat ready to make breast milk after the birth.

Height

Your height will be recorded on the first visit because it is a rough guide to the size of your pelvis. Some small women have small pelvises and although they often have small babies they may need to discuss their baby's delivery with their doctor or midwife.

General physical examination

The doctor will check your heart and lungs and make sure your general health is good.

Urine

You will be asked to give a sample of urine each time you visit. This will be checked for a number of things including:

• sugar - pregnant women may have sugar in their urine from time to time but, if it is found repeatedly, you will be checked for diabetes (some women develop a type of diabetes in pregnancy known as 'gestational diabetes' which can be controlled during pregnancy usually by a change of diet and, possibly, insulin; the condition usually disappears once the baby is born);
• protein, or 'albumin', in your urine may show that there is an infection that needs to be treated; it may also be a sign of pregnancy-induced hypertension (see High blood pressure and pre-eclampsia on page 84).

Blood pressure

Your blood pressure will be taken at every antenatal visit. A rise in blood pressure later in pregnancy could be a sign of pre-eclampsia.

Blood tests

You will be offered a blood test to carry out a number of checks. Discuss these with your doctor (see box). The tests are for:

• your blood group;
• whether your blood is rhesus negative or positive - a few mothers are rhesus negative (usually this is not a worry for the first pregnancy. Some rhesus negative mothers will need an injection after the birth of their first baby to protect their next baby from anaemia; in some units, rhesus negative mothers are given injections called 'anti-D' at 28 and 34 weeks as well as after the birth of their baby - this is quite safe and is done to make sure that the blood of future babies is not affected by rhesus disease);
• whether you are anaemic - if you are, you will probably be given iron and folic acid tablets to take (anaemia makes you tired and less able to cope with losing blood at delivery);
• your immunity to rubella (German measles) - if you get rubella in early pregnancy, it can seriously damage your unborn baby and if you are not immune to rubella and come into contact with it, blood tests will show whether you have been infected; if so, you'll be offered the option of ending your pregnancy after discussing the possible problems your baby might have;
• for syphilis - it is vital to detect and treat any woman who has this sexually transmitted infection as early as possible;
• for hepatitis B - this is a virus that can cause liver disease and may infect the baby if you are a carrier of the virus or are infected during pregnancy. Your baby can be immunised at birth to prevent infection, so you will be offered a test to check if you are carrying the virus.

Tests

A number of tests will be offered at your first visit, and some of these will be repeated at later visits. You are under no obligation to have any test, although they are all done to help make your pregnancy safer or to help assess the well-being of your baby. Discuss the reasons for tests with your midwife or doctor so that you can make an informed choice about whether or not to have them. There is also written information available about the tests. Ask to have the results explained to you if you do decide to go ahead.

If you are found to be HIV positive, or already know that you are, your doctor will need to discuss the management of your pregnancy and delivery with you.

• There is a 1 in 6 chance of your baby being infected.
• 20% of HIV infected babies develop AIDS or die within the first year of life, so it's important to reduce the risk of
  transmission.
• Treatment may reduce the risk of transmitting HIV from you to the
  baby.
• Your labour will be managed to reduce theriskof infection to your baby. This may include an elective Caesarean delivery.
• Your baby will be tested for HIV at birth and at intervals for up to two years. If the baby is found to be HIV infected, paediatricians will be able to anticipate certain illnesses which occur in infected babies, and so treat them early. All babies born to HIV positive mothers will appear to be HIV positive at birth but many later test negative because antibodies passed to them by their mothers disappear.
• You will be advised not to breastfeed because HIV can be transmitted to your baby in this way.
• for HIV - this is the virus that causes AIDS. If you are infected you can pass the infection to your baby during pregnancy, at delivery or after birth by breastfeeding. As part of your routine antenatal care a named confidential test for HIV infection will be offered and recommended. If you are HIV positive, both you and your baby can have treatment and care that reduces the risk of your baby becoming infected (see box). If your test result is negative, the fact that you accepted the test as part of your antenatal care should not affect your ability to obtain insurance.

If you think that you are at risk of getting HIV, or know you are HIV positive, ask your doctor or midwife for the opportunity to discuss HIV testing and counselling. You can also get free confidential advice from the National AIDS Helpline. You can also talk in confidence to someone at Positively Women.

