Pregnancy Advice & Help

Pregnancy

Pregnancy comes hand in hand with a whole range of emotions, thoughts and feelings, both positive and negative. While it is normal for many parents-to-be to experience concerns about pregnancy and parenthood, it is also important to enjoy this life-changing time. Therefore, if you have any worries, do talk to your GP or midwife, they are there to support you and allay any concerns you may have.

Life can continue much the same as before but, now that there are two of you to look after, you just need to take a few sensible precautions and think about your health and lifestyle. If this involves making some adjustments to the way you live, remember that it is all for a good cause.

Health & Lifestyle

In matters of health and lifestyle, you should always follow the advice of your GP or midwife. Their recommendations will be based on hard and fast clinical evidence and a wealth of experience in the areas which are valuable to you especially if this is your first pregnancy.

If they make suggestions such as making changes to your diet, to smoking or to alcohol consumption, their advice should be considered very carefully indeed.

Confirming your Pregnancy

You can confirm your pregnancy, when your period is a day or more overdue, by carrying out a simple home pregnancy test. Kits for these tests can be bought at your chemist or local supermarket and the procedure takes only a few minutes.

If the test indicates you are pregnant, make an appointment to visit your GP or a local midwife to start your antenatal care. It is important to see a GP/Midwife as soon as possible, so that you get the antenatal care and all the information for you to have a healthy pregnancy. They will give you an Estimated Date of Delivery (EDD). The date of delivery is calculated as 40 weeks from the first day of your last period. However, this date is only an estimate and many babies are born in the two weeks before or after the EDD (only five percent of babies arrive on their EDD).

Your first visit with your midwife or GP is the appointment when you tell them that you are pregnant.

You will be given information about folic acid and vitamin D supplements, nutrition, keeping healthy, lifestyle factors that may affect your health and the health of your baby such as smoking, alcohol and recreational drugs and antenatal screening tests. It is important to tell your midwife or doctor if you have had any complications or infections in a previous pregnancy or delivery, such as:

• Pre-eclampsia or premature birth
• You are being treated for a chronic disease, such as diabetes or high blood pressure
• You or anyone in your family have previously has a baby with an abnormality, such as spina bifida
• If there is a family history of an inherited disease, such as sickle cell or cystic fibrosis.

When you are pregnant you will be advised to take some supplements as well to make sure you get everything you need. It is recommended that you take 10 micrograms of vitamin D each day throughout your pregnancy and you should also carry on taking this after your baby is born if you breastfeed and also 400 micrograms of folic acid each day. You should take this from before you are pregnant until you are 12 weeks pregnant.

Antenatal Care

Once your pregnancy has been confirmed by your GP or midwife, you will be given your first antenatal (or 'Booking In') appointment - probably with the midwife who will monitor your pregnancy. Your GP surgery or children’s centre can put you in touch with your nearest midwifery service.

Ongoing care may be divided between the community midwife and/or your GP and/or hospital antenatal clinic, depending on the development of your pregnancy, your own choice and the care available in your area.

Your first antenatal appointment should happen before you are 10 weeks pregnant. If you are more than 10 weeks pregnant then contact your GP or midwife as soon as possible. Your GP or midwife will discuss your medical history with you to see whether there are any issues of which they should be aware; they will also check your blood pressure, take a blood and urine sample, weigh and measure you and offer you an ultrasound.

Use this opportunity to ask any questions you might have, your GP or midwife will be happy to talk to you, and it will enrich your experience in those first weeks as parents to have the support of a GP or midwife that you trust.

It goes without saying that antenatal appointments are important and should be kept so that any problems can be recognised at an early stage.

If this is your first pregnancy then you will have up to ten antenatal appointments. If this is your second or more then you may have around seven antenatal appointments. Usually one a month until 28 to 32 weeks, then one a fortnight until 36 weeks and one a week after that. You will be offered more appointments if needed by you or your baby.

As a matter of routine, you will be asked to give a blood test at your first antenatal appointment. This test determines your blood group and whether or not your blood is Rhesus negative or positive. If you are Rhesus negative, you will be offered Anti-D injections at 28 and 30 weeks of pregnancy, After birth a sample of your baby’s blood will be taken from the umbilical cord and depending on the blood results, you may also be offered another Anti-D injection within 72 hours of giving birth. This injection is safe for you and the baby. The first blood test also checks for things such as anaemia, sexually transmitted diseases, Hepatitis B and may include a check for HIV (subject to your consent).

You will also be asked for a urine sample, which, among other things, will be used to check for protein in your urine. If protein is found it may mean that you have an infection that needs to be treated, it may also be a sign of pre-eclampsia. You will be asked to bring a urine sample to each antenatal visit to test for protein in your urine.

If you are at greater risk of gestational diabetes, you will be offered an oral glucose tolerance test (OGTT), which is done between 24-28 weeks.

Other routine checks include measuring your blood pressure, listening to your baby’s heartbeat and discussing its movements, checks for swelling, and questions about your health and feelings along with the opportunity for you to ask about any concerns that you may have.

You will be given your notes to look after by your midwife. These notes may be digital, in an app or website, or written down in a book or folder. It is important to keep these notes and bring them to every appointment and ask if there is anything in them that you don’t understand.

Antenatal Tests

The NHS will offer you two scans routinely. A dating scan between 11 to 14 weeks and a mid-pregnancy scan between 18 to 21 weeks.

Most hospitals can provide one or two pictures of the scan, however there will be a charge. The traditional scan pictures are created on thermal paper and, although quite stable they are temperature sensitive and will go black if heated, and therefore are not suitable for lamination.

