You can confirm your pregnancy, where 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 and the procedure takes only a few minutes.
If the test indicates you are pregnant, make an appointment to visit your GP or local midwife immediately. He or she 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).
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. 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 will probably take place between the eighth and twelfth weeks of your pregnancy. 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. However, if you are in good health, you should not need more than eight to ten antenatal visits - usually one a month until 28 to 32 weeks, then one a fortnight until 36 weeks and one a week after that. You may be offered fewer appointments in subsequent pregnancies.
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 34 weeks of pregnancy, as well as after the birth of your baby. This injection is safe for you and the baby.
The first blood test also checks for things such as anaemia, immunity to rubella (German measles), sexually transmitted diseases, Hepatitis B and may include a check for HIV (subject to your permission). You will also be asked for a urine sample which, among other things, will be used to check for diabetes and protein (a possible warning sign for pre-eclampsia). You may be asked to bring a urine sample to each antenatal visit, when a further blood sample will probably be taken between 28 and 36 weeks to test for anaemia, gestational diabetes and antibodies in women who are Rhesus Negative.
Other routine checks include listening to your baby's heartbeat and discussing its movements, checks for swelling, and questions about your health and feelings. You may be given your notes to look after by your midwife - it is important to bring them to every appointment and ask if there is anything in them that you don't understand.
Ultrasound scan: you are likely to be offered two NHS ultrasound scans during your pregnancy; these are completely painless and safe. The dating scan to confirm your EDD will take place between approximately eight to 14 weeks. At 18 to 22 weeks, you will have an anomaly scan, which is to check that the baby is developing properly. Additional scans may be advised if considered necessary. The number of scans offered may vary depending on where you live.
It may be possible to find out the sex of your baby at the anomaly scan because its genitalia should be defined enough to see on the scan (if the baby cooperates and is in the right position!). You should ask the sonographer if you are keen to find out the sex of the baby prior to the birth. Some Primary Care Trusts have a blanket policy to refuse to disclose the sex of a baby, in which case you may be able to arrange a gender scan through a private organisation instead.
Most hospitals will provide one or two scan pictures for you to take home as a memento of your pregnancy. There may be a small charge or you may be asked to give a small donation towards the print costs. Scan pictures can fade in sunlight if you frame the originals, so it's worth scanning the pictures in to your computer and framing a copy.
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 may cost anywhere between £100 to £300, 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.
Other Special Tests
Depending on your age, family history and current state of health, you may be offered one or more of the tests listed. You should discuss any concerns you may have about these tests with your doctor and, of course, your partner and family. Some women prefer to be armed with as much information as possible if their child is likely to have Down's Syndrome, for example, but others prefer not to have these tests as it will not change the outcome of their pregnancy. You must do what feels right for you.
Nuchal translucency scan: this is a special ultrasound scan that may be carried out at around 12 to 14 weeks to check for Down's syndrome and other conditions. It is the latest and most accurate screening test for Down's Syndrome and measures the thickness of the layer of fluid at the nape of the foetus's neck.
Double or Triple test: this test uses a blood sample to check for the possibility of Down's syndrome, spina bifida or other neural tube defects. You will normally give a blood sample for this test when you are 16 to 18 weeks pregnant. By considering two to three markers in your blood alongside your age, this test is used to calculate the likelihood of your baby having one of these conditions.
The Double or Triple test can only give you a statistical figure - for example, results may show that a baby has a 1 in 25,000 chance of having Down's Syndrome, which would mean that if 25,000 babies were born with the same markers, only one of them would have Down's Syndrome. The point at which a foetus is considered at high risk from Down's Syndrome or other neural tube defects may vary slightly across the Primary Care Trusts but many hospitals use 1 in 150 as the cut off point; so if your results were to be 1 in 100 or 1 in 50, for example, you would be offered further tests.
Amniocentesis: this test may be offered between 15 to 19 weeks of pregnancy to women who are over 35 years of age or at high risk of having a baby with a genetic disorder. The test checks for Down's syndrome and other chromosome abnormalities. This test is now usually only carried out after a nuchal scan or triple test, and involves testing a sample of amniotic fluid. Although it is an accurate way of screening for a number of genetic disorders, it does carry a small risk (0.5% - 1%) of miscarriage.
CVS - Chorionic villus sampling: an alternative to amniocentesis, this test uses a sample of the placenta, which is taken with a needle through the abdomen or via the placenta. The test may be carried out between the 11th and 14th weeks. This test is not available in all areas and does carry a 1% - 2% chance of miscarriage.
Sickle Cell Anaemia and Thalassaemia: these conditions are hereditary and affect only certain sections of the population. If you are in one of those sections, then you may be offered the appropriate tests. 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.
Mouthwash Test: this test can reveal if you are a carrier of cystic fibrosis but it is currently only available in some parts of the UK.
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