Unlinked Anonymous surveys

In addition to named testing, some antenatal clinics are taking part in unlinked anonymous surveys to find out how widespread HIV and other infectious diseases are in the general population. If your antenatal clinic is one of these, leaflets and posters explaining the survey should be on display. Unlinked Anonymous testing involves testing blood left over after completion of the routine checks for HIV and other infectious diseases. Details that could identify you are permanently removed before the testing, so that there is no possibility that your result can be traced back to you. (Some general information, like your age group, will be connected to the sample.) You can ask for your specimen to be excluded from the survey if you so wish. Whether you take part, or not, will not affect your antenatal care in any way.

Sickle cell disease and Thalassaemia

Sickle cell disease is a blood condition that mainly affects people of African and West Indian origin and, less often, people from India, the Middle East and Mediterranean. Thalassaemia, another blood condition, mainly affects people of Mediterranean and Asian origin. If you, your partner, or your parents originally come from these parts of the world, you'll probably be offered a blood test to find out whether you are a carrier. It is possible for either you or your partner to be a carrier without it affecting your baby at all. But if both of you are carriers, or if either of you suffer from the disease yourself, you should discuss the implications for the baby with your doctor or midwife. Or contact the Sickle Cell Society or the UK Thalassaemia Society.

Internal examination

Occasionally, the doctor might consider it necessary to do an internal examination. Discuss the reasons for this with the doctor. By putting one or two fingers inside your vagina and pressing the other hand on your abdomen, your doctor can judge the age of your baby. Most doctors prefer to use an ultrasound scan for this purpose either at the first or a later visit.

Cervical smear

You will be offered a cervical smear test now if you haven't had one in the last three years. The test detects early changes in the cervix (the neck of the womb) which could later lead to cancer if left untreated. By sliding an instrument called a speculum into your vagina, the doctor can look at your cervix. A smear is then taken from the surface of the cervix and will be examined under a microscope. The test may feel a bit uncomfortable but it is not painful and won't harm the growing baby.

Herpes

If you, or your partner, have ever had genital herpes, or you get your first attack of genital blisters or ulcers during your pregnancy, let your doctor or midwife know. This is important because herpes can be dangerous for your newborn baby and he or she may need treatment.

Later visits

Later visits are usually shorter. Your urine and blood pressure, and often your weight, will be checked. Your abdomen will be felt to check the baby's position and growth. And the doctor or midwife will listen to your baby's heartbeat. You can also ask questions or talk about anything that is worrying you. Talking is as much a part of antenatal care as all the tests and examinations.

From now on, antenatal checks will usually be every four weeks until 28 weeks, every two weeks until 36 weeks, and then every week until the baby is born. If pregnancy is uncomplicated, you may be offered the option of less frequent antenatal appointments.

If you can't keep an antenatal appointment, let the clinic, GP or midwife know, and make another appointment.

Ultrasound scan

This test uses sound waves to build up a picture of the baby in the womb. Most hospitals will offer women at least one ultrasound scan during their pregnancy. An ultrasound scan can be used to:

• check the baby's measurements - this gives a better idea of the baby's age and can help decide when your baby is likely to be born - this can be useful if you are unsure about the date of your last period or if your menstrual cycle is long, short or irregular; your due date may be adjusted according to ultrasound measurements;
• check whether you are carrying more than one baby;
• detect some abnormalities, particularly in the baby's head or spine;
• show the position of the baby and the placenta - in some cases, for example where the placenta is low in late pregnancy, special care may be needed at delivery or a Caesarean section may be advised;
• check that the baby is growing and developing normally (this is particularly important if you are carrying twins or more).

The scan is completely painless, has no known serious side-effects on mothers or their babies (although research is continuing), and can be carried out at any stage of pregnancy. Most hospitals scan all women at 18 to 20 weeks to check for certain abnormalities.

You will probably be asked to drink a lot of fluid before you have the scan. A full bladder pushes your womb up and this gives a better picture. You then lie on your back and some jelly is put on your abdomen. An instrument is passed backwards and forwards over your skin and high-frequency sound is beamed through your abdomen into the womb. The sound is reflected back and creates a picture which is shown on a TV screen. It can be very exciting to see a picture of your own baby before birth, often moving about inside.

Ask for the picture to be explained to you if you can't make it out. It may be possible for your partner to come with you and see the scan. Many couples feel that this helps to make the baby real for them both. Ask if it's possible to have a copy of the picture (there may be a small charge for this).