The first scan is often called the dating scan or the 12 week scan and is designed to establish the viability of the pregnancy by seeing the fetal heartbeat, to give an estimated due date (EDD) by measuring the length of the baby, to check whether you are expecting more than one baby, check the baby is growing in the right place and check the baby’s development. The dating scan can include a nuchal translucency (NT) scan, which is part of the combined screening tests for Down’s syndrome, Edward’s syndrome and Patau’s syndrome.

The second scan is often called the mid pregnancy scan or the 20 week scan. This scan looks into how your baby is developing and checks specifically for 11 physical conditions in your baby.

At the 20 week scan you may be able to find out the sex of your baby, however this all depends on the policy at the hospital. Speak to the sonographer at the start of your scan if you would like to know the sex of your baby.

Some women may be offered more than two scans. This depends on their health and pregnancy.

3D/4D scans: these remarkable scans produce either a 3D picture of your unborn baby or, in the case of a 4D scan, allow you to see your baby in 3D in real-time.

Generally, these scans can be arranged through private organisations operating across the country and the cost will vary depending on the service on offer (it's wise to find out exactly what you will be paying for in advance). These scans give parents the pleasure of seeing their baby in the womb rather than being used for medical screening purposes. 4D scan packages often include a DVD of the scan and a CD of still images for you to keep.

Non-Invasive Prenatal Test (NIPT)

NIPT will be added to the existing NHS screening program for Down's Syndrome, Edward's Syndrome and Patau's Syndrome as part of the evaluated rollout from June 2021. NIPT will be offered free to women who receive a higher chance result from a combined or quadruple test.

NIPT uses a blood sample from the mother to analyse DNA from the placenta for certain chromosome conditions that could affect the baby's health.

NIPT has far fewer false positive and false negative results than nuchal screening or the Quad test. (Quad test is a quadruple blood screening test between 14 and 20 weeks).

The NIPT test can be performed from 10 weeks, before this it is difficult to collect enough cell-free DNA. Results can take up to 10 weeks. It does not give you a definite yes or no answer, it just gives a probability. It is not currently offered routinely in the NHS but us us available at private clinincs. Cost can vary depending on where you live.

Down's syndrome, Edward's syndrome and Patau's syndrome

These screening tests should be carefully considered before the scan appointment. You do have a choice, you can decide not to have these test. If you do choose to have this test it is called the combined test as it combines an ultrasound scan with blood tests. The combined test is carried out at around 10-14 weeks into your pregnancy.

You will have a sample of blood taken and an ultrasound scan. This scan can be done at the same time as your dating scan. At the scan the fluid at the back of your baby neck is measured to determine the nuchal translucency. As well as your age and the information from these tests they can work out the chance of your baby&rsqu;s having Down’s, Edward’s or Patau’s syndromes.

If it is not possible to gain a nuchal translucency measurement either because of the baby's position or you are too far along in your pregnancy then the alternative is a quadruple test. This can be carried out between 14 and 20 weeks of pregnancy, (This test is only available for Down's syndrome and it is not as accurate as the combined test). The quadruple blood test screening measures four different substances in the maternal blood and is similar in performance to the combined test. For Edward's and Patau's syndromes, if your too far along into your pregnancy to have the combined test.

For Edward’s and Patau’s syndromes, if you are too far along into your pregnancy to have the combined test then you will be offered a midpregnancy scan. At this scan they will look for physical abnormalities and 11 other rare conditions.

The results of these screenings are generally presented as a risk figure, like 1 in 150. The current thinking is to recommend an invasive test if the risk is higher than 1 in 150. If there is a high risk from the screenings tests then you can choose to have a diagnostic test such as Chorionic Villus Sample (CVS), test. This is done between 11 and 14 weeks of pregnancy. A tiny sample of tissue is taken from the placenta and the cells from this are tested.

An amniocentesis test can be done between 15 and 20 weeks of pregnancy but you can have it after 20 weeks if necessary

They will collect a small sample of fluid that is surrounding the baby, this contains cells from your baby and these cells are tested.

These tests are very similar in that they use a fine needle to take a sample from the pregnancy (either placental or amniotic fluid) both have a small increased risk of miscarriage of around 1% compared with the background rate.

Usually if the test shows a lower chance result then you should be notified within two weeks, if the test shows a higher chance result then you will be notified within 3 working days.

Talk to your midwife about what happens in your area and when you can expect to receive your results. You will be offered an appointment to discuss the results and what options you have available to you.

Other Special Tests

During your antenatal appointments all women are asked if they want to be screened for addition conditions when your bloods are being taken.

Sickle Cell Disease (SCD) and Thalassaemia: These conditions are hereditary and affect only certain sections of the population. If you are in one of those sections, then you will be offered the appropriate tests.

Screening for Sickle Cell Anaemia and Thalassaemia should be offered to all women ideally as early as 10 weeks. If you or your partner have sickle cell disease and are currently planning a family, ask your GP to refer you to a genetic counsellor. All babies are screened for sickle cell disease using the newborn spot blood test when they are a few days old.

Cystic Fibrosis: If you have a history of cystic fibrosis in yours or your partners family then you may choose to get a carrier test. After birth all babies are screened for cystic fibrosis using the newborn spot blood test. The newborn blood spot test will also find out if your baby has 1 of 9 rare conditions and is carried out when the baby is around 5 days old.

Your Baby’s Movements

You should start to feel your baby move between 16 and 24 weeks of your pregnancy. (Around 20 weeks if this is your first pregnancy). You may start to notice fluttering or swirling movements, then later into your pregnancy you will feel kicks and see your belly move.

Each pregnancy is different and it is important to get to know your baby’s movements. If you notice any changes in your baby’s pattern or you cannot feel your baby move then call your GP or midwife urgently.

If you have not felt your baby move by 24 weeks then make contact with your GP or midwife and they will check your baby’s heartbeat and movements.