If you feel doubtful about having a scan, talk it over with your GP, midwife or obstetrician.

Tests to detect abnormalties in the baby

It is important to realise that no test can guarantee that your baby will be born without abnormality. No test is 100% accurate and some abnormalities may remain undetected.

The tests below are designed to detect structural abnormalities like spina bifida or genetic disorders like Down's syndrome. Down's syndrome is caused by an abnormal number of chromosomes. Chromosomes are the structures within every cell of a person's body which carry the individual genetic code or recipe to make that person. Conditions like cystic fibrosis and achondroplasia (dwarfism) are caused by abnormalities within the chromosomes (so causing a 'mistake' in the recipe). Talk to your midwife, GP or obstetrician about the tests mentioned below as they are not available in all hospitals.

When you are deciding whether or not to have a test, think what you might do if the test suggests that your baby has an abnormality. If a screening test (serum screen or nuchal translucency) suggests a 'high' risk of genetic abnormality, you will be offered amniocentesis or chorionic villus sampling (CVS). Since these carry a risk of miscarriage, you may decide not to have these tests or even a screening test if you would choose to continue with the pregnancy. Having a test, however, may reassure you that your baby is likely to be born healthy, allow you to consider the termination of an affected baby or give you time to prepare for the arrival of a baby with special needs. Discuss the issues with your partner, midwife, doctor and friends.

Ultrasound scan

Since ultrasound provides an image of the baby in the womb, it detects structural abnormalities, particularly of the spine and head. Recently, however, it has been found to be useful in screening for Down's syndrome and some other abnormalities of chromosome number. Several research studies have shown that the thickness of the 'nuchal fold' at the back of the baby's neck is related to the risk of Down's syndrome. An ultrasound scan at 10 to 13 weeks enables a measurement to be taken. This measurement then allows a risk factor to be calculated. The nuchal translucency scan is not widely available at present but it is becoming more so.

Alpha-fetoprotein (AFP) test

This test is performed at about 15 to 20 weeks to find out the level of alpha-fetoprotein (AFP) in your blood. This protein is made by your baby and passes into your blood during pregnancy. High levels are associated with spina bifida and so an ultrasound scan will then be offered to check for this. High levels may be seen in normal pregnancy and also in twin pregnancy. Low levels of AFP are associated with Down's syndrome pregnancies. Ultrasound and amniocentesis will then be suggested to achieve a diagnosis.

Some hospitals routinely offer the AFP test to all women; others don't, or restrict the test to older women since the risk of Down's syndrome, and some other abnormalities of chromosome number, increases with age.

If a test detects an abnormality, you may like to contact the appropriate organisation (see the list of usful organisations) for further information. They may be able to put you in touch with parents who have decided to continue with a pregnancy in which an abnormality has been detected. ARC (Antenatal Results and Choices) will offer support and information if you are considering termination for abnormality.

Serum screening

This is the term used for a test of the mother's blood which screens for Down's syndrome. It combines the AFP result (and so gives information about the risk of spina bifida) with the measurement of other blood chemicals to give the relative risk of having a baby with Down's syndrome. There are various tests available ('double test', 'triple plus test', etc.) which differ slightly from each other, but they are all types of serum screening. They are not helpful in twin or other multiple pregnancies.

Some units give the result as 'screen negative' or 'screen positive'. A negative result means that Down's syndrome is unlikely. A positive result means that Down's syndrome is more likely. An amniocentesis will be suggested to give more information. Other units give a numerical result, for example 1:250 risk of Down's syndrome. You may like to compare this risk to that for your age (about 1:900 at 30) or to the risk of miscarriage with amniocentesis (about 1:100). Your doctor or midwife will explain the significance of the result to you. If the test is not available locally on the NHS, you may be able to obtain
a test privately.

Amniocentesis

This test may be offered from 14 weeks of pregnancy:

• to women who have an AFP, serum screening or nuchal translucency scan result which indicates an increased risk of Down's syndrome;
• when an ultrasound scan detects an abnormality which is associated with a genetic disorder;
• when a woman's past or family history suggests that there may be a risk of her baby having a genetic disorder such as Down's syndrome.

An ultrasound scan is performed to check the position of the baby and placenta. Whilst continuing to scan with the ultrasound probe, a fine needle is passed through the wall of the abdomen into the amniotic fluid which surrounds the baby. A small sample of this fluid is drawn off and sent to the laboratory for testing. Most women feel only mild discomfort.

Within the fluid are cells which contain the same chromosomes as the baby. Looking at these chromosomes is a complex process which is why the results take up to three weeks. This test will reveal your baby's sex. Tell your doctor whether or not you want to know what it is. Some disorders such as haemophilia and muscular dystrophy are only found in boys (although girls may carry the disorder in their chromosomes and pass it on to their sons). Tell your doctor if these or other genetic disorders run in your family as it may then be important to know your baby's sex.

Amniocentesis is associated with a 0.5-1% risk of miscarriage. At most, one test in a hundred will result in pregnancy loss. When deciding whether or not to go ahead with this test try to balance the risk of miscarriage against the value of the result to you. Remember that a normal result only reassures you about the number of chromosomes unless specific tests for disorders such as cystic fibrosis have been done.

Chorionic villus sampling (CVS)

This test is usually only available in large hospitals but smaller units are able to refer to these units if necessary. It tests for genetic disorders. It does not give information about spina bifida.

CVS can be carried out earlier than amniocentesis at around ten weeks but may carry a slightly higher risk of miscarriage, at about 1%. CVS before ten weeks has been associated with a slightly increased risk of limb deformities. Women at risk of having a child with an inherited disorder such as cystic fibrosis or muscular dystrophy may accept the increased risk of miscarriage in order to obtain an earlier diagnosis.

The test takes 10 to 20 minutes and may be a little uncomfortable. Using ultrasound as a guide, a fine needle is passed through the woman's abdomen, or sometimes a fine tube through the vagina and cervix, into the womb. A tiny piece of the developing placenta, known as chorionic tissue, is withdrawn. Again, the chromosomes in the cells of this tissue are looked at.

The results take up to two weeks.

If you feel the test would be helpful, talk over the matter carefully with your GP or midwife early in your pregnancy or before conception, as well as with your partner or a close friend. You can also contact your regional genetic centre direct (telephone the Genetic Interest Group for details of your nearest centre).

 

If you have a disability which means that you have special requirements for your antenatal appointments or for labour, let your midwife know so that arrangements can be made in advance.

Making the most of Antenatal Care

Having regular antenatal care is important for your health and the health of your baby. However, sometimes antenatal visits can seem quite an effort. If the clinic is busy or short-staffed you may have to wait a long time and, if you have small children with you, this can be very exhausting. By increasing the number of women that are cared for by their GP and community midwife, antenatal care should become more convenient. Try to plan ahead to make your visits easier and come prepared to wait. Here are some suggestions.

• In some clinics you can buy refreshments. If not, take a snack with you if you are likely to get hungry.
• Write a list of any questions you want to ask and take it with you to remind you. Make sure you get answers to your questions or
  the opportunity to discuss any worries. Sometimes this can take quite a lot of determination.
• If your partner is free he may be able to go with you. He'll be able to support you in discussing any worries or in finding out what you want to know. It will also help him to feel more involved in your pregnancy.
• If you regularly wait for long periods at your clinic, bring this to the attention of the hospital management. They have a responsibility to ensure that Patient's Charter standards are met.

Your Antenatal Notes

At your first antenatal visit, your doctor or midwife will enter your details in a record book and add to them at each visit. Many hospitals ask women to look after these notes themselves. Other hospitals keep the notes and give you a card which records your details. Take your notes or card with you wherever you go. Then, if you need medical attention while you are away from home, you will have the information that's needed with you.

The page opposite gives a sample of the information your card or notes may contain, as each clinic has its own system. Always ask your doctor or midwife about anything on your card which you would like to have explained.

POSITION

The above abbreviations are used to describe the way the baby is lying - facing sideways, for example, or frontwards or backwards. Ask your midwife to explain the way your baby is lying.

Relation to brim At the end of pregnancy your baby's head (or bottom, or feet if it is in the breech position) will start to move into your pelvis. Doctors and midwives 'divide' the baby's head into 'fifths' and describe how far it has moved down into the pelvis by judging how many 'fifths' of the head they can feel above the brim (the bone at the front).

They may say that the head is 'engaged' - this is when 2/5 or less of the baby's head can be 'felt' (palpated) above the brim. This may not happen until you are in labour. If all of the baby's head can be felt above the brim, this is described as 'free' or 5/5 'palpable'.

Blood pressure (BP) This usually stays at about the same level throughout pregnancy. If it goes up a lot in the last half of pregnancy, it may be a sign of pre-eclampsia which can be dangerous for you and your baby

Fetal heart 'FHH' or just 'H' means 'fetal heart heard'. 'FMF' means 'fetal movement felt'.

Oedema This is another word for swelling, most often of the feet and hands. Usually it is nothing to worry about, but tell your doctor or midwife if it suddenly gets worse as this may be a sign of pre-eclampsia.

Hb This stands for 'haemoglobin'. It is tested in your blood sample to check you are not anaemic.

Date This is the date of your antenatal visit.

Weeks This refers to the length of your pregnancy in weeks from the date of your last menstrual period.

Presentation This refers to which way up the baby is. Up to about 30 weeks, the baby moves about a lot. Then it usually settles into its head downward position, ready to be born head first. This is recorded as 'Vx' (vertex) or 'C' or 'ceph' (cephalic). Both words mean the top of the head. If your baby stays with its bottom downwards, this is a breech ('Br') presentation. 'PP' means presenting part, that is the bit of the baby that is coming first. 'Tr' (transverse) means your baby is lying across your tummy.

Urine These are the results of your urine tests for protein and sugar. '+' or 'Tr' means a quantity (or trace) has been found. 'Alb' stands for 'albumin', a name for one of the proteins detected in urine. 'Nil' or a tick or 'NAD' all mean the same: nothing abnormal discovered. 'Ketones' may be found if you have not eaten recently or have been vomiting.

Height of fundus By gently pressing on your abdomen, the doctor or midwife can feel your womb. Early in pregnancy the top of the womb, or 'fundus', can be felt low down, below your navel. Towards the end it is well up above your navel, just under your breasts. So the height of the fundus is a guide to how many weeks pregnant you are. This column gives the length of your pregnancy, in weeks, estimated according to the position of the fundus. The figure should be roughly the same as the figure in the 'weeks' column. If there's a big difference (say, more than two weeks), ask your doctor about it. Sometimes the height of the fundus may be measured with a tape measure and the result entered on your card in centimetres.

Who's Who

Many mothers would like to be able to get to know the people who care for them during pregnancy and the birth of their baby. The NHS is now working to achieve this. However, you may still find that you see a number of different carers. Professionals should, of course, introduce themselves and explain what they do but, if they forget, don't hesitate to ask. It may help to make a note of who you have seen and what they have said in case you need to discuss any point later on.

Below are the people you're most likely to meet. Some may have students with them who are being trained and you will be asked if you mind them being present.

• A midwife is specially trained to care for mothers and babies throughout normal pregnancy, labour and after the birth, and therefore provides all care for the majority of women at home or in hospital. Increasingly, midwives will be working both in hospital and in the community so that they can provide better continuity of care. You should know the name of the midwife who is responsible for your midwifery care.
• A hospital midwife will probably see you each time you go to a hospital antenatal clinic. A midwife will look after you during labour and will probably deliver your baby, if your delivery is normal. If any complications develop during your pregnancy or delivery, a doctor will become more closely involved with your care. You and your baby will be cared for by midwives on the postnatal ward until you go home. You will probably also meet student midwives and student doctors.
• A community midwife will probably get to know you before your baby is born and will visit you at home, after you leave hospital during the early weeks. Community midwives are sometimes attached to GPs' practices and may be involved in giving antenatal care. They are also involved in delivering babies in community and GP or midwife units and are responsible for home deliveries. Some community midwives also accompany women into the hospital maternity unit to be with them for the birth.
• Your general practitioner (GP) can help you to plan your antenatal care. This may be given at the hospital, but it is quite often shared with the GP. Sometimes the GP may be responsible for all your antenatal care and in some areas may be responsible for your care in hospital. If you have your baby in a GP or midwife unit or at home, your GP may be involved in your baby's birth. If your baby is born in hospital, your GP will be notified of your baby's birth and will arrange to see you soon after you return home. Don't forget to register your baby with your GP.
• An obstetrician is a doctor specialising in the care of women during pregnancy, labour and soon after the birth. If you are having a hospital birth you will usually be under the care of a consultant and the doctors on his or her own team, together with other professionals such as midwives. In some hospitals you will routinely see an obstetrician; in others, your midwife or GP will refer you for an appointment if they have a particular concern such as previous complications of pregnancy or labour or chronic illness. If everything is straightforward, a midwife will usually deliver your baby. You should ask to see your consultant if you wish to discuss any matter you think is important.
• A paediatrician is a doctor specialising in the care of babies and children. The paediatrician may check your baby after the birth to make sure all is well and will be present when your baby is born if you have had a difficult labour. If your baby should have any problems, you will be able to talk this over with the paediatrician. If your baby is born at home or your stay in hospital is short, you may not see a paediatrician at all. Your GP can check that all is well with you and your baby.
• An obstetric physiotherapist is specially trained to help you cope with the physical changes of pregnancy, childbirth and afterwards. Some attend antenatal classes and teach antenatal exercises, relaxation and breathing, active positions and other ways you can help yourself during pregnancy and labour. Afterwards, they advise on postnatal exercises to tone up your muscles again. When no obstetric physiotherapist is available your midwife can help you with these exercises.
• Health visitors are specially trained nurses concerned with the health of the whole family. You may meet yours before the birth of your baby. The health visitor will contact you to arrange a home visit when your baby is ten days old to offer help and support. You may continue to see your health visitor either at home, or at your Child Health Clinic, health centre or GP's surgery, depending on wherethey are based.
• Dietitians are available to advise you on healthy eating or if you need to follow a special diet such as that recommended for women with gestational diabetes.

Research

You may be asked to participate in a research project during your antenatal care, labour or postnatally. This may involve a new treatment or be to find out your opinions on an aspect of your care, for example. The project should be fully explained to you and you are free to decline, but your participation will be most welcome. Such projects are vital if professionals are to improve maternity care.

Students

Many of the professionals mentioned have students accompanying them at times. They will be at various stages of their training but will always be supervised. You can choose not to be seen by a student at any time but agreeing to their presence helps in their education and may even add to your experience of pregnancy and labour.

Antenatal Classes

Think about what you hope to gain from antenatal classes so that, if there is a choice, you can find the sort of class that suits you best. You need to start making enquiries early in pregnancy so that you can be sure of getting a place in the class you choose. You can go to more than one class. Ask your midwife, or health visitor, your GP, or the local branch of the National Childbirth Trust

Antenatal classes can help to prepare you for your baby's birth and for looking after and feeding your baby. They can also help you to keep yourself fit and well during pregnancy. They are often called parentcraft classes and may cover relaxation and breathing, and antenatal exercise. They're a good chance to meet other parents, to talk about things that might be worrying you and to ask questions - and to make new friends. They are usually informal and fun. You may be able to go to some introductory classes on babycare early in pregnancy. Otherwise, many classes will start about eight to ten weeks before your baby is due. Classes are normally held once a week, either during the day or in the evening and last one or two hours. Some classes are for expectant women only. Others will welcome partners, either to all the sessions or to some of them, or you can go alone or with a friend. In some areas there are classes especially for women whose first language is not English, classes for single mothers and classes for teenagers. The kinds of topics covered by antenatal classes are:

• health in pregnancy;
• what happens during labour and birth;
• coping with labour and information about pain relief;
• exercises to keep you fit during pregnancy and help you in labour;
• relaxation;
• caring for your baby, including feeding;
• your own health after the birth;
• 'refresher classes' for those who have already had a baby;
• emotions surrounding pregnancy, birth and the early postnatal period.

Some classes will try to cover all these topics. Others will concentrate more on certain aspects, such as exercises and relaxation or babycare.

The number of different antenatal classes available varies very much from place to place. Classes may be run by your hospital, by your local midwives or health visitors, by your own GP or health centre. The National Childbirth Trust also runs classes, usually in the evenings and in the leader's home. The groups tend to be smaller and may go into more depth.

Antenatal classes may give you the opportunity to get to know some of the professionals involved in your care and to ask questions and talk over any worries you may have. You can find out about arrangements for labour and birth and the sort of choices available to you. This can help you in thinking about making your own birth plan. You'll usually be able to look round the labour and postnatal wards. You may also be able to meet some of the people who will be looking after you when the time comes for your baby to be born. Classes can give you confidence as well as information. You'll be able to talk over any worries and discuss your plans, not just with professionals, but with other parents as well. Speak to your community midwife if you can't go to classes. The midwife may have videos to lend you or you may be able to hire or buy one.

 

Classes may be available in your area for specific groups such as single women and teenagers. Ask your midwife for details.